Abstract
BackgroundDespite a high burden of mental health problems among refugees, there is limited knowledge about effective mental health care provision for this group. Although substantial efforts in understanding the complexity of cross-cultural psychotherapy – which in the context of this study we use to refer to therapy with client and therapist of different cultural backgrounds – have been made, there remains a dearth of research exploring barriers for effective cross-cultural psychotherapy. This study aimed at narrowing this gap in knowledge by exploring major challenges encountered by psychotherapists in cross-cultural psychotherapy and strategies which have proven useful in overcoming such challenges.MethodsWe employed a qualitative study design, conducting semi-structured in-depth interviews with 10 purposely selected psychotherapists working with refugees in Germany. Respondents were from varying theoretical background and had varying levels of experience. Data were analyzed using a thematic approach, following a mix of deductive and inductive coding.ResultsRespondents reported three main challenges in their cross-cultural practice: different or unrealistic expectations of clients towards what psychotherapy would offer them; challenges grounded in different illness explanatory models; and communication challenges. In dealing with these challenges, respondents recommended psychoeducation to overcome issues related to problematic expectations towards psychotherapy; “imagining the real”, identifying “counter magic” and other client-appropriate resources to deal with issues related to clients’ foreign illness attributions; and translators in dealing with communication barriers, though the latter not univocally.ConclusionsResults show that psychotherapy with refugees can be very successful, at least from the psychotherapist perspective, but also poses significant challenges. Our findings underline the importance of developing, testing, and institutionalizing structured and structural approaches to training psychotherapists in cross-cultural therapy at scale, to accommodate the rising mental health care need of refugees as a client group.
Highlights
Despite a high burden of mental health problems among refugees, there is limited knowledge about effective mental health care provision for this group
Asylum seekers and refugees are exposed to various traumatic events pre, peri, or post-migration, which put them at high risk to develop mental health issues [4, 5]
In the following, we first present the main challenges in working with refugee clients reported by participants, and the strategies they have found useful in dealing with these challenges
Summary
Despite a high burden of mental health problems among refugees, there is limited knowledge about effective mental health care provision for this group. Recent reviews on the prevalence of mental health issues among young and adult refugees and asylum seekers in Europe reported higher prevalences of posttraumatic stress disorder, anxiety disorders, depression, and other mental health issues compared to the general population [6,7,8], with substantial variation by origin and other factors. This emerging client group and their health care needs challenge existing care systems in host countries, including Germany. The extent to which these factors limit refugees’ actual access to mental health care are underlined by a recent study showing that in a major German refugee registration and reception center, not one of the newly arrived refugees referred to psychotherapy had received outpatient psychotherapeutic treatment within 3 months of their referral [23]
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