Psychotherapeutic work with refugees: Understanding the therapist's countertransference

Abstract

Most therapists are chosen to work with refugees because they speak the language or come from the same cultural or racial background and/or have had experiences which resonate with those of the client. They are often people who can easily understand the clients' experiences, which creates interesting and potent therapeutic dynamics. They can offer a great deal of support to the person, but often with the high risk of over-identification. This paper is an attempt to examine from the therapist's perspective the complex dynamics involved in working with refugee clients. It is a collection of thoughts and feelings expressed in psychotherapeutic and supervisory work by different types of refugee mental health workers. It is an attempt to understand the therapeutic relationship further by focusing on the therapist's psychological response to the client. The paper will outline briefly some of the common themes reported by refugees, but the primary aim is to focus on the therapist's countertransference feelings. Countertransference in this context is defined as a personal psychological response, as well as consisting of socio-political components.     

“You cannot forgive and you cannot forget”: The Serbian refugee settlement experience in Australia

Currently, there is limited research on the settlement experiences of refugees from the Balkan regions and in particular Serbia. There is also a need to provide a contextual understanding of the refugee settlement experience. The current study explored the refugee experience of 12 male Serbian refugees (aged 30 to 65), who migrated to Australia following the Yugoslav Civil War (1991–2001). A qualitative, phenomenological methodology explored the experiences of the refugees from their own perspective. Thematic coding of the interview data revealed the two major themes of settlement and traumatic experiences, as central to the experiences of this group of refugees. Language difficulties, discrimination, stigmatization of Serbian identity, multiple losses and grief, and failing of the justice system to establish accountability and provide reparation to the victims were all significant obstacles to successful settlement. Most salient, however, were the experiences of torture and trauma. Participants were still trying to negotiate these memories years after the events. Nevertheless, some participants showed strong resilience and the belief that they became stronger as a consequence of their experiences. We encourage those working with Serbian refugees to help them search for meaning in their stories of trauma.     

A Qualitative Study of the Career Aspirations of Resettled Young Sudanese and Somali Refugees

The study documents and explicates the academic experiences, visions, hopes and desires which shape the vocational aspirations of young Sudanese and a Somali refugee who have resettled in Australia. Semi-structured interviews were conducted to examine the experiences of a sample of 14 young resettled refugees in Brisbane, Australia. Adopting a qualitative methodology, the interviews covered the aspirations of the participants across three time periods: life in the country of origin, transit and resettlement. Participants expressed high ambitions despite their experiences of school disruption pre resettlement and language difficulties post resettlement. The situation in the country of origin emerged as influential upon their aspirations in both pre and resettlement life. English language difficulties emerged as the most common consideration influencing aspirations following resettlement. A number of considerations were found that influenced their vocational aspirations before and after resettlement. Such considerations may enlighten service providers working with resettled young African refugees.     

The experience of psychological therapies for people with multiple sclerosis: A mixed-methods study towards a patient-centred approach to exploring processes of change

Psychological therapies are effective for managing multiple sclerosis (MS) symptoms such as depression, pain and fatigue. Cognitive behavioural therapy (CBT), mindfulness and other theory-led approaches have been applied and were found to have moderate effects. The present study adopts a patient-led approach to investigate people with MS' (PwMS) experiences of psychological therapies and the change processes they identify. In this naturalistic, mixed-methods design, semistructured interviews were conducted and three questionnaires were administered to 20 PwMS at two different times. Qualitative data collection and analysis followed the interpretative phenomenological analysis (IPA) guidelines, and quantitative data were analysed using paired t tests. Four superordinate themes described the participants' experiences of change as related to their psychological therapy: from despair to relief; from feeling their body as alien to becoming acquainted with an unpredictable new body; from helplessness to empowerment; and from punishment to forgiveness. Quantitative results showed that physical function and general health perception improved, and anxiety was significantly reduced. Despite seeking help from diverse psychological therapy modalities, the analysis revealed common themes that the participants found significant in their therapy stories. Following a patient-centred approach, the development of psychological therapies for PwMS should focus on their relationships, everyday lives, body perception, losses, shame and guilt. PwMS also need to be understood and acknowledged beyond their condition.     

The two‐sided nature of individual and intragroup experiences in the aftermath of collective victimization: Findings from four diaspora groups

Most social psychological research on collective victimhood has examined its consequences for intergroup relations. Less attention has been paid to individual and intragroup processes associated with collective victimization, which the present study aimed to examine. We conducted eight focus group interviews among four diaspora communities (Armenian Americans, Burundian refugees, Jewish Americans, Nepali‐speaking Bhutanese refugees) with historical or more recent experiences of collective victimization. Thematic analysis revealed three major foci shared across communities (but with different emphases within each focus), which included juxtaposed themes that highlight the two‐sided nature of experiencing and coping with collective victimization and its aftermath: Vulnerability and struggle versus resilience and strength, loss versus continuity and renewal, and silence about versus transmission of knowledge about ingroup victimization. These findings illustrate how groups integrate seemingly opposite poles of collective victimization that characterize this complex and multifaceted experience, which has important theoretical implications.     

It’s my safe space: The life-saving role of the internet in the lives of transgender and gender diverse youth

Abstract

Background: Public awareness of Transgender and Gender Diverse (TGD) identities has grown significantly; however, acceptance and support remain elusive for many TGD youth. Resultant experiences of marginalization and stigmatization contribute to elevated rates of psychological distress and suicidality among TGD youth. Emergent evidence suggests that the internet may offer TGD youth safety, support, and community previously unavailable.

Aim: The primary aim of this qualitative inquiry is to engage in an in-depth exploration of the online experiences and processes which help protect against psychological distress and promote well-being among TGD youth.

Methods: Data were culled from a mixed-methods, online study of sexual and gender minority youth from across the United States and Canada which followed Institutional Review Board approved protocols. Participants for this study represent a sample (n?=?260) of TGD participants aged 14–22 (x? = 17.30). Data were analyzed using Charmaz’ grounded theory strategies.

Results: Data revealed that the internet offers TGD youth affirming spaces that, for the most part, do not exist in their offline lives. Online, TGD youth were able to engage meaningfully with others as their authentic selves, often for the first time. These experiences fostered well-being, healing, and growth through five processes: 1. Finding an escape from stigma and violence, 2. Experiencing belonging, 3. Building confidence, 4. Feeling hope, and 5. Giving back.

Discussion: The unique and innovative ways in which participants use online spaces to foster resilience offer important insights to inform affirmative practices with TGD young people.     

No Ordinary Life: Complex Narratives of Trauma and Resilience in Under-Resourced Communities

This investigation examines the occurrence and impact of chronic adversity for young adults who grew up amidst poverty and community violence. Young adults in such contexts, particularly those who have been involved with the courts, are not commonly conceptualized through the developmental lens of complex trauma but rather described by maladaptive behaviors and risk to society. This grounded theory analysis explored how participants perceive and make meaning of their experiences. Interview data revealed consistent narratives of childhood neglect and psychological maltreatment, chronic loss, intergenerational trauma exposure, and the resulting survival-based adaptation. We identified 3 primary themes across the participant narratives: (a) lack of need fulfillment; paradoxical experience of self, others, and the world; and persistent sense of purpose and meaning. Findings illuminated the complexity of ongoing struggle, adaptation, and resilience in adult survivors. The need for an increased focus in trauma-informed treatment of adults in underresourced communities is discussed.     

Building seven bridges with young asylum seekers living in exile in the UK (Part 1)

This first paper focuses on the key themes that emerge in work with young asylum seekers and refugees and on our assessment of the needs of individual young asylum seekers, alongside the ways in which we meet the needs of these young people given the holistic, integrated and developmental approach of the Baobab Centre. The fact that psychotherapeutic methods are useful in this context and the need to have flexible approach to psychotherapy in our context are two ideas explored here. This paper will explore how we can slowly build sturdy and protective connections during and after the developmental years following experiences of sequential violence. This means building bridges and links within the internal worlds of these young people between: (1) different aspects of themselves that emerge after violence and loss; (2) themselves and their peers; (3) listening adults; (4) various social influences; (5) cultural influences; (6) their past, present and future lives; (7) links with local, national and international communities all of which are addressed via a ‘Transitional Non-Residential Therapeutic Community’. A case example will illustrate how this work may take place.     

Reconceptualising hope within the context of vulnerability in South Africa

This study was aimed at clarifying conceptualisations of hope amongst vulnerable young people in a high HIV/AIDS prevalence South African setting. Participants were four young people ranging from 15 to 19, and interview data were collected on their household conditions, lived experiences in the communities and schools, and family support systems. Analysis applied grounded theory process to characterise main themes. Four mechanisms characterised the nurturing of hope processes in the context of vulnerability, namely: predatory, protective, promotion and possibility processes. Six protective intrapersonal themes were also identified: finding purpose, building a sense of the future; building faith in a higher power; embracing educational opportunities; thinking positively; building on strengths; and adopting supportive networks. Findings suggest that conceptualisations of hope need to be grounded in social context and the imperatives of social justice to support vulnerable young people in realising their future aspirations.     

Human capital,acculturation and social identity: Bosnian refugees in Australia

This article explores the processes of acculturation and identity among refugees from Bosnia and Herzegovina who resettled in the Australian cities of Perth and Sydney during the 1990s. We start from the idea that refugees, through the process of forced migration, lose aspects of their identities that were embedded in their former communities, jobs, skills, language, and culture. Upon arrival in a new society, they seek to reconstruct their identity, and we argue that this happens in the context of the process of acculturation. We use two social psychological perspectives, social identity theory and acculturation theory, and the sociological theory of the migration of human capital, to examine our data collected by qualitative research methods from refugees and Australian professionals who work in the government‐funded refugee resettlement programme. Our data highlight the loss of identity experienced in forced migration, difficulties in refugee acculturation and identity reconstruction, and collective and individual strategies in acculturation and identity adaptation. We see our perspective as essentially interdisciplinary, and take an interactional view of the acculturation and identity processes, as the characteristics of both the host society and the immigrants affect them. Copyright © 2003 John Wiley & Sons, Ltd.     

“I didn’t understand their system,and I didn’t know what to do”: Migrant Parents’ Experiences of Mandated Therapy for Their Children

In this phenomenological study, we explored the experiences of migrant parents whose children received mandated therapy in Southern California. Migrants are people who move to a host country either voluntarily as immigrants or involuntarily as refugees. Mandated therapy means that the school or court system required that their children receive services from a mental health provider. Parents often participated by having to take parenting classes and join in some sessions with their children; however, the children were the identified clients. We conducted eight, in-depth interviews with migrant parents. We employed Giorgi and Giorgi’s (Qualitative research in psychology: expanding perspectives in methodology and design. American Psychological Association, Washington, 2003; Qualitative psychology: a practical guide to research methods. Sage, London, 2008) phenomenological psychological research approach to analyze data. Analysis revealed four constituents, which are overarching themes related to the essential structure of the shared phenomenon: (a) migrant parents encountered discrimination and devaluation; (b) migrant parents experienced increased exposure to US culture and the mental health system, which accelerated acculturation; (c) the degree of cultural sensitivity exhibited by providers both positively and negatively influenced participants’ attitudes and perceptions toward mental health services; and (d) migrant parents used their mandated therapy experiences as opportunities to examine their family relationships and to learn new skills and concepts.     

Aetiology of Coexisting Mental Health and Alcohol and Other Drug Disorders: Perspectives of Refugee Youth and Service Providers

In the general population, people with comorbid mental health (MH) and alcohol and other drug (AOD) disorders (comorbidity) have great difficulty accessing appropriate services, and poor outcomes. Little is known about comorbidity in resettled refugees in Australia. This study was designed to identify risk factors and patterns of comorbidity development in young people from refugee backgrounds living in a disadvantaged urban region of Adelaide, South Australia. This qualitative study utilised in‐depth semi‐structured interviews (n = 30) with resettled refugee youth and workers from MH, AOD, and refugee support services. Thematic analyses were conducted to investigate the aetiology of MH and AOD disorders in young refugees. Interviews with both groups revealed how the interrelated nature of risk factors may place young people from refugee backgrounds at heightened risk of experiencing MH and AOD problems. The situations and conditions described by both groups are discussed under six main themes: pre‐migration experiences of torture and trauma; familial factors of intergenerational conflict; post‐migration adjustment difficulties in terms of language, culture, education, and employment; exposure to and availability of substances; maladaptive coping strategies and self‐medication; and access to information and services. Implications for psychologists and MH professionals are identified, emphasising the need for clinicians to understand the complexities surrounding the aetiology of comorbidity in these youth. The initial assessment needs to be comprehensive, including pre‐ and post‐settlement experiences and cultural and family dimensions of their current situation. Treatment may often need to simultaneously address multiple contributing factors and involve culturally sensitive psycho‐education.     

Affective spectrality in therapeutic space

Spaces for therapy and counselling are haunted spaces, spaces whose physical characteristics can manifest past inhabitation and cue connections to trauma. This paper explores findings from a research project which aimed to understand the perceptions of spatiality of individuals who self harm, and the role of the built environment in supporting therapeutic processes and experience. The data collection and analysis were designed to preserve the integrity of the voices of mental health service users who self harm and communicate their self-reported spatial perceptions. Comparisons between lived/embodied experiences, analysis of intrinsic properties of accounts and exploration of therapeutic sites underpinned the findings relative to the psycho-cognitive geographies of experiences. This paper explores how individuals who self harm experience particular connections between physical and psychological spaces, how their self-reported encounter with interior space is overlaid with the inhabitation of past occupants and memories, which reduces opportunities for access to the therapeutically supportive dimensions of the space, and exercises in self production. This paper first defines ‘haunted space’ ‘trace’ and ‘trauma’; secondly reviews existing literature on affective spectrality, atmospheres and materialites; thirdly discusses the methods used in the study reported in this paper; and finally, explores the relationships between sensory encounters, affective traces, signifiers, felt architecture and the therapeutic function for which spaces are designed. The paper concludes with implications for future research and practice.     

Shared Near-Death and Related Illness Experiences: Steps on an Unscheduled Journey

This paper discusses the key social features in shared journeys into near-death experiences (NDEs) and related illness experiences of other people. Of special interest in this paper is the way that those persons who are not ill or near death account for their sharing of these experiences. These are often people who are caregivers or intimates of NDErs or dying people but who claim to share part of the NDE or dying experience. We provide case examples to illustrate the essential psychological and social experiences that these people undergo during their joint experiences with NDErs and other seriously ill people. From an analysis of the recurrent themes emergent in these joint experiences we identify and discuss the major conceptual steps in the creation of their personal explanations: (1) Exit the Familiar, (2) Extraordinary Experiences, (3) Extraordinary Experiences End, (4) What Happened to Me? (5) The World Responds, and (6) The Return of the Native. In the final analysis, the processes that these people undergo in the search for explanations is similar in most respects to those at the center of near-death and other related illness experiences.     

Her Body Speaks: The Experience of Dance Therapy for Women Survivors of Child Sexual Abuse

This qualitative, phenomenological study explores the experiences of dance therapy for 5 women who had been sexually abused as children. Using in‐depth, largely unstructured interviews, the women reflect on their dance therapy experiences and on their perceptions of the role of these experiences in their psychological healing. Analysis of these data revealed 6 common themes related to the women's sense of spontaneity, permission to play, struggle, freedom, intimate connection, and bodily reconnection. The implications of the findings are discussed in terms of the therapeutic nature of dance therapy and how this therapeutic modality facilitates change and healing in clients' lives.     

‘That's just what I do’: Placing emotion in academic activism

In this paper, I wish to critically reflect on the role of emotion/s in how I position myself with regards to research, teaching and learning, drawing on experiences over the past three years as a human geography lecturer ‘doing’ research with refugees and asylum seekers in a local inner city area. While there has been increasing debate regarding what constitutes ‘the activist-academic’, in particular deconstructing any dualism or border between ‘academic’ and ‘activist’, the motivation for undertaking such a role is generally ascribed to an ‘ideological commitment’ to social and personal change of one type or another. For me, such a commitment cannot be separated from how I feel about the issues that I research, learn and teach about. In particular, I explore how emotions relate across different spaces and places in my life to produce motivation for activism and how that activism – specifically the encounters with people through it – feeds back into emotional geographies across my professional (and personal) endeavours. More broadly, I'm concerned with the ways in which emotional becomings and the interconnectivities across spaces of activity/ism and everyday life play out beyond my own individual subjective experience, but rather are caught up in ‘situated, relational perspectives’ (after Bondi, 2005). I argue that recognising the significance of emotion has implications for how we conduct and disseminate research.     

Unwanted attention: The psychological impact of cyberstalking on its survivors

This exploratory study investigated experiences of cyberstalking by analysing the psychological impact on young adult users (n = 12; females = 9). The participants completed in-depth e-mail interviews documenting their lived experiences as cyberstalking survivors. The data were thematically analysed. The findings indicate that young adults who have experienced cyberstalking report a wide-ranging psychological impact on them; including feelings of stress, hurt, paranoia, insomnia, betrayal, anger, fear, and in some cases even depression. These findings advocate the need for tailored interventions to alleviate the impact on cyberstalking survivors.     

The Management of Disclosure in Children’s Accounts of Domestic Violence: Practices of Telling and Not Telling

Children and young people who experience domestic violence are often represented as passive witnesses, too vulnerable to tell the stories of their own lives. This article reports on findings from a 2 year European research project (Understanding Agency and Resistance Strategies, UNARS) with children and young people in Greece, Italy, Spain and the UK, who had experienced domestic violence. It explores children and young people’s understandings of their own capacity to reflect on and disclose their experiences Extracts from individual interviews with 107 children and young people (age 8–18) were analysed. Three themes are presented, that illustrate children and young people’s strategies for managing disclosure: (1) “Being silenced or choosing silence?”, explores children and young people’s practices of self-silencing; (2) “Managing disclosures: Finding ways to tell” outlines how children and young people value self-expression, and the strategies they use to disclose safely; and in (3) “Speaking with many voices” considers how children and young people’s accounts of their experiences are constituted relationally, and are often polyvocal. The article concludes that children and young people can be articulate, strategic and reflexive communicators, and that good support for families struggling with domestic violence must enable space for children and young people’s voice to be heard. This is possible only in an integrated framework able to encompass multiple layers and perspectives, rather than privileging the adult point of view. Practitioners who work with families affected by domestic violence need to recognize that children and young people are able to reflect on and speak about their experiences. This requires that attention is paid to the complexity of children and young people’s communication practices, and the relational context of those communications.     

The Lived Experiences of Resilient Single Mothers Who Raised Successful Black Men

This transcendental phenomenological study (Moustakas, 1994) describes the lived experiences of resilient mothers who raised successful Black men in absent‐father homes. The 8 themes that captured the essence of the participants' experiences are explored in detail. The author provides recommendations for counselors, public school administrators, and community organizations providing services to single mothers and their children.