Scaling Up Family Therapy in Fragile, Conflict‐Affected States

• Author: Laurie L. Charlés
• DOI: http://doi.org/10.1111/famp.12107
• Date: 01 September 2015
• Published date: 01 September 2015

Scaling Up Family Therapy in Fragile,

Conflict-Affected States

LAURIE L. CHARL

ES*

This article discusses the design and delivery of two international family therapy-focused

mental health and psychosocial support training projects, one in a fragile state and one in a

post-conflict state. The training projects took place in Southeast Asia and the Middle East/

North Africa. Each was funded, supported, and implemented by local, regional, and inter-

national stakeholders, and delivered as part of a broader humanitarian agenda to develop

human resource capacity to work with families affected by atrocities. The two examples

illustrate how task-shifting/task-sharing and transitional justice approaches were used to

inform the scaling-up of professionals involved in each project. They also exemplify how

state-citizen phenomena in each location affected the project design and delivery.

Keywords: International Training; Mental Health and Psychosocial Support; Fragile

States; Postconflict States

Fam Proc 54:545–558, 2014

Clinical practice in countries where human rights atrocities are part of the everyday

landscape is political work. As Watts (1961) noted, “the therapist who is really inter-

ested in helping the individual is forced into social criticism” (p. 8). In liberal democra cies,

the practice of psychotherapy may indeed qualify as social criticism, as Watts (1961)

observed. Yet, such criticism is not likely to disappear you from your home in the middle

of the night, result in your detention and possible torture, or risk harm to your family.

Watts’ (1961) statement is taken to its extreme when considered within the borders of

fragile, conflict-affected states. In these locations, it can be a risk to perform clinical work

with those who have suffered political violence and persecution. It can be risky precisely

because it can be construed as social criticism.

In this article, I discuss how conditions in one fragile state and one postconflict state

informed the design and delivery of family therapy training projects. A ‘fragile state’ is a

label used to describe a range of phenomena associated with state weakness and failure,

including “state collapse, low administrative capacity, political instability, conflict, and

repressive polities.” A postconflict state, according to the World Bank, is one that has “suf-

fered from a severe and long-lasting conflict; experienced a short, but highly intensive,

conflict or a newly sovereign state that has emerged through the violent break -up of a for-

mer sovereign entity.” In this article, I primarily use the term fragile, confli ct-affected

states to capture the circumstances described in each country.

As an investment in host country nationals, who are typically the beneficiaries of such

projects, technical training in family therapy and mental health and psychosocial support

can contribute to a population’s psychosocial well-being. The increased production of

mental health services is seen to benefit the overall economic potential of the country

*Family, Couple, and Individual Psychotherapy Master’s Program & Doctoral (PsyD) Program in Counseling

Psychology, Our Lady of the Lake University, San Antonio, TX.

Correspondence concerning this article should be addressed to Laurie L. Charl

es, Ph.D., L.M.F.T.,

Department of Psychology, 411 S.W. 24th St., San Antonio, TX 78207. E-mail: lcharles@ollusa.edu

545

Family Process, Vol. 54, No. 3, 2015 ©2014 Family Process Institute

doi: 10.1111/famp.12107