No abstract

An interview study among mental-health professionals working with victims of war and violence in postwar Nicaragua suggests that the professionals frame their understanding of problems, methods of interventions, definitions of aims and goals, as well as their professional role, in a sociopolitical context rather than in a clinical or an academic one. They tell about war heroes becoming marginalized and excluded as the sociopolitical context changed, and about the onset of posttraumatic stress reactions in relation to poverty and social isolation. In response to these conditions, community-oriented psychosocial work, with emphasis on social reconstruction and reconciliation, is emphasized. The experiences of the professionals and their ways of framing and confronting postwar issues are discussed as important contributions to a contextual understanding of trauma and reactions to traumatic events. The role of cultural understandings and meaning systems in which events and reactions are embedded is highlighted.Mental health professionals in Nicaragua working with victims of war and violence were invited to describe their psychosocial work and reflect on their methods, their objectives, and the problems they encounter. The theoretical and practical implica-

Refugee families referred for therapy present a wide array of problems and expectations, not always in accordance with what therapy may offer. Major differences between referring professionals, families and therapists regarding problem definitions and solutions may complicate collaboration. Interventions that may overcome these barriers and move initial interviews into a therapeutic context are described. Three patterns regarding referral process, problem presentation and expectations (here called referral contexts) are outlined: ‘the relational’, where families ask for psychological and interpersonal assistance, ‘the unfocused’, where families are referred to therapy without expressing any wish for it, and ‘the fixed solution’, where families seek support for solutions that are not of a therapeutic nature. The interventions described form part of a negotiation where motives and interest for therapy are explored and agreements regarding further therapy are outlined.

The strengthening of international criminal law through an increased focus on the right to reparation and rehabilitation for victims of crimes against humanity represents an important challenge to health professionals, particularly to those in the field of trauma research and treatment. A brief outline of some developments in the field of international law and justice for victims of gross human rights violations is presented, with a focus on the right to reparation including the means for rehabilitation. The fulfillment of this right is a complex endeavor which raises many questions. The road to justice and reparation for those whose rights have been brutally violated is long and burdensome. The active presence of trauma-informed health professionals in this process is a priority. Some of the issues raised within the context of states’ obligations to provide and ensure redress and rehabilitation to those subjected to torture and gross human rights violations are discussed, and in particular how rehabilitation can be understood and responded to by health professionals.

The possible benefits of including referring professionals in the first family interviews are being explored as a way to engage refugee families in therapy. Families in exile confront a number of problems related both to premigration traumatic exposures and to present adaptation processes. Refugee clients and the referring professionals in the larger system frequently see the problems and their solutions quite differently. This situation may often result in unclear working alliances in a context of therapy. We will describe first family interviews in which referring professionals are interviewed about their reasons for referrals, and where the families are invited to discuss these considerations. The conversations permit families, referrers, and therapists to reflect upon differences in positions and perspectives. Their experiences suggest that agreements or contracts based on these joint interviews are less ambiguous and more clearly formulated than contracts based on interviews with families alone. Finally, these experiences are discussed as a potentially valuable approach in a cross-cultural context.