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Naturalistic Evaluation of the Effectiveness of Psychodynamic Psychotherapy top With Adults with Intellectual Disabilities Nigel Beail, Sharon Warden, Kim Morsley and David Newman
Intake and outcome measures
This study was concerned with outcome in normal clinical practice and therefore measures were needed that encompassed a range of symptoms rather than a single trait. Psychotherapy studies have also been criticized for being primarily symptom orientated and thus insensitive to changes in interpersonal functioning and the self. This study therefore explored the use of measures evaluating symptom, interpersonal and self-change, used in general psychotherapy outcome research that could be administered in an assisted completion format. These were the Symptom Checklist 90-Revised (SCL-90-R; Derogatis 1983), the Inventory of Interpersonal Problems-32 (IIP-32; Barkham et al. 1996) and the Rosenberg Self Esteem Scale (Rosenberg 1965).
The SCL-90-R
The SCL-90-R provides scores in nine symptom areas as well as general indexes of distress. The SCL-90-R can be administered in an assisted completion format and this has been found to have good reliability and discriminative validity with people with intellectual disabilities (Kellett et al. 1999). The IIP-32
The original IIP (Horowitz et al. 1988) has 127 items, some of which involve language and concepts too difficult for people with intellectual disabilities. The shorter version (Barkham et al. 1996) has only 32 items and was administered in an assisted completion format. However, this was exploratory, as no reliability data are available on this measure when used with people with intellectual disabilities. Also, only 14 of the 20 participants could complete this measure.
Rosenberg Self-Esteem Scale
The Rosenberg Self-Esteem Scale is brief, widely used and only requires minor modifications to wording to be used with people with intellectual disabilities. However, there are no reliability data on its use with people with intellectual disabilities.
The service
Psychodynamic psychotherapy is provided by the authors as part of a comprehensive range of psychological services to adults with intellectual disabilities living in an area with a population of 227 000. Clients are referred by a wide range of professionals and carers and by themselves. The service is provided on an outpatient basis in the same setting as services for non-disabled people. The therapists were clinical psychologists who work with people with intellectual disabilities with a special interest and had further training in psychodynamic psychotherapy.
The treatment
In psychodynamic psychotherapy the therapist is concerned with the patient's mental representation of themselves within the world and seeks to identify the origin, meaning and resolution of difficult feelings and inappropriate behaviours. The work entails making links between early life experiences and how these experiences influence unconscious and conscious expectations of relationships in the present day.
Psychodynamic sessions begin with the therapist providing the client with space to free associate. This involves inviting the client to say whatever is in their mind and whatever comes to mind. The psychotherapist will be interested in anything that the client says, including information on their current problem, circumstances, current and past relationships, dreams, fantasies and so on. The therapist resists giving the client information about them. The therapist presents him or her self as a type of screen on to which the client can project their imagined perceptions of the therapist.
The therapist uses a number of methods to enable the client to tell their story and then formulates interpretations aimed at accessing and making sense of unconscious content. Thus, the therapist may give information giving responses about their treatment, reason for referral, and about matters such as time left in the session and so on. However, advice and instruction are not usually within the remit of the psychodynamic model. The therapist will be carefully listening to and observing the client's verbal communications. The therapist attends to what the person says in terms of the factual content, the words used and also what is not said. The therapist also observes the client's mood, as communicated through what they say, the way they say it and how they behave. The client may talk about a range of things and the therapist does not interrupt. Whilst listening to the client the therapist monitors their own feelings, fantasies and reactions in response to the client's material. These are accepted as meaningful elements in the communication between client and therapist. This is referred to as the counter-transference.
At various times when the client is telling their story the therapist may reflect back, paraphrase or précis what the client has been telling them or acting out. Also, exploratory and information seeking responses attempt to draw out more information from the client. These are generated from hypotheses about what the client may not be saying in words but may be hinting at through behaviour or tone of voice. Information seeking responses are aimed at clarification, which helps sort out what is happening by questioning and rephrasing. Psychodynamic psychotherapists also make linking responses. Here, words and/or actions are linked together as a tentative interpretation to try and understand the nature of the client's anxiety in the session. These responses differ from the others in that they aim to elucidate unconscious feelings and ideas.
Psychodynamic therapists seek to understand with the client the latent or unconscious meaning of the client's communications. In order to do this they recontextualize the manifest content of the communications as transference (Smith 1987). Freud (1912) described transference as occurring when psychological experiences are revived and instead of being located in the past are applied to dealings with a person in the present. In psychodynamic psychotherapy the establishment, modalities, interpretation and resolution of the transference are in fact what define the cure (Laplanche & Pontalis 1988). Transference within therapy allows the therapist to identify interpersonal issues and deal with them as empirical data in the here-and-now. This process allows early traumatic experiences and empathic failures on the part of parents and other caregivers to be relived and corrected.
Psychodynamic psychotherapy also seeks to understand unconscious communications through models of the internal world. Most significantly, we all have an ego, which is the location of the anxiety caused by unconscious material. It is the ego that employs a range of defences to ward off anxiety. There is also a range of psychodynamic theories of development, which the therapist may also employ to understand the origins or development of difficulties and conflicts, as well as coping styles. Clarkson (1993) highlights the reparative/developmentally needed relationship and defines this as the intentional provision by the therapist of a corrective/reparative or replenishing parental relationship (or action) where the original parenting was deficient, abusive or over-protective. Such a relationship modality is a further facet of the therapist's intervention and style.
Malan (1979), depicts the aim of psychotherapy in the form of the
'Two Triangles' (see
Fig. 1). The two triangles describe the process of psychodynamic
psychotherapy. Each triangle stands on its apex. The aim of the
therapeutic endeavour is to reach beneath the defence and anxiety to the
true feeling. At this point, the true feeling can be traced back from
the present transference location
Discussion
The results presented here suggest that psychodynamic psychotherapy, provided in routine clinical practice, can produce significant reductions in psychological distress, improve interpersonal functioning and increase self esteem in adults with intellectual disabilities. However, this was a naturalistic study and, therefore, beset with associated limitations. However, researchers cannot justify conducting controlled studies without a period of developmental work in line with the hourglass model. This study indicates that people with intellectual disabilities may benefit from psychodynamic psychotherapy and, therefore, the treatment warrants the level of investment that further investigation would entail. This study can inform future research in the area of design and methodology.
The study provides some indications on significant decisions that researchers need to make. Readily available psychotherapy outcome measures were used. This was achieved by employing the assisted completion format as suggested in the SCL-90-R manual and developed by Kellett et al. (1999) to be suitable for people with intellectual disabilities. The results show that change could be detected on these measures, but further work on their reliability and validity is needed. Some clients could not complete the IIP sufficiently for inclusion and so the language on this scale needs to be reviewed to increase inclusion.
A major design question is how long should treatment be in an efficacy or effectiveness study. This has been difficult to determine because of lack of exploratory studies or series of case reports. This study did not set a limit on treatment length. The results show that the average number of sessions provided was 13.2 with 65% of recipients completing treatment in 16 sessions. This is similar to the findings of Beail (1998) in which nearly half of the recipients completed psychodynamic treatment in 6 months or less. However, length of treatment was not related to outcome for three of the four outcome scores. Thus, a more controlled study could explore the outcome of shorter psychodynamic interventions. However, this and previous studies (Beail 1995, 1998, 2001) suggest that there are also clients that may need long-term treatment. This is no different to the findings of psychotherapy researchers generally (Roth & Fonagy 1996). The researcher needs to set entry criteria to improve internal validity of treatment trials. This study had fairly wide entry criteria and therapists were kept blind regarding the assessment results. Thus, the recipients were a heterogeneous group. However, nine of the participants were referred for aggression. Thus, if a homogeneous sample were to be recruited then the chances of recruiting sufficient numbers would be increased by selecting people referred for aggression. This would also seem to be reflected in the few published research studies on cognitive-behavioural psychotherapy with people with intellectual disabilities (Whittaker 2001; Beail 2003).
In planning research on outcomes, some estimate needs to be made of the rates of attrition. In this study 10 people who agreed to participate dropped out of treatment and therefore the study. This figure compares favourably with studies in non-disabled populations where several times the desired sample size is often recruited (Bergin & Garfield 1994). A further difficulty when conducting any form of research with people with intellectual disabilities is capacity to consent.
Five potential participants were unable to give consent in this study. They were provided with treatment, which had the impact of increasing the length of the study. This was a fairly simple study in terms of design features. Researchers need to make plans to accommodate this within their designs and anticipate further difficulties with more complex designs involving randomization.
This study originally included session by session process measures, which were also completed in an interview format. The therapists were also kept blind to this procedure. Unfortunately, funding available for graduate psychologists fluctuated throughout the project and so data collection at this level could not be sustained and insufficient data were collected. However, a project evaluating the process of assimilation of problematic experience in psychotherapy with people with intellectual disabilities has been reported (Newman & Beail 2002). The report illustrates the degree of investment needed to include a process element to such studies.
In summary, this study shows that people with intellectual disabilities can benefit from psychodynamic psychotherapy, provided in routine clinical practice. The study has obvious limitations because of its uncontrolled, open trial design. However, the study had a participant group that represents the client population and thus has greater generalisability to clinical practice. The methods can also be realistically adopted in more routine audit and evaluation exercises (Newman et al. 2003). This study also provides some suggestions regarding length of treatment and participant characteristics, which may inform how more rigorous designs could be conducted.
References
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Barkham M., Hardy G. & Startup M. (1996) The IIP32: a
short version of the inventory of interpersonal problems. British
Journal of Clinical Psychology 35, 21 · Clarkson P. (1993) On Psychotherapy. Whurr Publishers, London, UK.
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Denman C. (1995) Questions to be answered in the
evaluation of long-term therapy. In: Research Foundations for
Psychotherapy. (eds M. Aveline & D. A. Shapiro), pp. 175 · Derogatis L. R. (1983) SCL-90-R: Administration, Scoring and Procedures. Manual II. Clinical Psychometric Research, Towson, MD, USA.
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Frankish P. (1989) Meeting the emotional needs of
handicapped people: a psychodynamic approach. Journal of Mental
Deficiency Research 33, 407 · Rosenberg M. (1965) Society and the Adolescent Self-esteem. Princeton University Press, Princeton, NJ, USA. · Roth A & Fonagy P. (1996) What Works for Whom: A Critical Review of Psychotherapy Research. Guildford Press, New York, NY, USA.
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Smith D. L. (1987) Formulating and evaluating hypotheses
in psychoanalytic psychotherapy. British Journal of Medical Psychology
60, 313 · Sinason V. (1992) Mental Handicap and the Human Condition: New Approaches from the Tavistock. Free Associations, London, UK. g
ICT supporting women to cope with HIV/AIDS in Kenya
The Kenya AIDS Intervention Prevention Project Group established community based informal learning centres in western Kenya, giving priority to orphans, widows, low-income women and older vulnerable children from HIV/AIDS affected households. The participants are taught about nutrition, and receive training in relevant skills to enable them to care for people living with AIDS and to become economically and to become economically and socially empowered. The project organized a health and agriculture community radio network for women who had completed the training. The participants were organized into six radio listening groups, and were trained in the use of audio and video recording equipment to enable them to exchange information, for example, on farming techniques, and to raise public awareness about HIV/AIDS.
The groups were also trained in photography and the use of drama and traditional oral storytelling as tools for learning, education and development. A radio/cassette player and a mobile phone were distributed to each of the group, and the participants were encouraged to communicate with national FM radio stations-to respond to programmes, obtain information and share their experiences with a wider audience. g DIPLOMATIC BRIEFINGS NEWS VIEWS & REVIEWS Kenya, Ethiopia in a joint security meeting
The meeting which was
scheduled to take three days was organized by both the Kenyan and
Ethiopian governments and focused on tribal conflicts between the two
communities. Eritrea-Ethiopia: Peacekeepers' withdrawal from Asmara completed
The United Nations completed the withdrawal of 180 of its Western staff from Eritrea. The deadline for expelling the peacekeepers was set by Eritrea recently. The world body has since Thursday been temporarily relocating its American, Canadian and European staff to Ethiopia after Eritrea ordered them out last week.
Six Cleared for Uganda Elections His exit triggered a series of chanting from his supporters, mainly ministers and Members of Parliament. All clad in yellow, they sang praise songs for President Museveni, who at the time was being led out of the stadium, with journalists both local and international in hot pursuit. Mama Miria's verification was also swift. She was in the company of Party officials Mr Peter Walubiri, Mr Joseph Ochieno, Prof Okello-Okello, and her son Eddie Obote, who were all dressed in red t-shirts bearing her portrait. Ten minutes later, Dr Kiggundu declared her a presidential candidate, sending the anxious party officials into celebrations. They sang party songs as they were led out of the stadium by election commission officials. Mr. Abed Bwanika, another independent candidate too was successfully nominated. g Museveni rival on treason trial
Ugandan opposition leader Kizza Besigye has pleaded not guilty at the start of his treason trial at the High Court in the capital, Kampala. He is also due to face a separate court-martial, where he is accused of terrorism and weapons offences. Dr Besigye was arrested in November, soon after returning from years in exile to contest presidential elections, set for 23 February 2006. His lawyers say the charges are designed to exclude him from the poll. He is seen as the first credible challenger to President Yoweri Museveni, who has been in power for 19 years. These will be the first multi-party elections since Mr. Museveni took power.
The BBC's Will Ross in Kampala says the atmosphere is calmer than the last time Dr Besigye and his 22 co-defendants were in court. He says this may be due to the slight confusion over the proceedings - Dr Besigye is expected to appear in the military court either later on Monday or later this week.
Justice challenged The High Court has ordered the military to suspend its trial until the Constitutional Court rules on whether it is legal. But the military has said its trial will go ahead, as it is not subordinate to the High Court. "We are living in a country which has no rule of law," Dr Besigye told reporters before being taken to the court. Dr Besigye's lawyers argue that it is unfair for him to face two trials on similar charges of having links to rebel groups. They also say that, as a civilian, he should not face military justice. He is also facing charges of rape. Despite being held in prison for more than a month, Dr Besigye was able to submit his nomination papers for next year's elections. The trial is due to end before polling day. If convicted, Dr Besigye would be barred from the poll. He denies having links to rebel groups but refused to enter a plea in the military court. The authorities say they have enough evidence to bring the charges and deny they are politically motivated.g Chad accuses Sudan after clashes
Chad has accused Sudan of being behind a rebel raid on a border town that reportedly ended in 100 deaths. A Chadian minister said Sudan was "wholly responsible" for an attack allegedly launched from Sudan on the eastern town of Adre. Hourmadji Moussa Doumgor said the raid was repulsed by the Chadian army. Several new rebel groups have begun operating in eastern Chad recently, led by mutinous military officers who say President Idriss Deby must step down. The raid on Adre is the second attack in the area in just three days, the BBC's Stephanie Hancock in Chad reports. Trading accusations Mr. Doumgor, who is Chad's communications minister, said the rebels launched their attack on a garrison in Adre shortly after 0700 local time (0600 GMT), using 17 vehicles. The minister said the army launched a counter-attack, and the rebels were driven back, sustaining heavy casualties. There has been no independent confirmation of the death toll given by government in N'djamena. Aid workers in the western Sudanese province of Darfur reported hearing the sound of explosions and fighting coming from across the border. Mr. Doumgor said that Chad "holds the Sudanese government wholly responsible for this morning's attack, mounted from its territory". He added that Chadian "government forces are now using their right of pursuit to ward off any further threat" against the border town. Chad and Sudan has been recently trading accusations amid growing tension on their joint border. Chad has accused Sudan of hosting rebels, while Khartoum has blamed N'djamena of deploying planes and troops on its territory.
In 2002, the government of Chad signed a peace agreement with one of the main rebel groups, operating in the east of the country. The Chadian conflict has claimed several thousand lives since 1998. g
Premier confers with UK Minister for Africa Addis Ababa, December 19,2005 – Prime Minister Meles Zenawi conferred with the UK Minister for Africa Lord David Triesman came to Addis Ababa on December 17, 2005. UK Minister for Africa Lord David Triesman said that UK wants to help the Ethiopian people achieve a better quality of life and to have benefits of the democracy, peace and jobs. Lord Triesman told a press conference held here at the British Embassy that this is a difficult time for all Ethiopians but Ethiopians can put this period behind them, adding that all parties should avoid violence, instead they should commit themselves to resolving differences through inclusive dialogue, respecting internation-al principles of human rights, the rule of law and the constitution. He further indicated that as there was needed for a spirit of national recognition, magnani-mity and political consensus in dealing with each other to advance the cause of democracy. Lord Triesman also held separate meetings earlier with some representatives of the oppose-tion in the parliament and discussed the current circumsta-nces in Ethiopia. He also expressed serious concern about recent Eritrean restrictions on UNMEE and emphasized the need for both sides, to deal constructively with the problems, to show maximum restrain and to avoid war. He further welcomed Ethiopia’s recent commitment to return to the December 2004 level of deployment, and the clear statement made by Prime Minister Meles that Ethiopia wants peace and normality with its neighbors. Local and foreign journalist attended the press conference and forwarded various questions about the Ethio-Eritrea border conflict and the detained suspects of CUD leaders. Lord David Triesman paid his first visit to Addis Ababa, it was learnt. g ETHIOPIA: Gov't to pull back troops from tense border Ethiopia will pull back
troops from its tense border with Eritrea to comply with a United Nations
order to avert fresh conflict in the Horn of Africa, the Ethiopian foreign
minister said. In a letter to the UN Security Council, Seyoum Mesfin said
Ethiopia was ready to reduce its troops to December 2004 levels to help
ease tension. A statement published in the state-run Ethiopian Herald on
Saturday said the withdrawal would take place despite some risks to the
country's security.
How Horn of African brothers fell out Michela Wrong, author of a recent book on Eritrea, reflects on the differences in outlook between two nations that have made the Ethiopia-Eritrea conflict so intractable.
The two-hour drive between the Eritrean capital, Asmara, and the town of Keren includes what even blase locals regard as a particularly challenging stretch of road.
Built by the Italians, it zigzags down a mountainside, tracing a hair-raising route past giant boulders, deep ravines and sprays of candelabra cactus.
Torturous and twisted, the stretch is known as the "Heart of Tigray", after the neighbouring Ethiopian province that was once an ally in Eritrea's fight for independence, now the enemy.
"We Eritreans think with our hearts, but the Tigrayans are very wily, very complicated. Just like the road," any local driver is happy to explain.
The fact that ordinary Eritreans have gone so far as to baptise a road after a neighbour's perceived perfidy gives some insight into the strength of the emotions that have allowed a minor dispute over a border village to balloon into an issue that threatens to sabotage peace in the Horn of Africa.
Since Eritrea and Ethiopia first went to war in 1998 over the dusty settlement of Badme - a conflict that threatens to reignite at any moment - diplomats, international emissaries and United Nations officials have learnt to their cost how deep the hostility and suspicion runs between the two former rebel movements now ruling both states.
They have also come to appreciate, if not to savour, the character traits that make it hard for either regime to compromise, with both leaderships demonstrating what can seem a suicidal readiness to see their own communities hungry and bankrupt rather than be caught blinking first.
Fraternal rivalry
During the 1980s, when the Eritrean People's Liberation Front (EPLF) and Tigrayan People's Liberation Front (TPLF) combined forces against Ethiopia's Marxist dictator, Mengistu Haile Mariam, analysts dwelt on the fraternal relationship between Isaias Afewerki and Meles Zenawi, the groups' respective leaders.
The two men were undoubtedly close, but brothers can also be intensely, destructively competitive. The relationship was always a stormy one, with each side brooding over perceived slights, chafing over their enforced intimacy.
Looking back across the centuries, the Eritreans mulled over the bloody raids staged by Ras Alula, the ruthless 19th century Tigrayan warlord and slave trader who crushed any local chieftain foolish enough to stand up to his employer, Ethiopian Emperor Yohannes IV. That historical resentment was offset by a more recent sense of cultural superiority. Eritreans took pride in their 1890 colonization by the Italians, a contact, they felt, that had left them better educated and more sophisticated than their neigh-bours to the feudal south. That impression was furthered by the fact that after Eritrea was forcibly annexed by Ethiopia's Haile Selassie in 1962, poor Tigrayans flooded into Asmara in search of work as janitors, cleaners and labourers. If a job was dirty and demeaning in Eritrea, it was probably done by the "Agame", as the Tigrayans were dismissively known. Weapons Once the rebel movements came into their own, this Eritrean superiority complex acquired a military dimension.
More experienced, better-organised, battle-hardened, the EPLF boasted a far more impressive array of stolen weapons than the TPLF. "We had to teach them how to fight. Without us, Mengistu would still be in power," former Eritrean fighters still scoff.
The TPLF, for its part, did not appreciate being given lessons in military strategy or being lectured over political ideology. Each group committed acts regarded as unforgivable by their some-time allies.
The episode in the mid 1980s when the EPLF cut the aid route to Tigray, stopping food reaching the province's starving peasants, was a particular cause for bitterness.
After the TPLF, supported by EPLF tanks, captured Addis Ababa in 1991, there was a sense the tables had turned. Now in control of a country whose population, land mass and resources dwarfed those of tiny Eritrea, the TPLF felt it was owed gratitude for granting Eritrea independence and respect as a key player on the African stage. Famously prickly, Mr Isaias never obliged. Logjam Since the 1998-2000 war, in which some 90,000 died, the words "Shabia" and "Woyane" - popular terms for "EPLF" and "TPLF" - are more often spat than pronounced.
With Ethiopia refusing to demarcate the border in defiance of an international boundary commission ruling, and Eritrea rejecting dialogue until its sovereignty has been formally recognised, all exchange has ground to a halt. Outsiders who try unblocking the logjam usually depart defeated, exasperated with both players. "Too much damn testosterone," was the succinct verdict of one American diplomat I met. On Eritrea's side, a history of foreign meddling has given rise to intransigence those verges at times on paranoia. Ignored by the UN, which had promised to protect Eritrea's short-lived federation, Eritrea then fell victim to Cold War politicking, as first the United States and then the Soviet Union filled Mengistu's warehouses with arms. Inflexibility
Decades of superpower cynicism left the EPLF convinced foreign advice was suspect and Eritrea must go it alone, a frame of mind not suited to deal-making. But the TPLF is hardly renowned for its pliable nature, either. Born in a famine-prone province traditionally neglected by Addis Ababa and despised by the dominant Amhara, the group shared the EPLF's stiff-backed pride, its determination never to lose face. Attempting to explain this mutual absence of malleability, some researchers seek explanations in the macho, isolationist culture of the highlands, the notions of absolute truth preached by the Orthodox Church and the rigidity of classic Marxist ideology. Albanian socialism, cited by Mr Meles as his inspiration, is hardly associated with flexibility, after all. "I don't know whether it's cultural, religious or historical. All I know is that room for manoeuvre and compromise don't seem to feature in politics in the Horn," remarks an aid worker who has worked in both areas. "Both sides seem adept at getting themselves into a position where there is no end game." Like the vitriolic exchanges on Eritrean and Ethiopian websites, remarkable for their bile, this is a world of black-and-white certainties, bereft of shades of grey. g
CHRONOLOGY-Key events in Ethiopia-Eritrea border row Dec 15 - Western peacekeepers began leaving Eritrea on Thursday after the United Nations agreed to pull out Americans, Canadians and Europeans from its mission set up to prevent war with Ethiopia. Below is a chronology of the border conflict between the two countries that has killed 70,000 people since 1998.
May 1998 - Eritrean and Ethiopian forces clash in the western border region of Badme, launching the border war. May 12 - Eritrea occupies Ethiopian-administered Badme. June 4 - Ethiopia accepts a peace plan drawn up by the United States and Rwanda which requires Eritrea to withdraw to pre-May 6 positions. June 14 - Both sides agree a moratorium on air raids as the Organisation of African Unity (OAU) and the United States attempt to negotiate a peace deal. Nov 8 - Ethiopia accepts the OAU peace plan but Eritrea objects to certain elements, talks fail. Feb 6, 1999 - Fighting erupts again. Feb 26 - Ethiopia recaptures Badme after days of World War One-style trench warfare with the loss of thousands of lives. May 17, 2000 - U.N. Security Council votes for an arms embargo against both sides in punishment for renewing the war. May 31 - Ethiopian Prime Minister Meles Zenawi declares the border war has ended. June 18 - A peace agreement brokered by the OAU is signed in Algiers. The plan calls for an immediate ceasefire and the deployment of a U.N. peacekeeping force in a 25-km (15 mile) buffer zone. Jan 2001 - A 4,200-strong UN peacekeeping force is deployed to monitor peace between the two countries. April 13, 2002 - The Hague-based five-member Eritrea-Ethiopia Boundary Commission (EEBC) delivers a ruling on border but fails to delineate the disputed town of Badme on the ground, saying it requires more time. Mar 21, 2003 - The EEBC finally rules that Badme is in Eritrea, but Ethiopia rejects the ruling. Nov 25 - Ethiopia accepts "in principle" the 2002 EEBC ruling but wants a dialogue with its neighbour first, which Eritrea refuses. Oct 4, 2005 - Eritrea bans U.N. helicopters from its airspace. Nov 2 - U.N. peacekeepers say both Ethiopia and Eritrea have moved troops and tanks towards the border. Nov 23 - The U.N. Security Council threatens sanctions on both nations if they fail to step back. Nov 24 - The U.N. says Ethiopia has occupied a demilitarised zone for five days; Eritrea dismisses the threat of U.N. sanctions as a glaring example of big power bias. Dec 7 - Eritrea orders U.N. peacekeepers from Western countries to leave within 10 days. Dec 14 - The U.N. Security Council agrees to pull out American, Canadian and European peacekeepers from Eritrea and relocate them "temporarily" in Ethiopia. Day 6: Ministers agree on declaration that ‘puts Round back on track’ Ministers from the WTO’s 149 member governments approved a declaration that many described as significant progress both since the July 2004 “package” and after six days of intensive negotiations in Hong Kong which the chairperson described as “working like a dog”.
The 18 December 2005 Despite the long hours and hard work, “it was worth it,” WTO Director-General Pascal Lamy told a press conference late in the evening of the final day. “We have managed to put the Round back on track after a period of hibernation. Hong Kong’s Commerce, Industry and Technology Secretary John Tsang, who chaired the conference, outlined the achievements in the declaration: Ø “We have secured an end date for all export subsidies in agriculture, even if it is not in a form to everybody’s liking. Ø “We have an agreement on cotton. Ø “We have a very solid duty-free, quota-free access for the 32 least-developed country members. Ø |
the
therapy room 
We
had to teach them how to fight. Without us, Mengistu would still be in
power 
