A Practical Guide to Therapeutic Work with Asylum Seekers and Refugees

Paul Cilia La Cilia La Corte, Angelina Jalonen

• Publisher: Jessica Kingsley Publishers
• Year: 2017
• ISBN:
  9781784503345
• Topic: Psychologie
• Subtopic: Histoire et théorie en psychologie

The need to support refugees has never been more urgent, but how can everyone working with them provide consistently effective care? Written for a range of professionals including therapists, teachers, social workers, housing support workers and healthcare professionals, this essential guide offers a holistic, person-centred framework to ensure that all those working with refugees to provide them with excellent support.

Informed by the authors' direct work with refugees, the book starts with a comprehensive introduction to understanding the underlying issues that lead to the complex needs of an asylum seeking client group. Using an easy-to-follow 'what?', 'why?' and 'how?' structure, within the four key phases of refugee experience. It also shows professionals how to sensitively address trauma, loss and separation with clients who are adjusting to a foreign culture and language using three core principles (therapeutic relationship, bearing witness and psycho-education).

Informed and accessible, this guide will help you create a safe, welcoming environment for asylum seekers in all stages of their journey to improve their psychosocial wellbeing and mental health.

PART 1

UNDERSTANDING: THE
REFUGEE PHENOMENA

Part 1 of this book is divided into six chapters:

Chapter 1: The Refugee Experience. Understand the four phases of the refugee experience, which we term: Homeland Phase of Apprehension, Persecution Phase of Terror, Asylum Phase of Hope and Fear, and Rebuilding Phase of Relief with Sadness.

Chapter 2: Loss, Separation and Trauma in the Four Phases. Empathise with the impact of loss caused by refugees leaving their home country.

Chapter 3: Host Country Acculturation. Have awareness of both the difficulties and opportunities available in the host country.

Chapter 4: The Complex and Multiple Levels of Needs. Appreciate the many and complex needs these factors create, especially as an asylum seeker who sits between a loss of home and being granted refugee status in the host country.

Chapter 5: Self-Identity and Human Resilience. Have an insight into the impact on one’s identity, and be open to ways that asylum seekers respond on a spectrum. This can range from feeling incapacitated to being empowered while facing the challenges the asylum process brings, including integration in the host country.

Chapter 6: Refugee Trauma and Mental Health. The complexities in understanding refugee mental health and how it may differ from your own perspective.

CHAPTER 1

THE REFUGEE EXPERIENCE

You must not lose faith in humanity. Humanity is an ocean; if a few drops of the ocean become dirty, the ocean does not become dirty.

Mahatma Gandhi

The refugee experience is generally described as three stages: ‘before, during and after’ or ‘pre-flight, flight and post-flight’ (Hanson and Vogel 2012). Papadopoulos (2002) identifies four, making a distinction in the pre-flight stage between the time before the violence, that he calls ‘anticipation’, and the actual violence, that he terms ‘devastating events’; and names ‘flight and post-flight’ as ‘survival and integration’ respectively. We have found this four-phase model to be invaluable in identifying both trauma as well as resilience and strengths throughout each phase of a refugee’s journey (Papadopoulos 2007).

Our work with refugees seeking asylum in a host country has been informed by their commonly held emotional responses linked to what is happening at each phase. Namely, apprehension at the prospect of losing their homeland which turns to terror during the actual persecution that forces them to leave. Then hope (of permanent safety) and fear (of a return to persecution) in a temporary sanctuary during the asylum process. Finally, relief when granted refugee status that allows them to rebuild their home in a safe country, yet with sadness as they realise that they may never see their homeland again. We refer to these as: Homeland Phase of Apprehension, Persecution Phase of Terror, Asylum Phase of Hope and Fear, and Rebuilding Phase of Relief with Sadness.

Homeland Phase of Apprehension

Mahdi was a respected elder in the village where he was born and brought up, before war broke out in his country. He was married and they had four children, one son and three daughters. When the war started, Mahdi recalls how they lived in disbelief for five months, constantly listening to the radio in anticipation of the restoration of law and order. Their village supplies of food and electricity were discontinued after four months of fighting, which is when his wife and three daughters fled to a neighbouring country. Mahdi and his son decided to remain behind in order to protect their properties and land.

He said, ‘I didn’t think the war was going to be serious. I hesitated to make decisions and I did not want to show my family that I was afraid. I did not have enough money to pay for their escape and I could not imagine separating my family. We had always lived together. It was only because of lack of food and electricity that it seemed right that my wife and daughters should go somewhere safe. We could not all afford to leave and I was still reluctant to go. Because of this I didn’t say a proper goodbye to my wife and daughters, as I presumed it was just for a short while and they could return to us.’

Mahdi reflected, ‘I was also worried about my parents. My youngest sister was looking after them but she is a woman and may not be well equipped to protect them.’

In Priathan’s case, she had lived for many months in the apprehension phase. She had first heard about the conflict in her country on the news. When neighbours began to talk about people they knew personally becoming involved, Priathan felt scared; yet she also remembered other times of difficulty that had come and gone, and which she had safely lived through.

Priathan reflected, ‘This was the country where I was born, got married and raised my two children. It had never been perfect but we all managed to have a good life. Even when my husband became involved politically, I saw this as positive at the time. I believed that if enough people stood up to protest against the cruelty of the authorities towards its people, they would realise they could not get away with it and stop.’

As a woman, Priathan knew her place when it came to politics. She believed this was a male domain and it would be a disgrace for a woman to share her opinions or have a view on what might be going on, let alone suggest any solutions. She also knew of a woman who was persecuted because she spoke up against the government regime.

‘She should have known better. Football and politics belong to men and I have no interest in either,’ Priathan added.

Persecution Phase of Terror

Mahdi reflected on his experiences as the war continued in his country.

At this time, Mahdi and a few other community men had identified a safe underground shelter where they took their parents for safety. Although it was crowded and had no windows, at least it would protect them for a while until the country was stable again.

‘The government was losing control and the rebels were closing in,’ he explained. ‘My son was called to help the government fight on the frontline, while I took up the role of hiding and supplying weapons of war to the frontline. Unfortunately, while supplying weapons, I was arrested by the rebels. I was held in a small dark room for five days. The rebels tried to elicit information from me by torturing me. My head was submerged in dirty water and they burned me on my thighs with cigarettes. In the end, I submitted and disclosed sensitive information on a hideout location of senior government officials. After two days, I was being transferred to another location. Fortunately, during transportation, there was a missile attack in which the bus was hit and, in the commotion, I was able to escape.’

‘I went back to the site where my son was fighting and discovered that he had been killed in action. Devastated by the death of my son, my betrayal of the government and the impending danger of persecution, I feared for my life and I had no choice but to flee the country through the first available exit route, which gave me no time to find out where my wife and three daughters had fled. I fled and at the same time part of me resisted going, not knowing what lay ahead in the direction I was taking or if it was a safe route to escape. My life was in tatters, I found myself all alone.’

For Priathan, recollecting this phase of persecution was extremely distressing. It was two weeks since her husband disappeared. There were rumours that he had joined the rebels to fight the government-controlling regime to bring change in the country, and this created fear for the family. She had withdrawn her children from school for fear of being harassed along the way.

Soon after this, the government started sending agents to suspected homesteads looking for such rebels or government opponents. Those who were found were arrested for protesting against their regime and such people were tortured or risked a death penalty.

‘I could not have imagined they would react with such violence. It was only when I realised that the security forces were prepared to kill me that I made the decision to leave. I had made no plan, and therefore I had no idea of where I was going or how to get there. I was totally unprepared.’

‘They tore my clothes,’ Priathan stated, looking down and explained what happened when security forces came to her home after her husband was arrested for political activism. She continued, ‘They wanted more information about my husband’s political involvement, but I did not know any more than I had already told them.’ Priathan’s shoulders slumped, ‘I then realised that, for the sake of my children, I had to leave my country.’

Although Priathan was not a political activist and did not consider herself to be part of the problem, she soon realised that she carried her husband’s sins and was equally at risk of persecution for his activities.

This realisation of being in mortal danger, and having to fight, hide, and/or flee marks the second phase: the Persecution Phase of Terror.

Even when living in apprehension for months, or even years, if it becomes clear that to remain will carry the risk of being tortured or killed, people take the actual decision to leave their homeland in an instant. Like Priathan and Mahdi, most people live in denial that they are not safe and partly in hope that things will get better.

Additionally, their country is the place in which they have been raised, developed their self-identity and their status and made other significant attachments. The thought of leaving everything they own behind and walking out into the unknown can be extremely frightening and traumatic. Therefore, when the decision is made to leave, it frequently occurs in haste and without a plan of where to go and how to get there, or with sufficient resources to fund the journey.

Asylum Phase of Hope and Fear

The third phase begins when a refugee has to leave their home. Loss of ‘home’ in this case means many things, including a person’s house, country, culture, environment, friends and family.

Priathan reflected on the moment that she reluctantly waved her father and mother-in-law goodbye. She did not shake their hands or hug them, as she was too angry and, at the same time, fearful. She did not want to go and yet she did not have a choice. From an early age, she had been dedicated to caring for her parents and when she got married this included her mother-in-law; however, due to the acts of violence and threat to her life she was no longer able to fulfil this commitment. Such a huge shift in one’s purpose in life can be experienced as an overwhelming loss that can impact dramatically on a refugee’s self-identity.

Priathan stated, ‘I had not discussed with my daughters about what was going on; I could see in their eyes how fearful they were and I was not ready to speak about the danger we were in. I had already paid some smugglers to collect us at night as we did not want our neighbours to know.’

In Mahdi’s case the decision to leave his homeland was deeply painful and eroded his self-identity as the protector of his family. He was forced to leave behind all that had made him what he was, his primary role having been to provide for and protect his family. This had now been compromised and he too became a victim of the conflict and war in his country. When crossing through the neighbouring country, he was questioned about his identity by border guards and had to keep his ethnicity secret for fear of further persecution. He stayed in a refugee camp and although water, food, shelter and first aid were available, there was a lack of safety and he witnessed women and children being abused. He felt powerless to protect them, which triggered more fear for his family. This made him more determined to risk crossing the sea into Europe, hoping he would be able to get help to find his family.

Mahdi reflected on his journey, ‘I travelled at night and hid during the days along the danger zones. I had to pay and negotiate my way with ruthless and powerful people smugglers. At times, I was vulnerable and had to compromise my dignity for survival. I witnessed various abuses along the way and I helped the weaker ones to keep going. It took me three months before I ended up in Europe without my family and I applied for safety as a refugee.’

This third phase involves a journey, most often to an unknown location by air, land and/or sea. The journey usually involves risk, is often lengthy and, for the whole duration, is outside the protection of any government. This puts refugees at risk of many types of abuse and exploitation.

Priathan was given money by her ailing father for her escape. She felt heartbroken to leave her father behind in such a vulnerable state but he had insisted that she needed to protect her daughters. Priathan paid an agent and travelled in the back of a truck with her two children.

‘It took many, many days. I don’t know how many exactly, because we were sealed inside a metal container without any windows. Two men came in with torches every time the truck stopped and brought water and some food for my children.’

Priathan’s eyes widened and her voice became hushed, ‘They took me to the other side of the container while my children ate.’ She appeared frozen and fell silent. ‘I prayed silently and constantly. I have always observed our spiritual rituals from my young age but this time I did not feel worthy of God’s grace because I f...

Table of contents

• Cover
• Title Page
• Contents
• Foreword by Jerry Clore
• Preface
• Introduction
• Part 1: Understanding: The Refugee Phenomena
• Part 2: Three Core Principles
• Part 3: Working with Groups and Separated Children
• Part 4: Practitioners First Aid and Toolbox
• Appendix A: Family Genogram
• Appendix B: External Factors
• Appendix C: Fear and Sadness
• Appendix D: Crisis Intervention
• References
• Index
• About the Authors
• Join Our Mailing List
• Acknowledgements
• Copyright
• Copyright