Multi-layered systemic and narrative interventions with refugees and asylum seekers in a community child and adolescent mental health service

Amias, David, Hughes, Gillian and Barratt, Sara (2014) Multi-layered systemic and narrative interventions with refugees and asylum seekers in a community child and adolescent mental health service. Human Systems: The Journal of Therapy, Consultation & Training, 25 (1). pp. 20-30. ISSN 0960-9830

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It is argued here that work with refugee communities requires a dif-ferent approach to standard therapeutic practice, in order to account for the specific contexts of refugee lives. The work of a Refugee team based in a Child and Adolescent Mental Health Service (CAMHS) at the Tavistock Centre in London is presented here as a multi-layered set of systemic and narrative-based interventions in the domains of direct clinical work with individuals, families and groups, communi- ty interventions, consultation and teaching. Included in the paper is a detailed case example of the treatment of a young Afghani asylum seeker to illustrate the complexity of typical referrals to the team and the multi-modal approach used to address the presenting concerns. Work with refugee and asylum seeking families is fraught with complexity as many authors have noted (Papadopoulos 2002). Often member of such families have been exposed to violence, traumatic separations from loved ones, destruction of their property and other gross human rights violations, including violence from state institutions. The loss of trust in others has made people fearful and suspicious of external agencies even those purporting to offer them help. When they are referred to a mental health service whose task may be mysterious to them their suspicions of the role of professionals may be heightened. Furthermore the way that distress is shown cannot be related to a specific diagnosis or clear-cut mental health difficulty, but rather thorough traumatic experiences at multiple levels where even contact with helping services can be perceived as potentially re-traumatising. Consider the following account of a session with an Afghani refugee: Mr C said the two children shout and cry and then his wife does the same. It becomes too much to bear. ‘When they shout I need to go out’. When I commented on his poor health and how much pressure both were suffering he became angry and vented his frustration at the situation in Afghanistan. He spoke with fury about how Afghan society is broken and how the British and Americans originally supported the Taliban. At one point he seemed to be directing his anger personally at me as representing the British and what ‘we’ have done to his country. He was profoundly pessimistic about the prospects of any change saying it is their `very bad luck’. Here the attempt to help is politicised and associated with intrusion and invasion.

Item Type: Article
Subjects: Race and Culture > Refugees
Department/People: Children, Young Adult and Family Services

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