Contemporary Family Therapy

, Volume 36, Issue 1, pp 41–57 | Cite as

Establishing Therapeutic Dialogue with Refugee Families

Original Paper

Abstract

The article describes an investigation into dialogues between native Swedish psychotherapists and refugee families. Dialogue is needed to establish the therapeutic alliance, which is ultimately important for healing, whether of individual sickness or family crisis. However the development of dialogue is hindered by cross-cultural and language barriers. We concentrate on one aspect of research originally presented in a Doctoral Thesis by the first author, asking how culture and power differences, together with their resettlement in a strange country, affected meetings with refugee families, and how these problems were overcome; language and the presence of an interpreter are not discussed. A multi-perspective methodology was used in the original research, combining text analysis, review of video-recordings by the participating therapists, and interviews with the families. All these forms of investigation are drawn on here, but particularly text analysis. Significant hindrances to dialogue turn out to be differences in cultural values between refugee and therapist, their different power positions, and the refugee’s weariness and distrust of meetings. Strategies to minimise power differences are an essential aspect of the Finnish open dialogue approach, which turns out to be particularly relevant to such refugee meetings.

Keywords

Refugee Dialogue Therapeutic alliance 

References

  1. Andersen, T. (1997). Conversation, language and possibilities. New York: Basic Books.Google Scholar
  2. Anderson, H. (2001). Postmodern collaborative and person-centred therapies: what would Carl Rogers say? Journal of Family Therapy, 23, 339–360. doi:10.1111/1467-6427.00189.CrossRefGoogle Scholar
  3. Anderson, H., & Goolishian, H. A. (1992). The client is the expert: A not-knowing approach to therapy. In S. MacNamee & G. Gergen (Eds.), Therapy as social construction (pp. 54–68). London: Sage.Google Scholar
  4. Arborelius, E., & Bremberg, S. (1992). What can doctors do to achieve a successful consultation? video-taped interviews analysed with “consultation map” method. Family Practice, 9(1), 61–66. doi:10.1093/fampra/9.1.61.PubMedCrossRefGoogle Scholar
  5. Blackwell, D. (1997). Holding, containing and bearing witness: The problem of helpfulness in encounters with torture survivors. Journal of Social Work Practice, 11(2), 81–89.CrossRefGoogle Scholar
  6. Brune, M., Eiroá-Orosa, F. J., Fischer-Ortman, J., Delijaj, B., & Haasen, C. (2011). Intermediated communication by interpreters in psychotherapy with traumatised refugees. International Journal of Culture and Mental Health, 4(2), 144. doi:10.1080/17542863.2010.537821.CrossRefGoogle Scholar
  7. Elvins, R., & Green, J. (2008). The conceptualisation and measurement of therapeutic alliance: An empirical review. Clinical Psychology Review, 28, 1167–1187. doi:10.1016/j.cpr.2008.04.002.PubMedCrossRefGoogle Scholar
  8. Escudero, V., Heatherington, L., & Friedlander, M. L. (2010). Therapeutic alliances and alliance building in family therapy. In J. C. Muran & J. P. Barber (Eds.), The therapeutic alliance; An evidence-based guide to practice (pp. 240–262). NY and London: The Guilford Press.Google Scholar
  9. Falicov, C. J. (1988). Learning to think culturally. In H. A. Liddle, D. C. Breunlin, & R. C. Schwartz (Eds.), Handbook of family therapy: Training and supervision (pp. 335–351). NY and London: The Guilford Press.Google Scholar
  10. Falicov, C. J. (1995). Training to think culturally: a multidimensional comparative framework. Family Process, 34(4), 372–388.CrossRefGoogle Scholar
  11. Fatahi, N., Nordhom, L., Mattson, B., & Hellström, M. (2010). Experiences of Kurdish war-wounded refugees in communication with Swedish authorities through interpreter. Patient Education and Counseling, 78, 160–165. doi:10.1016/j.pec.2009.03.010.PubMedCrossRefGoogle Scholar
  12. Guilfoyle, M. (2003). Dialogue and power: a critical analysis of power in dialogical therapy. Family Process, 42(3), 331–343. doi:10.1111/j.1545-5300.2003.00331.x.PubMedCrossRefGoogle Scholar
  13. Gunaratnam, Y. (2003). Researching ‘race’ and ethnicity: Methods, knowledge, and power. London: SAGE Publications.CrossRefGoogle Scholar
  14. Guregård, S. (2009). Open dialogue across cultures: Establishing a therapeutic relationship with the refugee family. Doctoral Thesis in Systemic Psychotherapy, Tavistock Clinic, University of East London.Google Scholar
  15. Hartzell, M., Seikkula, J., & von Knorring, A.-L. (2010). Parent’s perception of their first encounter with child and adolescent psychiatry. Contemporary Family Therapy, 32(3), 273–289. doi:10.1007/s10591-010-9119-1E.CrossRefGoogle Scholar
  16. Heeren, M., Mueller, J., Ehlert, U., Schnyder, U., Copiery, N., Maier, T. (2012) Mental health of asylum seekers: A cross-sectional study of psychiatric disorders. BMC Psychiatry 12:114 on-line version: www.biomedcentral.com/1471-244X-12-114. doi:10.1186/1471-244X-12-114.
  17. Holm, U. (1987). Empati: Att förstå andra människors känslor.(Empathy, understanding others feelings). Stockholm: Natur och Kultur.Google Scholar
  18. Horvath, A. O., & Bedi, R. B. (2002). The alliance. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapists contributions and responsiveness to patients (pp. 37–70). Oxford: Oxford University Press.Google Scholar
  19. Kagan, N. (1975). Interpersonal process recall: A method of influencing human interaction. Houston, Texas: Educational Psychology Department University of Houston-University Park.Google Scholar
  20. Kurtz, R. R., & Grummon, D. L. (1972). Different approaches to the measurement of therapist empathy and their relationship to therapy outcomes. Journal of Consulting and Clinical Psychology, 39(1), 106–115.Google Scholar
  21. Laitila, A., et al. (2001). Narrative process coding system in marital and family therapy: An intensive case analysis of the formulation of a therapeutic system. Contemporary Family Therapy, 23(3), 309–322. doi:10.1023/A:1011183016456E.CrossRefGoogle Scholar
  22. Lambert, M. J., & Barley, D. E. (2001). Research Summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy, 38(4), 357–361. doi:10.1037/0033-3204.38.4.357.CrossRefGoogle Scholar
  23. Lantz, J., & Gyamerah, J. (2002). Existential family trauma therapy. Contemporary Family Therapy, 24(2), 243–255. doi:10.1023/A:1015341307140E.CrossRefGoogle Scholar
  24. Leiman, M. (1998). Words as intersubjective mediators in psychotherapeutic discourse: The presence of hidden voices in patient utterances. In M. Lähteenmäki & H. Dufva (Eds.), Dialogues on bakhtin: Interdisciplinary readings (pp. 105–116). Jyväskylä: Centre for Applied Language Studies.Google Scholar
  25. Leiman, M. (2004). Dialogue sequence analysis. In H. Hermans & C. Dimaggio (Eds.), The dialogical self in psychotherapy. Brunner-Routledge: Sussex.Google Scholar
  26. Linnel, P. (2009). Rethinking language, mind, and world dialogically. Charlotte NC: Information Age Publishing.Google Scholar
  27. 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(1), 27–39. doi:10.1037/0002-9432.75.1.27.PubMedCrossRefGoogle Scholar
  28. Oxford (2006). In: C. Soames & A. Stevenson (eds.). Concise Oxford English Dictionary; 11th Edition, Revised. Oxford: Oxford University Press.Google Scholar
  29. Papadopoulos, R. K. (2002). Refugees home and trauma. In R. K. Papadopoulos (Ed.), Therapeutic care for refugees: No place like home (pp. 9–39). London and NewYork: Karnac.Google Scholar
  30. Papadopoulos, R. K. (2007). Refugees, trauma and adversity-activated development. European Journal of Psychotherapy and Counselling, 9(3), 301–312. doi:10.1080/13642530701496930.CrossRefGoogle Scholar
  31. Papadopoulos, R. K., & Hulme, V. (2002). Transient familiar others: uninvited persons in psychotherapy with refugees. In R. K. Papadopoulos (Ed.), Therapeutic care for refugees: No place like home (pp. 139–163). London and NewYork: Karnac.Google Scholar
  32. Pinsoff, W. M., & Catherall, D. R. (1986). The integrative psychotherapy alliance: Family, couple and individual therapy scales. Journal of Marital and Family Therapy, 12(2), 137–151. doi:10.1111/j.1752-0606.1986.tb01631.x.CrossRefGoogle Scholar
  33. Raval, H. (2005). Being heard and understood in the context of seeking asylum and refuge: Communicating with the help of bilingual co-workers. Clinical Child Psychology and Psychiatry, 10(2), 197–216. doi:10.1177/1359104505051211.CrossRefGoogle Scholar
  34. Reichelt, S., & Sveaass, N. (1994). What is good conversation? Reflections based on therapeutic work with refugee families. Family Process, 29, 273–287. doi:10.1111/j.1545-5300.1994.00247.x.CrossRefGoogle Scholar
  35. Rober, P. (2005). The therapist’s self in dialogical family therapy: Some ideas about not knowing and the therapist’s inner conversation. Family Process, 44(4), 477–495. doi:10.1111/j.1545-5300.2005.00073.x.PubMedCrossRefGoogle Scholar
  36. Rober, P. (2008). Positioning in the therapist’s inner conversation: a dialogical model based on a grounded theory analysis of therapist reflections. Journal of Marital and Family Therapy, 34(3), 406–421. doi:10.1111/j.1752-0606.2008.00080.x.PubMedCrossRefGoogle Scholar
  37. Rober, P. (2010). The interactive-reflective training exercise: addressing the therapist’s inner conversation in family therapy training. Journal of Marital and Family Therapy, 36(2), 158–170. doi:10.1111/j.1752-0606.2010.00192.x.PubMedCrossRefGoogle Scholar
  38. Roth, G. (2006). A prospective study of mental health among mass-evacuated Kosovo Albanians [dissertation]. Stockholm: Karolinska institutet.Google Scholar
  39. Seikkula, J. (2002). Open Dialogues with good and poor outcomes for psychotic crises: Examples from families with violence. Journal of Marital and Family Therapy, 28(3), 263–274. doi:10.1111/j.1752-0606.2002.tb01183.x.PubMedCrossRefGoogle Scholar
  40. Seikkula, J. (2003). Dialogue is the change: understanding psychotherapy as a semiotic process of Bakhtin, Voloshinov and Vygotsky. Human Systems: The Journal of Systemic Consultation and Management, 14(2), 83–94.Google Scholar
  41. Seikkula, J. (2011). Becoming dialogical: Psychotherapy or a way of life? Australian and New Zealand Journal of Psychotherapy, 32(3), 179–193. doi:10.1111/j.1752-0606.2011.00238.x.Google Scholar
  42. Seikkula, J., Alakare, B., & Aaltonen, J. (2011). The comprehensive open-dialogue approach (II). Long-term stability of acute psychosis outcomes in advanced community care; the Western Lapland Project. Psychosis, 3, 1–13. doi:10.1080/17522439.2011.598819.CrossRefGoogle Scholar
  43. Seikkula, J., Laitila, A., & Rober, P. (2012). Making sense of multi-actor dialogues in family therapy and network meetings. Journal of Marital and Family Therapy, 38(4), 667–687. doi:10.1111/j.1752-0606.2011.00238.x.PubMedCrossRefGoogle Scholar
  44. Seikkula, J., & Olson, M. E. (2003). The open dialogue approach to acute psychosis: its poetics and micropolitics. Family Process, 42(3), 403–418. doi:10.1111/j.1545-5300.2003.00403.x.PubMedCrossRefGoogle Scholar
  45. Seikkula, J., & Trimble, D. (2005). Healing elements of therapeutic conversation; dialogue as an embodiment of love. Family Process, 44(4), 461–475. doi:10.1111/j.1545-5300.2005.00072.x.PubMedCrossRefGoogle Scholar
  46. Sutherland, O. (2007). Therapist positioning and power in discursive therapies: a comparative analysis. Contemporary Family Therapy, 29(4), 193–209. doi:10.1007/s10591-007-9050-2E.CrossRefGoogle Scholar
  47. Wadensjö, C. (1992). Interpreting as Interaction. Studies in Arts and Science, 83, Linköping University.Google Scholar
  48. Wampold, B. (2001). The great psychotherapy debate. Mahwah, New:Jersey: Erlbaum Associates.Google Scholar
  49. Werner-Wilson, R. J., Michaels, M. L., Thomas, S. G., & Thiesen, A. M. (2003). Influence of therapistbehaviors on therapeutic alliance. Contemporary Family Therapy, 25(4), 381–390. doi:10.1023/A:1027356602191E.CrossRefGoogle Scholar
  50. Wierzbicka, A. (2006). The concept of “dialogue” in cross-linguistic and cross-cultural Perspectives. Discourse Studies, 8(5), 675–703. doi:10.177/1461445606067334.CrossRefGoogle Scholar
  51. Woodcock, J. (2000). A Systemic approach to trauma. Context, The Magazine for Family Therapy and Systemic Practice, 51, 2–4.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.South Älvsborg HospitalBoråsSweden
  2. 2.Department of PsychotherapyUniversity of JyväskyläJyväskyläFinland

Personalised recommendations