Initial Phase (Weeks 1-4 of Group Treatment)

The IPT group in which Amadi participated consisted of the facilitator (C.N.) and eight women, ranging in age from forty-five to seventy, with three women in their late forties; two, including Amadi, in their fifties; two in their sixties; and one in her seventies. Like Amadi, four other members of the group were bereaved following the deaths of one or more loved ones, either recently or dating back many years. A number of group members were struggling with disagreements with those close to them. For example, one group member fought frequently with her husband; another had a conflict with her son, who accused her of being a witch. Women in the group also struggled with lack of resources and financial losses, such as a husband’s recent unemployment, as well as illness. All group members started treatment experiencing high levels of sadness and hopelessness, and most noted they had been crying very frequently. They all seemed to be intensely worried about their problems and had difficulty functioning in their lives.

The first four group sessions were structured around the initial phase of IPT, during which group members become acquainted with each other. At the beginning of the first session, the women appeared anxious, sad, and withdrawn. When C.N. asked them to share their experiences, silence enveloped the group. Finally, Amadi volunteered to speak, but broke down before she could complete her first sentence. Through her tears, she recounted that the death of her beloved youngest son, following so many other losses, had robbed her of any remaining hope and happiness. “Nothing good will happen now,” she declared, almost defiantly. Prompted by C.N., she described how she learned of his death and suffered through the funeral rituals. She said that he had been living in a city several hours away, and that although she had received word from her sister-in-law that he was ill, she had not realized the extent and rapidity of his decline. “One day my husband’s sister came to me with the news of his death, I never even got to say goodbye,” she reflected sadly. She continued that, during the burial period, she had refused food for days, developed diarrhea, and at one point collapsed. In addition, she revealed to C.N. and the group that her daughter had recently disappeared and, in her words, “not even a mutilated body was recovered for burial.” Responding to Amadi’s outpouring of grief, the group commiserated with her, shedding tears for the next half-hour. One group member placed her hand on Amadi’s back to comfort her, while another gently cradled Amadi’s head in her lap. An air of hopelessness and despondency filled the room. When asked to come up with a plan for the week, Amadi told the group that she had no plan except to “put everything to God”

At the beginning of the second session, when each member described changes in their depression since the previous week, Amadi reported worsening of her symptoms, especially her sadness and loneliness, which she attributed to the death of her close friend, Bacia. She also reported feeling increasingly weak herself. When C.N. asked her about her past and recent relationship with Bacia, Amadi reported that they had worked together making mats for many years, and that she had been the godmother to Bacia’s first son. Amadi also revealed that they had shared in their grief when Bacia lost a daughter to “the illness” several years earlier. “She was the only one who could understand me,” Amadi added.

By the third session, the group members’ support for each other had increased: they were better able to comfort those in the group who were bereaved and started offering each other suggestions more directly. C.N. facilitated this process by prompting the members to express their feelings and support, as well as to give advice to one another: “I can see the pain in your faces as Amadi is talking about her son. What would you like to tell Amadi right now?” However, Amadi seemed to have further deteriorated since the second session: she was thinking obsessively about her dead children, could not stop crying or force herself to eat or sleep, and was losing strength with each passing day. As the session closed, the group’s weekly plan for Amadi was that she try to dig in her shamba to take her mind off her lost loved ones, and go to bed earlier in an effort to rest.

At the beginning of the fourth session, C.N. noticed some members smiling shyly when they met for the group, while two more arrived together in a pair. During the session she observed that the women were beginning to establish eye contact when addressing one another, and when one member broke down discussing a recent argument with her son, the others comforted her without the hesitancy and selfconsciousness they had shown during previous sessions. Slowly, a change was coming over the group. Above and beyond offering practical advice, support, and encouragement to their fellow members, it seemed to C.N. that they were beginning to establish a collective bond, trust each other more, and empathize more deeply with one another. C.N. noticed, for the first time, some improvements in Amadi, too. She announced during the symptom review that she had been going to bed earlier and that her sleep and appetite had somewhat improved. She attributed these improvements to encouragement from the group, an increasing awareness that others in the group were going through similar situations, and praying regularly. She was somewhat more proactive than in previous sessions, offering advice to another member for the first time, encouraging her to take time to rest and to find comfort and strength through prayer.

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