Relationship and Family Therapy for Newly Resettled Refugees: An Interpretive Description of Staff Experiences

Abstract

The needs of refugees are of crucial concern internationally. Relational trauma is an area that is particularly under-emphasised and under-researched. The Strength to Strength program (STS) was a relationship and family counselling service for recently arrived refugees in Sydney, Australia. The service model built on post-Milan systemic family therapy principles to include cultural and trauma-informed aspects of care. This study explored the design and impact of the program, through qualitative accounts provided by service users. This paper focuses on the experiences of staff of the program, and the ways in which more traditional, Western-informed modes of family therapy were transformed by refugee client needs. The specific study aim was to identify and describe transformations to the delivery of relationship and family counselling with refugees that enabled care, from the perspective of STS staff. A thematic analysis of interviews with STS service staff (bicultural workers, family therapists, managers; n = 10) was undertaken, guided by an interpretive description framework. Findings revealed that acceptable and useful clinical innovations to standard care included the use of community groups, the unique role of the bicultural worker, and increased reliance on more directive and practical modes of family therapy rather than insight-oriented post-Milan techniques. The role of community-based intervention to enrich existing Western-informed models of care for use with refugees was vital. STS was an example of staff-driven innovation to the therapeutic care of refugee families resettling in a Western country and took into account their unique and complex set of cultural, practical, and psychological client needs. Future service delivery is best guided by the incorporation of multi-faceted approaches to care that allow for phasing of treatment in line with client culture, needs, and readiness.

Trauma Aware and Anti-Oppressive Arts-Health and Community Arts Practice: Guiding Principles for Facilitating Healing, Health and Wellbeing

“…Notable exceptions included Harden et al’s (2015) work with young people in minority communities who experienced community violence and Muenzenmaier, Margolis, Langdon, Rhodes, Kobayashi & Rifkin’s (2015) work with women experiencing serious mental illness. Karageorge et al’s (2018) work with ‘newly resettled refugees’ acknowledged the collective nature of trauma experienced by people who experience forced migration, but an overt critical or anti-oppressive approach was not evident. Muenzenmaier et al (2015) combined a trauma informed approach with the critical concept of intersectionality to acknowledge the layering up of traumatic experiences that can occur due to race, gender, ethnicity, socioeconomic status, immigration and severe child abuse.…”

“…Creatively combining culturally familiar and "safe" activities such as music making, cooking, or sport with unfamiliar or challenging tasks can be a way of safely extending participants' threshold for discomfort. Karageorge et al (2018) found that culturally familiar interest-based group activities were supportive for people who experienced forced migration related trauma and ongoing relational trauma during resettlement. The groups allowed participants to "get to know each other, to come out of their spaces and to know the community'".…”

“…In refugee resettlement, Karageorge et al, (2018) observed the importance of 'bicultural' workers in refugee support programs who shared deep cultural knowledge with and of participants alongside commitment and compassion for participants (p. 310). Creatively combining culturally familiar and "safe" activities such as music making, cooking, or sport with unfamiliar or challenging tasks can be a way of safely extending participants' threshold for discomfort.…”

“…Incidental and informal 'counselling' emerged as both a valued and challenging dynamic of trauma aware and informed practice. Karageorge et al (2018) spoke about the 'accidental' and 'informal' counselling that bicultural trauma-informed support workers undertook. In Karageorge et al's study, workers were prepared for those situations and had supporting networks for referring program participants for in depth counselling and support.…”

“…Existing research shows that traumatic experiences can deeply affect family and social relationships. For example, research with people who experienced forced migration has shown that psychological distress associated with traumatic experiences is often heightened by changes in family dynamics and increased relational conflict during resettlement (Karageorge et al, 2018, p. 304). At the same time, family and community support and healing are often protective factors in navigating the effects of trauma on individuals (Atkinson, 2002; Simich et al, 2003).…”