The Premise of Intersectionality for Family Therapy Interventions With Asylum Seekers in the United States

Changes in migration policy and governmental systems have increased anti-immigration rhetoric and attitudes toward asylum seekers within the United States. Consequently, asylum-seeking families contend with changes in culture, relationships, and roles, which exacerbate experiences of trauma, isolation, and mental health symptoms. While the United States still harbors an atmosphere of racist nativism, postmigration stressors uncover other forms of structural oppression, such as heterosexism and genderism. Intersectionality serves as an indispensable theoretical framework to examine intersecting forces of oppression and how they accentuate asylum-seeking family experiences in therapy. To address sociopolitical experiences and oppression impacting the well-being and relationships of asylum-seeking families, the article (a) outlines key definitions and research trends on family relationships and interventions with asylum-seeking families; (b) elaborates intersectionality's core tenets; and (c) synthesizes applications from intersectionality to enhance asylum-seeking family interventions and research.

Caring for the mental health of Afghan refugee youth through a decolonial paradigm: A qualitative analysis of distress, coping mechanisms, and priorities for treatment

Despite the compounded adversities that displaced youth must navigate throughout their forced migration, they consistently exhibit steadfastness in caring for themselves and their families. Extant scholarship, however, often frames these individuals as needy and inept at informing the models of mental health care they are offered. In this study, we use semistructured interviews to learn from the experiences of Afghan refugee youth (N = 34; M age = 19; range 18-24) who were resettled in the United States after the United States withdrawal from Afghanistan in August of 2021 and explore their insights that can inform decolonial and equitable mental health services. Specifically, we elucidate their most salient sources of psychological distress, current coping mechanisms, and priorities for treatment, with a specific focus on the unique experiences of accompanied versus unaccompanied youth. Unaccompanied youth reported more frequent and intense sources of distress, including pre-resettlement (e.g., exposure to life-threatening sociopolitical conflicts) and post-resettlement challenges (e.g., limited access to basic resources and legal status precarity). Youth used faith-based, relationship-based, and ethnocultural-based mechanisms of coping. While 62% of participants reported doubts about the usefulness of mental health care, most of those who expressed an openness to treatment prioritized clinicians who have personal experience in navigating common challenges among refugees. We situate these findings within decolonial and intersectional theoretical frameworks that capture the nuances of Afghan refugee experiences and offer recommendations for ensuring refugee youth's rights to access equitable mental health services.

'I worry about you more': insights from older care recipients' experiences during the Israel-Hamas war

OBJECTIVES

This study explored the experiences and challenges of older adults with functional disabilities in Israel during the ongoing Israel-Hamas war, particularly those receiving care from migrant live-in carers. The main objectives were to identify their main concerns and coping strategies during this period.

METHOD

A qualitative methodology was employed, involving face-to-face interviews with 13 older adults (mean age 91.33, SD = 5.31). All participants liveded in separate housesholds with the assistance of migrant live-in carers. They were recruited through purposive and snowball sampling techniques. The interviews were analyzed using thematic content analysis.

RESULTS

Two main themes emerged from data analysis: 1) Concerns for others affected by the war and concerns for oneself, and 2) Coping strategies, including utilizing personal resources such as optimism and distraction, seeking connections with family members and carers, and contributing to the community.

CONCLUSION

The study highlights the interplay between the vulnerabilities and strengths of older adults during wartime. Their ability to mobilize both internal and external coping strategies reflects an active approach to managing the stress and uncertainties of war, underscoring their resilience and agency and challenging the perception of older adults as passive recipients of care.

Relational ethics in immigrant families: The contextual therapy five-dimensional framework

Contextual family therapy offers a unique explanatory and clinically valuable framework to address complex multigenerational processes in families of immigrants who experience cumulative migration-related traumas. In this paper, we offer a new extended, specific conceptualization of immigrant families' generational dynamics using existing literature within the five-dimensional contextual therapy framework illustrated with a clinical example. We highlight the importance of social and relational justice, loyalty, entitlement, and parentification in transgenerational processes in addressing manifestations of these traumas that are frequently overlooked in clinical practice with different generations of immigrant families. Clinical guiding principles include acknowledgment of the social nature of situational injustices and their consequences for relational justices, exploration of loyalty conflicts (familial, cultural, and national), active dialogue of mutual care, exoneration, and stimulating constructive entitlement through active giving. This paper contributes to further development of contextual therapy theory and provides practical guidance for clinicians working with international migrants including second and third generations.

Trauma-Informed Cultural Humility Mental Health Practice: Centering History among African American Women

Social work has made significant strides in providing mental health services. However, advancement in mental health practices grounded in social work values, such as trauma-informed care and cultural humility mental health practice (CHMHP), is still lacking. One possible reason is that many strategies overlook clients' historical contexts, particularly the collective history held by the community to which the client belongs. By centering "history" in social work practices, clinical social workers can be more equipped to provide high-quality, client-centered services. This article advocates for adopting trauma-informed CHMHP as a critical strategy to elevate history in clinical social work practice and proposes that trauma-informed CHMHP can improve mental health service quality among clients of color who are profoundly disrupted by historical trauma. Specifically, this article proposes that using trauma-informed CHMHP to address historical trauma can enhance mental health treatment outcomes and experiences for African American women. Clinical social workers trained to address these interconnected issues can help reduce disparities in quality treatment access.

Attitudes of Refugees Towards Integration: The Experience of South Sudanese Refugees in Adjumani District in Uganda

The question of how socioeconomic situations in and around refugees' settlement in Uganda affect their motivation and attitudes towards integration has not been clearly addressed in the literature. To address this gap, this study explores the integration framework, and uses thematic and content analysis to analyse data collected via in-depth interviews and focus group discussions. The study finds that access to socioeconomic factors such as livelihood opportunities and social services, especially education and health, can either motivate and positively affect refugees' attitudes, or demotivate and negatively affect refugees' attitudes towards integration in the host community. Other motivating factors were family history and success stories of refugees who were successfully integrated in the host community. Suggestions for improving refugee integration included empowerment in vocational skills, access to grants and loans, access to land for agriculture, and access to labour market. These require greater cooperation among different stakeholders, including policy makers, nongovernmental organisations, international organisations, and governments, to coalesce resources and buttress integration of refugees in the host society.

Considerations in designing trauma-focused interventions for displaced Afghan women

In light of the 2021 United States military withdrawal from Afghanistan, as well as the humanitarian crises of mass displacement and subsequent health system strain that have ensued, practitioners worldwide will need to develop a more nuanced understanding of the adverse life experiences that women from Afghanistan frequently endorse. As they bear a disproportionate impact of constraints within Afghan society, and as patriarchal systems affect most of their life domains, women from Afghanistan may present with high levels of baseline trauma upon resettlement, and health systems may seek to attenuate this distress; However, the nature of these traumatogenic events may shape women's receptivity to psychosocial interventions, particularly those which are at least partially rooted in Western modalities. In the absence of sufficient literature on evidence-based interventions for this population, a diversity of ethnographic and clinical literature is synthesized, including literature on interventions alleged to be compatible with Afghan norms. As it will be essential to support Afghan women's mental health following social reorganization on a massive scale, considerations arising from the interdisciplinary literature are offered so that they may inform the development of structured, trauma-focused interventions and so that the health systems with which they interface may be better prepared to serve them.

The Impact of COVID-19 Pandemic Lockdowns on Refugee Mental Health: A Narrative Review

With over 80 million persons around the world forcibly displaced from their homes, 26.3 of whom are refugees, recent estimates indicate that the number of forced migrants has reached an all-time high (UNHCR, 2020). Already at a disadvantage, the closures of schools and key community resources aimed at combating the spread of the virus during the early stages of the pandemic contributed to further distress on the well-being of refugees. Recognizing that forced migrants are a vulnerable and underserved population and that the COVID-19 virus and the lockdowns put in place to reduce its spread severely worsened their multidimensional stressors, the authors used a qualitative narrative review with attention to the thematic analysis model to explore the impact of lockdowns on refugees’ mental health by reviewing publications from April 2020 through May 2021. The review findings are categorized under three themes: (a) negative impact on mental health, (b) suggested intervention approaches/strategies, and (c) recommendations. Implications for counseling and research are discussed.

“You Have to Go Gently”: Mentors’ Perspectives of a Peer Mentoring Empowerment Program to Reduce Marginalization in Refugee and Migrant Women

The Empowerment and Peer Mentoring of Migrant and Refugee Women pilot program (EMPOWER) provides a mechanism for migrant women who have established lives in Australia to mentor newly arrived women to build the ability, confidence, and knowledge to overcome barriers to the social determinants of health such as employment. Female migrant mentors (n = 21) met with their mentees (n = 32) on a regular basis over a period of 3 to 12 months between September 2019 and November 2021. The individual mentoring was augmented by group workshops facilitated by content experts and the research team. The unique perspectives of the mentors were explored through individual interviews (n = 15) and analysis of journal entries (n = 58) submitted regularly by mentors throughout the program. Thematic analysis revealed that mentors were intrinsically motivated to build strong and trusting connections with their mentees, which were pivotal to reducing inequalities for mentees and their families. Mentors had high expectations of themselves and demonstrated commitment and flexibility to accommodate mentees’ needs. However, they sometimes struggled when supporting mentees who were overwhelmed by the systemic and other stressors associated with resettlement and pre-migration trauma. Regular networking and moral support for mentors would enhance future programs.

Survivor Guilt: A Cognitive Approach

Survivor guilt is a common experience following traumatic events in which others have died. However, little research has addressed the phenomenology of survivor guilt, nor has the issue been conceptualised using contemporary psychological models which would help guide clinicians in effective treatment approaches for this distressing problem. This paper summarises the current survivor guilt research literature and psychological models from related areas, such as posttraumatic stress disorder, moral injury and traumatic bereavement. Based on this literature, a preliminary cognitive approach to survivor guilt is proposed. A cognitive conceptualisation is described, and used as a basis to suggest potential treatment interventions for survivor guilt. Both the model and treatment strategies require further detailed study and empirical validation, but provide testable hypotheses to stimulate further research in this area.

Disability pension and mortality in individuals with specific somatic and mental disorders: examining differences between refugees and Swedish-born individuals

BACKGROUND

More than half a million refugees have arrived to Sweden during the last decade. The aim was to investigate differences between refugees and Swedish-born individuals regarding different specific somatic and mental disorders, and subsequent disability pension and mortality.

METHODS

All refugees (n=239 742) and Swedish-born individuals (n=4 133 898), aged 19-60 years, resident in Sweden on 31st of December in 2009 were included in this population-based prospective cohort study. Data from six nationwide Swedish registers were linked by the unique anonymised identification number. HRs with 95% CIs were computed for disability pension and mortality 2010-2013 by Cox regression models.

RESULTS

Compared with their Swedish-born counterparts with mental or somatic diagnoses, refugees with these diagnoses had a higher risk of subsequent disability pension and a lower risk of mortality. Highest estimates for disability pension were seen for refugees with neoplasm (HR: 1.72; 95% CI: 1.56 to 1.91), musculoskeletal disorders (HR: 1.57; 95% CI: 1.47 to 1.67), diseases of the circulatory system (HR: 1.33; 95% CI: 1.22 to 1.45), depressive disorders (HR: 1.31; 95% CI: 1.21 to 1.41) and diabetes mellitus (HR: 1.30; 95% CI: 1.15 to 1.47). The risk of mortality was lowest for refugees with regard to bipolar disorders (HR: 0.37; 95% CI: 0.16 to 0.82), post-traumatic stress disorder (HR: 0.37; 95% CI: 0.25 to 0.54) and least pronounced in regard to neoplasm (HR: 0.69; 95% CI: 0.61 to 0.77) compared with Swedish-born with similar disorders.

CONCLUSION

Refugees have a generally higher risk of disability pension compared with Swedish-born with specific somatic and mental disorders. Despite this, refugees with all specific disorders have lower risk estimates of mortality, probably due to a healthy selection. The higher risk of disability pension might therefore be due to other causes besides poor health.

Refugee mental health research: challenges and policy implications

Mental illness is common among forced migrant populations, and ongoing mental illness can hinder refugees' ability to negotiate the asylum process. This editorial rehearses the challenges of undertaking research among forced migrant populations, exploring how they could be addressed in future research, and outlines differences between forced migrant groups. It points to the growing body of evidence that can be called on in advocating for systemic change in government policy and mental health services, with significant support for a sensitive and objective inquisitorial approach to gathering evidence in support of asylum claims.

Race Dialogues in Group Psychotherapy: Key Issues in Training and Practice

Growing racial and ethnic diversity in the United States and globally requires culturally competent mental health professionals who can address ongoing racial tensions and experiences of racism and xenophobia. Attending to racial and ethnic issues and infusing race and ethnic dialogues in group psychotherapy can play a major role in addressing mental health problems, promoting racial harmony, and healing deep psychological wounds and trauma that are the result of racial tensions. This article describes seven key issues necessary to effectively address race and ethnicity in group psychotherapy.

Critical reflections, challenges and solutions for migrant and refugee health: 2nd M8 Alliance Expert Meeting

Throughout recent years, we have witnessed an increase in human migration as a result of conflict, political instability and changes in the climate. Despite the growing number of migrants and refugees, provisions to address their health needs remain inadequate and often unmet. Whilst a variety of instruments exist to assert and emphasise the importance for migrant and refugee health, the lack of shared priorities between partners and stakeholders results in poor access to healthcare and essential medicines. In response to the growing health challenges faced by migrants and refugees, members of the M8 Alliance launched an annual Expert Meeting on Migrants' and Refugees' Health. This report is shaped by discussions from the second M8 Alliance Expert Meeting (Sapienza University of Rome, Italy, 15-16 June 2018) and is supported by supplementing literature to develop a framework addressing critical reflections, challenges and solutions of and for migrant and refugee health. This report aims to inform decision-making fostering a humanitarian, ethics and rights-based approach. Through a series of country-specific case studies and discussions, this report captures the most prominent themes and recommendations such as mental health, tuberculosis (TB) and best practices for increased access.

Strength, solidarity, strategy and sustainability: A counseling psychologist’s guide to social action

The roles of counseling psychologists vary by setting, population, and circumstances. Yet, social justice can be a unifying force beyond the boundaries of daily responsibilities. No matter how insightful or profound counseling psychology theories or practice are, if they are focused on individual change alone, they will never sufficiently address injustice. Injustice and the inadequacy of traditional, individually focused paradigms present tensions between counseling psychologists’ work to help individuals cope with life’s challenges and inadvertent (or intentional) support of systems that perpetuate oppression. This paper explores this dichotomy, avenues for moving to action, and personal sustainability in the face of professional fatigue. Experiences as a counselor and counseling psychologist, as well as research, shape the way I see advocacy and activism and have given rise to strategies I have found helpful. A resulting framework for developing a “personal social action plan” is represented by four pillars: Strength, Solidarity, Strategy and Sustainability (S-Quad). National and local challenges across the globe reflect enormous differences in contexts, needs, politics, and resources. Yet, sharing strategies for social action, activism, and advocacy can provide seeds for optimism and action toward justice and positive change.

Healing stories: An expressive-narrative intervention for strengthening resilience and survival skills in school-aged child victims of war and political violence in the Gaza Strip

Within a preventive framework, we outline a school-based intervention aimed at strengthening skills of survival and psychological functioning in children who have experienced war and political violence in the Gaza Strip. In accordance with a socio-ecological perspective on wellbeing and resilience, the pilot study aimed at evaluating the outcomes of a psychosocial narrative school-based intervention with a group of school-aged children in the aftermath of war. The intervention was oriented at empowering positive emotions, life satisfaction, and optimism in children as protective factors in preventing posttraumatic reactions after war. Findings showed the efficacy of the intervention in favoring life satisfaction in different ecological domains. Children in the intervention group showed greater appreciation for friends, school, family, themselves, and their living environment. At the end of the activity, children were increased the level of positive emotions, but negative feelings were stronger than before the narrative intervention. Clinical implications and future direction or community work are, then, discussed.