Narrative Exposure Therapy: A Case for Use With Refugees via Telehealth With the use of an Interpreter

Abstract

Rates of PTSD and depression are as high as or higher among samples of refugees than in the general population. There have been few randomized controlled trials of trauma-focused therapies conducted with refugees. Additionally, there has been little research on the use of interpreters in psychotherapy with refugees, but across the studies included in a meta-analysis, a nonsignificant difference between studies that used an interpreter and those that did not was found. Due to COVID-19, mental health providers have had to adapt to the crisis by utilizing telemental health. Research on telemental health with refugee clients is limited, despite a recognition in the literature that telemental health can address some mental healthcare disparities. We review the case of a 26-year-old Afghani/Iranian bilingual diagnosed with post-traumatic stress disorder (PTSD) who presented with intrusive thoughts, panic attacks, nightmares, and flashbacks. Narrative Exposure Therapy (NET) was used with an interpreter via telehealth because it is effective in reducing symptoms of trauma in refugee populations. Treatment success for this case was reflected in the client’s self-reported reduction in symptoms. From this case study, we can conclude that (a) NET is a short-term, cost-effective means for providing trauma-focused care for refugees/asylum-seekers; (b) NET diminishes trauma symptoms with the use of an interpreter via telehealth; (c) a good relationship between therapist, interpreter, and client aids in the effectiveness of NET; and (d) clinician flexibility in the delivery of telemental health and interventions being utilized with refugee/asylum-seeker populations is imperative.

A cross-sectional study exploring equity of access to telehealth in culturally and linguistically diverse communities in a major health service

“…These low numbers are corroborated by studies assessing interpreter use and reporting the insufficient uptake, use of protocols and awareness of interpreter use in telehealth services. 27,[31][32][33] Although the low amount of interpreter uptake found in our study could have biased our association away from the null, our analysis adjusted this factor for potential confounders such as country of birth, socioeconomic disadvantage level and English use. It also aligns with other studies, 11,19,27 exposing the urgent need to address cultural and language barriers in telehealth design and use.…”

Narrative Exposure Therapy for Treating Post-Traumatic Stress Among Transgender Youth of Color With Selective Mutism

“…In general, studies have highlighted the ability to culturally adapt NET to meet the needs of diverse clients, though details on these adaptations are limited (Wright et al, 2020). Increasing exploration of the use of NET via telehealth has appeared promising (Olavarrieta & Benuto, 2022). However, in general, clinical research with TGNB youth has remained scant particularly in the context of the ongoing COVID-19 pandemic and challenges with accessing mental health services among TGNB individuals (Kidd et al, 2021).…”

“…2021; Olavarrieta & Benuto, 2022). Moreover, outside of outcome data collected, there was limited information on additional supports and resources that were available during this time which may have impacted the clients' progress and maintenance of treatment gains following NET.…”

“…Thus, we were unable to determine whether these modifications would be as effective if delivered fully via telehealth. Though additional work is needed to evaluate these modifications via telehealth, existing guidelines and case research support the adaptation of NET for online delivery (Kaltenbach et al, 2021; Olavarrieta & Benuto, 2022). Moreover, outside of outcome data collected, there was limited information on additional supports and resources that were available during this time which may have impacted the clients’ progress and maintenance of treatment gains following NET.…”

Skills Training in Affective and Interpersonal Regulation for Refugees Integrated With Narrative Exposure Therapy: A Case Study on the Treatment of PTSD and Emotion Dysregulation for Refugees and Asylum-Seekers

“…While this significantly reduced the barrier to attending sessions, it necessitates a careful navigation between the establishment of side relationships between the interpreter and client. Further, the ITA model may not be accessible in all settings, such as community clinics, due to financial or staffing considerations (Olavarrieta & Benuto, 2022; Woodward et al, 2020). However, it is noteworthy that clinical trials of NET with refugees have been found to be effective in both high and low resource settings (Cooper et al, 2019).…”