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Literature review of therapeutic effectiveness of counselling of asylum seekers and refugees. Essay Example

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Literature Review

Literature Review of Therapeutic Effectiveness of Counselling of Asylum Seekers and Refugees


In spite of the clear evidence demonstrating the effectiveness of psychotherapy and counselling, identifying particular reasons for effectiveness or pinning down effective approaches remains challenging. Basically, the research evidence concerning the effectiveness of psychotherapy as well as counselling is somewhat unambiguous, but still, counselling does work. The therapeutic efficacy examination has coerced people to acknowledge that the impact of interventions as well as techniques is associated closely with the characteristics of the patient and psychotherapist in addition to their therapeutic relationship. The literature review focuses on the therapeutic effectiveness of counselling of asylum seekers and refugees.

Review of Literature

According to Lecomte (2010), for nearly three decades, studies have established that the difference in patient outcome is associated closely with the differences amongst individual psychotherapists, and not the treatments and techniques used. Nearly 30 per cent of therapists according to Lecomte (2010) get superior results as compared to their colleagues, regardless of the used approach. There is a great variability of therapists’ effectiveness, whereby some get deterioration effects. Lecomte (2010) established that up to 50 per cent is experienced by certain therapists, patients and that their rate of discontinuation is 50 per cent lower as compared with others. Therefore, regardless of the efforts of mitigating variance because of the influence of psychotherapist through intervention manuals and standardized training, Lecomte (2010) posits that this factor appears to influence the outcomes significantly. The variability of the obtained results is explained to a large extent by the psychotherapist in all therapeutic process, regardless of the approach used. In her study, Tribe (2002) shows how refugees experience scores of losses. In different countries across the globe, the world psychiatrists as observed by Tribe (2002) are working together with community leaders and assisting them to create community-based interventions. Besides that, culture can be a very crucial variable that helps in maintaining people’s equilibrium. Tribe (2002) argues that the sense of identity and familiarity can be threatened severely for a number of refugees when fleeing to a country whose culture is different from that of their own. Besides, when refugees talk about their experiences and beliefs it sometimes results in their detention and possibly torture as well as organised violence; for that reason, talking cure at first appears not frightening.

Contrary to the refugees living in the third world nations, where access to mental health services such as psychotherapy is very limited, those in the developed countries have relatively better access to mental health professionals. For instance, in the U.S., programs for mental health intended for refugee and asylum seekers are available in nearly all major cities. Even though these programs vary with regard to the targeted communities, Miller (2005) posits that the majority of mental health programs for refugees focus on psychotherapy provision, in addition to other psychosocial as well as psychiatric services, so as to assist refugees recover from anguish associated with forced migration and experiences of hostilities. Given that few psychotherapists understand the languages spoken by asylum seekers and refugee, Miller (2005) asserts that mental health programs have conventionally depended on interpreters, normally asylum seekers and refugee themselves, in order to facilitate communication between clients and the therapists. Considering that the number of mental health programs for refugees and asylum seekers have increased lately, the utilisation of interpreters has become more important. Regarding the hiring of the interpreters, Miller (2005) established that the interpreters must have similar characteristics as those possessed by the psychotherapists. Besides that, they should have a high level of self-awareness and empathy, should have a sufficient support system, and must see psychotherapy as an effective way of healing. As cited by Annelisa (2014), the number of people forcibly displaced from their countries as of 2012 was 35.8 million, and 900,000 of these people were seeking for asylum. The number of people living in UK as an asylum seeker, refugee or as stateless as of 2012 was 0.33 per cent of the total population. Generally, the asylum seekers and refugees in the UK come from countries that have continuously experienced serious conflict or violation of human rights such as Eritrea, Pakistan, Afghanistan, Sri Lanka and Iran. Even though asylum seekers ad refugees live in deplorable conditions, Annelisa (2014) posits that the suitable role played by the mental health service provider can appear challenging to determine. For this reason, the ethics of using psychiatric therapies and medications developed by the West to treat refugees and asylum seekers from non-Western backgrounds is widely debated. The debate is underlined by an intricate question of the suitability of treating asylum seekers and refugees (mostly of non-Western origin) with treatments like the Eye movement desensitization and reprocessing (EMDR), narrative exposure therapy as well as Insightorientedpsychotherapy, all of which have been developed by Western scientists as well as clinicians for people of Western origin. Annelisa (2014) mentions that the difficulty in determining the suitable means of combining mental health treatment with the general support given to the asylum seekers and refugees is brought about by many legal and social pressures that face this group of patients.

For refugees and asylum seekers to get effective care, the host countries should offer culturally sensitive treatments facilitated by psychotherapists experienced in treating patients of diverse cultural and ethnic backgrounds. According to Annelisa (2014), transcultural’ counselling emphasises on the significance of training practitioners so as to become culturally sensitive, multi-culturally skilled and be able to understand the effect of cultural dynamics in identification of psychopathology. According to van Wyk and Schweitzer (2014), refugees and asylum seekers endure considerably poorer well-being as well as mental health as compared to the general population. Even though there is some debate concerning the diagnosis cross cultural validity, van Wyk and Schweitzer (2014) affirm that depression and posttraumatic stress disorder (PTSD) are prevalent amongst the refugee populations. Basically, mental health problems have a negative impact on refugee wellbeing as well as adjustment: Depression and PTSD reduce quality improvements of life. Additionally, in spite of improvement, refugees and asylum seeks always remain at risk of getting mental health problems and these symptoms are inclined to recur when they are stressed. Generally, therapeutic interventions as observed by Lecomte (2010) and Droždek and Bolwerk (2010) can positively impact the quality of life and mental health for refugees and asylum seekers. By reviewing the previous studies, van Wyk and Schweitzer (2014) noted that ccognitive-behavioural therapy is the most researched treatment and together with narrative exposure therapy, it is the most recommended therapeutic interventions for refugees and asylum seekers. A number of therapeutic interventions such as pharmacotherapy, community based interventions and psychological therapy can help reduce anxiety and PTSD symptoms amongst refugees and asylum seekers.

In their study, Droždek and Bolwerk (2010) observed that refugees and asylum seekers face a great complexity and diversity of life difficulties. Some of the common pre-migration difficulties experienced by these persons include incarceration, war, ethnic cleansing, sexual and physical violence, witnessing of brutality, distressing grief, malnourishment, lack of health care as well as homelessness. Moreover, migration from their country is very risky and always dangerous and may result in the separation of a family. On the other hand, post-migration difficulties include incarceration, discrimination, dispersal, and deprivation. Other adversities include denial of health care or the right to work and taking long to decide on asylum applications. According to Droždek and Bolwerk (2010) well-timed support creates a platform for traumatised survivors to make known their mental state as well as integrate their experiences meanings. Offering a secure therapeutic environment is crucial for restoring the feelings of safety, especially because other sources of care as well as reassurance could be inaccessible to refugees and asylum seekers. Such a precondition is crucial for PTSD treatment and a suitable environment for creating curative emotional experiences (Droždek & Bolwerk, 2010). According to Murray, Davidson and Schweitzer (2008), the diversity that accompanies the cultural backgrounds, flight experiences as well as trauma before the flight results in challenges for mental health specialists who intend to familiarise themselves regarding the cultures as well as conditions in presenting the refugees’ countries of origin. The resettlement programs nature is always changing and this result in challenges for efficient and effective delivery of service in addition to the evaluation and development of mental health programs. Refugees as mentioned by Murray, Davidson and Schweitzer (2008) have a high risk of getting mental health problems while resettling because of the substantial personal experiences of trauma, torture as well as loss which they experienced. Generally, refugees exhibit higher levels of psychological disturbance as compared to the general population, which includes the higher rates of PTSD as well as Major Depressive Disorder. Still, particular psychopathology rates amongst the refugee and asylum seeker samples have differed extremely; a number of studies have established that the psychopathology rates are lower amongst refugees as compared to the general population.

Kira and Tummala-Narra (2015) article seeks to enrich the knowledge of clinicians about the differences between general population and refugee patients dealing with interpersonal trauma so as to improve their competence while working with them. According to Kira and Tummala-Narra (2015), refugees normally experience evacuation and relocation far from their culture, community, home and, sometimes from their family. Displacement and the associated marginalisation dynamics normally results in mental health problems and generate deep disconnections in relationships. Losing family ties is associated with uprootedness; therefore, asylum seekers and refugees who have left their family in the home country normally show symptoms of depression and PTSD as well as more mental health problems as compared to those with no family back in the home country. Furthermore, traumatic experience associated with genocide political oppression may lead to group obliteration fear and anxiety of culture annihilation. Citing a number of empirical findings, Kira and Tummala-Narra (2015) point out that trauma and challenges related to acculturation to unknown cultural setting, together with posttraumatic stress, result in identity annihilation anxiety and fear of cultural extinction amongst some refugees and asylum seekers. In addition to fears regarding cultural extinction and uprootedness, scores of girls and women undergo severe gender discrimination in their home country. According to World Health Report, sexism is prevalent in the majority of refugee societies and this normally leads to severe negative mental health effects and other life traumas (Kira & Tummala-Narra, 2015). Gender discrimination has resulted in trauma spectrum disorders such as PTSD, especially amongst female refugees who have experienced torture. A certain traumatogenic condition, which affects community-based interventions negatively have exhibited evidence of improving the durability and generalizability.

According to Murray, Davidson and Schweitzer (2010), the enduring psychological effects of traumatic experiences before resettlement have been studied widely in refugee research. Being exposed to trauma can result in different psychological reactions such PTSD. Refugees that experience the trauma’s psychological effects often show signs of anger, sadness, fear and guilt. In view of this, psychological sequelae involve substance misuse, anxiety as well as depression. Syndromes associated with trauma such as impaired functioning or distress, normally involves intrusive emotions and thoughts concerning the distressing events, emotional numbing as well as avoidance. Murray, Davidson and Schweitzer (2010) propose numerous therapeutic interventions for asylum seekers and refugees, and these interventions have been carried out in contexts that are widely varying. Hitherto, a number of case review, pilot studies as well as small empirical studies have been conducted, but the major efficacy trials are noticeably absent. Numerous therapeutic interventions for reducing distress symptoms amongst the refugees have been examined, which include narrative exposure therapy, CBT as well as testimonial psychotherapy. Such therapeutic interventions according to Murray, Davidson and Schweitzer (2010) have been limited by sample sizes that are exceedingly small, with no control groups and lacking uniform evaluative measures. Nevertheless, the interventions outcomes are very promising, but Murray, Davidson and Schweitzer (2010) think that the interventions need further advancement. Slobodin and Jong (2014) argue that the complex problems of refugee patients signify a challenge for every level of care. Cultural differences, language barriers as well as clinical severity result in challenges in comprehending ailments and symptoms. Practitioners involved in treating such patients, agree that the general treatment conditions are not adequate and that mental health services fail to provide sufficient help, particularly with reference to traumatization.

Moreover, mental health practitioners who work with asylum seekers and refugees face numerous challenges in offering sufficient care. Therapeutic interventions for asylum seekers and refugees are challenged by uncertainty and instability of treatment. Normally, asylum seekers are moved to a different centre while some disappear to unidentified locations that are hard to identify. When asylum seekers’ applications are declined, their health insurance is revoked; therefore, leading to a pre-mature therapy termination. Asylum seekers and refugees are normally inclined to withdraw from therapeutic treatment because of different treatment expectations, symptoms interpretation, language problems as well as communication challenges with the therapist. Slobodin and Jong (2014) posit that because the problems associated with mental health are part of the reasons that may grant asylum, psychotherapists are normally expected to point out the illness of their patients. A number of asylum seekers hold the view that when their stress symptoms are improved, it can consequently reduce their chance of being granted asylum, and can even embellish trauma experiences so as to make their claims stronger. According to Slobodin and Jong (2014), such complicated concerns unquestionably have an effect on the therapeutic alliance, the treatment outcome as well as the attitudes of the therapists toward the refugee patients, and this pose a serious setback to mental health practitioners. When refugees adapt to new countries, Murray, Davidson and Schweitzer (2008) posit that they face a loss of identity creating the need to reconstruct their identity in the new context. For that reason, researchers as well as clinicians have started to change the emphasis far from the trauma experiences in addition to post-traumatic stress symptoms toward comprehending refugees’ challenges and experiences in the environment where they are resettled and toward promoting resilience, capacity and strength amongst communities and individuals. Murray, Davidson and Schweitzer (2010) asserts that the need to pursue a holistic approach that recognizes cultural differences has increased. For effective therapeutic treatment, the refugees and asylum seekers’ wisdom as well as inherent strengths must be identified.

In sum, there is a continuing desire to develop mental health services that are culturally appropriate for marginalized as well as socially under-included populations. Refugees and asylum seekers normally experience forced migration as well as persecution in their home country and then they experience discrimination as well as social exclusion in the countries where they are resettled. Still, working with refugees and asylum seekers presents health professionals such as psychologists and psychotherapists an exceptional set of difficulties, which differentiate the refugees’ need for mental health service from those of the general populations. Besides that, it shows the common service needs of refugees, in spite their historical, cultural and social diversity. As mentioned in the literature review, their experiences of trauma as well as persecution results in psychological reactions such PTSD. When forcefully relocated from their home countries, refugees are predisposed to symptoms that need therapeutic interventions.


Annelisa, P. «Perspectives of mental health professionals on treating refugees and asylum seekers in the United Kingdom.» International Journal of Psychology and Counseling 6, no. 4 (2014): 40-52.

Droždek, Boris, and Nina Bolwerk. «Group Therapy With Traumatized Asylum Seekers and Refugees: For Whom It Works and for Whom It Does Not?» Traumatology 16, no. 4 (2010): 160– 167.

Kira, Ibrahim Aref, and Pratyusha Tummala-Narra. «Psychotherapy with Refugees: Emerging Paradigm.» Journal of Loss and Trauma 20, no. 5 (2015): 449-467.

Lecomte, Conrad. «How Can Therapeutic Effectiveness Be Improved?» Integrating Science and Practice 1, no. 1 (2010): 7-9.

Miller, Kenneth E. «The Role of Interpreters in Psychotherapy With Refugees: An Exploratory Study.» American Journal of Orthopsychiatry 75, no. 1 (2005): 27–39.

Murray, Kate E, Graham R Davidson, and Robert D Schweitzer. Psychological Wellbeing of Refugees Resettling in Australia. Working Paper, Melburne VIC: The Australian Psychological Society Ltd, 2008.

Murray, Kate E, Graham R Davidson, and Robert D Schweitzer. «Review of Refugee Mental Health Interventions Following Resettlement: Best Practices and Recommendations.» Am J Orthopsychiatry 80, no. 4 (2010): 576–585.

Slobodin, Ortal, and Joop TVM de Jong. «Mental health interventions for traumatized asylum seekers and refugees: What do we know about their efficacy?» International Journal of Social Psychiatry 1, no. 1 (2014): 1-10.

Tribe, Rachel. «Mental health of refugees and asylum-seekers.» Advances in Psychiatric Treatment 8 (2002): 240–248.

van Wyk, Sierra, and Robert Schweitzer. «A systematic review of naturalistic interventions in refugee populations.» Journal of Immigrant and Minority Health 16, no. 5 (2014): 968-977.