Trauma and Migration[Recurs electrònic] : Cultural Factors in the Diagnosis and Treatment of Traumatised Immigrants

This book provides an overview of recent trends in the management of trauma and post-traumatic stress disorders that may ensue from distressing experiences associated with the process of migration. Although the symptoms induced by trauma are common to all cultures, their specific meaning and the strategies used to deal with them may be culture-specific. Consequently, cultural factors can play an important role in the diagnosis and treatment of individuals with psychological reactions to extreme stress. This role is examined in detail, with an emphasis on the need for therapists to bear in mind that different cultures often have different concepts of health and disease and that cross-cultural communication is therefore essential in ensuring effective care of the immigrant patient. The therapist’s own intercultural skills are highlighted as being an important factor in the success of any treatment and specific care contexts and the global perspective are also discussed. Foreword 6 Contents 8 Part I: Trauma and Migration: Epidemiological and Conceptual Issues 10 1: Introduction: The Relevance of Trauma Among Immigrants 11 References 14 2: Rethinking Trauma as a Global Challenge 17 Introduction 17 The Genealogy of Trauma as a Mental Injury 18 Trauma and PTSD 20 Re-examining the Impact of Organised Violence, Armed Conflict and War on Population Health 25 The Global Impact of War and Violence 27 Contemporary Wars and the Emergence of New Forms of Warfare 30 Refugees and Internally Displaced Populations (IDPs) 31 Humanitarian Interventions Aimed at Civilian Populations in War-Torn Countries and Conflict Zones 32 Concluding Remarks 34 References 35 3: The Epidemiology of Post-traumatic Stress Disorder: A Focus on Refugee and Immigrant Populations 40 Background 40 Prevalence of PTSD and Traumatic Events 41 Prevalence of PTSD in Refugee Populations 41 Risk Factors Associated with PTSD 42 References 43 4: Cross-Cultural Communication with Traumatised Immigrants 45 Introduction 45 Cross-Cultural Communication 46 Language 47 Health Literacy 48 Idioms of Distress 48 Communicative Style and Discourse Systems 49 Culture, Trauma, Emotional Reactions 50 Cross-Cultural Communication Barriers 51 Bridging Barriers in Cross-Cultural Communication 52 The Narrative 52 Interpreters 53 Cultural Brokers 54 Self-Reflection and Supervision 54 Assessment and the Cultural Formulation Interview 54 Diagnostic Categories and Sense of Coherence 55 Building Trust and a Therapeutic Alliance 55 Case, Soran 56 Summary of Key Points for a Successful Intercultural Communication with Traumatised Immigrants 58 References 59 5: Trauma and Migration: The Role of Stigma 62 The Issue of ‘the Other’ 63 Migration and Mental Health 66 Trauma and Mental Health 67 Stigma and Stigmatisation 68 Responses to Stigma 69 The Issue of ‘Roots’ 70 Conclusions 71 References 72 Some of the Relevant United Nations Documents 73 6: Migration, Trauma and Resilience 74 Introduction 74 Definitions 75 Trauma 75 Resilience 75 Types of Migration 75 Cultural Bereavement 76 Culture Conflict 77 Culture Shock 77 Racism and Ethnic Identity 78 Resilience 82 Conclusions 83 References 83 Part II: Trauma and Migration: Diagnostic Issues 85 7: Clinical Diagnosis of Traumatised Immigrants 86 Migratory Phenomena Affecting Mental Health 86 Differences in Socialisation 87 Parenting and Family Structure 87 Tradition 88 Sense of Shame 89 Concepts of Illness 89 Somatisation 90 Expectations Towards the Professional 90 Interaction with the Sick 91 Refugees: Relevance of Trauma and Legal Issues 91 Problems Related to Reduced Language Proficiency 92 Use of Psychometric Measures 93 What Do Professionals Need? A Critical View of the Term “Intercultural Competence” 94 References 94 8: Special Problems in the Assessment of Psychological Sequelae of Torture and Incarceration 97 Introduction 97 Symptom-Related Characteristics in the Assessment of Psychologically Reactive Sequelae of Trauma 98 Dissociative Symptoms of Complex PTSD 102 Trauma-Specific Aspects of Transference and Countertransference 104 Distinction from Other Psychiatric Disorders 105 Right to Asylum and Residence 106 Special Problems in Residence Legal Procedures Determined by Linguistic and Cultural Differences 107 Conclusion 107 References 108 9: Gender and Trauma 110 Sex and Gender 110 Gender and Health 113 Gender, Mental Health and Trauma 113 Gender and Mass Traumas 121 Armed Conflicts, Wars and Trauma 122 Disasters, Trauma and Gender 125 Gender and Perceiving Benefits in Adversity 129 Concluding Remarks 134 References 135 10: Exposure to Trauma and Forced Migration: Mental Health and Acculturation Patterns Among Asylum Seekers in Israel 140 Forced Migration to Israel 140 Forced Migration and Mental Health 142 Migration and Mental Health in Adults 142 Migrant Adolescents and Mental Health 143 Acculturation and Mental Health 145 Studies Related to Forced Migration in Israel 146 Exposure to Trauma During the Journey to Israel Among Asylum Seekers 146 Studies of Acculturation Among Asylum Seekers in Israel 147 Acculturation Among Adult Asylum Seekers 148 Acculturation Among Adolescents 149 Discussion 150 References 153 Part III: Trauma and Migration: Treatment Issues 158 11: Cultural Competence in Trauma 159 Introduction 159 Culturalist 160 Race Based 161 Experience 161 Expression 162 Explanation 163 Expectations 164 Knowledge 164 Attitudes 165 Skills 166 Trauma as a Sociocultural Construct 167 Trauma in Context 169 Conclusions 172 References 173 12: Intercultural Trauma-Centred Psychotherapy and the Application of the EMDR Method 176 Introduction 176 Epidemiology 177 Trauma and Migration 178 Diagnosis of Post-traumatic Stress Disorder 178 Special Aspects in Intercultural Treatment Processes 179 Working with Interpreters (Linguistic and Cultural Mediators) 180 Intercultural Trauma-Centred Psychotherapy 181 EMDR 182 Final Considerations 184 References 185 13: Resilience-Oriented Treatment of Traumatised Asylum Seekers and Refugees 190 Introduction 190 Trauma-Focused and Resilience-Focused Interventions 191 The ROTS Model 192 Resources of Resilience 194 Biological Resources 194 Understanding the Body 194 Physical Exercise 194 Stress Management/Relaxation 195 Medication 196 Treatment of Nonpsychiatric Illnesses 196 Psychological Resources 196 Positive Emotions and Humour 196 Cognitive Flexibility 197 Empowering Self-Esteem 198 Coping 198 Social Resources 199 Social Relatedness/Connectedness to the Family 199 Social Support 200 Meaningful Activities 200 Religious/Spiritual Resources 201 Cultural Resources 202 Conclusion 203 References 203 14: Traumatised Immigrants in an Outpatient Clinic: An Experience-Based Report 208 Introduction 208 The Concept of the Psychiatric Outpatient Clinic (PIA) 209 Patients with a Migration Background in Psychiatric Outpatient Institutions 209 Therapeutic Approach to Treating Traumatised Refugees and Asylum Seekers in Our PIA 210 Special Group Concept 212 Working with Interpreters 214 Interpretation Costs 218 Conclusion 219 References 219 15: Psychotherapy with Immigrants and Refugees from Crisis Zones 221 Introduction 221 Mentally Ill Refugees and the Health System 222 Mental and Psychosomatic Disorders in Migrants from Crisis Zones 223 Diagnostic Approaches with Patients with a History of Displacement 226 Specifics in Psychotherapeutic Work with Refugees 227 Psychotherapy with Interpreters 230 Clinical Certificates and Statements in Psychotherapy with Refugees 231 Why Do Clinical Certificates Play an Important Role in Asylum and Immigration Law Procedures? 231 Mandatory Conditions for Clinical Professionals 233 Standards for Expert Assessment and Examination According to the Istanbul Protocol 235 References 236 16: A Therapy Model for Traumatised Refugees in Denmark 240 Resume 240 Introduction 240 Historical Aspects 241 The Initiation of Therapeutic Interventions 242 Statistical and Brief History of Immigration in DK 243 Outline of Health Services in Denmark (With Focus to Treatment of Trauma) 244 Public and Private Institutions, Organisations and Units Offering Specialised Treatment to Traumatised Refugees in Denmark 244 Institutions in Denmark Focusing on Traumatised Refugees 245 Medical Technology Assessment 247 An Overview of the Different Therapies for Traumatised Refugees Used in Denmark 248 The Competence Centre for Transcultural Psychiatry (CTP) (www.psykiatri regionh.dk) 248 Future Perspectives for Treatment of Traumatised Refugees in Denmark 251 Concerns 252 International Collaboration and Networking 253 References 254 Front Matter....Pages i-viii Front Matter....Pages 1-1 Introduction: The Relevance of Trauma Among Immigrants....Pages 3-8 Rethinking Trauma as a Global Challenge....Pages 9-31 The Epidemiology of Post-traumatic Stress Disorder: A Focus on Refugee and Immigrant Populations....Pages 33-37 Cross-Cultural Communication with Traumatised Immigrants....Pages 39-55 Trauma and Migration: The Role of Stigma....Pages 57-68 Migration, Trauma and Resilience....Pages 69-79 Front Matter....Pages 81-81 Clinical Diagnosis of Traumatised Immigrants....Pages 83-93 Special Problems in the Assessment of Psychological Sequelae of Torture and Incarceration....Pages 95-107 Gender and Trauma....Pages 109-138 Exposure to Trauma and Forced Migration: Mental Health and Acculturation Patterns Among Asylum Seekers in Israel....Pages 139-156 Front Matter....Pages 157-157 Cultural Competence in Trauma....Pages 159-175 Intercultural Trauma-Centred Psychotherapy and the Application of the EMDR Method....Pages 177-190 Resilience-Oriented Treatment of Traumatised Asylum Seekers and Refugees....Pages 191-208 Traumatised Immigrants in an Outpatient Clinic: An Experience-Based Report....Pages 209-221 Psychotherapy with Immigrants and Refugees from Crisis Zones....Pages 223-241 A Therapy Model for Traumatised Refugees in Denmark....Pages 243-257 "This book provides an overview of recent trends in the management of trauma and post-traumatic stress disorders that may ensue from distressing experiences associated with the process of migration Although the symptoms induced by trauma are common to all cultures, their specific meaning and the strategies used to deal with them may be culture-specific Consequently, cultural factors can play an important role in the diagnosis and treatment of individuals with psychological reactions to extreme stress This role is examined in detail, with an emphasis on the need for therapists to bear in mind that different cultures often have different concepts of health and disease and that cross-cultural communication, assisted by a professionally trained and certified interpreter if necessary, is therefore essential in ensuring effective care of immigrant patients The therapist's own intercultural skills are highlighted as being an important factor in the success of any treatment, and specific care contexts and the global perspective are also discussed - Font no determinada