title: Potential treatment mechanisms of counseling for children in Burundi: a series of n=1 studies.
abstract: Little is known about the impact and treatment processes of psychosocial counseling in low-income countries. This study aimed to generate hypotheses on key working mechanisms of counseling in Burundi. The authors carried out 11 empirically grounded n=1 studies with children (11-14years) screened for depression and anxiety who received counseling. The authors used quantitative (symptom scales) and qualitative instruments (treatment content and perceptions). Weekly measurements were taken preintervention (4 time points), during the intervention period (8-10 time points), and postintervention (4 time points). Five treatment mechanisms continua appeared associated with outcome trajectories: client centeredness, therapeutic alliance, active problem solving, trauma-focused exposure, and family involvement. Higher levels appeared associated with better outcomes. Contrarily, cases that demonstrated no change were characterized by a heavy focus on counselors' norms, containment and self-control, unstructured retelling and explicit avoidance, advice-oriented problem solving, and noninclusion of family members, respectively. The authors found a distinct clustering of outcome trends per therapist. The findings suggest that integrative counseling, which combines universal therapist variables with active use of specific therapeutic techniques and a systemic perspective, may be an adequate strategy to treat mental health symptoms of children in Burundi.
authors.affiliation: HealthNet TPO, Amsterdam HealthNet TPO, Bujumbura Johns Hopkins University University of Amsterdam. mark.jordans@hntpo.org
authors.forename: Mark J D
authors.initials: MJ
authors.lastname: Jordans
authors.forename: Ivan H
authors.initials: IH
authors.lastname: Komproe
authors.forename: Eva
authors.initials: E
authors.lastname: Smallegange
authors.forename: Prudence
authors.initials: P
authors.lastname: Ntamatumba
authors.forename: Wietse A
authors.initials: WA
authors.lastname: Tol
authors.forename: Joop T V M
authors.initials: JT
authors.lastname: De Jong
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000628:therapy*; D002063:Burundi; D002648:Child; D003376:Counseling / Q000379:methods*; D003863:Depression / Q000628:therapy*; D003906:Developing Countries; D037001:Directive Counseling / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D009629:Person-Centered Psychotherapy / Q000379:methods; D011340:Problem Solving; D011369:Professional-Patient Relations; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D016896:Treatment Outcome