Considering boundaries when doing therapeutic work with people who are seeking asylum: a reflective case study

Cowles, Megan; Griggs, Mary

doi:10.1080/03069885.2018.1507535

Cited by 3 publications

(10 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, if ASR have a good experience accessing mental health services, this may increase help-seeking and trust in the health system [ 50 ]. Potential approaches included cultural competence [ 61 ], explicit consideration of therapeutic boundaries [ 68 ], and psychotherapeutic support for trauma [ 69 ].…”

Section: Resultsmentioning

confidence: 99%

“…The literature identified explicit consideration of therapeutic boundaries as important[ 68 ]. Mental healthcare providers working with potentially vulnerable groups such as ASR experience many challenges.…”

Section: Resultsmentioning

confidence: 99%

“…ASRs may have undergone traumatic events that move providers beyond compassion and empathy towards secondary trauma. Additionally, providers without appropriate training may be at greater risk of overstepping boundaries of the therapeutic relationship [ 68 ]. The British Psychological Society outlined respect, responsibility, integrity, and competence as four pillars to guide ethical therapeutic practice [ 70 ].…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Mental healthcare for asylum-seekers and refugees residing in the United Kingdom: a scoping review of policies, barriers, and enablers

Pollard

Howard

2021

Int J Ment Health Syst

View full text Add to dashboard Cite

Background Since 2011, a large influx of asylum-seekers and refugees has put pressure on the UK’s under-resourced national health services and mental health services. Asylum-seekers and refugees (ASR) may experience traumatic events pre-departure, life-threating circumstances on their journeys, and difficulties integrating into host countries related to immigration policies, social isolation, poor living conditions, and unemployment, all of which can significantly affect their mental health. This topic is increasingly important due to the numbers of people seeking asylum and growing concern for their mental health on resettlement. This study examined UK-wide policies and guidance, healthcare practices, barriers, and enablers of mental healthcare for ASR residing in the UK. Methods We conducted a scoping review using Arksey and O’Malley’s 2005 framework, which included semi-structured interviews with stakeholders from non-governmental organisations, academia, UK National Health Service, and community groups. We synthesised and analysed literature and interview data thematically to examine current barriers and potential enablers of ASR mental health support in the UK. Results We included 39 literature sources, of 1,638 identified, and 10 stakeholder interviews. Sources, most published in 2019 (n = 13), included data from England (n = 13), Scotland (n = 3), Wales (n = 3), and Northern Ireland (n = 2) and covered access to care (n = 16), mental health disorders (n = 7), impacts on health (n = 7), barriers to care (n = 13), policies and plans (n = 4), and clinical recommendations (n = 3). Synthesised themes from literature and interviews included existing barriers (i.e. communication difficulties and lack of funding, resources, and political will) and potential enablers (i.e. proposed provision practices, social needs of ASR, and policy changes). Conclusions There is a gap in the literature regarding UK-wide assessment of access and delivery of mental healthcare for ASR in the UK. Time sensitive and culturally appropriate approaches are needed, with greater funding and resource support from the UK Government. This study provides justification for a call to relax hostile environment policies, and for ASR-specific mental health services and support to be considered within the UK. Further research is needed to assess implementation of guidelines across the UK.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Mental healthcare for asylum-seekers and refugees residing in the United Kingdom: a scoping review of policies, barriers, and enablers

Pollard

Howard

2021

Int J Ment Health Syst

View full text Add to dashboard Cite

show abstract

“…The importance of being attuned to intuition and reflecting on the meaning of gift-giving-and-receiving was highlighted, 'The therapist felt very uncomfortable receiving a gift from Mirella, especially in light of her financial situation. It felt important not to refuse the gift or to explore whether it was appropriate, but rather to gratefully accept the gift whilst making it clear that this was not expected' (Cowles & Griggs, 2019). Sharing emotional experiences with clients was a noticeable change to practice, while considering how appropriate and unavoidable it could be; 'if I cry, the client will also feel responsible.…”

Section: Thematic Synthesismentioning

confidence: 99%

“…Risks associated with being overly flexible included unnecessarily extending treatment periods, making fewer demands on clients and inadvertently creating a dynamic whereby the client may feel concern for the therapist; 'I wonder if [I had created a situation where] the patient was protecting me in hiding the most sordid details of his torture' (Mirdal et al, 2012). It is also worth noting that the discourse of therapeutic boundaries does not need to be polarised; 'A person-centred, warm and collaborative therapeutic relationship can be invaluable … although of course having firm boundaries does not necessitate that these are lacking' (Cowles & Griggs, 2019).…”

Section: Sub-theme 4: Balance Between Flexibility and Rigiditymentioning

confidence: 99%

Refugees and asylum seekers who have experienced trauma: Thematic synthesis of therapeutic boundary considerations

Davoren,

McEleney,

Corcoran

et al. 2023

Clin Psychology and Psychoth

View full text Add to dashboard Cite

ObjectiveTherapeutic boundaries are limits to appropriate behaviours within a therapist–client relationship (e.g. related to accepting gifts, self‐disclosures, therapist neutrality and advocacy). Therapeutic boundary considerations are fundamental in the care of refugees and asylum seekers. Research on the experiences of therapists navigating such boundaries is sparse and warrants further exploration. The aim of this qualitative systematic review was to thematically synthesise literature regarding therapists' (psychologists, psychotherapists, counsellors) experiences of implementing flexible therapeutic boundaries with refugee and asylum seeker clients and determine how such applications have been helpful for therapeutic interventions.MethodSix databases were searched. Following full‐text screening, 21 papers were included in the analysis. Boundary theory underpinned the analysis.ResultsThree major themes were developed: (i) Changes to Therapeutic Practice & Therapeutic Intervention, (ii) Re‐Conceptualisation of Therapy as ‘Clinical Political’ and Re‐Conceptualisation of Therapist Identity and (iii) Careful Monitoring of Personal Boundaries—Not becoming ‘Hardened’ or ‘Haunted’. Papers described how, when used in a reflective, considerate way, flexible therapeutic boundaries can strengthen the therapist–client alliance and positively impact therapeutic interventions. Many therapists acknowledged making conscious efforts to re‐conceptualise therapeutic work with refugee and asylum seeker clients from advocacy standpoints. However, systemic constraints, and lack of guidance, made this difficult to navigate and contributed to therapist burn‐out.ConclusionsBoundary considerations manifested as interpersonal, structural and cultural changes to practice. These have implications for clinical practice and developing guidelines on boundary practices with refugees and asylum seekers. Future research should explore promoting therapist well‐being and training needs for therapists supporting this population.

show abstract

Working with Arab women with PTSD: what do we know?

Beaini

Shepherd

2022

Australian Psychologist

View full text Add to dashboard Cite

Considering boundaries when doing therapeutic work with people who are seeking asylum: a reflective case study

Cited by 3 publications

References 24 publications

Mental healthcare for asylum-seekers and refugees residing in the United Kingdom: a scoping review of policies, barriers, and enablers

Mental healthcare for asylum-seekers and refugees residing in the United Kingdom: a scoping review of policies, barriers, and enablers

Refugees and asylum seekers who have experienced trauma: Thematic synthesis of therapeutic boundary considerations

Working with Arab women with PTSD: what do we know?

Contact Info

Product

Resources

About