On the Horizons: Barriers and Trends in the Development of Systemic Family Therapy in Africa


Systemic family therapists (SFTs), usually called marriage and family therapists (MFTs) in North America, are trained to conceptualize individual, couple, and family distress within the broader relational and diverse intersectional contexts in which people live. Although the SFT movement originated in Western European contexts, it has since expanded across the globe (Roberts et al., 2014; Sim & Sim, 2020). In 2021, we published an article in the Journal of Marital and Family Therapy (JMFT) entitled “Expanding our International Reach: Trends in the Development of Systemic Family Therapy Training and Implementation in Africa” in which we discussed past, current, and future SFT training and implementation initiatives on the African continent alongside challenges and opportunities for the continued growth and widespread application of SFT practices throughout the continent (see Asiimwe et al., 2021).

The main goal for this brief article is to highlight some of the main points from our 2021 JMFT article. We want to note here that although we refer to trends across the wider African continent, we are not suggesting homogeneity of African countries and cultures. We rather emphasize the importance of recognizing the immense cultural diversity of Africa (54 countries, and more than 1,000 ethnic groups) while remaining attuned to some shared commonalities (in values, beliefs, and practices) in African societies.[1]

Sociocultural, political, and historical milieu of Africa

A critical aspect to consider when discussing SFT development and practices in Africa is the role of colonialism and Western influences (e.g., the introduction of Christianity and Western science) in Africa. Prior to the introduction of western science and practices, including psychotherapy in Africa, Africans had their own traditional ways of resolving common marital and family problems. For example, when couples and families faced relational problems, a common practice was to assemble a council of trusted elders who would mediate between two conflicting parties (Nwadiora, 1996). This mediating team was comprised of members from the two conflicting parties and their role was to use their eldership position to understand the stories of both sides, and offer unbiased guidance to the parties (Nwoye, 2000). When problems were finally resolved, a communal ritual would be held to help the couple recommit their allegiance to one another. Additionally, traditional healers and practices (e.g., herbalists, spiritism, and animism) provided help for individuals with mental, emotional, physical, and psychological problems (Nwadiora, 1996). Unfortunately, most of these traditional practices and ways of resolving family problems were abandoned in favor of western ways with the advent of western science in Africa. Foreign influence demonized and dismissed Africans and their ways of knowing as savage, barbaric, and heathen. Colonialists perceived Africans as “blank spaces” to be explored and manipulated. Despite the significant western influences in Africa, many African societies have managed to thrive and maintain some of the indigenous practices (Nwoye, 2000). Moreover, some communities integrate Western practices alongside indigenous ways of healing and knowing.

[1] In this article, the prefix ‘African’ is used to indicate generalizable theoretical abstract theme(s) that are dominant and enduring across Africa. By no means does it imply that Africa is monolithic, but a recognition of the everchanging nature of cultural traditions. It is used in a similar manner as the prefix “Western” is often used in literature to refer to certain dominant themes in Western cultures and thought. It does not imply that all cultures or even traditions in the “West” are the same, but rather that some aspects of the traditions are shared among Western societies.

The potential barriers to SFT implementation in Africa

Any reflection on the potential contribution of SFT to mental health in Africa necessitates an understanding of the overall landscape of mental health in Africa, including barriers. Mental health problems continue to be a public health concern in many parts of Africa. Posttraumatic stress disorder (PTSD), substance use disorders, psychosis, and mood disorders, such as depression and anxiety, are among the most cited mental health problems in Africa (Patel & Stein, 2015). Research across the continent has also documented high rates of intimate partner violence (Mogale et al., 2012) and increased disruptions in parent-child relationships (Möllerherm et al., 2019).

In many African countries, structural barriers (e.g., poor mental health systems and limited resources) and unfavorable sociopolitical climates compound access to quality mental health care, including SFT (Asiimwe et al., 2021). Despite research indicating high prevalence of mental and relational problems in Africa, many African governments give less priority to quality mental healthcare for the masses. This is evident in countries such as Uganda, where only 1% of health expenditure is allocated to mental healthcare (Kigozi et al., 2010). Similarly, in South Africa, it is estimated that one in three people live with a mental illness of which 75% do not receive treatment, yet mental health services receive only 5% of the national budget (South African Society of Psychiatrists, 2023). Although several African governments have adopted the World Health Organization’s Comprehensive Mental Health Action Plan (MHAP; Saxena & Setoya, 2014) with the objective of promoting specific country-led mental health agendas (Bird et al., 2011), most countries have not adopted SFT interventions into their healthcare systems, despite global evidence that SFT interventions are effective in addressing several mental and relationship problems (Sprenkle, 2012). Despite these barriers, there are glimpses of research showing that SFT work is slowly growing on the African continent.

Past and current SFT trends in Africa

Although SFT as a profession seems to be an upcoming profession in Africa, its core principles, and practices are not entirely new to many Africans (2004). Many African cultures are embedded in a collectivist mindset in which relational interconnectedness, sharing, and cooperation among family and other group members are valued (Kamya, 2018).

The establishment of graduate-level training programs (two masters and a doctoral program) that exclusively offer MFT training is perhaps the most exciting recent SFT trend on the African continent. These programs are in universities in Nairobi, Kenya (Asiimwe et al., 2021). In one of the MFT master’s programs, there are specialties in trauma-informed approaches, family violence, and mindfulness; students can choose to specialize in one or all three components.

Research from this initiative will make significant contributions to informing culturally relevant ways of adapting EFT and other EBPs in Uganda, and other African contexts.

Besides established MFT graduate training programs, other SFT trends have included brief trainings in family therapy concepts and research testing the feasibility of some systemic evidence-based practices (EBPs). For example, in Uganda, McDowell et al. (2011) conducted a 7-day family therapy workshop at Bishop Magambo Counselor Training Institute (BMCTI) in Uganda. In qualitative interviews, counselors found concepts of family therapy (e.g., family hierarchy, structure, roles, and boundaries) culturally resonant to the Ugandan setting. Recently, inspired by evidence of the effectiveness of evidence-based relational practices such as emotionally focused therapy (EFT) for distressed couples in other contexts (e.g., Chang, 2014; Zeytinoglu‐Saydam, 2018; Zeytinoglu‐Saydam & Niño 2019), family therapy scholars from Uganda, South Africa, and the US are currently collaborating with the Uganda Counseling Association to train Ugandan mental health practitioners in EFT and explore these practitioners’ views about the applicability of this model in their own contexts. The photographs included with this article were taken during an EFT seeding event early this year for the upcoming training. Research from this initiative will make significant contributions to informing culturally relevant ways of adapting EFT and other EBPs in Uganda, and other African contexts.

In Kenya, Puffer and colleagues (2021) adapted concepts from systems-based therapies and concepts from parent training programs to develop the “Tuko Pamoja” (TP; Kiswahili) translated as “We are together” (English) family program. Post-training, the counselors delivered between 12-15 sessions of the intervention to 10 families over a period of 30 weeks to test its initial feasibility and acceptability. Qualitative content analysis indicated that the program and its concepts were feasible in the Kenyan setting. In South Africa, Lesch and colleagues (2018) explored the feasibility of the Hold Me Tight (HMT) psychoeducational program, based on the Emotionally Focused Therapy (EFT) model that is grounded in systemic principles, among 10 Black South African couples. Results indicated that couples related well to the HMT program and reported it could be helpful in enhancing their relationships.

Forging forward

To propel the SFT field forward in Africa, we must take the following pragmatic steps. First, we need to increase the public profile of SFT by familiarizing the public with SFT practices, what SFTs could offer (Asiimwe et al., 2021; Wampler et al., 2019), and how these fit with local views about appropriate interventions. Second, there is a need to develop treatment and implementation approaches that integrate systemic evidence-based approaches with African or indigenous practices and ways of knowing. The advent of Western science, including psychotherapeutic approaches seemed to erode indigenous knowledge and practices (e.g., spirit worship, storytelling, prayers etc.). Nonetheless, many African societies have found a way to integrate the two successfully. Thus, for SFT treatments to be more useful and effective in Africa, implementers need to think critically about treatment approaches that are culturally and contextually attuned. The work of Puffer et al. (2021) offers a good example of the development and successful implementation of a program that strikes this balance. Other indigenous practices that can be leveraged include the use of music, art, and storytelling as therapeutic tools. These are often an integral part of, and valued, in African communities (Nwoye, 2018). For example, liberation songs were tools for Black South Africans to 1) cope with depression and anxiety, 2) relaxation during desperate times, 3) verbalize and process their feelings related to apartheid; and 4) nurture resilience during apartheid in South Africa (Nwoye, 2018).

Third, the establishment of professional bodies to regulate and advance the SFT profession could play a critical role in ensuring ethical, evidence-based practice and enhance the standing of the field on the continent. To date, there is no registration category for SFTs in Africa. Even in countries like Kenya with exclusively MFT training programs, family therapists have neither a registration category nor a registered body to promote the interests of Kenyan MFTs. Instead, all MFTs in Kenya are under the jurisdiction of the Kenya Counseling and Psychological Association (KCPA), which is the umbrella professional Association for Counsellors and Psychologists in the country. This is similar to Uganda where the Ugandan Counseling Association oversees all therapy practice, including the practice of MFT (Asiimwe et al., 2021). In South Africa, the promising and vibrant South African Association of Marital and Family Therapy (SAAMFT) established in 1981 collapsed in the 2000s and has never been reinstalled or replaced with another body to promote the interests of SFTs (Mason & Shuda, 1999).

Existing universities with already established mental health departments can learn from the example of Kenya to set up country-specific MFT training programs at the graduate level.

Relatedly, fourth, the establishment of more SFT training programs at the graduate level could alleviate training challenges, and produce more competent African SFTs to ensure continuity of the profession in the future. These training programs should aspire to meet the minimum MFT educational competencies such as those set by the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE; Lal & Jonathan, 2021) in the United States. Existing universities with already established mental health departments can learn from the example of Kenya to set up country-specific MFT training programs at the graduate level. Importantly, the training of SFT in Africa should pay particular attention to unique cultural and contextual issues of Africa (e.g., HIV/AIDs, poverty, family violence, refugee crisis, war-related trauma, and others). Additionally, training should not only focus on teaching African SFTs the basic concepts of family systems theory and practices but should also teach students to 1) understand and incorporate indigenous practices in their clinical work, and 2) understand their history as a colonized continent. This would enhance a sense of cultural pride and as well, raise the critical consciousness of African scholars and encourage them to reflect and actively engage in decolonization of SFT practices on the continent (e.g., Ibrahima & Mattaini, 2019; McDowell et al., 2011). Second, it will help students to learn to see clinical work with families as a pedagogical practice i.e., a tool not only for individual change but community and social change (Nwoye, 2018).

In conclusion, SFT practices have the potential to positively impact the mental and relational well-being of families and communities in Africa. The already existing indigenous resources such as the arts, music, and oral practices (e.g., storytelling) offer useful tools for intervention, drawing inspiration, and healing of relationships in African families and communities. If the training of future SFTs in Africa can emphasize social justice and ideas of decolonizing family therapy, it would ensure the cultural relevance of the profession on the continent.

Ronald Asiimwe, AAMFT Professional member, grew up in Uganda and is currently a doctoral candidate in Human Development and Family Studies specializing in Couple and Family Therapy at Michigan State University. He holds a master’s degree in Marriage and Family Therapy from Oklahoma Baptist University–Shawnee, Oklahoma. Prior to moving to the United States, Asiimwe attended Makerere University in Kampala, Uganda where he received his bachelor’s degree in Community Psychology. He has research and clinical experience practicing in the USA, and in his home country of Uganda. His research interests are in parenting and family/relational-based interventions grounded in context and culture, mental health disparities, and systemic family therapy in Africa. Asiimwe believes that healthy human relationships are the foundation for a healthy and fulfilled life. With this, he has special interest in the cross-cultural exchange of scientific knowledge particularly around the development, adaptation, and implementation of relational-based interventions in Africa. He spends much time reading and writing about these topics and enjoys presenting on these topics at conferences and workshops. He has published articles in top-tier journals and also received numerous awards, including the 2020-2021 national leadership development award from the American Association for Marriage and Family Therapy (AAMFT), the 2023 Dissertation award, and New Writer’s Fellowship from the Family Process Institute (FPI).

Elmien Lesch, PhD is an associate professor and the director of the Clinical Psychology professional training program in the Psychology Department at Stellenbosch University in South Africa. She is a registered Clinical Psychologist and a certified EFT therapist, supervisor, and trainer. Prof Lesch is a South African National Research Foundation rated researcher. She has a specific interest in romantic and family close relationships and has produced a number of peer-reviewed articles in this area. She is also in the process of exploring the practice of couple interventions on the African continent.

The authors acknowledge the immense contributions of two co-authors of the original article upon which this piece is based. These authors are Dr. Adrian Blow, professor, and chair of the Department of Human Development and Family Studies at Michigan State University, and Dr. Michelle Karume from United States International University- Africa in Nairobi, Kenya. Their contributions to the original article, the MFT profession globally, and in Africa are invaluable.

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