Psychotherapy with Immigrants and Refugees from Crisis Zones

  • Ljiljana JoksimovicEmail author
  • Monika Schröder
  • Eva van Keuk


Offering appropriate care to refugees requires temporal and structural resources, specific competence in diversity and cross-cultural issues and expertise in the fields of psychosocial and socio-medical assessment and treatment. In our experience, the absence of appropriate structures within such care often leads to a delay in identifying mentally ill or traumatised victims of torture in particular; such a delay has medical, psychological and social consequences for the individuals affected as well as for their families.


Host Country Traumatic Experience Asylum Seeker Refugee Population Residence Permit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Acheson DT, Gresack JE, Risbrough VB (2012) Hippocampal dysfunction effects on context memory: possible etiology for posttraumatic stress disorder. Neuropharmacology 62(2):674–685PubMedCentralPubMedCrossRefGoogle Scholar
  2. Amnesty International (2013) Amnesty report 2013: Zahlen und Fakten. Retrieved 22 Oct 2014, from
  3. Deutschland erhält die meisten Asylanträge (2014) Retrieved 22 Oct 2014, from
  4. Baars EW, van der Hart O, Nijenhuis ER, Chu JA, Glas G, Draijer N (2010) Predicting stabilizing treatment outcomes for complex posttraumatic stress disorder and dissociative identity disorder: an expertise-based prognostic model. J Trauma Dissociation 12(1):67–87CrossRefGoogle Scholar
  5. Beagan BL, Kumas-Tan Z (2009) Approaches to diversity in family medicine “I have always tried to be colour blind”. Can Fam Physician 55(8):e21–e28PubMedCentralPubMedGoogle Scholar
  6. Berger JT (2008) The influence of physicians’ demographic characteristics and their patients’ demographic characteristics on physician practice: implications for education and research. Acad Med 83(1):100–105PubMedCrossRefGoogle Scholar
  7. Birck A (2002) Traumatisierte Flüchtlinge: wie glaubhaft sind ihre Aussagen? Asanger, HeidelbergGoogle Scholar
  8. Brenneis CB (1998) Gedächtnissysteme und der psychoanalytische Abruf von Trauma-Erinnerungen. Psyche 52(9/10):801–823Google Scholar
  9. Bundesamt für Migration und Flüchtlinge (Federal Office for Immigration and Refugees) (2013) Aktuelle Zahlen zu Asyl. (Current Statistics on Asylum). Retrieved 23 Dec 2013 from
  10. Cervantes RC, Salgado de Snyder VN, Padilla AM (1989) Posttraumatic stress in immigrants from Central America and Mexico. Hosp Community Psychiatry 40(6):615–619PubMedGoogle Scholar
  11. Cheung P (1993) Somatisation as a presentation in depression and post-traumatic stress disorder among Cambodian refugees. Aust N Z J Psychiatry 27(3):422–428PubMedCrossRefGoogle Scholar
  12. Eisenman DP, Gelberg L, Liu H, Shapiro MF (2003) Mental health and health related quality of life among adult Latino primary care patients living in the United States with previous exposure to political violence. JAMA 290(5):627–634PubMedCrossRefGoogle Scholar
  13. Engel CC Jr, Liu X, Clymer R, Miller RF, Sjoberg T, Shapiro JR (2000) Rehabilitative care of war-related health concerns. J Occup Environ Med 42(4):385–390PubMedCrossRefGoogle Scholar
  14. Fazel M, Wheeler J, Danesh J (2005) Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet 365(9467):1309–1314PubMedCrossRefGoogle Scholar
  15. Fisher HL, Jones PB, Fearon P, Craig TK, Dazzan P, Morgan K (2010) The varying impact of type, timing and frequency of exposure to childhood adversity on its association with adult psychotic disorder. Psychol Med 40(12):1967–1978PubMedCentralPubMedCrossRefGoogle Scholar
  16. Gäbel U, Ruf M, Schauer M, Odenwald M, Neuner F (2006) Prävalenz der posttraumatischen Belastungsstörung (PTSD) und Möglichkeiten der Ermittlung in der Asylverfahrenspraxis. Z Klin Psychol Psychother 35(1):12–20CrossRefGoogle Scholar
  17. Gerritsen AA, Bramsen I, Devillé W, Van Willigen LH, Hovens JE, Van Der Ploeg HM (2006) Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands. Soc Psychiatry Psychiatr Epidemiol 41(1):18–26PubMedCrossRefGoogle Scholar
  18. Gierlichs HW, van Keuk E, Greve C, Wenk-Ansohn M, Flatten G, Hartmann C, Wirtgen W (2005) Grenzen und Möglichkeiten klinischer Gutachten imAusländerrecht. ZAR–Z Ausländerrecht Ausländerpolitik 158:163Google Scholar
  19. Haenel F, Wenk-Ansohn M (eds) (2004) Begutachtung psychisch reaktiver Traumafolgen in aufenthaltsrechtlichen Verfahren. Beltz, WeinheimGoogle Scholar
  20. Hinton DE, Hinton SD, Loeum RJR, Pich V, Pollack MH (2008) The ‘multiplex model’ of somatic symptoms: application to tinnitus among traumatized Cambodian refugees. Transcult Psychiatry 45(2):287–317PubMedCrossRefGoogle Scholar
  21. Hofmann A, Fischer G, Koehn F (1999) Traumatic antecedents questionnaire (TAQ). Deutsches Institut für Psychotraumatologie, KölnGoogle Scholar
  22. Holtan N, Antolak K, Johnson DR, Ide L, Jaranson J, Ta K (2002) Unrecognized torture affects the health of refugees. Minn Med 85(5):35–39PubMedGoogle Scholar
  23. Ivezic S, Bagaric A, Oruc L, Mimica N, Ljubin T (2000) Psychotic symptoms and comorbid psychiatric disorders in Croatian combat-related posttraumatic stress disorder patients. Croat Med J 41(2):179–183PubMedGoogle Scholar
  24. Janet P, Paul E (1925) Psychological healing: a historical and clinical study, vol 1. G. Allen & Unwin, LondonGoogle Scholar
  25. Johnson H, Thompson A (2008) The development and maintenance of post traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: a review. Clin Psychol Rev 28(1):36–47PubMedCrossRefGoogle Scholar
  26. Joksimovic L (2009) Ethnosoziokultureller Leitfaden für die interkulturelle Psychotherapie mit Migranten aus dem ehemaligen Jugoslawien. In: Erim Y (ed) Klinische Interkulturelle Psychotherapie. Ein Lehr-und Praxisbuch. Kohlhammer, Stuttgart, pp 288–292Google Scholar
  27. Joksimovic L (2010) Diversity-Kompetenz bei der ärztlichen Untersuchung: Von Symptomen zur Diagnose. In: van Keuk E, Ghaderi C, Joksimovic L, David DM (eds) Diversity: transkulturelle Kompetenz in klinischen und sozialen Arbeitsfeldern. Kohlhammer Verlag, Stuttgart, pp 135–145Google Scholar
  28. Joksimovic L, Woeller W, Happ M, Tress W, Kruse J (2011) Group psychotherapy with traumatised refugees. Gruppenpsychotherapie Gruppendynamik 47(3):192–210CrossRefGoogle Scholar
  29. Joksimovic L, Kunzke D, Wöller W (2013) Pharmakotherapeutische Interventionen in der Psychotherapie von schweren Traumafolgestörungen: Grundsätzliche Überlegungen anhand einer Fallstudie. Z Psychosom Med Psychother 59(4):378–384PubMedGoogle Scholar
  30. Junghanss T (1998) Asylsuchende und Flüchtlinge: Gesundheitsversorgung einer komplexen Minderheit. Soz Praventivmed/Soc Prev Med 43(1):11–17CrossRefGoogle Scholar
  31. Klimidis S, Stuart G, Minas IH, Ata AW (1994) Immigrant status and gender effects on psychopathology and self-concept in adolescents: a test of the migration-morbidity hypothesis. Compr Psychiatry 35(5):393–404PubMedCrossRefGoogle Scholar
  32. Kluge U, Kassim N (2006) Der Dritte im Raum – Chancen und Schwierigkeiten in der Zusammenarbeit mit Sprach- und KulturmittlerInnen in einem interkulturellenpsychotherapeutischen Setting. In: Wohlfart E, Zaumseil M (eds) Transkulturelle Psychiatrie – Interkulturelle Psychotherapie. InterdisziplinäreTheorie und Praxis. Springer, Heidelberg, pp 178–198Google Scholar
  33. Kroll J, Yusuf AI, Fujiwara K (2011) Psychoses, PTSD, and depression in Somali refugees in Minnesota. Soc Psychiatry Psychiatr Epidemiol 46(6):481–493PubMedCrossRefGoogle Scholar
  34. Kruse J, Joksimovic L, Cavka M, Wöller W, Schmitz N (2009) Effects of trauma‐focused psychotherapy upon war refugees. J Trauma Stress 22(6):585–592PubMedGoogle Scholar
  35. Kunzke D, Güls F (2003) Diagnostik einfacher und komplexer posttraumatischer Störungen im Erwachsenenalter. Psychotherapeutische 48(1):50–70CrossRefGoogle Scholar
  36. Laban CJ, Gernaat HB, Komproe IH, Schreuders BA, De Jong JT (2004) Impact of a long asylum procedure on the prevalence of psychiatric disorders in Iraqi asylum seekers in The Netherlands. J Nerv Ment Dis 192(12):843–851PubMedCrossRefGoogle Scholar
  37. Laban CJ, Gernaat HB, Komproe IH, van der Tweel I, De Jong JT (2005) Postmigration living problems and common psychiatric disorders in Iraqi asylum seekers in the Netherlands. J Nerv Ment Dis 193(12):825–832PubMedCrossRefGoogle Scholar
  38. Larkin W, Read J (2008) Childhood trauma and psychosis: evidence, pathways, and implications. J Postgrad Med 54(4):287PubMedCrossRefGoogle Scholar
  39. Lin EH, Carter WB, Kleinman AM (1985) An exploration of somatization among Asian refugees and immigrants in primary care. Am J Public Health 75(9):1080–1084PubMedCentralPubMedCrossRefGoogle Scholar
  40. Markowitsch HJ (1998) The mnestic block syndrome: environmentally induced amnesia. Neurol Psychiatry Brain Res 6(2):73–80Google Scholar
  41. Marshall GN, Schell TL, Elliott MN, Berthold SM, Chun CA (2005) Mental health of Cambodian refugees 2 decades after resettlement in the United States. JAMA 294(5):571–579PubMedCrossRefGoogle Scholar
  42. Mollica RF, Sarajlić N, Chernoff M, Lavelle J, Vuković IS, Massagli MP (2001) Longitudinal study of psychiatric symptoms, disability, mortality, and emigration among Bosnian refugees. JAMA 286(5):546–554PubMedCrossRefGoogle Scholar
  43. Reddemann L (2004) Psychodynamisch imaginative traumatherapie (PITT)—das manual [psychodynamic imaginative trauma therapy—the manual]. Pfeiffer bei Klett-Cotta, StuttgartGoogle Scholar
  44. Reddemann L, Sachsse U (1998) Welche Psychoanalyse ist für Opfer geeignet? Einige Anmerkungen zu Martin Ehlert-Balzer: Das Trauma als Objektbeziehung. Forum Psychoanal 14:289–294CrossRefGoogle Scholar
  45. Reddemann L, Sachsse U (2000) Traumazentrierte Psychotherapie der chronifizierten, komplexen posttraumatischen Belastungsstörung vom Phänotyp der Borderline-Persönlichkeitsstörungen. In: Kernberg O, Dulz B, Sachsse U (eds) Handbuch der Borderline-Störungen. Schattauer, Stuttgart, pp 555–571Google Scholar
  46. Schreiber S (1995) Migration, traumatic bereavement and transcultural aspects of psychological healing: loss and grief of a refugee woman from Begameder county in Ethiopia. Br J Med Psychol 68(2):135–142PubMedCrossRefGoogle Scholar
  47. Shevlin M, Houston JE, Dorahy MJ, Adamson G (2008) Cumulative traumas and psychosis: an analysis of the national comorbidity survey and the British Psychiatric Morbidity Survey. Schizophr Bull 34(1):193–199PubMedCentralPubMedCrossRefGoogle Scholar
  48. Silove D, Sinnerbrink I, Field A, Manicavasagar V, Steel Z (1997) Anxiety, depression and PTSD in asylum-seekers: assocations with pre-migration trauma and post-migration stressors. Br J Psychiatry 170(4):351–357PubMedCrossRefGoogle Scholar
  49. Silove D, Steel Z, Bauman A, Chey T, McFarlane A (2007) Trauma, PTSD and the longer-term mental health burden amongst Vietnamese refugees. Soc Psychiatry Psychiatr Epidemiol 42(6):467–476PubMedCrossRefGoogle Scholar
  50. Smedley BD, Stith AY, Nelson AR (2009) Unequal treatment: confronting racial and ethnic disparities in health care (with CD). National Academies Press, WashingtonGoogle Scholar
  51. Sundquist J (1993a) Ethnicity as a risk factor for mental illness. A population-based study of 338 Latin American refugees and 996 age-, sex- and education-matched Swedish controls. Acta Psychiatr Scand 87(3):208–212PubMedCrossRefGoogle Scholar
  52. Sundquist J (1993b) Ethnicity; social class and health. A population-based study on the influence of social factors on self-reported illness in 223 Latin American refugees, 333 Finnish and 126 south European labour migrants and 841 Swedish controls. Soc Sci Med 40(6):777–787CrossRefGoogle Scholar
  53. Tschischka A (2014) Viele Flüchtlinge sind auch Folteropfer!. Retrieved 11 Jul 2014, from
  54. Tucker S, Price D (2007) Finding a home: group psychotherapy for traumatized refugees and asylum seekers. Eur J Psychother Couns 9(3):277–287CrossRefGoogle Scholar
  55. United Nations High Commissioner for Refugees (UNHCR) (2012) Displacement, the new 21st century challenge: global trends. Retrieved 23 Dec 2013, from
  56. van der Kolk BA, McFarlane AC, van der Hart O (1996) A general approach to treatment of posttraumatic stress disorder. In: van der Kolk BA, McFarlane AC, Weisaeth L (eds) Traumatic stress: the effects of overwhelming experience on mind, body, and society. Guilford Press, New York, pp 417–440Google Scholar
  57. van der Kolk BA, Burbridge JA, Suzuki J (1998) Die Psychobiologie traumatischer Erinnerungen. In: Streeck-Fischer A (ed) Adoleszenz und Trauma. Vandenhoek & Ruprecht, Göttingen, pp 57–78Google Scholar
  58. Warfa N, Curtis S, Watters C, Carswell K, Ingleby D, Bhui K (2012) Migration experiences, employment status and psychological distress among Somali immigrants: a mixed-method international study. BMC Public Health 12(1):749PubMedCentralPubMedCrossRefGoogle Scholar
  59. Wenk Ansohn A, Scheef Maier G, Gierlichs HW (2013) Zur Begutachtung psychischer Traumafolgestörungen – ein Update. In: Feldmann RE, Seidler GH (eds) Traum(a) Migration. Aktuelle Konzepte zur Therapie traumatisierter Flüchtlinge und Folteropfer. Psychosozial Verlag, Gießen, pp 283–302Google Scholar
  60. Wessa ML, Flor H (2002) Posttraumatische Belastungsstörung und Traumagedächtnis – eine psychobiologische Perspektive. Z Psychosom Med Psychother 48:28–37PubMedGoogle Scholar
  61. Wöller W, Leichsenring F, Leweke F, Kruse J (2012) Psychodynamic psychotherapy for posttraumatic stress disorder related to childhood abuse – Principles for a treatment manual. Bull Menninger Clin 76:69–93PubMedCrossRefGoogle Scholar
  62. Yehuda R (2002) Post-traumatic stress disorder. N Engl J Med 346:108–114PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Ljiljana Joksimovic
    • 1
    Email author
  • Monika Schröder
    • 2
  • Eva van Keuk
    • 3
  1. 1.LVR Klinikum Düsseldorf, Heinrich-Heine-University DüsseldorfDüsseldorfGermany
  2. 2.LVR-Klinikum DüsseldorfDüsseldorf (Registered society)Germany
  3. 3.Psychosocial Centre for RefugeesDüsseldorfGermany

Personalised recommendations