Potential Treatment Mechanisms of Counseling for Children in Burundi: A Series of n=1 Studies

Mark J.D. Jordans, Ivan H. Komproe, Eva Smallegange, Prudence Ntamatumba, Wietse A. Tol, Joop T.V.M. De Jong

Research output: Contribution to journalArticle


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.

Original languageEnglish (US)
Pages (from-to)338-348
Number of pages11
JournalAmerican Journal of Orthopsychiatry
Issue number3
StatePublished - Jul 1 2012


  • Burundi
  • Children
  • Client-centered counseling
  • Counselor directedness
  • Integrative counseling
  • Posttraumatic stress
  • Psychosocial counseling
  • Treatment mechanisms

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Arts and Humanities (miscellaneous)
  • Psychology (miscellaneous)
  • Psychiatry and Mental health

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