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Refugee families: Issues of systemic supervision

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Abstract

Families of refugees tend to evoke many powerful responses in all who come into contact with them. Loss and trauma, helplessness and victimhood, transition and change are some of the main themes that seem to dominate. In particular, in contact with mental health professionals, refugee families are more likely to be seen as ‘traumatized’ and their resilience less acknowledged. In this article I will endeavour to address some issues that contribute to this skewing of our perception of refugee families, especially in the context of supervision.

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... Professionals, however, continue to utilise a western medical model that places refugee experiences of hardship, deprivation and distress in the terrain of psychopathology, rather than seeing it as a 'normal' response to an abnormal situation (American Psychological Association, 2009). As a result, refugee resilience is often obscured by the pervasiveness of the trauma narrative in refugee people's lives (Papadopoulos, 2001). While definitions of resilience differ, it is often associated with a person's ability to bounce back "following adversity and challenge and connotes inner strength, competence, optimism, flexibility and the ability to cope effectively when faced with adversity" (Wagnild & Collins, 2009, p. 1). ...
... Unfortunately, the workers directly connected the client's current situation to a traumatised refugee background. Papadopoulos (2001) asserts: therapists tend to link refugee people's current difficulties to their refugee background overlooking refugee people's positive attributes and resilience. Moreover, Papadopoulos (2001) argues that the focus on the trauma story changes the power dynamic in the working relationship, where the clients can end up relying completely on the therapist for help in a way that fosters cycles of dependence. ...
... Papadopoulos (2001) asserts: therapists tend to link refugee people's current difficulties to their refugee background overlooking refugee people's positive attributes and resilience. Moreover, Papadopoulos (2001) argues that the focus on the trauma story changes the power dynamic in the working relationship, where the clients can end up relying completely on the therapist for help in a way that fosters cycles of dependence. If a refugee person is "essentially pathologised and seen as exclusively a victim, invariably the therapist is likely to occupy the saviour role" (Papadopoulos, 2005, p. 37). ...
Article
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Refugee people experience many trials prior to arriving in Australia and face ongoing challenges associated with re-settlement. Despite facing such difficulties many refugee people demonstrate enormous strength and resilience that facilitates their re-settlement process. The authors’ experience however suggests that professionals working with refugee people tend to focus on the trauma story to the neglect of their strengths. At times this means resilience is overshadowed by a dominant Western deficits model that defines refugee people as traumatised victims. Pathologising the trauma story of refugee people may further alienate refugee people from full inclusion into Australian life by denying their inherent resilience in the face of extraordinary life experiences. This article reviews Australian and International literature to explore factors that contribute to refugee resilience such as personal qualities, support and religion. The review also identifies elements that may impede resilience including; language barriers, racism, discrimination, and labelling the trauma story. The literature suggests refugee resilience moves beyond the Western individualised notion of resilience to a more communal construction of resilience that includes refugee people’s broader social context. The literature highlights important practice implications and the authors respond to the findings by reflecting on their own practice experience and considering implications for a more inclusive anti-oppressive strengths-based approach to work with refugee people.
... Moreover, the 'refugee trauma' discourse tends to be restrictive because it emphasises only one segment of the wide spectrum of the refugee experiences. This spectrum could be divided into at least four phases which have been identified as -'Anticipation': when people sense the impending danger and try to decide how best to avoid it, -'Devastating Events': this is the phase of actual violence, when the enemy attacks and destroys, and the refugees flee, -'Survival': when refugees are safe from danger but live in temporary accommodation and uncertainty, and -'Adjustment': when refugees try to adjust to a new life in the receiving country (Papadopoulos, 2000b;2001a;2001b). ...
... The literature on the nature, aetiology, diagnosis, socio-political parameters of trauma, especially with reference to refugee trauma, is enormous and the debates endless (e.g. Abramson 2000;Ager 1999;Arroyo and Eth 1996;Bagilishya 2000;Bentovim 1992;Bertrand 1998;Bloom 1997;Bracken and Petty 1998;Brunner 2000;Caruth 1996;De Jong and Clarke 1996;Eisenbruch 1991;Friedman and Jaranson 1992;Gorman 2000;Herman 1992;Kalsched 1996;Klain 1992;Kristal-Andersson 2000;LaCapra 2000;Lebowitz and Newman 1996;Marsella 1992;Marsella et al. 1996;J.R. Montgomery 1998;Muecke 1992;O'Brien 1998;Papadopoulos 2001aPapadopoulos , 2001bRechtman 2000;Shephard 2000;Summerfield 1999Summerfield , 2001Tedeschi and Calhoun 1995;van der Veer 1994;Woodcock 1994Woodcock , 2001Yehuda and McFarlane n.d.;Young 1997;Yule 1999;Zarowsky 2000;Zarowsky and Pedersen 2000;Zur 1996). Is it then at all possible to attempt to address anything about trauma afresh? ...
... First of all, trauma, in Greek, means wound, injury and it comes from the verb titrosko -to pierce. However, in a recent etymological investigation (Papadopoulos 2000b;2001a;2001b).) it was found that the root verb is teiro 'to rub' and, in this context, in ancient Greek it has two meanings: to rub in and to rub off, to rub away. Thus, according to the original definition, trauma is the mark left on a person as a result of something being rubbed onto him or her. ...
... This understanding can be expressed in the 'Trauma Grid' which outlines the 'consequences and implications' of trauma along with its basic meanings and levels(Papadopoulos, 2004).To begin with, it is important to consider the different meanings of the word 'trauma'.The common meaning of trauma (in Greek) is wound or injury and it comes from the verb titrosko -to pierce. This means that the original meaning of trauma is the mark, the injury that is left as a result of piercing.Papadopoulos' etymological investigations (2000b;2001a;2001b) revealed interesting new perspectives: i.e. titrosko comes from the verb teiro which means 'to rub' and in ancient Greek it had two meanings: to rub in and to rub off, to rub away. Accordingly, 'rubbing in' produces an injury, a wound,, whereas 'rubbing off' or 'rubbing away' has the effect of cleaning up a surface from whatever it was marked on it before, like an eraser erases the writing on a piece of paper.In the reality of clinical contexts as well as in post-conflict situations, the second meaning of trauma refers to the experience of renewal, of the need to reshuffle one's life priorities; people who had been traumatised often express spontaneously this need for looking at life afresh. ...
... This means that the totality of the different phases of trauma is suppressed under the weight of the simplistic narratives of the imposing triangle of conflict (aggressor/victim/rescuer). Yet, asPapadopoulos (2000bPapadopoulos ( , 2001aPapadopoulos ( , 2001b) emphasized, there are at least four phases of experiencing trauma in conflict situations. These he identified as 'Anticipation' (when people sense the impending danger and try to decide how best to avoid it), 'Devastating Events' (this is the phase of actual violence, when the enemy attacks and destroys, and the refugees flee), 'Survival' (when refugees are safe from danger but live in temporary accommodation and uncertainty), and 'Adjustment' (when refugees try to adjust to new life in the receiving country)(Papadopoulos, 2001a, p.6). Schematically,(Papadopoulos, 2000b(Papadopoulos, , 2001a(Papadopoulos, , 2001b, this can be illustrated INDIVIDUAL TO COLLECTIVE EXPERIENCESTo be able to help people and communities that have endured these shattering experiences, it is necessary to create conditions that can enable different narratives which, in turn, can empower people to reconsider their current dominant stories (often dictated by the simplistic tyranny of the triangular constellation of conflict), to explore the totality of their pain (not only restricted to one phase of trauma), and to activate their resilience and their adversity-activated development potentialities. ...
... Yet, asPapadopoulos (2000bPapadopoulos ( , 2001aPapadopoulos ( , 2001b) emphasized, there are at least four phases of experiencing trauma in conflict situations. These he identified as 'Anticipation' (when people sense the impending danger and try to decide how best to avoid it), 'Devastating Events' (this is the phase of actual violence, when the enemy attacks and destroys, and the refugees flee), 'Survival' (when refugees are safe from danger but live in temporary accommodation and uncertainty), and 'Adjustment' (when refugees try to adjust to new life in the receiving country)(Papadopoulos, 2001a, p.6). Schematically,(Papadopoulos, 2000b(Papadopoulos, , 2001a(Papadopoulos, , 2001b, this can be illustrated INDIVIDUAL TO COLLECTIVE EXPERIENCESTo be able to help people and communities that have endured these shattering experiences, it is necessary to create conditions that can enable different narratives which, in turn, can empower people to reconsider their current dominant stories (often dictated by the simplistic tyranny of the triangular constellation of conflict), to explore the totality of their pain (not only restricted to one phase of trauma), and to activate their resilience and their adversity-activated development potentialities. However, as the Trauma Grid suggests, this needs to be done not only at the individual level but also at the various other collective levels (i.e. ...
... They are often at the mercy of external sources to meet their basic needs and determine their asylum options. Children born in this phase undergo important stages of psychological development amid turmoil, and separation from parents and caregivers is encountered (Papadopoulos, 2001). ...
... Once refugees resettle in a host country, new belief systems, values, and mores challenge their adaptation (Papadopoulos, 2001). New roles and family models disrupt resettlement, and refugee children's cross cultures old and new. ...
Article
The phenomenon of forced migration due to the war in Ukraine generated enormous flows of population that moved to European countries and therefore also to Romania. A particularly complex and constantly evolving social phenomenon - the problem of refugees - is only at the beginning of sociological and social assistance investigations. In this article, we intended to detail the situation of Ukrainian refugees from a small sample selected in the north of Romania following three axes of analysis: the refugees' perception of their situation, the identification of the factors that contribute to the development of the refugees' resilience and the evaluation of the perception of the humanitarian aid received since leaving the country of origin by refugees. Exploratory research (undertaken as part of a master's thesis) can be a good start for wider research carried out in several areas in Romania where the reception and assistance of war refugees is in full swing.
... Η γενικευμένη και γενικευτική κατάταξη των εν λόγω ατόμων ως υποκειμένων ψυχικού τραύματος και ως φορέων μετατραυματικού στρες ενέχει μία σειρά από κινδύνους και παγίδες, τις οποίες είναι σκόπιμο να λαμβάνει υπόψη κάθε εκπαιδευτικός που εργάζεται με τέτοιους πληθυσμούς. Ο λόγος περί τραύματος, σε κοινωνικό αλλά και σε επιστημονικό επίπεδο, είναι τόσο εκτενής και διαδεδομένος, που δύσκολα μπορεί κανείς να τον παρακάμψει, πόσο μάλλον εφόσον ενεργοποιεί «θετικά» αντανακλαστικά υλικής, ψυχολογικής και πολιτικής συμπαράστασης (Papadopoulos 2001). Ωστόσο, η παθολογικοποίηση των ατόμων προσφυγικής προέλευσης ομογενοποιεί και στιγματίζει αυτήν την ομάδα, υπογραμμίζοντας την ευαλωτότητα και την τρωτότητά της, και τη διαχωρίζει από την πλειοψηφία των «μη θυμάτων»--ευνοώντας, τελικά, τις σχέσεις εξάρτησης και ανισότητας. ...
... Βεβαίως και υφίστανται τραυματικές εμπειρίες, οι οποίες επηρεάζουν με διάφορους τρόπους τις συμπεριφορές των παιδιών ανάλογα με την ηλικία τους, την ιδιοσυγκρασία τους, τις πολιτισμικές τους αποσκευές, αλλά και ανάλογα με την εκπαιδευτική (οπωσδήποτε και ευρύτερα κοινωνική) αντιμετώπιση που τους επιφυλάσσει ο εκάστοτε τόπος υποδοχής. Οι εμπειρίες που εμπιστεύτηκαν οι εκπαιδευόμενοι/ες στους συντελεστές του προγράμματος κατέστησαν σαφές ότι η βιωμένη δυσχέρεια δεν περιορίζεται στην προ-μεταναστευτική περίοδο, αλλά αφορά τη μεταναστευτική διαδρομή, καθώς και την πρώτη μετα-μεταναστευτική περίοδο, τις τρεις περιόδους που χρειάζεται να λαμβάνονται υπόψη προκειμένου να κατανοηθεί η προσφυγική εμπειρία ολιστικά (Papadopoulos 2001, Rutter 2006, Nilsson & Bunar 2017. Έτσι, η γενικευμένη βία, οι βομβαρδισμοί, η δημόσια περιφορά κομμένων κεφαλιών ως τροπαίων, αλλά και η βία στην ατομική σφαίρα (όπως ο εξαναγκασμός παιδιού να παρακολουθήσει τον βασανισμό του γονέα του) δίνουν τη θέση τους στο φόβο και το άγχος του μεγάλου και επικίνδυνου ταξιδιού κατά τη διάρκεια του οποίου χάνονται ζωές, ακόμη και μελών της οικογένειας. ...
Conference Paper
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The focus of this paper is to present some easy and flexible e-tools for CLIL (Content and Language Integrated Learning) subject teachers, aimed at simplifying and accommodating school content books also by creating original study material from adjusted web texts. The implementation of digital activities in higher education within a CLIL theoretical framework supports students in dealing with content-specific topics and disciplinespecific terms that may result too difficult to access in L2 (student’s second language).This article will depict some Web 2.0-scaffolded tasks created by simple ICT tools successfully used in CLIL settings to maximize school text's approachability and to facilitate subject-specific material's understanding, improving learners’ communicative and linguistic awareness together with cognitive skills at the same time. The interactive on-textexercises presented in this work focus on academic language and have been created with free software: they have been designed for learners with a different language of instruction in order to be easily adapted. The sample classroom activities typically target pupils at secondary school aged 14-16, whose first language is not the vehicular language (English). Subject-specific input and tasks for vocabulary building and reading comprehension within the e-learning environment will be proposed as scaffolding techniques. Keywords: CLIL (Content and Language Integrated Learning), Language Awareness, Scaffolding, CALL (Computer Assisted Language Learning), TELL (Technology- Enhanced Learning).
... Sequentially and gradually, through his engagement with the various institutions, his 'personal' story was unnoticeably trimmed, embellished, shaped and packaged to fit into the genre of 'trauma stories' that have acceptable currency with the various organisations, and tallying with the wider 'societal discourse on trauma'. This discourse is the unwritten and unspecified sum total of what society understands by 'trauma', framed in an oversimplified, linear and causal-reductive formula, according to which adversity 'causes' 'trauma', regardless of any mediating factors such as individual differences, personal histories, coping mechanisms, support systems, gender, race, age, time duration, spiritual dimensions, historical considerations, and a plethora of other contributing factors that affect the way one experiences external events (Papadopoulos, 2001a(Papadopoulos, , 2002(Papadopoulos, , 2020(Papadopoulos, , 2021a(Papadopoulos, , 2021c. ...
... Gradually, he recognised that there were many experiences that were not included in it, and yet they also had a 'traumatising' effect on him. These excluded experiences can be better understood if considered using the framework of the six phases of refugee experiences that I have developed to address the wide spectrum of typical refugee situations (Papadopoulos, 2001a(Papadopoulos, , 2001b(Papadopoulos, , 2021a. ...
Chapter
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People seeking asylum face unique challenges and frequently experience mental health problems. Effective support requires an understanding of their mental health needs in the broader context of their lives, cultures and extreme experiences. This book provides practical guidance for professionals and services working with people seeking asylum in mental health, social care, legal, government. managerial and commissioning roles. With authors from a wide range of professional backgrounds, the book is enriched by accounts from people with first hand experience of the asylum system itself. It considers the challenges and dilemmas faced by all involved, including clients, clinicians and service planners, with a wealth of practical information about how to assess and understand strengths and needs, avoid inappropriate conclusions and discrimination, consider treatment options, and write records and reports. The authors emphasise that effective support depends on reflection, humanity and compassion. The book is a must-have resource for professionals working with those who have to seek asylum.
... A fourth phase has been suggested to be related to the refugees' trauma (Papadopoulos 2001). The plight of refugees and their experiences when fleeing has not only traumatizing effects in the country of their origin, but they also face psychosocial, psychological, and mental health issues in the host countries for various reasons, i.e., cultural isolation, social integration, economic uncertainty, and acculturation in the host society (Papadopoulos 2001). ...
... A fourth phase has been suggested to be related to the refugees' trauma (Papadopoulos 2001). The plight of refugees and their experiences when fleeing has not only traumatizing effects in the country of their origin, but they also face psychosocial, psychological, and mental health issues in the host countries for various reasons, i.e., cultural isolation, social integration, economic uncertainty, and acculturation in the host society (Papadopoulos 2001). ...
... Sequentially and gradually, through his engagement with the various institutions, his 'personal' story was unnoticeably trimmed, embellished, shaped and packaged to fit into the genre of 'trauma stories' that have acceptable currency with the various organisations, and tallying with the wider 'societal discourse on trauma'. This discourse is the unwritten and unspecified sum total of what society understands by 'trauma', framed in an oversimplified, linear and causal-reductive formula, according to which adversity 'causes' 'trauma', regardless of any mediating factors such as individual differences, personal histories, coping mechanisms, support systems, gender, race, age, time duration, spiritual dimensions, historical considerations, and a plethora of other contributing factors that affect the way one experiences external events (Papadopoulos, 2001a(Papadopoulos, , 2002(Papadopoulos, , 2020(Papadopoulos, , 2021a(Papadopoulos, , 2021c. ...
... Gradually, he recognised that there were many experiences that were not included in it, and yet they also had a 'traumatising' effect on him. These excluded experiences can be better understood if considered using the framework of the six phases of refugee experiences that I have developed to address the wide spectrum of typical refugee situations (Papadopoulos, 2001a(Papadopoulos, , 2001b(Papadopoulos, , 2021a. ...
... Kritikët në këtë drejtim argumentojnë se diagnoza e ÇSPT fokusohet në simptomat pa iu referuar shkaqeve të këtyre simptomave, pra duke mos marrë parasysh sistemet përreth në të cilat individi jeton (Papadopoulos, 2001;Kienzler, 2010;Papadopoulos, 2011). Simptoma të fshehura nën-klinike lënë individin në rrezik të aktivizimit progresiv të çrregullimit në rast të ekspozimit të mëtejshëm ndaj stresorëve jetësorë. ...
... Rrethanat socio-ekonomike dhe tranzicioni i pasluftës si ngarkesë traumatike psiko-sociale kërkojnë aktivizimin e individit në shoqëri, në mënyrë që përmes aktivitetit të ri dhe suksesit të konfrontohen konceptet e gabuara kognitive mbi veten dhe ndjenjat negative që lidhen më këto koncepte (Papadopoulos, 2001;. Është interesante se si ndjenja e pasivitetit dhe mendimit se dikush tjetër duhet të ndërrojë situatën në të cilën ndodhesh, "të duket se disi është mbjellë" dhe vazhdon të jetë prezent edhe sot e kësaj dite në popullatën e Kosovës. ...
Book
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“Duke pasur parasysh faktin se monografia e studion traumën psikologjike dhe transmetimin e saj në kontekstin e Kosovës që historikisht njihet si shtet e territor ku me shekuj janë ballafaquar dhe kanë bashkëjetuar qytetërime me dallime të mëdha etnike, kulturore e fetare, ky studim shkencor fiton në peshë e relevancë për studimet e mëtutjeshme në këtë lëmi. Monografia në fjalë ofron bazament solid e të argumentuar për shqyrtimin e mirëfilltë analitik të aspekteve shumë shtresore të kësaj patologjie poliedrike të shëndetit mendor me implikime të shumëfishta sociale, ekonomike e politike. Studiuesit, profesionistët e shëndetit mendor dhe politikëbërësit vendor mund të gjejnë, në këtë monografi, burim solid të informatave dhe argumenteve të zgjedhura shkencore përkitazi me traumën psikologjike dhe aspektet e ndryshme të transmetimit të saj në kontekstin Kosovar kundruar nëpër prizmën e studiuesve më eminentë botëror në këtë lëmi. Gjë që mund t’i ndihmojë ata në dizajnimin e intervenimeve adekuate parandaluese dhe terapeutike përkitazi me komorbiditetin e traumës psikologjike me patologjitë e ndryshme të shëndetit mendor, si dhe dizajnimin e modeleve multi-disciplinare të shërbimeve të shëndetit mendor për adresimin e tyre, të bazuara në modelin e reziliencës së familjes dhe komunitetit të gjërë, si dhe intervenimeve inovative parandaluese në komunitetin e mësimdhënësve. Me gjuhën e saj të kuptueshme, qasjen integrative shumë sektoriale dhe paraqitjen sistematike të të dhënave relevante, monografia paraqet tekst të rëndësishëm akademik edhe për studentët, në veçanti ata të mjekësisë, psikologjisë, shkencave sociale, politike dhe të edukimit, duke u ofruar atyre mundësi për zhvillimin e të menduarit gjithëpërfshirës analitik në fushën e një teme me rëndësi strategjike për shtetin dhe shoqërinë.” Prof. Ass. Dr. Sc. FERID AGANI Recensent
... Lustig et al. (2004, pp. 29 -30) (2001) and Pernice (1994) in observing that "checklists or structured interviews focusing on posttraumatic symptoms may fail to capture the variety of refugee childrens' stress reactions, such as of grief, loss, or readjustment difficulties". Papadopoulos (2001) highlights that "the pervasive 'trauma' discourse forms an unavoidable background noise in every therapeutic endeavour with refugees", arguing that it can influence the way we work with refugees, to the point of becoming the main focus of therapy even when more relevant and current factors may be present. ...
... 29 -30) (2001) and Pernice (1994) in observing that "checklists or structured interviews focusing on posttraumatic symptoms may fail to capture the variety of refugee childrens' stress reactions, such as of grief, loss, or readjustment difficulties". Papadopoulos (2001) highlights that "the pervasive 'trauma' discourse forms an unavoidable background noise in every therapeutic endeavour with refugees", arguing that it can influence the way we work with refugees, to the point of becoming the main focus of therapy even when more relevant and current factors may be present. Having discussed child asylum seekers' exposure to stressors specific to their population and resulting mental health needs, and the recommendations of the College of Psychiatrists of Ireland (2017), it is clear there is a need for access to specific training for work with refugees for the mental heath care professionals working with them, such as access to training in cultural sensitivity. ...
Thesis
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In the light of the unique challenges faced by child asylum seekers in Direct Provision it is examined whether they have access to mental health care adequate for their needs, and whether Art Therapy could be an effective intervention for this client group. To place this paper within appropriate context, current statistics regarding asylum seekers and the system of Direct Provision were extensively researched (viewable under Appendix A). This Extended Literature Review explores current research regarding the mental health of refugee and asylum seeking children; available literature regarding current access to mental health services for child asylum seekers in Ireland; and the appropriateness of Art Therapy as an intervention for asylum seeking children. Following this recommendations are made by the author, and a final note regarding the reflexive role of therapists in inclusivity, advocacy and activism is included. Following the main body of the Literature Review, the Literature Review methodology is presented for transparency and clarity. The paper concludes with the author’s personal reflections.
... 38 Children may have to relocate without their caregivers and are often at the mercy of external sources to meet their basic needs during resettlement. 39 Forced displacement means loss of homeland, family, friends, and material possessions. Loss of loved ones may be accompanied by few opportunities to stay in touch with family members across geographic and political boundaries. ...
... Loss of loved ones may be accompanied by few opportunities to stay in touch with family members across geographic and political boundaries. 39 This may result in cultural bereavement, a loss of touch with the attributes of the homeland, which may lead to survivor guilt, anger, and ambivalence. 40 The violent nature of death during war places youth at heightened risk for development of traumatic grief. ...
Chapter
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Many children grow up knowing only war throughout their lifetime. Children make easy targets during war as they are unable to protect themselves; thus they bear some of the greatest consequences. The effects of war are far reaching and impact youth in a multitude of ways ranging from physical injuries, health problems, loss of home, and possessions to psychological problems such as anxiety, depression, grief, and posttraumatic stress disorder (PTSD). This chapter will focus on the development of PTSD in war-exposed youth and the impact of the secondary effects of separation and loss. We will present distinctions between acute versus chronic and direct versus indirect exposure, current psychosocial interventions for war-exposed youth and treatment challenges and discuss applications of an ecological framework to address some of these challenges. We will conclude with research and policy directions that will help advance the field.
... For instance, rising islamophobia and antiimmigrant stances may reduce safety and increase re-traumatization (Yako & Biswas, 2014). Thus, the experience of being a refugee includes dimensions of the political, ethical, ethnic, religious, and sociological, in addition to the psychological (Papadopoulos, 2001), and therefore, treatment models need to go beyond individual conceptualization of psychopathology (Kira et al., 2012). ...
... Thus, issues of hierarchy and power may be complicated due to the intersection of societal and family-level processes of power and privilege. For family therapists who conceptualize mental health symptoms systemically, an intersectional lens may be well integrated within their existing approaches (Papadopoulos, 2001). ...
Article
In this article, we discuss incorporating the transnational intersectionality framework in family therapy with resettled refugees. Transnational intersectionality is an extension of the framework of intersectionality which helps to better understand complexities of power and oppression across national contexts and their influence on refugees' lives. Adopting this framework alerts family therapists to: (a) develop critical awareness of refugee's transnational contexts; (b) understand differences in experiences of social identities across contexts; (c) acknowledge postmigration factors of oppression affecting resettlement; and (d) critically reflect upon therapist–interpreter–client intersectionalities. This shifts our conceptualization of therapy with refugees to actively consider transnational contexts which refugees uniquely occupy. We describe the framework and provide two case illustrations to highlight its usefulness.
... It intersects political (including domestic and foreign policies), religious, ethnic, sociological, financial, and ecological dimensions (e.g. where refugee housing is constructed, etc.) (Papadopoulos 2001). An approach that takes into account these dimensions, and permits helping professionals to also locate themselves in the context of the service systems in which they belong is a politico-economic, systemic approach. ...
... An approach that takes into account these dimensions, and permits helping professionals to also locate themselves in the context of the service systems in which they belong is a politico-economic, systemic approach. As Papadopoulos (2001) asserts, "systemic approaches are useful in working with refugees because they can sharpen the professionals' epistemological sensitivity and inform them about the interaction of the various narratives that each one of these systems uses to express itself" (p. 406). ...
Chapter
This chapter focuses on the family therapy clinical services in postwar Kosova, and on how the war has significantly changed interactional aspects of the cultural and family dynamics—particularly for former combatants (veterans), and for adolescents and their parents. Highlighting statements by patients we have worked with over the years, and through the use of case vignettes and case examples, we illustrate how the family system has been impacted directly and indirectly by the war. In conclusion, we offer our impressions of family needs in postwar Kosova, and our views of requirements for ongoing training of family therapists in our setting.
... At the same time, supervisors also need to understand what beliefs they hold about refugees, be knowledgeable in refugee-related information, and understand their own positionality, meaning, the social and political context that inform their identity and their work with refugees and supervisees. Papadopoulos (2001) identified how the refugee trauma discourse tends to pathologize refugees by describing them as traumatized and to use a deficit model to conceptualize their problems. In this sense, he suggests supervisors and supervisees need to be mindful of the type of language they use to refer to the refugee experience and to pay attention to the refugee narratives shaped by the host country's attitudes toward certain groups and the dominant narratives portrayed in mainstream news platforms. ...
Article
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More people than ever in history are being displaced and becoming refugees due to political conflict, climate change, and persecution, among others. Meeting the mental health care needs of refugees has become a global priority. This population’s needs are unique due to the multiple traumatic experiences of refugees, their difficulties in navigating various systemic barriers, and the minimal specialized cultural training in refugee care. In order to improve the health of refugees, it is important to examine how care is delivered and the provider and systemic factors that perpetuate inequities and cultural misunderstandings in providing care. Most of the refugee literature focuses on refugee factors that limit access to care but falls short on discussing providers’ lack of training in refugee care. In the following paper, we present refugee mental health training considerations for providers. These considerations are based on the lessons learned from direct clinical work in a refugee clinic located in a major public academic hospital in the New England area (United States of America). The authors discuss the particular context of caring for refugee populations, the skills needed to work with this population, and considerations for navigating provider and systemic barriers that arise in refugee care. We believe that training mental health providers can have significant implications for refugee mental health care utilization, patient improved treatment outcomes, and on refugees’ increased sense of self-determination.
... Professionals, however, continue to utilize a western medical model that places refugee experiences of hardship, deprivation, and distress in the terrain of psychopathology, rather than seeing it as a 'normal' response to an abnormal situation. As a result, refugee resilience is often obscured by the pervasiveness of the trauma narrative in refugees' lives [47]. ...
Article
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This study made a claim that perceived discrimination, socio-economic strain, and structural strain on displaced people have an adverse impact on their mental health. Our claim also acknowledges that these people potentially have a unique set of strengths and abilities that they rely on to overcome their immediate and future problems. The aim of this study is thus to examine the relationship between post-migration life adversity and mental health problems, and assess the potential mediating role of resilience among asylum seekers and refugees (219 asylum seekers and 42 recognized refugees) living in South Korea. Structural equation modelling was used to examine hypothesized pathways between post-migration life adversity, mental health and resilience. Fit indices showed adequate to excellent fit of the examined models with mental health as the outcome. Mental health was positively regressed on PMLA and negatively regressed on R. In addition, R partially mediated the association between PMLA and MH. In addition to providing the academic contributions of this study to the ongoing study of resilience and its social welfare implications, the result of the study indicated the necessity of improving the present and future socio-environmental factors that foster resilience among refugees and asylum seekers.
... Refugees' mental health has received increasing attention from researchers, along with increased awareness of the impact of trauma and stress on the psychological well-being of refugees. 5 Researchers have often perceived refugees as traumatised and vulnerable victims, dependent on services and in need of support, [6][7][8] with mental illnesses such as depression and post-traumatic stress disorder (PTSD) often seen as their default state. [9][10][11] This approach may be understandable, given the high prevalence of mental health difficulties in this population 12,13 and the multitude of traumatic events that many refugees experience, 13,14 along with the difficulty in accessing help for their mental health for various reasons, including unstable living conditions, language barriers and stigma. ...
Article
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Aims and method Refugees’ mental health has attracted great interest from researchers recently, in view of increasing numbers of refugees settling in Europe. A deficit model, focusing on mental disorder, has often dominated the discourse on the subject, but a strength-based model is becoming more recognised and adopted. Through semi-structured interviews, and using interpretative phenomenological analysis as a data analysis tool, the current study sought to explore the lived experiences of Syrian refugees in the UK in relation to resilience factors. Results Three main themes were identified reflecting interpersonal and family factors, factors related to religion, faith and belief systems, and personal qualities. Clinical implications The study calls for perceiving refugees as resilient individuals with strengths and adaptive qualities. It also demonstrates that refugees’ resilience is essentially an interpersonal process, advocating therefore for engagement and therapeutic approaches that are systemic, relational, and culturally and spiritually competent.
... Trauma, according to Papadopoulos (2000Papadopoulos ( , 2001, is not necessarily a mark of pathology; it is in fact a neutral word indicating that 'a strong emotional experience has taken place and which has left some mark -either a mark of injury or of cleansing and renewal' (2001, p. 413). People who experience adversity, such as forced migrants, find it difficult to return to previous ways of life and their adversity experiences may be too overwhelming and disorientating, being the cause of severe distress. ...
... In addition to potential challenges to their mental health, refugees often experience losing all that is familiar as they face new languages, values, and cultures that are distant from their own, when they arrive in their new country (d' Abreu et al., 2019;Kirmayer et al., 2011;Lustig et al., 2004;Papadopoulos, 2001). Intercultural contact often results in a process of cultural and psychological change, called "acculturation," and the outcomes of said process can determine newcomer youth's adaptation to their new life (Berry et al., 2006). ...
Article
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Refugee youth constitute around a third of the refugee population in Germany. We studied the experiences of newly arrived Syrian and Iraqi refugee youth, aged 14 to 18 years ( N = 20), in Germany. We utilized semi-structured interviews and thematic analysis to investigate (a) the main challenges faced by youth and (b) their main coping resources to deal with these challenges. We grouped challenges into three levels: the individual level, the immediate social level, and the broader societal level. The most frequently mentioned challenges in our sample related to psychological wellbeing, school, friendship, accommodation, and discrimination. Youth reported relying on social support (friends, family, social services) and on themselves (through avoidance, persistence, activity seeking, active engagement) to cope with their challenges. Our findings provide insights into refugee youth’s experiences in Germany, encompassing the acculturative, developmental, and generational aspects of their lives and demonstrating their coping and resilience. We discuss our results in relation to the literature on refugee youth in high income countries.
... Abschließend werden Handlungsimplikationen für die Supervision, aber auch für strategische und qualitative Positionen innerhalb der Hilfesysteme abgeleitet. (Papadopoulos 2001;Lansen 2002;Fritz 2010;Staskiewicz 2016). Konkrete Forschungsarbeiten und einschlägige Publikationen zu dieser Themenkombination scheinen jedoch unterrepräsentiert. ...
... Refugee trauma is a special topic for the researchers, because this kind of clients suffers not only from combat trauma, but also has re-traumatization in new living places: culture shock, the loss of home, stress from a culture of the host country, and xenophobia in the society. However, the opinion about refugee trauma is still controversial in the scientific literature (Papadopoulos, 2001). It is important to distinguish between 'refugee trauma' and psychological trauma (Alcock, 2003;Boehnlein & Kinzie, 1995). ...
Thesis
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How do traumatized clients manage their lives (mixed method research)
... Refugee children will often face a difficult journey to a host country which may include a period in a refugee camp (Papadopoulos, 2001). They have to deal with the difficult process of adjusting to life in a new country and a new culture. ...
... Refugee children will often face a difficult journey to a host country which may include a period in a refugee camp (Papadopoulos, 2001). They have to deal with the difficult process of adjusting to life in a new country and a new culture. ...
... Second such adversity can lead some people to experience dysfunction, including emotional distress, PTSD, anxiety, and depression (Steel et al., 1999;Steel et al., 2002;Ssenyonga et al., 2013). Third, despite the adversity faced, many refugees do not display dysfunction but are resilient in the face of this adversity (Hutchinson and Dorsett, 2012;Powell et al., 2003;Papadopoulos, 2001). Finally, while identity can play a role in explaining resilience to adversity (Powell and Baker, 2014), issues related to identity for refugees are more complicated (vis-à-vis non-refugees) regarding identifying with "birth" and "residing" country. ...
Article
Executive summary People face adverse events in a variety of forms. Some individuals are resilient to adverse events in that they are able to maintain positive functioning while others experience considerable disruption. In explaining heterogeneity in resilience, research has emphasized people's resource endowments and pre-adversity organizing prior to the adverse events as well as people's cognitive and behavioral responses to such events. Therefore, for most resilience studies, adversity is an event. Although it is critically important to understand resilience to these short- to medium-term adverse events, there is a need to understand resilience over an extended period. In this regard, we focus on Palestine refugees who were born in refugee camps and as adults have known nothing other than being a refugee. When it comes to substantial and persistent adversity, entrepreneurial action likely plays a central role in resilience to such adversity. To explore these relationships, we conducted an extensive data-collection effort over 15 months on refugee entrepreneurs (in refugee camps and not in camps), including 110 interviews. We find the importance of direct, indirect, and recursive relationships among actions (i.e., entrepreneurial action and integration activities), multiple identities, and resilience outcomes under conditions of substantial and persistent adversity. Furthermore, we find important differences between refugee entrepreneurs who live in refugee camps and those who live outside these camps—differences in affiliation, language use, and social capital development—which enable those refugee entrepreneurs living outside the refugee camps to achieve resilience outcomes not accessible to those living inside the camps. Overall, this study makes a number of contributions to the entrepreneurship literature. First, research has investigated resilience in terms of resources, endowments, and capabilities before an adverse event. The implicit assumptions in this research are that capabilities matter and that adversity has a beginning and subsides over time. In this study, we focus on resilience outcomes in the context of refugees facing substantial adversity over a substantial period and extend the capability argument of resilience in the following ways: (1) the “social” capability for resilience, not as an endowment but created through activities that build a social basis for resilience outcomes, (2) social integration activities are initiated and facilitated by engaging in entrepreneurial action with non-similar others, and (3) resilience outcomes help individuals both engage in integration activities and build a social capability of resilience. Therefore, in the context of substantial and persistent adversity, refugee entrepreneurs need to act in order to build (rather than simply deploy) their social capability for resilience outcomes. Second, resilience has been explored as either a process or as an outcome. In this study, we find that resilience outcomes are both a consequence and an antecedent of entrepreneurial action—a mutually dependent relationship. Specifically, we find the dimensions of resilience outcomes to include proactive problem solving, moral gains as a broader purpose in life, self-reliance, realistic optimism, and multiple sources of belonging. What is interesting is that these outcomes are also important inputs to entrepreneurial action and the resilience process. Finally, there has been an important stream of research on the role of identity in recovery from adversity. We find that refugee entrepreneurs' actions provide a basis for changing the mix of their multiple identities. Therefore, we enrich the entrepreneurship identity literature through the insight that in this persistently adverse context, the relationship between entrepreneurial action and identity is not one way and static but bidirectional and dynamic. Furthermore, over and above refugee entrepreneurs' prosocial motivation of compassion, we find a new form of prosocial motivation for entrepreneurial action—the motivation to promote solidarity: “You are not alone; we are in this together as part of a broader purpose in life.”
... Sidoqoftë ndërhyrjet klinike të bazuara në këtë qasje dhe në psikoterapi të ndryshme individuale, janë kritikuar në momentin që disa individë filluan të shfaqin simptomat e ÇSPT-së shumë kohë pas përjetimit të ngjarjes traumatike. Kritikët në këtë drejtim argumentojnë se diagnoza e ÇSPT fokusohet në simptomat pa iu referuar shkaqeve të këtyre simptomave, pra duke mos marrë parasysh sistemet përreth në të cilat personi jeton (Papadopoulos, 2001;Kienzler, 2010;Papadopoulos, 2011). Simptoma të fshehura nën-klinike lënë individin në rrezik të aktivizimit progresiv të çrregullimit në rast të ekspozimit të mëtejshëm ndaj stresorëve jetësorë. ...
Thesis
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Studimi mbështetet në qasjen psiko-sociale ku perceptimi i mbështetjes sociale si ndryshore e rëndësishme në raport me shëndetin mendor, eksplorohet te veteranët e luftës në Kosovë. Si rezultat i procedurës hulumtuese, evidentimi i raportit në mes të Çrregullimit të Stresit Pas Traumatik (ÇSPT) dhe përceptimit të mbështetjes sociale është më i përditësuar (rreth 19 vite pas luftës). Po ashtu ndryshoret e studimit janë zgjeruar duke përmbushur qëllimin e përgjithshëm të këtij studimi që ka të bëjë me elaborimin e përjetimit psikologjik të traumës dhe trans-traumësnë Kosovë. Më konkretisht, studimi synon të përcaktojë në mënyrë empirike, incidencën e reagimit patologjik ndaj traumës së luftës, në formë të Çrregullimit të Stresit Pas Traumatik (ÇSPT) në brezin e parë dhe lidhjet e tij me funksionimin e disa aspekteve afektive e kognitive në brezin e dytë. Incidenca patologjike në brezin e parë hulumtohet në dy mostra të dryshme: a) te veteranët e luftës dhe bashkëshortet e tyre dhe b) te mësimdhënësit kosovarë. Këto dy grupe përfaqësojnë dy burime të rëndësishme për bartjen e mundshme të traumës në brezin e dytë (te fëmijët/nxënësit). Pra, një ndër synimet e studimit është evidentimi se, në vendet ku trauma ka ndodhur, transmetimi i traumës mund të bëhet përmes linjës familjare dhe asaj komunitare/institucionale. Kështu, studimi u realizua në dy nën-studime paralele me një mostër totale prej 571 subjektesh, e cila u stratifikua në grupe gjatë procedurës hulumtuese. Aftësitë vetërregulluese të brezit të dytë, numri i treguesve të shqetësimeve emocionale dhe format e perceptimit të lidhjes me të rriturin e brezit të parë (prindin apo mësimdhënësin), janë disa ndër aspektet kognitivo-afektive që u maten brezin e dytë për të hulumtuar nëse ato kanë ndonjë lidhje me funksionimin patologjik ose jo të brezit të parë ndaj traumës së përjetuar. Për fund, studimi nuk përjashtoi as adresimin e raportit në mes të ndryshoreve demografike dhe ÇSPT. Rezultatet e studimit tregojnë se incidenca e ÇSPT është e lartë në mostrën e brezit së parë edhe 19 vite pas luftës në Kosovë. Konfirmohen gjetjet e studimeve të ngjashme në lidhje me prolongimin e simptomave pas-traumatike te veteranët e luftës, ndërsa për herë të parë matet incidenca e këtij çrregullimi në populacionin e mësimdhënësve. Ky studim nuk gjen ndonjë dallim në perceptimin e mbështetjes sociale në mes të grupeve të veteranëve me dhe pa simptoma të ÇSPT-së. Rezultatet, po ashtu, tregojnë se prezenca e ÇSPT në brezin e parë ka lidhje me funksionimin e disa aspekteve kognitive, afektive e të sjellës brezin e dytë. Rëndësia e studimit qëndron në faktin se vërteton simptomat afatgjata të ÇSPT te veteranët e luftës dhe familjet e tyre. Aset i veçantë është dokumentimi i incidencës së ÇSPT te stafi mësimdhënës. Këto gjetje i kontribuojnë studimeve të mëtutjeshme në fushën e trans-traumës. Ato vënë theksin në transmetimin e mundshëm jashtë linjës familjare dhe pasqyrojnë rëndësinë e lidhjes me mësimdhënësit në fazat e hershme të zhvillimit. Fjalët kyçe: Mbështetja sociale, ÇSPT, vetë-rregullimi, shqetësimet emocionale, transmetimi i traumës, trauma te mësimdhënësit kosovarë etj.
... Assessments of war-affected youths typically measure loss and adversity (Montgomery 2008;Summerfield, 2002). This pathology-inducing perspective (Summerfield, 2000(Summerfield, , 2002Watters, 2001) may increase access to services or benefits but can downplay child refugees' resilience and strengths (Betancourt & Khan, 2008;Lustig et al., 2003;Papadopoulos, 2001;Watters, 2001). ...
... On the other side, Hollifield et al. (2002), in a critical review of the literature on refugee trauma and mental health morbidity argue that data on the field are conflicting and difficult to interpret: they are overly descriptive while using instruments with limited or untested validity and reliability for this population, lacking theory-based construct definitions specifically for the refugee populations. Hence, Papadopoulos and Hildebrand (1997: 209), drawing on Bracken and Petty (1998), Muecke (1992) and Summerfield (1999Summerfield ( , 2001 argue that the usual conceptualisation of refugees is within a 'pathology or deficit model', which articulates a 'trauma discourse' vis-a-vis their mental health; this discourse erects an unavoidable background wall of noise in every therapeutic endeavour with refugees (Papadopoulos, 2002a). The migration condition comprises a reality of particular complexity, uniqueness and totality (Papadopoulos, 2002b). ...
Conference Paper
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Greece in the past three years has been put in aposition to address a massive and overwhelming influx of refugees moving mostly from the war afflicted areas of Syria, Afghanistan and Iraq. Such a massive movement came at a time of the most severe financial crisis, when little state attention or funding could be provided for the medical, mental health and psychosocial care, accommodation and integration of migrants or refugees. This condition opens up many issues for qualitative inquiry both with the mental health professionals as well as on the organisation of psychosocial services. The proposed submission draws on an ongoing post-doctoral project on the supervision needs and best practices of the mental health professionals working in the Greek refugee regime. We will focus on the accounts of mental health professionals who participated in the pilot phase of this project. Our data comes from a corpus of 35 in-depth, qualitative interviews, effected through purposive homogeneous sampling, designed to elicit their experiences supporting the refugees, their needs, their emotions and their ways of coping, while taking into account the local context of the embodied intersubjective relationship of researcher-participant. Through an interdisciplinary, critical psychosocial lens, drawing on recent theorising by Wetherell et al., we will address the research question of the affective/discursive practices mental health professionals mobilise to account for needing supervision, i.e. a structured relationship with experienced professionals with the goal of helping supervisees to cope in the field and gain the skills to be more effective. In our critical discursive psychological analysis, we will employ the concepts of the affective/discursive canon and the tropes of accounting to analyse the affective/discursive practices of mental health professionals as in situ, embodied and relational meaning-making work. Our findings suggest that participants mobilise taken-for-granted and common-sense tropes to position themselves as in urgent need of supervision due to the workload and the traumatic narratives of the refugees. They construct certain ‘affected’ positions of their professional practice with the refugees, oscillating between development and trauma, while establishing a relational canon of need. Such a normative positioning is discussed as evident not only of the affective economy of the Greek refugee regime, but also of the structural organisational deficits in its political economy. Finally, we aim to address the implications for policy-setting of psychosocial services and health care for the refugees, on the issue of the organisation of peer supervision practices for mental health professionals, with an inclusive multicultural and social justice approach. Keywords: refugees, supervision, mental health professionals, subject positions, affect (4) Needing Supervision: The affective/discursive canon of accounting for the urgency of supervision by mental health professionals working with refugees in Greece | Request PDF. Available from: https://www.researchgate.net/publication/327225820_Needing_Supervision_The_affectivediscursive_canon_of_accounting_for_the_urgency_of_supervision_by_mental_health_professionals_working_with_refugees_in_Greece [accessed Aug 25 2018].
... Adapting to the new environment gets easier with the support of familiar connections from their old culture, friends, and religious values [4]. However, loss of family members leads to new family roles and causes additional challenges [5]. ...
Article
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Objective: To examine the mental health states of a sample of Yazidi refugee children and adolescents who migrated from war-torn Iraq’s Sinjar region and to determine the risk and protective factors for psychiatric disorders among the refugee children and adolescents. Method: The participants of this research were children and adolescents between ages 6 and 17 who live in a refugee camp in Turkey. Their parents/guardians provided written informed consents for the research. The research was approved by the Ethics Council of Sakarya University. Participants with intellectual disabilities and autism spectrum disorders were excluded from the study. Two child and adolescent psychiatrists speaking their native language interviewed and evaluated each of the participants. Collected data included socio-demographic information about previous and current living situations, Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime – Turkish Version (K-SADS-PL). Results: One hundred and thirty-six children and adolescents (76 boys, 63 girls; mean age = 11.05 ± 3.11 (SD)). At the time of the assessment, 43.4% had posttraumatic stress disorder (PTSD) (n = 59), 27.9% depression (n = 38), 10.3% nocturnal enuresis (n = 14), 9.6% behavioural problems (n = 7), and 5.1% anxiety disorders (n = 13). Conclusions: Many of the refugee children and adolescents had developed psychiatric disorders, or are at risk for PTSD and depression. Also, the ongoing ambiguity regarding their living conditions, interruption of their education, a lack of hope for the future and anxiety regarding the ones they left behind are considered to be risk factors for the development of psychiatric and social problems in the future. Living with family members and not having losses from the immediate family are protective factors. KEYWORDS: Posttraumatic stress disorder, depression, refugees, psychiatric disorder, risk factor, protective factor
... This type of therapeutic encounter is similar to what I have previously referred to as "therapeutic witnessing" (Papadopoulos, 1999(Papadopoulos, , 2001, a form of ordinary communication within an overall therapeutic intention and direction. ...
... Such approaches do not resonate with meaning making processes of an individual or address di¡erences in sociocultural values that might exist. In addition, these methods risk privileging particular phases of the refugee experience over others, such as the time when devastating events occurred pre migration, thus ignoring the traumatic nature of other phases of experience, such as survival and adjustment (Papadopoulos, 2001a;Papadopoulos, 2001b). Researchers should assist refugees to account for the entire range of their experiences, as opposed to certain phases in isolation, so as not to perpetuate the narrative of trauma as a purely pathological process. ...
Article
While the need for psychotherapeutic services for refugees is well documented, little is known about the acceptability and validity of these approaches, especially from refugee and sta¡ perspectives. Qualitative studies of user experience provide critical insight into the utility of current service approaches, and is both clinically and ethically indicated.Therefore, a systematic review of client and provider experiences of psychotherapeutic services is presented (11 studies), combining thematic synthesis and meta-ethnographic approaches. Key concepts to achieving acceptable care were: mutual understanding, addressing complex needs, discussing trauma and cultural competence. Each concept was enabled, or hindered, by a set of related themes. Results found that while practical assistance and advocacy are important to refugee clients, these aspects of care should remain rooted in therapeutic processes of mutual understanding, narrative continuity and self-empowerment through self-e⁄cacy. Further, more ethically rigorous research is still needed in this critical area
Article
This field reflection is a reflective dialogue between a supervisor and supervisee focusing on work with Afghan evacuees undertaken by the Centre for Anxiety, Stress & Trauma within Central and North West London NHS Foundation Trust. This field reflection focuses on five themes that emerged between the supervisor and supervisee during clinical supervision. The themes are posed as questions that may help others working in the context of a humanitarian crisis to utilize supervision to effectively support both staff and the target population. The reflections conclude with recommendations on how supervision can support staff well-being and, in turn, offer a supportive service to people feeling their homeland in the context of war.
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Актуальність дослідження: представлене дослідження сприяє розумінню вразливості та резильєнтності серед неповнолітніх, які не мають притулку у примусовій міграції до Європи та представляють результати втручання пілотної групи для підвищення резильєнтності та зменшення психологічного дистресу. Мета дослідження: метою дослідження було оцінити ефективність групового психосоціального втручання (за участю, ТП) для підвищення стійкості та зменшення психологічних страждань в неповнолітніх, які не мають притулку після переселення у Великобританії. Методи: вибірка (n = 30) представлена від 15 до 17 років, були випадковим чином віднесені до однієї з двох груп: експериментальна (n = 15) та контрольна (n = 15) груп. Експериментальна група отримала 14 годин інтервенцій для підвищення навичок резильєнтності. Вимірювання резильєнтності та психологічного дистресу вводили до та після інтервентів обох груп. Результати: Аналізи показали, що експериментальна група мала значно більш високі показники резильєнтності (тобто збільшення оптимістичного мислення, зменшення песимістичного мислення) та зниження психологічного дистресу (тобто зменшення депресивних симптомів) після інтервенції. Висновки: Психосоціальна інтервенція сприяла підвищенню резильєнтності та зменшенню психологічного дистресу у неповнолітніх без супроводу, які знаходяться у пошуку притулку
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This study is based on the group sandplay therapy that we provided to Burmese Chin children living in Malaysia as ethnic and religious refugees and our analysis of the themes in the children’s sandboxes using an art-based research method. All the participants were Burmese Chin refugee children aged 10 to 13 years old, attending an international refugee school in Kuala Lumpur, the capital of Malaysia. Participation was voluntary, with written consent from legal guardians. The sample chosen for the study comprised 12 children, with six males in one group and six females in the other group. Altogether, the children took part in five sandplay sessions, which lasted 120 minutes each. During these sessions, all the participants expressed individual the sandtray and then gathered to share and talk about the scenes they had made in the sand. After each session, it construed the children’s sand scenes, imaginative stories and symbolic image from an analytical psychology perspective and categorized the contents by common themes. As a result, six themes emerged: the loss of a place of life, abandoned children, bystanders, safety bases, and liberation/resettlement. Through the sandplay therapy, the refugee children could express their trauma in a safe, supportive environment. Sandplay provided these children with an opportunity to identify their trauma, independently overcome that trauma, and grow.
Article
The end of the last decade saw record numbers of refugee arrivals to Italy, straining the existing reception and integration systems. Although significant research attention has focused on the prevalence of posttraumatic stress disorder (PTSD), depression, and suicidal ideation in refugee populations, there are increasing calls to study the interactions between distress, resilience, and positive outcomes of adversity. To fully understand the complexity of the refugee experience, these voices must be heard in dialogue. Studies must be framed within a more nuanced view of refugees, characterizing them not exclusively as victims but also as advocates for their own well-being and the well-being of their communities. This exploratory study performed a thematic analysis of 15 interviews conducted with refugee community leaders in Italy, each a founder or leader of a community association and actively engaged in civil society. In keeping with Papadopoulos' (2007) construct of adversity-activated development, an inductive analysis identified three distinct patterns of positive adversity response: meaning, motivation, and mobilization. A deductive analysis identified the most appropriate theories of resilience to describe the sample, which included resilience as a dynamic positive adaptation and resilience as resistance to change in moral codes and personal value systems. The resulting image of refugee community leaders in Italy is that of individuals who are exposed to adversity and experiences of suffering and distress but safeguard their core values while positively adapting to a new country.
Chapter
Supervision beschäftigt sich bereits seit einiger Zeit mit der Begleitung und Beratung innerhalb von Gruppen und Organisationen, die sich der Unterstützung von Geflohenen haupt- oder ehrenamtlich widmen. Die Autoren sehen das sozialpädagogische Handlungsfeld Flucht- und Migration als Charakteristikum einer volatilen und komplexen VUCA-Welt, welchem vertiefte wirkungsorientierte Feldanalysen gewidmet werden sollten. Insbesondere die global-politische Relevanz dieser Thematik impliziert die Notwendigkeit einer kritischen Auseinandersetzung mit Supervision und Sozialer Arbeit in diesem Setting. Dieser Beitrag präsentiert eine Verknüpfung zweier Aspekte von Supervision in der Sozialpädagogik im Bereich Fluchtmigration: Einerseits wird das Arbeitsfeld Soziale Arbeit mit Geflohenen als Handlungsfeld von Supervision analysiert, andererseits ist Ziel dieses Artikels einen Transfer zwischen der theoretischen Analyse und der Praxis von Supervision herzustellen. Nach einer einleitenden Feldanalyse des VUCA-Begriffes und seiner Passgenauigkeit zur sozialpädagogischen Arbeit mit Geflohenen, folgt ein Einblick in die supervisorische Praxis in einer Einrichtung für unbegleitete minderjährige Flüchtlinge. Abschließend werden Handlungsimplikationen für die Supervision, aber auch für strategische und qualitative Positionen innerhalb der Hilfesysteme abgeleitet.
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Adolescence is a critical stage of development for health, well-being, and individual identity. As a result, mental health challenges often first emerge during adolescence. Refugee adolescents are a particularly vulnerable group, as normal adolescent stress is compounded with resettlement stress. This research examined how Syrian refugee adolescents conceptualize mental health. Data was collected using semi-structured interviews with Syrian refugee adolescents (n = 7) and service providers (n = 8) in the Greater Toronto Area. Data analysis was informed by grounded theory. The findings indicate that conceptualizations of mental health are highly dependent on how the concept is framed. However, when expressed using alternative descriptors, adolescents were able to identify factors that they believed influence mental health status, including factors at the individual, microsystem, and mesosystem level. Throughout interviews, aspects of adolescents’ identity emerged.
Article
Альбина Александровна Нестерова – д.психол.н., профессор, кафедра социальной психологии, Московский государственный областной университет, Москва, Россия. Электронная почта: anesterova77@rambler.ru Интенсификация миграционных процессов и их влияние на детей мигрантов создает необходимость разработки конструктивных, адаптированных с учетом возраста и социальной ситуации переселения программ развития и поддержания адаптационных ресурсов этой уязвимой группы мигрантов. Статья направлена на изучение особенностей адаптации несо­вершеннолетних детей мигрантов, которые не являются единой и однородной группой. В связи с этим необходим дифференцированный подход к организации сопровождения адаптационных процессов детей мигрантов, способов их поддержки. В междисциплинарном ключе рассматриваются их психосоциальные проблемы, обосновывается необходимость разработки различных для каждой группы детей способов поддержания их социального и психологического благополучия. Объектом исследования стали дети, охваченные миграционными процессами, среди которых: дети, мигрировавшие вместе с родителями (так называемое «полуторное поколение»); дети, родившиеся в семьях мигрантов в стране приема; дети-беженцы, находящиеся без сопровождения взрослых в ситуации локальных военных конфликтов; дети, оставленные/покинутые родителями–мигрантами в стране происхождения или пребывания. Так, дети, в разном возрасте покинувшие страну совместно с родителями («полуторное поколение»), часто сталкиваются с проблемой освоения языка, новой культуры, ощущением «культурной раздвоенности». Дети мигрантов, принадлежащие ко второму поколению, в большей мере демонстрируют потребность в поддержке процессов их идентификации и в развитии межкультурной компетентности. Для детей-беженцев необходима организованная психологическая помощь, которая требует профессиональной подготовки. Для детей, оставленных на родине родителями-мигрантами, нужна поддержка специалистов, понимающих психологические последствия эмоциональной депривации, разрыва привязанности и сепарации. Исследование проведено в период 2014–2017 гг. в Москве и Московской области на совокупной выборке 179 детей мигрантов. Кроме того, анализируются глубинные интервью с 18 детьми мигрантов в возрасте от 10 до 15 лет, выходцами из Узбекистана, Кыргызстана, Таджикистана, Армении, Украины, а также с их родителями и учителями.
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This article sets out to explore the use of art therapy with refugee children, from the perspective of art therapists and their experiences. Three semi-structured interviews were conducted to gain insights by capturing experiences and stories. Using thematic analysis, five themes were identified: (1) giving voice; (2) rebuilding trust, opening wounds; (3) sharing stories, healing pain; (4) exploring identity, discovering new-self; and (5) understanding art therapy. Upon reflection, two key aspects of art therapy were established, these were identified as: (1) providing refugee children with a safe space to heal and discover new-self, and (2) giving refugee children a voice to express and share stories. Despite the last of the five themes (understanding art therapy) being established as a factor that limits the use of art therapy, this has created an avenue for further research. From the findings, it was concluded that art therapy can be a useful form of psychotherapy for refugee children. Art therapy can provide these children with a safe space to heal, and give them a voice to be heard. Plain-language summary This research explores the use of art therapy with refugee children from the art therapist’s perspective. Three semi-structured interviews were carried out with art therapists who had experience of working with refugee children. Once interviews were collected, these were then analysed using a method of analysis which enables common themes to be found amongst the unique set of experiences and stories collected. The analysis generated five themes, which were: (1) Giving Voice, (2) Rebuilding Trust, Opening Wounds, (3) Sharing Stories, Healing Pain, (4) Exploring Identity, Discovering New-self, and (5) Understanding Art Therapy. The first four themes suggested that art therapy is a useful form of therapy for refugee children. However, theme 5 (understanding art therapy) could be a limitation for art therapy with this client group, as art therapy is often unknown to them. Taking this research forward, it will be important to explore the use of art therapy with refugee children by carrying out further research with the children themselves. In conclusion, art therapy can be a useful form of therapy for refugee children. Art therapy provides these children with a safe space to heal, and gives them a voice to be heard.
Article
Adopting a children's rights perspective, a critique and analysis underpinned by documentary research methodology was undertaken in order to assess the extent to which the government's Green Paper (Department of Health and Social Care and Department of Education, 2017. Transforming children and young people's mental health provision: a green paper. Available at: https://www.gov.uk/government/consultations/transforming-children-and-young-peoples-mental-health-provision-a-green-paper (accessed 7 December 2017)) addresses the mental health and well-being needs of refugee children and young people in England and Wales, identifying strengths, limitations and challenges for future policy and practice. Findings suggest that there is much of potential benefit to refugee children and young people's future mental health and well-being. However, a paradigm shift, explicit in implications, scale and time frame, will be required, if the Green Paper is to achieve those changes in attitudes, practice and service delivery which it anticipates. We argue that this Green Paper's overarching challenge is that it is premised on Western-centric models in its understanding of the experiences of refugee children and young people, and management of trauma and mental health. It fails to recognize the meanings and significance of culture, and of diversity and difference, and the need to invest in all communities in facilitating engagement and support for children and young people's mental health issues.
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Numerous studies have linked the high rates of traumatic events experienced by refugees to the elevated rate of mental health problems in these populations. A growing body of evidence has also highlighted the importance of considering postmigratory stressors when making sense of displaced person distress. This study explored the relationship between mental health and postmigratory stress for asylum seekers and refused asylum seekers in Britain. The study further examined if those refused asylum experienced elevated distress and postmigratory stress compared to those awaiting the outcome of asylum applications. Results indicated that participants (N = 97) had endured a range of pre- and postmigratory stressors and had high scores on measures of anxiety, depression, and PTSD. A postmigratory factor comprising items associated with isolation, restrictive policies, and stressors associated with having an insecure immigration status, was significantly associated with PTSD scores. This relationship remained when controlling for the variance accounted for by premigratory trauma predictors. Being refused asylum was the strongest predictor of depression and anxiety. Those refused asylum scored higher on a factor associated with barriers to accessing services. Social materialist theories of distress are drawn upon to contextualise the heightened vulnerability of those refused asylum. The paper concludes by emphasising the problems associated with taking an exclusively trauma-focussed approach when working with asylum seekers and argues for community orientated interventions to support displaced people to cope with the various stressors endured in exile.
Thesis
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Abstract Afghan refugees in Greece are trapped in a stalemate of continuously postponed or temporarily progressed levels of integration into the EU/Greek process of asylum. Asylum applications and the follow up interviews are carried out between 7 to13 years after the original claim. A population based cross sectional study was used to assess the association between trauma and quality of life among long-term Afghan refugees living in Greece. Convenience sampling was used to identify and recruit subjects in June and July 2016. All subjects were males, identifying as ethnic Hazara, with the mean age 29 (SD ±4.87) years that ranged from 19 to 45 years. The mean length of stay was 9.8 years (SD ± 2.61) and ranged from 5 to 16 years. Participants completed self-reported questionnaires, consisting of the Afghan Symptom Checklist (ASCL), the World Health Quality of Life scale (WHOQOL-BREF), an adapted version of the Comprehensive Trauma Inventory-104 (CTI-104), and a modified Psychological Acculturation Scale (PAS). Odds ratio and 95% confidence intervals were used to assess the association between trauma (torture and hardship) and quality of life. Stratification analysis assessed the association between trauma and quality of life by depression status. Age, length of stay, acculturation and torture or hardship was also examined. Bivariate analyses showed that people who were acculturated were almost twice as likely to have a good quality of life compared to those who were not acculturated. The current study advocates for further research concerning mental health services for refugee in Greece. Keywords: Afghanistan, Refugees, Greece, Asylum, Quality of life, Mental Health
Article
This research investigates the perceptions of refugee children, refugee parents and school staff regarding the positive adaptation of refugee children in a new social context and the effects on mental health and psychological well-being. This included an exploration of resilience and the role of risk and protective factors. Few studies have focused on views from a resilience perspective, and these have tended to use quantitative rather than qualitative measures. This mixed methods piece of “real world” research adopted a “what’s working well” perspective and explored the important voices of these children, parents and school staff. Staff, parent and child responses were triangulated to provide a rich picture of the potential protective factors operating within the school and family environment. Implications for practice are discussed.
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The objective of this essay is to demonstrate the multidimensionality of refugee experience with reference to the Palestinian refugee problem, which has become one of the longest standing issues in the world. I will be using the novel Taam Al- Foraq (‘A Taste of Exile’), written by Rabea Al Madhoun in order to illustrate some of the main dimensions of refugee experience in general, and Palestinian refugee situation in particular. Furthermore, I will evaluate themes such as trauma humiliation, frustration of hope and loss of home as they appear in the novel and assess the psychological impacts that they have on refugees. In this essay I am going to identify the salient psychological impacts resulting from “the Nakaba” throughout ‘A Taste of Exile’: trauma’, ‘nostalgic disorientation’, and hope and humiliation. I will examine how these are reflected in this novel, using Papadopoulos's ‘Trauma Grid, Adversity activated Development (AAD), and Nostalgic Disorientation’3. I shall also be making use of Boris's4 theory of hope and Lindner's5 theory of humiliation, in order to show that refugee experience involves numerous dimensions and that it cannot be understood solely through reference to PTSD.
Chapter
This chapter brings together two global developments: the increasing number of transnational families and the expansion of information and communication technologies (ICTs). It is assumed that we as family/systemic therapists and trainers have to react to these changes by providing new concepts as well as new methods. “World families” make visible how globalization becomes embodied in marital and family relations; this model criticizes explicitly the “methodological nationalism” (Beck and Beck Gernsheim 2010) usually applied in family studies. We propose the Genogram 4.0 Interview for therapy, training and research. This tool scrutinizes unquestioned certainties like the concept of “home” and focuses on the use of digital technology in everyday communication processes. It shall help us to understand how one-national or transnational families are “doing family” (Morgan 1996) in the world today.
Chapter
War rips the social fabric of refugees’ lives, disrupting physical, psychological, and emotional structures that may have been in place for generations and leaving persons without a home and without a sense of belonging. This chapter engages a crucial dimension of trauma—the disruption of the unifying thread of temporality—and the unique challenges presented by ambiguous loss in internally displaced Greek Cypriot refugee families with a missing member. A clinical vignette highlights the different ways family members respond or recalibrate to identification of remains of a loved one. Therapeutic work with refugee families erodes the Western dichotomy between public and private, and involves modalities that move beyond the “talking cure” of traditional psychotherapy. The chapter concludes with a brief discussion of the discourse of refugee trauma and the positionality of systemic practitioners who seek to be helpful with refugee families.
Chapter
This chapter discusses the relationship between migration and mental health, as it is illustrated in the way trends are formulated, in the field of relevant research on the one hand and, on the other, in the recommendations offered for the mental health of migrants on the other. The second part deals with the basic organisational and operational aspects of a mental health unit for migrants, the Babel Day Centre (Athens, Greece), and presents the challenges that its multidisciplinary team faces along with the ways it attempts to manage them. Upon completion of this chapter, the reader will have received ample stimuli for reflection on the important issue of service provision to migrants.
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This article outlines some key elements of therapeutic work with a group of Bosnian medical evacuees and their families. The unusual feature of this work has been the fact that the clients had not requested any psychological assistance and the therapist had to adapt to this fact and develop ways of dealing with it. The approach followed emphasizes the importance of ‘therapeutic presence’ instead of imposing formal psychotherapy, and is characterized by an avoidance of psychologizing the evil nature of war atrocities and pathologizing political dimensions. Six central dilemmas which therapists and clients face in connection with this type of work are identified and discussed, and suggestions are offered for developing appropriate therapeutic strategies in these contexts.
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The scale of refugee movements has expanded dramatically in recent years. At the same time international assistance for refugees and displaced persons has declined. Increasingly limited opportunities for resettlement and limited resources for assistance do not bode well for meeting the nutritional, housing, health, and psychological needs of millions of adults and children. This article reviews these global trends and identifies the international and service issues they raise. Future prospects for meeting the needs of refugees and for repatriation are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Two paradigms that have shaped our understanding of refugee health are identified: the objectification of refugees as a political class of excess people, and the reduction of refugee health to disease or pathology. Alternative paradigms are recommended: one to take the polyvocality of refugees into account, and one to construe refugees as prototypes of resilience despite major losses and stressors. The article is organized into three sections, mirroring the life history of refugees from internal displacement in the country of origin to asylum in a second (usually neighboring) country, and for some, to permanent resettlement in a third country. In each of the three sections, the primary topics that are treated in the literature are identified, and key problems identified for discussion.
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This paper examines some of the difficulties of exporting the Western concept of Post Traumatic Stress Disorder (PTSD) to non-Western cultures. Using data drawn from Guatemala 1 where I lived and worked among Quiché Mayan war widows, illustrates how cultural ly-specif ic understandings of events and reactions to them affect the well-being (or otherwise) of people exposed to extreme adverse events. The paper turns² to the voices of the widows, who experienced and survived intense political conflict, explaining their experiences of violence within their particular context.
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A central assumption behind psychiatric diagnoses is that a disease has an objective existence in the world, whether discovered or not, and exists independently of the gaze of psychiatrists or anyone else. In other words, neolithic people had post-traumatic stress disorder as have people in all epochs since. However, the story of post-traumatic stress disorder is a telling example of the role of society and politics in the process of invention rather than discovery. The diagnosis is a legacy of the American war in Vietnam and is a product of the post-war fortunes of the conscripted men who served there. They came home to find that they were being blamed for the war. Epithets like “babykiller” and “psychopath” were thrown at them by some who had watched on television the US military's atrocities against defenceless peasants. This reception was a primary factor in the well publicised difficulties—such as antisocial behaviour—that some military personnel had in readjusting to their peacetime roles. Those who were seen by psychiatrists were diagnosed as having an anxiety state, depression, substance misuse, personality disorder, or schizophrenia; these diagnoses were later supplanted by post-traumatic stress disorder. Early proponents of the diagnosis of post-traumatic stress disorder were part of the antiwar movement in the United States; they were angry that military psychiatry was being used to serve the interests of the military rather than those of the soldier-patients. The proponents lobbied hard for veterans to receive specialised medical care under the new diagnosis, which became the successor to the older diagnoses of battle fatigue and war neurosis. The new diagnosis was meant to shift the focus of attention from the details of a soldier's background and psyche to the fundamentally traumatogenic nature of war. This was a powerful and essentially political transformation: Vietnam veterans were to be seen …
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The scale of refugee movements has expanded dramatically in recent years. At the same time international assistance for refugees and displaced persons has declined. Increasingly limited opportunities for resettlement and limited resources for assistance do not bode well for meeting the nutritional, housing, health, and psychological needs of millions of adults and children. This article reviews these global trends and identifies the international and service issues they raise. Future prospects for meeting the needs of refugees and for repatriation are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Book
The word 'position' has long been used in the field of social psychology. Now social psychologists are creating new theories on group positioning by studying everyday language and discourse and the application of some of these ideas has revealed the necessity of paying close attention to the local moral order within which both public and private intentional acts are performed. The study of local moral orders as ever-shifting patterns of rights and obligations of speaking and acting has come to be called by a new name - positioning theory - of which Rom Harré is one of the leading exponents. In this book, Rom Harré gives a state of the art overview of positioning theory via contributions from some of the world's leading experts in the field.
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"A War of Nerves" is a history of military psychiatry in the twentieth century--an authoritative, accessible account drawing on a vast range of diaries, interviews, medical papers, and official records, from doctors as well as ordinary soldiers. It reaches back to the moment when the technologies of modern warfare and the disciplines of psychological medicine first confronted each other on the Western Front, and traces their uneasy relationship through the eras of shell-shock, combat fatigue, and post-traumatic stress disorder. At once absorbing historical narrative and intellectual detective story, A War of Nerves" weaves together the literary, medical, and military lore to give us a fascinating history of war neuroses and their treatment, from the World Wars through Vietnam and up to the Gulf War. In so doing, he answers recurring questions about the effects of war. Why do some men crack and others not? Are the limits of resistance determined by character, heredity, upbringing, ideology, or simple biochemistry? Military psychiatry has long been shrouded in misconception, and haunted by the competing demands of battle and of recovery. Now, for the first time, we have a definitive history of this vital art and science, which illuminates the bumpy efforts to understand the ravages of war on the human mind, and points towards the true lessons to be learned from treating the aftermath of war.
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Trauma and Recovery: The Aftermath of Violence — from Domestic Abuse to Political Terror, Judith Lewis Herman. New York: Basic Books, 1992. 276 pp. 27.00.ISBN0465087655.ShatteredAssumptions:TowardANewPsychologyofTrauma,RonnieJanoffBulman.NewYork:TheFreePress,1992,256pp.27.00. ISBN 0-465-08765–5. Shattered Assumptions: Toward A New Psychology of Trauma, Ronnie Janoff-Bulman. New York: The Free Press, 1992, 256 pp. 24.95. ISBN 0-02-916015–4.
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Post-traumatic stress disorder (PTSD) is increasingly recognized as both a disorder of enormous mental health and societal burden, but also as an anxiety disorder that may be particularly understandable from a scientific perspective. Specifically, PTSD can be conceptualized as a disorder of fear and stress dysregulation, and the neural circuitry underlying these pathways in both animals and humans are becoming increasingly well understood. Furthermore, PTSD is the only disorder in psychiatry in which the initiating factor, the trauma exposure, can be identified. Thus, the pathophysiology of the fear and stress response underlying PTSD can be examined and potentially interrupted. Twin studies have shown that the development of PTSD following a trauma is heritable, and that genetic risk factors may account for up to 30-40% of this heritability. A current goal is to understand the gene pathways that are associated with PTSD, and how those genes act on the fear/stress circuitry to mediate risk vs. resilience for PTSD. This review will examine gene pathways that have recently been analysed, primarily through candidate gene studies (including neuroimaging studies of candidate genes), in addition to genome-wide associations and the epigenetic regulation of PTSD. Future and on-going studies are utilizing larger and collaborative cohorts to identify novel gene candidates through genome-wide association and other powerful genomic approaches. Identification of PTSD biological pathways strengthens the hope of progress in the mechanistic understanding of a model psychiatric disorder and allows for the development of targeted treatments and interventions.
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![][1] This is a timely publication. Military psychiatry is currently in the spotlight, owing to the recent commencement of a class action in the High Court alleging that the British military medical services failed in their duty of care to prevent trauma and then adequately treat
Article
We hope that we have presented information in a way that is accessible to clinicians, laypersons, and . . . other people who have experienced trauma. We have also tried to summarize a far-flung literature and describe a way of understanding the process of growth that will encourage more attention from researchers. In addition, we believe that this book can be used as a supplementary text in courses on human development, crisis intervention, and introductory courses in counseling and psychotherapy. It is also our hope that this book will be useful as a resource for helping professionals in a variety of disciplines, including psychology, social work, psychiatry, family counseling, human services, nursing, and sociology. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
In this book I explore the ways in which texts of a certain period—the texts of psychoanalysis, of literature, and of literary theory—both speak about and speak through the profound story of traumatic experience. The chapters . . . explore the complex ways that knowing and not knowing are entangled in the language of trauma and in the stories associated with it. Each one of these texts engages, in its own specific way, a central problem of listening, of knowing, and of representing that emerges from the actual experience of the crisis. My main endeavor is . . . to trace in each of these texts a different story, the story or the textual itinerary of insistently recurring words or figures. The key figures my analysis uncovers and highlights—the figures of "departure," "falling," "burning," or "awakening"— in their insistence, here engender stories that in fact emerge out of the rhetorical potential and the literary resonance of these figures, a literary dimension that cannot be reduced to the thematic content of the text or to what the theory encodes, and that, beyond what we know or theorize about it, stubbornly persists in bearing witness to some forgotten wound. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
the present chapter has 3 major purposes: (a) to summarize and critically review the existing cross-cultural posttraumatic stress disorder (PTSD) literature, especially as it pertains to veterans and refugees, the 2 groups most frequently studied; (b) to discuss some of the major conceptual and methodological issues involved in understanding the relationship between culture and PTSD; and (c) to recommend conceptual and research approaches for studying enthnocultural aspects of PTSD (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Trauma is increasingly understood in terms of its effect on cognitive–affective meaning structures and processes, referred to as themes. This idea is contextualized within the theoretical perspectives now dominant in the field of traumatic stress to illustrate its potential as a unifying principal. An argument is developed for the clinical utility of focusing on themes in both assessment and treatment, and recent research supporting this perspective is reviewed. A clinical case is presented to illustrate the utility of a thematic approach to assessment and treatment. Finally, limitations and future directions of the research are discussed.
Article
Refugee families referred for therapy present a wide array of problems and expectations, not always in accordance with what therapy may offer. Major differences between referring professionals, families and therapists regarding problem definitions and solutions may complicate collaboration. Interventions that may overcome these barriers and move initial interviews into a therapeutic context are described. Three patterns regarding referral process, problem presentation and expectations (here called referral contexts) are outlined: ‘the relational’, where families ask for psychological and interpersonal assistance, ‘the unfocused’, where families are referred to therapy without expressing any wish for it, and ‘the fixed solution’, where families seek support for solutions that are not of a therapeutic nature. The interventions described form part of a negotiation where motives and interest for therapy are explored and agreements regarding further therapy are outlined.
Article
War and political atrocity are endemic, and the denial of what has befallen survivors who become refugees has both therapeutic and human rights dimensions. The work described in this article considers the psychological and political aspects of the suppression of memory and culture and how psychotherapy engages with these processes. Narrative, in its customary form as the creation of stories, is discussed as one of the ways of enabling survivors to be given a voice that allows them to process events of atrocity, displacement and exile. The usefulness of psychoanalytic ideas and their integration with systemic practice is demonstrated. The interplay between difficult psychotherapeutic material, the patient or family and the therapist is shown and the use of supervision noted. The discussion is exemplified with descriptions of therapeutic work with individuals, families and small groups. The thinking that emerges is applicable not only to work with survivors but has general implications for systemic work in general as it struggles with its contemporary identity.
Article
Programmes costing millions of dollars to address 'posttraumatic stress' in war zones have been increasingly prominent in humanitarian aid operations, backed by UNICEF, WHO, European Community Humanitarian Office and many nongovernmental organisations. The assumptions underpinning this work, which this paper critiques with particular reference to Bosnia and Rwanda, reflect a globalisation of Western cultural trends towards the medicalisation of distress and the rise of psychological therapies. This paper argues that for the vast majority of survivors posttraumatic stress is a pseudocondition, a reframing of the understandable suffering of war as a technical problem to which short-term technical solutions like counselling are applicable. These concepts aggrandise the Western agencies and their 'experts' who from afar define the condition and bring the cure. There is no evidence that war-affected populations are seeking these imported approaches, which appear to ignore their own traditions, meaning systems, and active priorities. One basic question in humanitarian operations is: whose knowledge is privileged and who has the power to define the problem? What is fundamental is the role of a social world, invariably targeted in today's 'total' war and yet still embodying the collective capacity of survivor populations to mourn, endure and rebuild.
Article
There are pitfalls in the singular application of western categories in diagnosing psychiatric disorders and distress among refugees. Based on my research with Cambodian refugees I argue that cultural bereavement, by mapping the subjective experience of refugees, gives meaning to the refugee's distress, clarifies the 'structure' of the person's reactions to loss, frames psychiatric disorder in some refugees, and complements the psychiatric diagnostic categories. Cultural bereavement includes the refugees' picture--what the trauma meant to them; their cultural recipes for signalling their distress; and their cultural strategies for overcoming it--and the cultural interpretation of symptoms commonly found among refugees that resemble post-traumatic stress disorder. Cultural bereavement may identify those people who have post-traumatic stress disorder on the Diagnostic and Statistical Manual (DSM) criteria but whose 'condition' is a sign of normal, even constructive, rehabilitation from devastatingly traumatic experiences. Cultural bereavement should be given appropriate status in the nosology.
Article
In this paper, destructiveness is approached as a multi-dimensional phenomenon where the mental health perspective addresses only one of these dimensions. An attempt is made to locate this phenomenon in the context of epistemological and societal considerations. Critical of mono-dimensional explanations based on causal-reductive epistemology, the paper instead proposes the idea of an 'ecology of destructiveness', according to which mental health professionals cannot possibly continue to assume the role of detached observers. The ordinariness and archetypal fascination of destructiveness are discussed as preventing the psychologizing and pathologizing of it. In addition, it is suggested that 'destructiveness may be a tragic facet of the human condition', without this implying any justification of it. Based on my work with a group of Bosnian ex-camp prisoners, some basic principles of how one can work with survivors of atrocities are derived and discussed. A central feature of this work is the attempt to create an appropriate therapeutic context within which a 'therapeutic presence' and 'therapeutic witnessing' can be developed. Finally, the relevance of Jungian insights to this kind of work is reviewed and the emergence of new types of defences of the self is identified.
Article
Programmes costing millions of dollars to address 'posttraumatic stress' in war zones have been increasingly prominent in humanitarian aid operations, backed by UNICEF, WHO, European Community Humanitarian Office and many nongovernmental organisations. The assumptions underpinning this work, which this paper critiques with particular reference to Bosnia and Rwanda, reflect a globalisation of Western cultural trends towards the medicalisation of distress and the rise of psychological therapies. This paper argues that for the vast majority of survivors posttraumatic stress is a pseudocondition, a reframing of the understandable suffering of war as a technical problem to which short-term technical solutions like counselling are applicable. These concepts aggrandise the Western agencies and their 'experts' who from afar define the condition and bring the cure. There is no evidence that war-affected populations are seeking these imported approaches, which appear to ignore their own traditions, meaning systems, and active priorities. One basic question in humanitarian operations is: whose knowledge is privileged and who has the power to define the problem? What is fundamental is the role of a social world, invariably targeted in today's 'total' war and yet still embodying the collective capacity of survivor populations to mourn, endure and rebuild.
The role of cognitive-affective themes in the assessment and treatment of trauma reactions 420 Renos K. Papadopoulos ã 2001 The Association for Family Therapy and Systemic Practice rMarsella, A Ethno-cultural diversity and the international refugee. Challenges for the global community
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Lebowitz, L. and Newman, E. (1996) The role of cognitive-affective themes in the assessment and treatment of trauma reactions. Clinical Psychology and Psychotherapy, 3: 196–207. 420 Renos K. Papadopoulos ã 2001 The Association for Family Therapy and Systemic Practice rMarsella, A.J. (1992) Ethno-cultural diversity and the international refugee. Challenges for the global community. In A.J. Marsella et al. (eds) Amidst Peril and Pain. The Mental Health and Social Wellbeing of the World’s Refugees. Washington, DC: American Psychological Association
Refugees, therapists and trauma: systemic reflections. Context: The Magazine of the Association for Family Therapy
  • R K Papadopoulos
Papadopoulos, R.K. (2001) Refugees, therapists and trauma: systemic reflections. Context: The Magazine of the Association for Family Therapy, 54: 5-8. Special edition on refugees, edited by Gill Gorell Barnes and Renos K. Papadopoulos.
Amidst Peril and Pain. The Mental Health and Social Wellbeing of the World's Refugees
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  • J Jaranson
Friedman, M. and Jaranson, J. (1992) The applicability of the PTSD concept to refuges. In A.J. Marsella et al. (eds) Amidst Peril and Pain. The Mental Health and Social Wellbeing of the World's Refugees (pp. 207-228). Washington, DC: American Psychological Association.
Is home where the heart is? Narratives of oppositional discourses in refugee families
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