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Culture, Health & Sexuality: An International Journal for Research, Intervention and Care Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/tchs20

Editorial Introduction: Sexuality, intimacy and counselling: perspectives from Africa a

b

c

Eileen Moyer , Marian Burchardt & Rijk van Dijk a

Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands b

Max Planck Institute for the Study of Religious and Ethnic Diversity, Göttingen, Germany c

African Studies Centre, Leiden, The Netherlands Published online: 14 Nov 2013.

To cite this article: Eileen Moyer, Marian Burchardt & Rijk van Dijk (2013) Editorial Introduction: Sexuality, intimacy and counselling: perspectives from Africa, Culture, Health & Sexuality: An International Journal for Research, Intervention and Care, 15:sup4, S431-S439, DOI: 10.1080/13691058.2013.829977 To link to this article: http://dx.doi.org/10.1080/13691058.2013.829977

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Culture, Health & Sexuality, 2013 Vol. 15, No. S4, S431–S439, http://dx.doi.org/10.1080/13691058.2013.829977

Editorial Introduction Sexuality, intimacy and counselling: perspectives from Africa Eileen Moyera, Marian Burchardtb* and Rijk van Dijkc

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a Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands; bMax Planck Institute for the Study of Religious and Ethnic Diversity, Go¨ttingen, Germany; cAfrican Studies Centre, Leiden, The Netherlands

In the name of counselling: skilful revelations of intimate life in contemporary Africa Across the world, talk about sex is seen as exciting and dangerous – and therefore subject to endless rules, taboos, incitements and proscriptions. Moral frameworks of conversation on intimate matters are often culturally specific, varying from place to place, but they also draw upon and feed into the large-scale institutional assemblages of public and global health campaigns that travel and span vast territories (Pigg and Adams 2005). In these institutional contexts, sexuality is addressed in terms of social or health problems and behavioural change. Tackling issues such as HIV and AIDS, gender-based violence, postconflict trauma or reproductive health (for both women and men), such institutional assemblages link everyday experiences embedded in cultures of intimacy with rationalities of physical enhancement, health, population politics and prescriptive socialities (Lupton 1995). As a consequence, the social practices of speaking about sex are critically placed between calls to sexual openness on the one hand, and secrecy and concealment on the other (Reid and Walker 2005; Hardon and Posel 2012; Moyer 2012). This special issue of Culture, Health & Sexuality is dedicated to examining practices of counselling as one of the most important social forms in which the dialectics of revelation and concealment play out. In fact, while the interface of sexuality and discourse is fairly well theorised – there are numerous excellent ethnographies of cultures of intimacy on the one hand, and of institutional apparatuses dealing with sexuality, public health or otherwise on the other (Nguyen 2010; Langwick, Dilger, and Kane 2012) – there are hardly any focused studies on such socially and institutionally impregnated forms. Counselling as a psychological practice has been a subject of study within the social sciences for many years. This is easily evidenced by the wide range of journals specifically devoted to the topic. Remarkably, however, counselling has hardly been studied in an interpretive mode. This special issue breaks new ground since it is the first collection of social science papers explicitly dealing with counselling on issues of intimacy and sexuality in contemporary Africa. Focusing on counselling allows researchers to study sites and interactions in which discourse on sexuality is cast into specific moulds, binding people in situations that generate observable practices that have important, if often also unintended, consequences.

*Corresponding author. Email: [email protected] q 2013 Taylor & Francis

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This special issue therefore approaches counselling as a set of practices embedded in wider social institutions and contexts linked to specific repertoires of expertise, experience and knowledge. As such, it picks up where studies of counselling that focus on efficacy and intervention leave off, framing counselling as a social phenomenon worthy of scientific exploration in its own right. The papers it contains demonstrate that researching counselling is important for understanding the dynamics of sexuality and intimacy for both empirical and theoretical reasons. The range of topics addressed serves as an indicator of the remarkable recent and relatively rapid emergence of social practices being carried out under the name of counselling.1 We examine practices of counselling on sexual matters with regard to three analytical concerns, which cut across most of the articles. First, there seem to be clear links between the expansion of contemporary counselling and the expansion of global attention to health and humanitarian-related crises in Africa, especially HIV and AIDS. HIV has allowed for the sexual body to be positioned as a medicalised problem to be worked on through modern forms of advice and therapy. Against this backdrop, we see counselling emerging in Africa in response to globally circulating and politically accepted constructions of need. These constructions of need form the context of the operations of international development and humanitarian non-governmental organisations and health agencies, as well as faith-based institutions, that have become entangled with global health projects. The growing popularity of institutionalised forms of counselling appears closely associated with urbanisation and the emergence of middle classes with particular anxieties and sensitivities in many African societies, including the breakdown of traditional modes of advice giving related to marriage, child rearing and coming of age. In some contexts, both tendencies are connected in that the HIV epidemic is perceived as particularly threatening to notions of modernity, progress and respectability so integral to middle-class sensibilities. These class-based anxieties are most visible in the papers by Rijk van Dijk and Linda van de Kamp, which explore counselling in the context of Pentecostal churches in Botswana and Mozambique, respectively. Whereas middle-class couples in Botswana partake in pseudo-psychological talk therapy to improve intimacy in marital relations, couples in Mozambique, influenced by Brazilian inducements toward public displays of affection, are collectively induced to perform publicly their love during ‘love sessions’. Second, we examine how socially defined ideas of legitimacy, that is, who may counsel whom on sexual matters, play out in counselling situations and interactions, as well as the social relationships they may come to constitute. Often, counselling seems to be based on notions of trust and confidentiality. On the basis of the prescribed social closure that counselling promises, clients are encouraged to reveal or disclose otherwise intimate aspects of their lives. By operating through a social distance to forms of everyday talk, counselling may also establish or reinforce the discreet or private nature of such intimacies. Even if often breached, ideals of trust and confidentiality seem to run through much of what is done in the name of counselling. It is this aspect of intimacy that explains much of the ‘elective affinity’ between sexuality and counselling. The papers by Emmy Kageha Igonya and Eileen Moyer, by Louise Rasmussen, by Marian Tankink and by Eva Vernooij and Anita Hardon examine the tensions arising from that breach, as well as the diverse configurations of privacy and intimacy through which counselling acquires its cultural thickness. Third, we examine questions related to the diverse intended and unintended effects of counselling. Counselling may lead to behavioural and cultural changes in ways anticipated by the organisations for which counsellors work, but the changes may also go beyond that. Counsellors are often guided by claims to progress, rationality and ‘responsible

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sexualities’ against which the targeted, culturally framed practices are posited as irrational or detrimental to modern values of success and development. However, counselling may also be disconnected from such changes and, instead, reflect skilfully staged performances of respect, cultural values and social hierarchy.2 Researchers must reckon with the fact that such strategic adaptations thwart the assumption that counselling automatically assists in rendering targeted populations as legible subjects to be ‘fixed’. Although the study of the consequences of counselling is often focused on clients, counselling practices and counsellors may also have an effect on the institutions and organisations that house them. For example, while, typically, institutions function by promoting indifference towards people’s private concerns, counselling forces empathy and attention on the individual and, at times, the individual couple (see Joseph Simbaya and Eileen Moyer in this issue). By focusing attention on specificities, counselling has the potential to counter the dysfunctional effects of the notorious ‘one-size-fits-all’ approach characteristic of many interventions. Clearly, the rise of counselling is linked to the HIV epidemic and the ways in which counselling became part of HIV-related projects, from prevention campaigns to care and support to biomedical mass treatment programmes (Burchardt 2009; Richey 2012). Although, as the articles by Joseph Simbaya and Eileen Moyer and by Louise Rasmussen indicate, the shift toward antiretroviral treatment programmes over the last few years has led to a decline in donor support for counselling targeting behaviour change, the idea of offering advice to individuals and heterosexual couples as a means of transforming them into to responsible patient-citizens remains strong. Beyond the domain of HIV, counselling also takes place in psychiatric interventions in response to gender-based sexual violence in Rwanda, the Congo, Sudan, Sierra Leone and other (post-)conflict areas and, increasingly, in the context of domestic violence programmes in public health facilities. Counselling has also seen an almost revolutionary rise in Christian contexts, both in mission churches and Pentecostal congregations, in the form of marriage counselling and advice on intimate issues of all sorts, including sexual health and sexual pleasure (Bochow 2010; Burchardt 2011a; Bochow and van Dijk 2012). This range of concerns and topics is reflected in the choice of papers that are part of this special issue. With the exception of papers by Marian Tankink and Marieme Lo, all mention HIV as either the focus of counselling or part of the broader, relevant context in which counselling is taking place. Three papers (by Marian Burchardt, Rijk van Dijk and Linda van de Kamp) examine counselling in religious contexts, while Joseph Simbaya and Eileen Moyer demonstrate how the church in Zambia, with its focus on compassion and Christian duty, has been involved in providing HIV-related counselling since the beginning of the epidemic, shaping counselling practices at community and national levels for more than 25 years. Their historical examination of the emergence and transformation of counselling in Zambia complements Nguyen’s paper tracing the Western genealogies that have shaped the HIV counselling guidelines and practices that commonly accompany international aid programmes. In addition to the particular genealogies traced by Nguyen, several other papers in the collection illustrate how counselling in Africa has been shaped by diverse sources (Annemiek Richters, Theoneste Rutayisire and Henny Slegh; Linda van de Kamp; Rijk van Dijk, Joseph Simbaya and Eileen Moyer). The papers by Annemiek Richters, Theoneste Rutayisire and Henny Slegh and by Marian Tankink explore the ways non-African (namely Dutch) ideas about counselling and openness intersect with cultural norms related to gender, silence and shame in Rwanda and Sudan, respectively. Practices resembling counselling have, of course, long been the object of anthropological studies of ‘traditional’ systems of African healing and advice giving

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(e.g. Turner 1968; Evans-Pritchard 1976). Practitioners of traditional healing have been recognised as careful observers of their social world, whose powers tend to flourish in moments of heightened social anxiety. Like traditional healers, contemporary counsellors skilfully work with patient-clients to reveal causes of social, physical or mental disorder. There are also some differences, however. Healers gain their authority through personal charisma, through the existential experience of crisis and illness (the ‘wounded-healer’ paradigm of the acknowledgement of their authority), through lines of descent by which their expertise is handed down from one generation to the next and through the embodiment of expert knowledge shrouded in secrecy and ineffability. In comparison, the authority of counsellors at a first glance appears to be constituted through what might be termed as a Weberian notion of ‘office’, or a position in society that is not dependent on descent or through the embodiment of (personal) crisis and revelation but is related to formalised and externalised requirements and institutionalised training. Yet, on closer inspection, these two epistemic models of the healer versus the counsellor become blurred if one considers forms of advice-giving that seem to resonate with both the ‘charisma’ and ‘office’. Josien de Klerk’s paper points out how advice-giving in rural Tanzania is a culturally sanctioned practice conjoining ideas of age sets and seniority, and Marieme Lo’s paper illustrates the ways established, middle-aged market women increase their already considerable respect by offering advice on matters of marriage, intimacy and sexual pleasure. By contrast, as the articles by Rijk van Dijk and by Joseph Simbaya and Eileen Moyer demonstrate, the authority of contemporary counsellors is gained through their association with publically accessible forms of science, training, technical expertise and specialist knowledge. At the same time, it is clear that there are extremely close relationships between inherited, charisma-based forms of advice-giving and everyday, often status-based, practices of assistance on the one hand, and modern counselling on the other. Questions of traditional cultural legitimacy in terms of who may counsel whom (between women and men, people of different degrees of seniority and people with different levels of training and degrees of experience) often shape perceptions of counselling roles in clinical settings. In other cases, the disregard for inherited norms in modern counselling settings is viewed as either liberating or socially disruptive, as Eva Vernooij and Anita Hardon show in their analysis of health workers’ perceptions of counselling standards in rural Uganda. In a fundamental sense, the experiences of everyday life, with their own hierarchies of relevance, norms and themes, feed into institutionally-based forms of counselling. In rural settings, this is simply based on the fact that the counsellors and their clients are often members of the same village communities. This implies that they are subject to shared social codes beyond the counselling situations, and adherence to these codes may override in importance any notion they may hold of ‘good’ or ‘correct’ counselling. However, we suggest that, because of the tremendous scale and reach of public health programmes in Africa today, the horizons of informal and professionalised – that is, bureaucratically and scientifically mandated – counselling increasingly shape one another, and that such entanglements are important to study. Despite their many failures, global health campaigns and development programmes do have huge effects on existing forms of advice-giving in that they introduce new vocabularies and registers through which to view and assess such practices. This is especially true for the framework of human rights and the way it underpins notions of ethics, confidentiality and informed consent as entitlements due to patients and clients (Angotti et al. 2009). In this context, counselling is used to inform people about their possible choices as rights, for example the right to have, or to refuse, an HIV test, a

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treatment regime and so on. But since, in counselling, people trade in sensitive information, it is also a practice that calls for a protective, legally framed mechanism whereby social harm emerging for clients through information leakage to third parties is ruled out. Confidentiality and informed consent therefore both presuppose and rely on universal shared ethics and ideas of liberal, rights-bearing individual subjects. As such, institutionally embedded forms of counselling have become prime avenues for putting both norms in place as a means of protecting and enshrining the individual’s privacy. The widely diffused and officially endorsed notion that counselling should be non­ directive can be genealogically linked to the liberal norms of confidentiality and consent that emerged from social work theories during the 1970s in the West (cf., Richey 2012, 835). This notion suggests that counsellors should not tell people what to do, but rather map out possible alternative lines of actions, always, as it were, in terms of choices (Burchardt 2011b, 149). In practice, this often implies that people’s sexual practices are normatively charged as ethical choices for which they alone are called to assume responsibility. What public health discourse prosaically glosses as ‘behavioural change’ for many people really means a personal transformation of some kind. Working in the service of such transformations, counselling ‘transforms the “therapeutic gaze” into heterogeneous modes for people to scrutinise and act upon themselves, and thus into creative forms of ethical subject-formation’ (Burchardt 2009, 346). Counselling asks clients to problematise their behaviours and intimate everyday life practices while promulgating the establishment of new regimes of self-knowledge as the firm basis for the rational management of everyday life decisions. Our ethnographic studies, however, indicate an inherent tension to counselling, which results in what might be considered the necessary fiction required for counselling as a social form to endure. Although counsellors are tasked with routinely suggesting that people have choices and, indeed, must choose, in practice, counsellors often already ‘know’ or, more precisely, they are institutionally induced to think they know, what is in their clients’ ‘best interest’ – it is best to take pills on time, to take an HIV test, to engage in ‘sexual negotiation’ and discussions before intercourse, to be open about one’s HIV status, to consistently use condoms, to avoid unplanned pregnancies and so forth. The, often dramatised, ideas of choice and consent, as well as the premises of non-directive counselling, are therefore expressions of the necessary fiction of the institutional ‘counselling industry’, which rarely succeeds in its stated goal to empower individual subjects to make rational choices in their own best interest. Such notions teach us important lessons about the ways in which the settings in which counselling takes place are often, if not always, simultaneously embedded within, and also symbolically set apart and socially differentiated from, their social environs.3 The very idea that people should and can ‘be open’ and talk honestly about their behaviours inside the counselling setting is, at least as a conceptual premise, dependent on the idea that counsellors do not talk about it outside.4 That some people do not disclose in counselling settings often confirms this notion because their fears are based on the suspicion that counsellors might not play by the rules.5 Both the moral possibility and subjective value of ‘speaking the truth about oneself’ and ‘confessing’ to the counsellor rest on the particularity of the situation fenced off as it is, albeit to extremely varying degrees, from the broader flows of social and communicational life. Regardless of whether the boundaries around counselling settings are ‘policed’ morally, socially and even legally, these boundaries constitute the grounds of differential informational membership (‘who is allowed to know what’) and generate the specific value of gossip, secrets leaked, information passed on and so on.

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Counselling, then, induces both talk and silence. This is particularly evident in the papers by Josien de Klerk and by Marieme Lo, both of which focus on community-based forms of counselling where inducements to silence are central. As Lo’s paper demonstrates, it is precisely this dialectics of closure and connection that shapes practices of counselling and their links to the themes of intimacy and sexuality that entangle advicegiving on the one hand, and acts of disclosure of some sort on the other, in myriad ways. However, one may also question the extent to which silencing reproduces the very cultural norms that helped to create the need for counselling to begin with.6 Alternatively, in their paper about an HIV-positive men’s sex therapy group in Nairobi, Emmy Kageha Igonya and Eileen Moyer demonstrate the extent to which biomedical norms cloaked as liberating can silence group members wishing to discuss cultural norms associated with childbearing. The practice of counselling can be cast in the imagery of what Michael Taussig once called a scenario of ‘skilled revelation’ – that is, indicating the level at which competences of disclosure are required to make the practice work and be morally and socially respected and acknowledged. There are domains in which the work of counselling has, indeed, a long-standing record of reputation. This is especially the case with regard to religious practices that Vinh-Kim Nguyen (building on Foucault) has aptly phrased as a ‘confessional technique’ (Nguyen 2009, Nguyen this volume) in which especially the Christian faith has excelled in producing institutional spaces for the ‘speaking of the truth about oneself’. In many Christian traditions, confession and testimony-giving are speechacts that are intimately interwoven with the shaping of identity on the one hand, and the production and conceptualisation of an inner-self on the other. Confessions and testimonies bring an inner self into a domain of revelation, inspection and introspection, which in Christian circles is perceived as a necessary step in the moral cleansing and healing of a person or a community (Keane 2007). As Robbins (2004) demonstrated in his work on the introduction of Pentecostalism in Papua New Guinea, the fundamental process of ‘becoming a sinner’ that Christianity forcefully promulgated as the royal road toward achieving the status of a confirmed believer, required first and foremost the production of an inner-self that is potentially driven by unseen forces requiring close inspection. Much less based on the development of psychology in which the hidden innerself can harbour secrets that may become problematic, painful or traumatic, the Christian emphasis on shaping speech acts expresses a valuation of the moral status and quality of what is motivating a person in his/her choices and emotions. Fundamental to Christian understandings of speech acts of confession, counselling and testimony is the assumption that a person cannot be the moral judge of the own ‘self’. Instead, in the moral construction of the self, a sympathetic mirroring needs to take place vis-a`-vis an other or others, so as to achieve such as an assessment. There is a mimetic principle (see Fleming and Girard 2004) in these speech acts that constitutes the subject as reflecting and internalising the moral standing, authority and identity of – in this case – the pastor, priest or any figure of similar spiritual disposition. These speech acts do not only express the workings of the divine on the moral shaping of the subject, but are the vehicle that brings about that moral subject. In many parts of Africa, words and speech are powerful in bringing about a realisation of the subject, more than just being an expression of intentions and motivations. The contributions by Marian Burchardt, by Linda van de Kamp and by Rijk Van Dijk demonstrate the ways in which this constitutive capacity of the speech act of counselling in southern African Christian circles must be understood not only in the perspective of the shaping of subject positions, but first and foremost in its power of the shaping of

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relationality. Counselling in Pentecostal circles in South Africa, Mozambique and Botswana brings about a simultaneous (re-)formulation of the constitution of a moral subject and a moral relationship. Much is invested in terms of time, knowledge, exchange and resources in producing a social space in which counselling constitutes relations – relations not only in terms of the religious-moral exchange between leaders and followers, but especially in terms of the relations between the sexes, in particular relations that will and must lead to marriage (such as relating to pre-marital, marital and enrichment counselling). These three papers show how counselling is productive of notions of the morality of sexuality, intimacy and knowledge of the body, and how these matters can and must be integrated into ideas of building a relationship. Such counselling offers space for the ventilation of specific Christian moral agendas concerning matters such as the tying of sexuality exclusively to the institution of marriage, the shaping of a new and responsible masculinity (as men are usually perceived as the ones for whom a moralised subjective understanding concerning their sexuality is the most urgent) and reproductive responsibilities. Van de Kamp’s paper explicitly draws attention to this constitutive power of the social space created as she shows how semi-public counselling sessions bring about acts of demonstrating affection and intimacy between partners for which there is little space of acceptance in the Mozambican public domain. In the counselling sessions she describes, partners are requested to touch and hug one another, translating the counsellor’s (moral) message on relationality into corporal terms. This subset of papers on Christianity therefore demonstrates that the speech act’s constitutive power can be counter-cultural in intent as it generates a minutia of politics in words spoken and the (moral) messages exchanged. By situating itself in local notions and practices of relationships, counselling has the potential to be critical if not antagonistic of the local ‘culture’ and ‘tradition’. Ethnographies of the practices of counselling in Christian circles call our attention to the problematic of the political nature of the social space that counselling is occupying and the manner in which its constitutive principles are understood by society at large. In conclusion, the various forms of counselling and the dialectics of openness and closure, authority and agency they engender, highlight a remarkable process taking place in many parts of Africa. This represents a new institutional development in Africa not in the image of a ‘global shadow’ (cf. Ferguson 2006) but as relating to, and being produced by, local pro-active engagement and appropriation of (globally) circulating notions of the ‘conduct of conduct’. While, on the one hand, counselling represents and highlights a process of emplacement, this emplacement is at the same time part of local enactments of the authority of speech, knowledge and experience. Instead of something that could be perceived as having been parachuted onto the African continent, the continuous making and remaking of counselling and advice-giving renders it open to a critical analysis of localised institutional formation. Although Foucault never set foot in Africa, he may have been bewildered by this European de-centred idea of an emplaced configuration of practices, notions and discourses of a ‘conduct of conduct’ that these forms of counselling represent. The creativity that is illustrated in the rise of counselling in Africa can be appreciated most adequately through ethnography. Part of our endeavour, therefore, has been to trace processes of vernacularisation of governmentality that Foucault may not have been able to predict. Simultaneously, we recognise that the paradigm of governmentality comes with serious limitations. These are apparent where ethnographers demonstrate how counselling is driven by entirely different or even competing logics having to do with local codes of respect and prestige, or how counselling becomes a form of window-dressing for public

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health officials where the unintended consequences fall outside the purview of governmentality. In order to grasp this variety of scenarios, we suggest that counselling should be studied using multiple theoretical inspirations and methods. Notes 1. 2. 3.

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4. 5. 6.

Whether these practices should be considered counselling in accordance with a strict definition of the term is up for debate. However, we argue that since they are being carried out ‘in the name of counselling’ they need to be examined in that light. This is made apparent in the papers by Burchardt, Igonya and Moyer, and by Rasmussen. The sociologist Simmel (1957) famously analysed this mechanism of simultaneous closure and connection with regard to bridges and doors. The papers by Rasmussen and by van Dijk make this clear. Burchardt (2013) ethnographically explores how these assumptions operate in the attempts to regulate information flows in HIV/AIDS support groups in South Africa. This also done in the papers by Richters, Rutayisire and Slegh, and by Tankink.

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Editorial introduction: Sexuality, intimacy and counselling: perspectives from Africa.

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