Rethinking a Familiar Model: Psychotherapy and the Mental Health of Refugees

This paper examines with a somewhat critical eye the primary role that psychotherapy and other clinic-based services currently play in addressing the mental health needs of political refugees in the industrialized countries. Two factors are considered which suggest that refugee mental health needs might be better served by complementing clinic-based treatments with a variety of community-based interventions. The first factor concerns the pervasiveness of psychological distress within refugee communities, coupled with the reluctance of many refugees to utilize formal psychological and psychiatric services. This calls into question both the adequacy and appropriateness of clinical-based services as cornerstones of our response to the mental health needs of refugees. More precisely, it suggests the need to complement such services with a variety of culturally grounded, community-based strategies that do not require attendance in formal mental health settings. Second, recent findings have shown consistently that a considerable amount of the distress reported by refugees is related not to prior exposure to violent events, but to a constellation of exile-related stressors such as the loss of one's community and social network, the loss of important life projects, changes in socioeconomic status and related concerns about economic survival, the loss of meaningful structure and activity in daily life, and the loss of meaningful social roles. It is suggested that while psychotherapy can play an important adjunctive role in helping people confront these exile-related stressors, they may most effectively be addressed through targeted community-based interventions. Examples of such community-based approaches are briefly described, and suggestions are offered for community-level strategies that might be explored. The paper concludes by emphasizing the complementary nature of clinical and community-based programs, and by suggesting that psychotherapy might best be conceptualized as one component of a more comprehensive approach to addressing the mental health needs of refugee communities.     

Integrating Women's Voices and Theory: A Comprehensive Domestic Violence Intervention for Latinas

Using both academic theories and two decades of experience in community, this article presents the work conducted by Caminar Latino (Latino Journey), a comprehensive intervention for Latino families affected by domestic violence. Having developed in both analogous and independent ways from theories in the academic field, Caminar Latino provides a unique opportunity to explore ways in which ecological theory and tenets of feminist therapy can be combined within a social justice framework to address this severe social problem. Of particular relevance to therapists, advocates and others working in this field is the ongoing inclusion of the voices of women participants as a central tenet of the intervention.     

Negotiating Reintegration and Meanings of Space: Formerly Abducted Youth in Uganda

The war in Northern Uganda has ended, and youth who were abducted by the Lord's Resistance Army continue to return to communities. Research conducted in the summer of 2010 in two locations in Uganda, Gulu and Masindi, shows that the process of reintegration is an ongoing process in which formerly abducted youth (FAY) negotiate social relations for reintegration in a very interactive way. FAY consciously decide to stay quiet about their past to avoid compromising social reintegration. The experience‐oriented approach has allowed for an in‐depth exploration and understanding of the reintegration process from the perspective of FAY. In Northern Ugandan cosmology, meaning given to FAY personal spaces dominates. With FAY facing social exclusion by community members and the need to overcome boundaries to reintegration, coping mechanisms are adopted to facilitate reintegration and to carve out personal space within the Northern Ugandan cosmology. In the exploration of the process of negotiating reintegration, a conceptual model is adopted and adjusted to represent personal space within Northern Ugandan cosmology. The main findings suggest that FAY negotiate social relations for reintegration in a very interactive way and that they consciously decide to stay quiet about their past so as to not compromise social reintegration. Copyright © 2013 John Wiley & Sons, Ltd.     

Stigmatised Identity and Service Usage in Disadvantaged Communities: Residents', Community Workers' and Service Providers' Perspectives

The impact of community stigmatisation upon service usage has been largely overlooked from a social identity perspective. Specifically, the social identity‐mediated mechanisms by which stigmatisation hinders service use remain unspecified. The present study examines how service providers, community workers and residents recount their experience of the stigmatisation of local community identity and how this shapes residents' uptake of welfare, education and community support services. Twenty individual and group interviews with 10 residents, 16 community workers and six statutory service providers in economically disadvantaged communities in Limerick, Ireland, were thematically analysed. Analysis indicates that statutory service providers endorsed negative stereotypes of disadvantaged areas as separate and anti‐social. The awareness of this perceived division and the experience of ‘stigma consciousness’ was reported by residents and community workers to undermine trust, leading to under‐utilisation of community and government services. We argue that stigmatisation acts as a ‘social curse’ by undermining shared identity between service users and providers and so turning a potentially cooperative intragroup relationship into a fraught intergroup one. We suggest that tackling stigma in order to foster a sense of shared identity is important in creating positive and cooperative service interactions for both service users and providers. Copyright © 2014 John Wiley & Sons, Ltd.     

What is happening in the world of therapeutic communities?

This overview of the contributions to the special edition illustrates something of how the collection of papers reflects the marginal nature of therapeutic communities, and makes parallels as to how they are forever struggling to survive, yet generate a passion of ideas and intellectual resilience that no project-managed health service can extinguish. It briefly describes the theoretical and geographical terrain covered, and signals how the cross-disciplinary incorporation of congruent ideas can be added to the traditional bedrock of therapeutic community practice. It ends by stating the context of the new, and seemingly successful, organization which assembled these contributions into its inaugural conference – and suggests that the journey could, and ultimate should, go further.     

Discomfort in the community. The place of psyche: Between zōē and bios

In this paper, the author considers the treatment of people diagnosed with a psychosis or borderline personality disorder in therapeutic communities from a psychoanalytic perspective, with a particular focus on the work of Jacques Lacan and of André Green. He discusses two key questions. First, how are these patients to recover life? – not just in the biological sense but in terms of subjectivity. Secondly, is it ever really possible to build relationships with them? In relation to this second question, the author emphasizes the importance of the training and supervision of practitioners, as well as their own analysis. Therapeutic communities, above all, he argues, can provide structure and security in a society which is increasingly fragmented and unstable.     

Determinants of ethnic identity development in adulthood: A longitudinal study

Ethnic identity is defined in terms of the interaction between exploration of and commitment to a given cultural background. The present study investigated the effect of individual background, role transitions, and the social environment on the development of ethnic identity in a sample of German adults aged 21–73 years (N = 2,940). Additionally, identity transitions and the moderating effect of disequilibrating life events on identity over time were examined (N = 827). Overall, results are consistent with findings for other identity domains: Respondents could be assigned to one of four identity stages, ranging from unexamined to achieved identity. Particularly, the individual background and the extent of community involvement affected ethnic identity formation in adulthood. Longitudinal analyses revealed that only one-third of respondents had remained in the same identity stage; most individuals had transitioned forward or backward. Changes in ethnic identity were not moderated by disequilibrating life events.     

The Incubator Treatment Development Model: The SAFETY Treatment for Suicidal/Self-Harming Youth

Youths who make suicide attempts or engage in repetitive self-harm are at risk for future suicide attempts and death by suicide or self-harm. This treatment development report focuses on the Safe Alternatives for Teens and Youth (SAFETY) treatment. SAFETY is a 12-week outpatient child and family-centered cognitive-behavioral treatment, informed by dialectical-behavior therapy, and designed to promote safety following a suicide attempt or repeated episodes of self-harm. Previous reports have described results of small open and randomized treatment development trials. Here, we describe our “incubator” treatment development model. Combining scientific rigor with attention to the community context in which treatment is delivered, the incubator model emphasizes laboratory-based treatment development trials and quantitative and qualitative data generated through partnerships with community treatment sites and youth and parent consumers of care. Aims of this approach are to: (1) integrate information from our partners throughout the treatment development process; (2) create a more feasible and easily transportable “youth” and “family” centered treatment; and (3) accelerate the pace with which laboratory-based treatment advances can be incorporated into improvements in community care. We describe our incubator treatment development model and how data generated through our treatment development process and interactions between the laboratory and community teams contributed to the development of the SAFETY treatment.     

The Shared Values of Humanity and Its Philosophical Implications: From the Perspective of Civilization

The concept of the shared values of humanity, embodying the spirit of putting people first and solving real-life problems, is of great significance for constructing a new global order and building a human community with a shared future. The shared values of humanity respect the differences in understanding and realization paths of different civilizations, and seek common grounds with an inclusive and open attitude. The core socialist values are an embodiment and an extension of the shared values of humanity. The fine traditional Chinese culture has also laid a profound cultural basis for the pursuit of the shared values of humanity, enabling us to make up a better scheme for building a human community with a shared future from the perspective of civilization.     

Engagement in community activities and trust in local leaders as concomitants of psychological distress among Israeli civilians exposed to prolonged rocket attacks

Background and objectives: Present study, conducted in the aftermath of the 2014 Israel–Gaza conflict, investigated psychological toll of exposure to rockets attacks in a sample of residents of central and southern Israel. Analyses focused on the distress-protective functions of collectively grounded resources: engagement in community activities and trust in local leadership.

Design: This cross-sectional study was conducted between 2 and 3 months after the hostilities.

Method: Participants (N?=?764) were recruited by an online survey company that distributed a questionnaire assessing, in addition to focal predictors, sociodemographic factors and prior exposure to trauma. The outcome variables were post-traumatic stress disorder (PTSD) and nonspecific distress symptoms.

Results: Conservative regression analyses revealed that greater exposure to rocket attacks was predictive of higher levels of posttraumatic stress symptoms. Higher engagement in community activities exhibited a partial trauma-buffering function. However, higher levels of trust in local leaders appeared to exacerbate, rather than diminish, negative impact of rocket exposure on PTSD. Symptoms of psychological distress were not influenced neither by trauma exposure nor by stressor interactions with resources. Trust in local leadership exerted a beneficial main effect on distress.

Conclusions: Collectively based resources are important for coping in times of community-wide stressors, yet their role is complex.