C3. Clinical Treatment Approaches – Oral Paper Session

Friday, 31 March 2017

Responding to refugee trauma: Explorations in narrative practices with people from refugee and asylum seeking backgrounds

Narrative therapy is a therapeutic practice that is informed by the idea that people know themselves through stories. It sees people’s lives and identities as multi-storied; though often there are dominant stories that can be highly problem-saturated. Narrative therapy seeks to discover and richly describe preferred, alternative stories. Narrative therapy sees people as separate to problems and is known for the idea, ‘the person is not the problem, the problem is the problem’. Narrative therapy positions people as experts in their lives and views them as having skills, knowledge, abilities, values, and commitments.

Narrative therapy has been drawn on to respond to trauma in a range of contexts. Michael White, co-founder of narrative therapy said:
When a person has been through recurrent trauma, their ‘sense of myself’ can be so diminished it can be very hard to discover what it is they give value to. This is because recurrent trauma is corrosive of what people treasure in life. It’s a violation of their purpose in life and of their sentiment of living. (2004, p. 46)

This paper will explore the application of narrative therapy as a response to experiences of trauma for people from refugee backgrounds. In the context of working with people from refugee backgrounds who have experienced trauma, this paper will consider:

– How might practices that seek to thicken multiple stories of self contribute to wellbeing?
– How might practices that position people as experts in their own lives contribute to wellbeing?
– How do practitioners engage with stories of trauma, while also hearing stories of resistance?

This paper will present some narrative principles as particularly relevant to responding to refugee trauma. It will explore useful narrative practices such as, double listening, documentation, and witnessing. Finally this paper will particularly use stories of practice from our work as Counsellor Advocates at Foundation House.

Chanelle Burns (Victorian Foundation for Survivors of Torture), Emma Preece Boyd (Victorian Foundation for Survivors of Torture (Foundation House)

Results from three consecutive randomised trials on the treatment effect among trauma-affected refugees: -What have we learnt and where should we go from here?

For many years there has been a lack of high quality studies looking at treatment outcome among trauma-affected refugees. Results from previous studies have pointed to a high level of emotional distress, a complexity in mental health and social problems and ongoing stressors affecting the present mental health. Since the Competence Centre for Transcultural Psychiatry (CTP) in Copenhagen was established in 2008, research on treatment outcome has been one of the primary focus areas. So far, three pragmatic randomised trials have been finished with a focus on the following treatment modalities:

1. Flexible cognitive behavioural therapy (CBT) and psychoeducation in combination with pharmacological treatment (sertraline and mianserin)

2. CBT with a focus on either stress management or cognitive restructuring

3. Pharmacological treatment with either sertraline or venlafaxine

The objective of this presentation is to describe the rationale, design and results from the first three randomised trials carried out at CTP and to on the basis of these large and methodological rigorous studies, summarize and discuss the results so far. Finally future directions for treatment outcome research will be discussed.

Jessica Carlsson (Competence Centre for Transcultural Psychiatry, Denmark), Charlotte Sonne (Competence Centre for Transcultural Psychiatry, Denmark)

Cross Cultural Assessment and Treatment of Psychological Trauma and PTSD: Western Conceptualisations and Eastern Experiences

War has a catastrophic effect on the psychological health and well-being of nations, communities, families and individuals. Refugees and asylum seekers represent a diverse range of cultural, religious and ethnic backgrounds. The relationship between trauma and culture is both significant and bi-directional. Trauma theorist Jerome Kroll and Laurence Kirmayor perceived the notion of trauma as a timeless, biological response to adversity that occurs independently of culture as naive. The experience of psychological trauma and the emotional reactions differ from culture to culture. Many Eastern communities have existed as a collective self for generations and it is crucial to acknowledge this in our current trauma approaches.

Culturally appropriate psychological trauma work can be achieved with an understanding of traditional cultural practices, through the use of religious symbolism and folk stories, re-telling trauma experiences through culturally appropriate language, exploring cultural norms and traditional ways of coping with stressors and providing psycho-education to reduce mental health stigma. Clinical interventions, culturally appropriate models, therapist’s awareness of their own cultural biases and challenges to therapy will be discussed.

Neeraja Sanmuhanathan (STARTTS)

Breaking the Silence through MANTRA: Empowering MAN survivors of Torture and Rape

The intense dread many individuals seeking asylum experience when they are expected to think and talk about their past may be directly linked to the extreme forms of torture and sexual violence they have endured. Specific forms of torture, especially details of sexual violence are seldom mentioned by men even in the safety of a therapeutic relationship. It is likely that desperate acts, such as self-harm are considered by survivors in efforts to cope with the humiliation, intense pain and the sequelae of torture and sexual violence.
Many individuals seeking asylum may not be ready or able to process their horrific traumas even when threatened with forced repatriation. Therapeutic approaches have generally relied on a combination of strategies to sustain and facilitate improvements in functioning. However, it has been observed that symptoms could persist, and an inability to form coherent narratives and integrate the past is a potential barrier to healing.

The authors therefore adopted a combination of group and individual treatment approaches to assist survivors to form a meaningful narrative of their past, by integrating multiple strategies, incorporating principles of NET (Narrative Exposure Therapy), cultural narratives and practices such as pranayama and mantras in a culturally sensitive manner.

Evaluation and psychometric measures indicate that these interventions contradicted the long standing belief that individuals seeking asylum may not be ready or willing to process their difficult past prior to the resolution of their claims for protection. As survivors began to integrate and construct a narrative of their past traumas the intensity of their symptoms of anxiety, avoidance and arousal decreased, and survivors became increasingly confident to share their traumas.

Assisting clients to narrate trauma experiences, gradually led to habituation to these experiences. The reduction in anxiety and the intensity of the emotional response to the traumatic memory led to the onset of a recovery process.

Pearl Fernandes (STARTTS), Yvette Aiello (STARTTS)