Understanding migrants’ experiences of talking therapy services, and how services might be improved.
Quick-read summary
Although there is significant research on the mental health care challenges of migrants, particularly refugees and asylum seekers, the treatment approach for this group has not received enough attention.
By analysing migrants’ experiences of mental health care in the UK, this study aimed to explore whether refugees and asylum seekers with various pre- and post-migration traumatic experiences might need different therapeutic approaches.
What is the issue?
Refugees and asylum seekers experience a higher rate of mental illness around the world.
A considerable number of studies have investigated the accessibility and effectiveness of mental health services for migrants to identify potential barriers and challenges.
However, these studies do not address the impact of the therapeutic approach. A therapeutic approach is the way in which a psychologist or counsellor might frame how their client/patient views their personal experiences and relationships – and then support them to work through the issues that occur for that client/patient throughout their lives.
Previous studies also do not propose what relevant treatments could be identified and adopted for migrant clients or how to identify them.
This study discusses how employing a ‘cultural models’ approach in mental health treatment would contribute to understanding clients better – so that the therapist can discover more about the underlying assumptions and expectations of a client in order to provide more relevant and effective treatments for them.
What do we mean by a ‘cultural models approach’?
Cultural models are the ways that a group of people with similar life experiences think about or organise knowledge about particular issues or events. The ‘cultural models’ approach implies a specific sense of culture. It is different to multicultural psychology, which implies that a nation or ethnic group has a ‘set’ or distinct culture. Instead, the ‘cultural models’ approach assumes that cultures are complex, consisting of commonalities and consistencies as well as contests, disagreements, conflicts, and changes.
Cultural models can shape a person’s view of the world, and can influence how someone interprets events, and behaves.
In the context of therapy, this would mean a therapist would use the idea of cultural models to explore the context in which a clients’ emotions occur, the ways in which they perceive and evaluate events, and the coping strategies that they use to process the emotions that they experience.
Research summary
Twenty-five refugees and asylum seekers living in the North East of England and Northern Ireland were interviewed.
Participants had used at least six sessions of talking therapy provided by the NHS or voluntary/charity organisations during the last three years.
The interviewees had been living in the UK for between one and four years. Most interviewees were from Iran, followed by Afghanistan, Syria, Somalia, Yemen, Palestine, and Sudan. The youngest participant was 20 years old, and the oldest was 56. The interviewees’ educational levels varied from primary school to the PhD level, with most having a high school diploma or an undergraduate degree.
The participants of this study evaluated their experiences with talking therapy differently, varying from quite satisfied with the services to absolutely unhappy.
Nevertheless, interviews indicated that in many cases, the clients’ underlying assumptions about therapy and their expectations of therapists differed from the services they received.
Our findings
Refugees and asylum seekers present to Western countries a specific set of mental health challenges that require a more nuanced therapeutic awareness and approach. The ‘cultural models’ approach can provide the necessary framework and method for making key therapeutic decisions.
This approach is a major advance over (but also generally aligned with) the values of multiculturalism, social justice, liberation psychology, and trauma-informed frameworks.
Our research suggests that if therapists use a ‘cultural models’ approach, they would be more able to build therapeutic alliances with clients and therefore provide more relevant and appropriate treatments for them.
(The therapeutic alliance is the connection between patient and therapist – and covers the mutual agreement to work together on tasks related to the patient’s wellbeing. The alliance is a joint sense of mission, collaboration, trust in the other, and hope).
The ‘cultural models’ approach would offer an innovative approach in mental health treatment by engaging with the client’s underlying assumptions and the meaning of a given experience for them.
Our study also showed that a ‘cultural models’ approach recognises individual differences and does not regard migrant clients as one group with the same expectations and assumptions. It highlights the social, cultural, and political contexts of traumas and mental health too.
Who is this evidence useful for?
- Researchers and scholars in fields of mental health, migrants’ studies, health inequalities, cognitive anthropology and cultural model’s studies.
- Therapists and counsellors.
- Anyone who works with migrants.
How were the public and patients involved in this work?
The lead researcher worked with two charity organisations in the North East of England and two community groups in Northern Ireland to recruit participants.
Find out more
Get in touch about this research:
Lead researcher: mohaddeseh.ziyachi@durham.ac.uk