Sweden's cultural diversity generates considerable challenges for occupational therapists. The aim of this study was to explore experiences and perceptions of occupational therapists working with immigrant psychiatric clients from the Middle East region. The study included interviews with eight occupational therapists employed in mental health care and working in a variety of settings. The data collection and analysis were carried out in accordance with the grounded theory approach. One core category, "the challenges of the multicultural therapeutic journey-a journey on a winding road" was identified. The core category included three categories: dilemmas in clinical practice, feelings and thoughts, and building cultural bridges, in turn comprising sub-categories and components. The results showed that the many dilemmas influencing effective multicultural occupational therapy were cultural, societal, and professional in nature. The dilemmas influenced feelings and thoughts, in turn influencing both motivation for seeking cultural knowledge and choice of adequate strategies in which the multicultural therapeutic relationship could develop. The results imply that culturally congruent occupational therapy practice needs to be further developed and more research is needed on how cultural issues can be met in occupational therapy practice.
Persons with a Middle Eastern background represent a minority in Sweden which has significantly increased in size over recent years. The purpose of the present study was to explore the elements that shape the experiences and perceptions of clients with a Middle Eastern background living by Muslim norms who received occupational therapy in mental health care at the time of participating in the study. The study included interviews with 11 clients who received occupational therapy in mental health care. Data collection and analysis were carried out in accordance with the grounded theory approach. One core category, desiring a union, described the clients' desire for an alliance with the therapists that encompassed the realities and truths embedded in their values, preferences, world-views, and belief systems, as well as a wish to reconstruct their abilities to function and perform daily life tasks within their cultural contexts. The core category included sub-categories: desiring relationship, desiring affiliation, and desiring affirmation as well as some related components. The overall findings showed a tentative model in which the notion of mahram affinity was embedded. The results demonstrated that the clients' views regarding desiring a union had their support in collectivistic world-views that often clash with those of the therapists.
Young immigrants who suffer from psychosis perceive their illness from the outlook of at least two cultures, which is often a source of confusion and misunderstanding for clients, their families, and clinicians. This article presents a case study with a narrative approach, aiming to illustrate how an occupational therapy intervention can highlight the role of culture and address bicultural identification in a young adult immigrant woman with mental health problems. The results show how a culturally adapted intervention model can be used to help the client go through a transition from an interdependent to a more independent self. During the course of occupational therapy, the client gained greater insight into her problems and could view herself as integrating numerous facets related to two different social and cultural contexts. Moreover, the client achieved better skills in dealing with discrepancies and cultural contradictions and became capable of relying on either or both of the cultures in different situations.
Having a mental illness and an immigrant background may infer a particular risk for low empowerment. The mental health services and society at large should consider measures for adjusting the support to this group, including an analysis of how environments and contexts may act as barriers to activity enrichment and culturally congruent support.
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