Single-sex groups comprising one facilitator and six to eight participants met in private settings in the local village for approximately ninety minutes on a weekly basis for sixteen weeks. Group facilitators were supervised on a weekly basis by two onsite psychologists on the staff of World Vision. They sent regular written progress reports to the IPT trainers, Helen Verdeli and Kathleen Clougherty, from whom they received weekly supervision via phone or email. In the clinical trial, active suicidal ideation was an exclusion criterion. The few potential participants who were excluded on this basis were referred to the on-site psychologists. Thoughts of death and passive suicidal ideation were nevertheless common among group members who participated in the study, and these were monitored closely by group facilitators and the supervising psychologists.
Four Phases of Intervention
Pre-group Phase (Two Individual Sessions)
Before beginning IPT-GU group meetings, members attended two individual pregroup meetings in which group facilitators introduced themselves and discussed the purpose of the study and the various participating organizations and individuals. The facilitators also established expectations of what the treatment would involve, and in particular clarified that, unlike many NGO-sponsored programs, no material goods or services would be provided. Initially, many prospective members protested: “Give me money, then I will no longer be depressed," declared one man. Others expressed doubt about the potential of group psychotherapy to help them: “I cannot find solutions to my problems, how can I help others?” and “How can others with Okwekyawa help me?” The facilitators encouraged them to try the groups, suggesting that the meetings might assist members in learning to live a life without Okwekyawa and Okwekubagiza, which compounded the burden they experienced from other life struggles. The adage “Give a man a fish and he will eat for a day. Teach a man to fish and he will eat for a lifetime” was frequently employed.
Facilitators then gauged group members’ current depression symptoms and functioning and provided psychoeducation, emphasizing that depression is a legitimate illness, that it is not the person’s fault, and that it is treatable. Facilitators also clarified that members were not experiencing madness, as many of them feared. Members were then assigned the “sick role” (using comments such as, “You may not be able to do all you need or want to do for a while, until you start feeling better. Who can step in and help you during this time?”) to temporarily relieve them of certain overwhelming social obligations. Next, facilitators conducted the interpersonal inventory to learn about the circumstances surrounding the onset and maintenance of members’ depression and to identify the appropriate interpersonal problem area(s) and goals for treatment.