Experiences of psychotherapists working with refugees in Germany: a qualitative study

Abstract

Background Despite a high burden of mental health problems among refugees, there is limited knowledge about effective mental health care provision for this group. Although substantial efforts in understanding the complexity of cross-cultural psychotherapy – which in the context of this study we use to refer to therapy with client and therapist of different cultural backgrounds – have been made, there remains a dearth of research exploring barriers for effective cross-cultural psychotherapy. This study aimed at narrowing this gap in knowledge by exploring major challenges encountered by psychotherapists in cross-cultural psychotherapy and strategies which have proven useful in overcoming such challenges. Methods We employed a qualitative study design, conducting semi-structured in-depth interviews with 10 purposely selected psychotherapists working with refugees in Germany. Respondents were from varying theoretical background and had varying levels of experience. Data were analyzed using a thematic approach, following a mix of deductive and inductive coding. Results Respondents reported three main challenges in their cross-cultural practice: different or unrealistic expectations of clients towards what psychotherapy would offer them; challenges grounded in different illness explanatory models; and communication challenges. In dealing with these challenges, respondents recommended psychoeducation to overcome issues related to problematic expectations towards psychotherapy; “imagining the real”, identifying “counter magic” and other client-appropriate resources to deal with issues related to clients’ foreign illness attributions; and translators in dealing with communication barriers, though the latter not univocally. Conclusions Results show that psychotherapy with refugees can be very successful, at least from the psychotherapist perspective, but also poses significant challenges. Our findings underline the importance of developing, testing, and institutionalizing structured and structural approaches to training psychotherapists in cross-cultural therapy at scale, to accommodate the rising mental health care need of refugees as a client group.

A Walk-In Clinic for Newly Arrived Mentally Burdened Refugees: The Patient Perspective

“…Post-traumatic stress disorder (PTSD), depression, anxiety disorder, somatoform disorders, and substance abuse are the most commonly reported mental health issues [ 3 , 5 ]. These facts result in a high need for psychosocial support services among refugees and asylum seekers which are, however, often insufficient and associated with many barriers [ 6 , 7 , 8 , 9 ].…”

Need for training or already OnTracc? Development and psychometric properties of an online transcultural competence questionnaire among psychotherapists

“…The data of our two studies provided important information and empirical insights based on a transparent and systematic study design. To ensure the content validity of the OnTracc, a questionnaire was constructed based on the current literature ( Asfaw et al, 2020 ) and theoretical models of transcultural competence ( Sue et al, 1992 ). A qualitative study design preceded the study by conducting semi-structured in-depth expert interviews with psychotherapists working with culturally diverse patients in Germany.…”

Impact of and Coping with Post-Traumatic Symptoms of Refugees in Temporary Accommodations in Germany: A Qualitative Analysis

“…The results of the current study show that the effects of traumatic sequelae in refugees and their living situations under insecure residency conditions reinforce each other and lead to a double burden of psychological distress. Moreover, access to therapeutic care for refugees is limited [ 59 ] and poses several challenges [ 60 ]. Therefore, it is necessary to provide adequate support for traumatized refugees and thus facilitate their integration into society.…”