Rachel Tribe

WPA guidance on mental health and mental health care in migrants

The purpose of this guidance is to review currently available evidence on mental health problems in migrants and to present advice to clinicians and policy makers on how to provide migrants with appropriate and accessible mental health services. The three phases of the process of migration and the relevant implications for mental health are outlined, as well as the specific problems of groups such as women, children and adolescents, the elderly, refugees and asylum seekers, and lesbian, gay, bisexual and transgender individuals. The concepts of cultural bereavement, cultural identity and cultural congruity are discussed. The epidemiology of mental disorders in migrants is described. A series of recommendations to policy makers, service providers and clinicians aimed to improve mental health care in migrants are provided, covering the special needs of migrants concerning pharmacotherapies and psychotherapies.

Working with interpreters in mental health

To ensure equality of access to health and social care services for all communities resident in Britain, services need to be appropriate and accessible. This requires ensuring that a range of policies is adhered to and that services are designed to make this possible. In a culturally diverse society, there will be people who are not fluent in the language of their country of residence, but who may require access to health and social care services, necessitating the services of a language interpreter. This means that clinicians need to be trained both to work with interpreters and to feel confident in so doing. This paper explores issues relating to working in partnership with an interpreter and offers guidance about good practice. The complex relationship between language, culture and worldview is discussed and suggestions are made about how these might be considered within clinical services. Finally, four diverse modes of interpretation are reviewed and illustrated.

Counselling psychologists' perceptions of the impact of mandatory personal therapy on professional development--an exploratory study

A qualitative study was carried out with recently qualified and trainee counselling psychologists to investigate their opinions as to the impact of mandatory personal therapy on their professional development. The methodology employed was grounded theory using data obtained from indvidual and group interviews. The results indicate that mandatory personal therapy can lead to perceived positive outcomes in terms of professional development including: a sense of the self as a professional through developing reflexivity as a result of being in the role of client; socialization into a professional role through validational and normative experiences such as the therapist modelling good and poor practice; support during times of personal difficulty; and, personal development that leads to a perceived improved ability for the participant to distinguish between personal issues and those of the client. An important effect for participants who did not have a previous substantial experience of personal therapy appeared to be the validation of therapy as an effective psychological intervention.

Bridging the gap or damming the flow? Some observations on using interpreters/bicultural workers when working with refugee clients, many of whom have been tortured

This paper will comment upon some of the dilemmas inherent in the task of using interpreters/bicultural workers when working with refugee clients who have fled to Europe, many who have been tortured. A high proportion of refugees may not speak European languages or share explanatory health beliefs. The author would argue that these differences should not act as barriers to obtaining health and counselling services and that employing interpreters/bicultural workers may help to bridge these gaps and improve service provision and delivery.

Working with interpreters across language and culture in mental health

Background: Mental health professionals need to be able to work effectively with interpreters to promote good clinical practice and ensure equality of access and service delivery as well as meet the requirements of European law. The process offers practitioners an opportunity to enrich their understanding of the diverse idioms of distress, cultural constructions and explanatory health beliefs. Aims: This paper draws upon the literature and clinical accounts to provide a set of positive practice guidelines on working with interpreters in mental health. Method: Key indicator words for the literature review were “interpreters and mental health” and “language and mental health”. Papers that related purely to linguistic theory, cultural theory, or sign language interpreting were not included. To assist with triangulation of the data the authors also drew upon accounts of support and supervision groups for interpreters and bicultural workers, expert panels on the topic, training programmes and published guidelines for interpreters and clinicians. Results and Conclusions: Mental health services around the world need to be accessible, inclusive, appropriate and accord with best practice and national legislation. The paper reviews opportunities and challenges in working with interpreters in mental health services and offers some positive practice guidelines for clinicians based on the available literature. Declaration of interest: None.

Therapeutic work with refugees living in exile: observations on clinical practice

Asylum seekers and refugees fleeing to Britain or other host countries face a range of dilemmas, which are qualitatively different from those facing any other client group. Refugees find themselves in an entirely different country, having often fled at short notice without making preparations. They may have suffered multiple practical and psychological losses. Significant numbers of refugees will have been subject to organised violence in their country of origin. Responding clinically to the needs of some of those becoming refugees has many implications and challenges for existing models of therapeutic intervention. This paper draws upon the authors clinical work in Britain and abroad, it details some observations on therapeutic practice and highlights the challenges and rewards of working with this client group.

What is the prevalence of narcissistic injury among trainee counselling psychologists

The purpose of this study was to ascertain the level of narcissistic injury among trainee counselling psychologists using the Narcissistic Injury Scale (Slyter, 1991). This 38-item Likert scale is based on Millers (1981) definition of narcissistic injury; a specific type of psychological damage which focuses on feelings about the self and past relationships related to self-development. Theorists suggest that if untreated, narcissistic issues can interfere with client work and lead to a number of problems for trainees, influencing drop-out rates and increasing burnout. The results of the study indicate that a high degree of narcissistic injury may be prevalent among trainee counselling psychologists and furthermore, that narcissistic injury does seem to be related to the quality of the perceived parent-child relationship. Consequently, the study suggests that therapeutic work could be affected in those trainees who fail to address their own narcissism. The study provides some tentative support for the utility of the Narcissistic Injury Scale.

Exploring the Three-Way Relationship in Therapeutic Work with Interpreters

In a companion paper, we have argued that therapeutic work with interpreters has been viewed more negatively than is warranted, and that the inherent advantages of this way of engaging with the non English speaking client have been minimised or ignored. This paper seeks to explore the aspects that may underlie the reluctance of clinicians to engage with therapeutic work with interpreters. Difficulties often appear to be centred on the anxieties provoked by working in the three‐way therapeutic relationship rather than in the traditional therapeutic dyad. It is also possible that the highly traumatised nature of some clients, who may be refugees or asylum seekers fleeing from political violence, also complicates such work. The intention in this paper is to consider both the dynamics of the three‐way relationship and the impact of traumatic experience, when relevant, on therapeutic work with interpreters, and to suggest how the pulls inherent in such work might be managed. It is hoped that by exploring these problematic areas, some light can be shed on the difficulties that all clinicians can experience but can equally overcome.

Issues in using interpreters in therapeutic work with refugees. What is not being expressed

‘Interpreting’ could be thought about as a legal equal opportunities or human rights issue. Whereas interpreters are likely to focus on the linguistic issues, and will be aware of the technical complexities of their work. Clinicians may worry about the impact on the therapeutic relationship of the interpreters presence, how this will be managed and how it may depend on the match or mismatch of such factors as the clients gender, age and first or other language. This paper considers the issue on each of these levels to reveal the complexities and dilemmas of effective clinical work with interpreters, but also what can be achieved: the multiple layers of meaning concerning the clients experience and communication which can be elicited through effective working between interpreter and clinician.

Psychological intervention with displaced widows in Sri Lanka

This paper describes a programme for war widows residing in refugee camps in Sri Lanka.The country has been traumatized by civil conflict for over 15 years and one in seventeen people have been displaced.The explicit aim of the programme is to promote mental health among the refugees, mainly by facilitating coping strategies. Self-help principles are utilized.An additional aim of the programme is to help foster relationships between women from the different sides of the conflict, thereby providing an opportunity for changing perceptions, attitudes and stereotyped beliefs. A blend of traditional models based on expert knowledge and a more radical model, which maximizes the resources of the women themselves, is used.The cultural and socio-political issues defining the intervention at micro- and macro-levels are also discussed.