Adapting therapeutic models of care for refugees: A qualitative inquiry into staff and client experiences of family therapy

Abstract

Refugees resettling in a new country often present with complex needs, however little is known about the validity of standard Western psychotherapeutic approaches in this context. This thesis begins with consideration of broader literature pertaining to what is known about psychotherapeutic intervention for refugees, before focusing in on the first study - a qualitative systematic review of 11 studies of staff and client service experiences. Using thematic synthesis and meta-ethnographic methods, key concepts to achieving acceptable care in praxis are identified, alongside barrier and enabler themes. Findings highlight the importance of rooting practical assistance within therapeutic processes of mutual understanding, narrative continuity and empowerment. The thesis continues with a focus on addressing relational trauma. Study two explores staff and client experiences of Strength to Strength, a rare and innovative family counseling service for refugees in Australia. The service model built on post-Milan systemic principles to include innovative cultural and trauma-informed aspects of care. Thematic analysis and narrative inquiry were undertaken within an interpretive description framework to highlight clinical implications for working with refugee families. Key innovations that improved acceptability were the use of community groups, the unique role of the bicultural worker, and more directive modes of family therapy. The thesis concludes with a synthesis of findings from both studies, as well as consideration of potential therapeutic mechanisms through which acceptable relational care with refugees is achieved. Future therapeutic service delivery for refugee families may best be guided by the incorporation of multi-faceted and community-level approaches to care that allow for phasing of treatment in line with client culture, needs, and readiness.