Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-10T05:38:12.445Z Has data issue: false hasContentIssue false
  • English
  • Français

Unaccompanied minors’ experiences of narrative exposure therapy

Part of: Being an Anti-Racist CBT therapist

Published online by Cambridge University Press:  08 March 2021

Glorianne Said ,
Yaman Alqadri  and
Dorothy King
Glorianne Said
Affiliation:
Foundation 63, London, UK
Yaman Alqadri
Affiliation:
Research Department of Clinical, Educational and Health Psychology, University College London, 1–19 Torrington Place, LondonWC1E 7HB, UK
Dorothy King*
Affiliation:
Foundation 63, London, UK
*
*Corresponding author. Email: dorothy.king1@nhs.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Despite the understanding that unaccompanied minors’ (UAM) experience high rates of post-traumatic stress, the provision of evidence-based trauma-focused therapies is low for this population. Narrative exposure therapy (NET) is an effective short-term intervention for treating post-traumatic stress disorder (PTSD) after multiple traumatic experiences, such as those experienced by UAM. Within the existing literature, there is a lack of research investigating unaccompanied minors’ experiences of NET or any trauma-focused therapy. Participants were four UAM experiencing PTSD who formed part of a pilot delivery of NET within a dedicated child and adolescent mental health service for refugee children. Semi-structured interviews were conducted and transcripts were analysed using interpretative phenomenological analysis (IPA). This project identified five themes that encapsulated unaccompanied minors’ experiences of receiving NET, including the process of preparing for this therapy, what it was like to receive it, and the differences they identified at the end of treatment. The significance of this taking place within a safe therapeutic relationship was explored within the context of the attachment losses experienced by UAM, and the impact this has on emotion regulation was considered. The potential of a reduction in PTSD symptoms facilitating a positive spiral in adolescence was reflected on within this paper.

Key learning aims

  1. (1) To understand the experience of unaccompanied asylum-seeking minors (UAM) receiving narrative exposure therapy (NET) for post-traumatic stress disorder.

  2. (2) To understand the key concerns and motivators for UAM when considering engaging in NET.

  3. (3) To understand how these experiences relate to theoretical frameworks and the existing literature relating to emotional difficulties in adolescence.

Keywords

adolescencepost-traumatic stress disordernarrative exposure therapyrefugee childrenunaccompanied asylum-seeking childrenunaccompanied asylum-seeking minors
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 14 , 2021 , e11
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Further reading

Brooks, M. (2019). The importance of using reflective practice when working with refugees, asylum seekers and survivors of torture within IAPT. the Cognitive Behaviour Therapist, 12.CrossRefGoogle Scholar
Eruyar, S., Huemer, J., & Vostanis, P. (2018). How should child mental health services respond to the refugee crisis? Child and Adolescent Mental Health, 23, 303–312.CrossRefGoogle ScholarPubMed
Fazel, M., & Betancourt, T. S. (2017). Preventive mental health interventions for refugee children and adolescents in high-income settings. The Lancet Child & Adolescent Health, 2, 121–132.CrossRefGoogle ScholarPubMed
Fazel, M., Stratford, H. J., Rowsell, E., Chan, C., Griffiths, H., & Robjant, K. (2020). Five applications of narrative exposure therapy for children and adolescents presenting with post-traumatic stress disorders. Frontiers in Psychiatry, 11.CrossRefGoogle Scholar
Mitra, R., & Hodes, M. (2019). Prevention of psychological distress and promotion of resilience amongst unaccompanied refugee minors in resettlement countries. Child: Care, Health and Development, 45, 198–215.Google ScholarPubMed
Schauer, M., Neuner, F., & Elbert, T. (2017). Narrative exposure therapy for children and adolescents (KIDNET). In Landolt, M. A., Cloitre, M., & Schnyder, U. (eds), Evidence-Based Treatments for Trauma Related Disorders in Children and Adolescents (pp. 227–250). Cham, Switzerland: Springer.CrossRefGoogle Scholar
Schauer, M., Robjant, K., Elbert, T., & Neuner, F. (2020). Narrative exposure therapy. In Ford, J. D. & Courtois, C.A. (eds), Treating Complex Traumatic Stress Disorders in Adults: Scientific Foundations and Therapeutic Models (pp. 309–331). New York, USA: Guilford Press.Google Scholar
Smith, P., Dalgleish, T., & Meiser-Stedman, R. (2018). Practitioner review: posttraumatic stress disorder and its treatment in children and adolescents. Journal of Child Psychology and Psychiatry, 60, 500–515.CrossRefGoogle ScholarPubMed
UNICEF (2017). The Adolescent Brain: A Second Window of Opportunity. Florence, Italy: UNICEF Office of Research – Innocenti, Florence.Google Scholar

References

Association of Clinical Psychologists – UK (2020). Practice guidelines for clinical psychologists for supporting appropriate care and treatment for Unaccompanied Asylum-Seeking Minors in the United Kingdom. UK: Association of Clinical Psychologists – UK.Google Scholar
Barker, C., Pistrang, N., & Elliott, R. (2016). Research Methods in Clinical Psychology: An Introduction for Students and Practitioners (3rd edn). Chichester, UK: John Wiley & Sons.Google Scholar
Blakemore, S.-J. (2008). Development of the social brain during adolescence. Quarterly Journal of Experimental Psychology, 61, 40–49.CrossRefGoogle ScholarPubMed
Blakemore, S.-J., & Mills, K. L. (2014). Is adolescence a sensitive period for sociocultural processing? Annual Review of Psychology, 65, 187–207.CrossRefGoogle ScholarPubMed
Brewin, C. R., Dalgleish, T., & Joseph, S. (1996). A dual representation theory of posttraumatic stress disorder. Psychological Reviews, 103, 670–686.CrossRefGoogle ScholarPubMed
Children and War Foundation (2005). Children’s Revised Impact of Event Scale (CRIES-13). Available at: http://www.childrenandwar.org Google Scholar
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2010). Trauma-focused cognitive-behavioral therapy for traumatized children. Evidence-Based Psychotherapies for Children and Adolescents, 2, 295–311.Google Scholar
d’Ardenne, P., Farmer, E., Ruaro, L., & Priebe, S. (2007a). Not lost in translation: protocols for interpreting trauma-focused CBT. Behavioural and Cognitive Psychotherapy, 35, 303–316).CrossRefGoogle Scholar
d’Ardenne, P., Ruaro, L., Cestari, L., Fakhoury, W., & Priebe, S. (2007b). Does interpreter-mediated CBT with traumatized refugee people work? A comparison of patient outcomes in East London. Behavioural and Cognitive Psychotherapy, 35, 293–301.CrossRefGoogle Scholar
Derluyn, I., & Broekaert, E. (2008). Unaccompanied refugee children and adolescents: the glaring contrast between a legal and a psychological perspective. International Journal of Law and Psychiatry, 31, 319–330.CrossRefGoogle Scholar
Dittmann, I., & Jensen, T. K. (2014). Giving a voice to traumatized youth – experiences with trauma-focused cognitive behavioral therapy. Child Abuse & Neglect, 38, 1221–1230.CrossRefGoogle ScholarPubMed
Eruyar, S., Huemer, J., & Vostanis, P. (2018). How should child mental health services respond to the refugee crisis? Child and Adolescent Mental Health, 23, 303–312.CrossRefGoogle ScholarPubMed
Fazel, M., & Betancourt, T. S. (2017). Preventive mental health interventions for refugee children and adolescents in high-income settings. The Lancet Child & Adolescent Health, 2, 121–132.CrossRefGoogle ScholarPubMed
Fazel, M., Reed, R. V., Panter-Brick, C., & Stein, A. (2012). Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. The Lancet, 379, 266–282.CrossRefGoogle ScholarPubMed
Fazel, M., Stratford, H. J., Rowsell, E., Chan, C., Griffiths, H., & Robjant, K. (2020). Five applications of narrative exposure therapy for children and adolescents presenting with post-traumatic stress disorders. Frontiers in Psychiatry, 11.CrossRefGoogle Scholar
Foa, E. B., Asnaani, A., Zang, Y., Capaldi, S., & Yeh, R. (2018). Psychometrics of the Child PTSD Symptom Scale for DSM-5 for trauma-exposed children and adolescents. Journal of Clinical Child & Adolescent Psychology, 47, 38–46.CrossRefGoogle ScholarPubMed
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: exposure to corrective information. Psychological Bulletin, 99, 20.CrossRefGoogle ScholarPubMed
Gardner, A. A., Zimmer-Gembeck, M. J., & Campbell, S. M. (2020). Attachment and emotion regulation: a person-centred examination and relations with coping with rejection, friendship closeness, and emotional adjustment. British Journal of Developmental Psychology, 38, 125–143.CrossRefGoogle ScholarPubMed
Gilbert, P., & Leahy, R. L. (2007). The Therapeutic Relationship in the Cognitive Behavioral Psychotherapies. New York, USA: Routledge/Taylor & Francis Group.CrossRefGoogle Scholar
Graham, S., & Johnson, D. R. (2019). Trauma therapy: exploring the views of young people in care. Residential Treatment for Children & Youth, 38, 2–18.CrossRefGoogle Scholar
Health and Social Care Act (2012). UK: HM Government. Retrieved from: https://www.legislation.gov.uk/ukpga/2012/7/contents Google Scholar
Hecker, T., Hermenau, K., Crombach, A., & Elbert, T. (2015). Treating traumatized offenders and veterans by means of narrative exposure therapy. Frontiers in Psychiatry, 6.CrossRefGoogle Scholar
Hiller, R. M., Meiser-Stedman, R., Fearon, P., Lobo, S., McKinnon, A., Fraser, A., & Halligan, S. L. (2016). Research review: changes in the prevalence and symptom severity of child post-traumatic stress disorder in the year following trauma – a meta-analytic study. Journal of Child Psychology and Psychiatry, 57, 884–898.CrossRefGoogle ScholarPubMed
Hodes, M., Jagdev, D., Chandra, N., & Cunniff, A. (2008). Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents. Journal of Child Psychology and Psychiatry, 49, 723–732.CrossRefGoogle ScholarPubMed
Huemer, J., Karnik, N. S., Voelkl-Kernstock, S., Granditsch, E., Dervic, K., Friedrich, M. H., & Steiner, H. (2009). Mental health issues in unaccompanied refugee minors. Child and Adolescent Psychiatry and Mental Health, 3, 13.CrossRefGoogle ScholarPubMed
Kobak, R., Zajac, K., & Madsen, S. D. (2016). Attachment disruptions, reparative processes, and psychopathology. In Cassidy, J. & Shaver, P. R. (eds), Handbook of Attachment: Theory, Research, and Clinical Applications (3rd edn, pp. 25–39). New York, USA: Guilford Press.Google Scholar
Laban, C. J., Gernaat, H. B., Komproe, I. H., Schreuders, B. A., & De Jong, J. T. (2004). Impact of a long asylum procedure on the prevalence of psychiatric disorders in Iraqi asylum seekers in The Netherlands. Journal of Nervous Mental Disorders, 192, 843–851.CrossRefGoogle ScholarPubMed
Laban, C. J., Komproe, I. H., Gernaat, H. B., & de Jong, J. T. (2008). The impact of a long asylum procedure on quality of life, disability and physical health in Iraqi asylum seekers in the Netherlands. Social Psychiatry and Psychiatric Epidemiology, 43, 507–515.CrossRefGoogle ScholarPubMed
Lambert, J. E., & Alhassoon, O. M. (2015). Trauma-focused therapy for refugees: meta-analytic findings. Journal of Counseling Psychology, 62, 28.CrossRefGoogle ScholarPubMed
Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38, 357–361.CrossRefGoogle Scholar
Lely, J. C. G., Smid, G. E., Jongedijk, R. A., Knipscheer, J. W., & Kleber, R. J. (2019). The effectiveness of narrative exposure therapy: a review, meta-analysis and meta-regression analysis. European Journal of Psychotraumatology, 10.CrossRefGoogle Scholar
Lewis, S. J., Arseneault, L., Caspi, A., Fisher, H. L., Matthews, T., Moffitt, T. E., … & Danese, A. (2019). The epidemiology of trauma and post-traumatic stress disorder in a representative cohort of young people in England and Wales. The Lancet Psychiatry, 6, 247–256.CrossRefGoogle Scholar
Lupien, S. J., McEwen, B. S., Gunnar, M. R., & Heim, C. (2009). Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nature Reviews Neuroscience, 10, 434–445.CrossRefGoogle ScholarPubMed
Majumder, P. (2019). Exploring stigma and its effect on access to mental health services in unaccompanied refugee children. BJPsych Bulletin, 43, 275–281.CrossRefGoogle Scholar
Majumder, P., Vostanis, P., Karim, K., & O’Reilly, M. (2018). Potential barriers in the therapeutic relationship in unaccompanied refugee minors in mental health. Journal of Mental Health, 28, 372–378.CrossRefGoogle ScholarPubMed
Metcalfe, J., & Jacobs, W. (1996). A ‘hot-system/cool-system’ view of memory under stress. PTSD Research Quarterly, 7, 1–3.Google Scholar
Mikulincer, M., & Shaver, P. R. (2019). Attachment orientations and emotion regulation. Current Opinion in Psychology, 25, 6–10.CrossRefGoogle ScholarPubMed
Miller, K. E., Martell, Z. L., Pazdirek, L., Caruth, M., & Lopez, D. (2005). The role of interpreters in psychotherapy with refugees: an exploratory study. American Journal of Orthopsychiatry, 75, 27–39.CrossRefGoogle Scholar
Mitra, R., & Hodes, M. (2019). Prevention of psychological distress and promotion of resilience amongst unaccompanied refugee minors in resettlement countries. Child: Care, Health and Development, 45, 198–215.Google ScholarPubMed
Müller, L. R. F., Büter, K. P., Rosner, R., & Unterhitzenberger, J. (2019). Mental health and associated stress factors in accompanied and unaccompanied refugee minors resettled in Germany: a cross-sectional study. Child and Adolescent Psychiatry and Mental Health, 13, 8.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (2011). Service user experience in adult mental health services. QS14. UK: National Institute for Health and Care Excellence.Google Scholar
National Institute for Health and Care Excellence (2018). Post-traumatic stress disorder: management. NICE guideline 116. UK: National Institute for Health and Care Excellence.Google Scholar
Nelson, E. E., Jarcho, J. M., & Guyer, A. E. (2016). Social re-orientation and brain development: an expanded and updated view. Developmental Cognitive Neuroscience, 17, 118–127.CrossRefGoogle ScholarPubMed
Neuner, F., Schauer, M., Klaschik, C., Karunakara, U., & Elbert, T. (2004). A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an African refugee settlement. Journal of Consulting and Clinical Psychology, 72, 579.CrossRefGoogle Scholar
England, NHS (2017). Building greater insight through qualitative research. UK: NHS England.Google Scholar
Onyut, L. P., Neuner, F., Schauer, E., Ertl, V., Odenwald, M., Schauer, M., & Elbert, T. (2005). Narrative exposure therapy as a treatment for child war survivors with posttraumatic stress disorder: two case reports and a pilot study in an African refugee settlement. BMC Psychiatry, 5, 7.CrossRefGoogle Scholar
Peltonen, K., & Kangaslampi, S. (2019). Treating children and adolescents with multiple traumas: a randomized clinical trial of narrative exposure therapy. European Journal of Psychotraumatology, 10, 1558708.CrossRefGoogle ScholarPubMed
Pfefferbaum, B., Nixon, S. J., Tucker, P. M., Tivis, R. D., Moore, V. L., Gurwitch, R. H., … & Geis, H. K. (1999). Posttraumatic stress responses in bereaved children after the Oklahoma City bombing. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 1372–1379.CrossRefGoogle ScholarPubMed
Purgato, M., Gross, A. L., Betancourt, T., Bolton, P., Bonetto, C., Gastaldon, C., … & Peltonen, K. (2018). Focused psychosocial interventions for children in low-resource humanitarian settings: a systematic review and individual participant data meta-analysis. The Lancet Global Health, 6, e390–e400.CrossRefGoogle ScholarPubMed
Robjant, K., & Fazel, M. (2010). The emerging evidence for narrative exposure therapy: a review. Clinical Psychology Review, 30, 1030–1039.CrossRefGoogle ScholarPubMed
Ruf, M., Schauer, M., Neuner, F., Catani, C., Schauer, E., & Elbert, T. (2010). Narrative exposure therapy for 7-to 16-year-olds: a randomized controlled trial with traumatized refugee children. Journal of Traumatic Stress, 23, 437–445.CrossRefGoogle ScholarPubMed
Said, G., & King, D. (2019). Implementing narrative exposure therapy for unaccompanied asylum-seeking minors with post-traumatic stress disorder: a pilot feasibility report. Clinical Child Psychology and Psychiatry, 25, 213–226.CrossRefGoogle ScholarPubMed
Schauer, E., Neuner, F., Elbert, T., Ertl, V., Onyut, L. P., Odenwald, M., & Schauer, M. (2004). Narrative exposure therapy in children: a case study. Intervention, 2, 18–32.Google Scholar
Schauer, M., Neuner, F., & Elbert, T. (2011). Narrative Exposure Therapy: A Short-Term Treatment for Traumatic Stress Disorders (2nd edn). Cambridge, MA, USA: Hogrefe Publishing.Google Scholar
Schauer, M., Neuner, F., & Elbert, T. (2017). Narrative exposure therapy for children and adolescents (KIDNET). In Landolt, M. A., Cloitre, M., & Schnyder, U. (eds), Evidence-Based Treatments for Trauma Related Disorders in Children and Adolescents (pp. 227–250). Cham, Switzerland: Springer.CrossRefGoogle Scholar
Schauer, M., Robjant, K., Elbert, T., & Neuner, F. (2020). Narrative exposure therapy. In Ford, J. D. & Courtois, C.A. (eds), Treating Complex Traumatic Stress Disorders in Adults: Scientific Foundations and Therapeutic Models (pp. 309–331). New York, USA: Guilford Press.Google Scholar
Sebastian, C., Burnett, S., & Blakemore, S. J. (2008). Development of the self-concept during adolescence. Trends in Cognitive Science, 12, 441–446.CrossRefGoogle ScholarPubMed
Shearing, V., Lee, D., & Clohessy, S. (2011). How do clients experience reliving as part of trauma-focused cognitive behavioural therapy for posttraumatic stress disorder? Psychology and Psychotherapy: Theory, Research and Practice, 84, 458–475.CrossRefGoogle ScholarPubMed
Sheldon, K., & Harding, E. (2010). Good practice guidelines to support the involvement of service users and carers in clinical psychology services. Leicester, UK: British Psychological Society.Google Scholar
Silverstein, L. B., Auerbach, C. F., & Levant, R. F. (2006). Using qualitative research to strengthen clinical practice. Professional Psychology: Research and Practice, 37, 351.CrossRefGoogle Scholar
Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative Phenomenological Analysis: Theory, Method and Research. London, UK: SAGE Publications.Google Scholar
Smith, J. A., & Osborn, M. (2003). Interpretative phenomenological analysis. In Qualitative Psychology: A Practical Guide to Research Methods (pp. 51–80). Thousand Oaks, CA, USA: Sage Publications, Inc.Google Scholar
Smith, P., Dalgleish, T., & Meiser-Stedman, R. (2018). Practitioner review: posttraumatic stress disorder and its treatment in children and adolescents. Journal of Child Psychology and Psychiatry, 60, 500–515.CrossRefGoogle ScholarPubMed
Smith, P., Perrin, S., Dyregrov, A., & Yule, W. (2003). Principal components analysis of the impact of event scale with children in war. Personality and Individual Differences, 34, 315–322 CrossRefGoogle Scholar
Suárez-Orozco, C., Bang, H. J., & Kim, H. Y. (2011). I felt like my heart was staying behind: psychological implications of family separations and reunifications for immigrant youth. Journal of Adolescent Research, 26, 222–257.CrossRefGoogle Scholar
Thompson, C. T., Vidgen, A., & Roberts, N. P. (2018). Psychological interventions for post-traumatic stress disorder in refugees and asylum seekers: a systematic review and meta-analysis. Clinical Psychology Review, 63, 66–79.CrossRefGoogle ScholarPubMed
Tribe, R. (2007). Working with interpreters. The Psychologist, 20, 159–161.Google Scholar
Tribe, R., & Keefe, A. (2009). Issues in using interpreters in therapeutic work with refugees. What is not being expressed? European Journal of Psychotherapy and Counselling, 11, 409–424.CrossRefGoogle Scholar
Tribe, R., & Thompson, K. (2009a). Exploring the three-way relationship in therapeutic work with interpreters. International Journal of Migration, Health and Social Care, 5, 13–21.CrossRefGoogle Scholar
Tribe, R., & Thompson, K. (2009b). Opportunity for development or necessary nuisance? The case for viewing working with interpreters as a bonus in therapeutic work. International Journal of Migration, Health and Social Care, 5, 4–12.CrossRefGoogle Scholar
Trickey, D., Siddaway, A. P., Meiser-Stedman, R., Serpell, L., & Field, A. P. (2012). A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clinical Psychology Review, 32, 122–138.CrossRefGoogle ScholarPubMed
UNHCR (2019). Putting the Child at the Centre: An Analysis of the Application of the Best Interests Principle for Unaccompanied and Separated Children in the UK. Retrieved from: https://www.unhcr.org/uk/publications/legal/5d271cdf7.pdf Google Scholar
UNICEF (2017). The Adolescent Brain: A Second Window of Opportunity. Florence, Italy: UNICEF Office of Research – Innocenti, Florence.Google Scholar
van Toorenburg, M. M., Sanches, S. A., Linders, B., Rozendaal, L., Voorendonk, E. M., Van Minnen, A., & De Jongh, A. (2020). Do emotion regulation difficulties affect outcome of intensive trauma-focused treatment of patients with severe PTSD? European Journal of Psychotraumatology, 11, 1724417.CrossRefGoogle ScholarPubMed
Vincent, F., Jenkins, H., Larkin, M., & Clohessy, S. (2013). Asylum-seekers’ experiences of trauma-focused cognitive behaviour therapy for post-traumatic stress disorder: a qualitative study. Behavioural and Cognitive Psychotherapy, 41, 579–593.CrossRefGoogle ScholarPubMed
Webb, D., & McMurran, M. (2008). A Delphi survey of patients’ views of services for borderline personality disorder: a preliminary report. Personality and Mental Health, 2, 17–24. doi: 10.1002/pmh.20 CrossRefGoogle Scholar
Weil, L. G., Fleming, S. M., Dumontheil, I., Kilford, E. J., Weil, R. S., Rees, G., … Blakemore, S.-J. (2013). The development of metacognitive ability in adolescence. Consciousness and Cognition, 22, 264–271.CrossRefGoogle ScholarPubMed
Willig, C. (2013). Introducing Qualitative Research in Psychology (3rd edn). Maidenhead, UK: McGraw-Hill Education.Google Scholar
Submit a response

Comments

No Comments have been published for this article.