Current perspectives on assessment and therapy with survivors of torture: the use of a cognitive behavioural approach

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Increasing numbers of refugees are presenting to mental health services in Europe and Scandinavia and pose significant clinical challenges for practitioners. The most clinically challenging to engage in a psychotherapeutic context are survivors of torture and politically organized violence. Much of the literature on therapeutic work with torture survivors has tended to focus on psychodynamic approaches. There have also been attempts to describe other approaches, such as the use of testimony, with some attempts to study and describe cognitive behavioural approaches in torture survivors. It has been demonstrated that cognitive behavioural therapy is effective for PTSD, as recommended by the NICE (2005) guidelines for the assessment and management of PTSD in primary and secondary care. This paper will review and critique the current literature on therapy with refugees and survivors of torture. Through case examples, the use of CBT will be illustrated as an effective treatment intervention for this group. It will be demonstrated that the model can have effective clinical outcomes and provide a practical, problem-orientated approach to working with survivors of torture and political violence. This paper will also describe the use of assessment and treatment approaches using CBT principles, demonstrating the flexibility and applicability of the model. It also demonstrates the utility of CBT in different cultural contexts, despite perceived cultural limitations. Implications for assessment and practice in a cross-cultural setting will be discussed.