Compare And Contrast The Narrative And Systemic Approaches With Refugee Populations

Narrative and Systemic Approaches with Refugee Populations

Colleen Cummings
SOWK 5208 - 090
August 7, 2013
Narrative and Systemic Approaches with Refugee Populations
In today’s world millions of displaced people have had to flee or have been forced to leave their homes. These people may be internally displaced within their own borders or living in another country with refugee status, having left due to war, natural disasters, shifts in political allegiances, ethnic conflicts, and more. It is important that practitioners and professionals be aware of the best practices with this population because once granted refugee status in the U.S., the country has taken
on responsibility of offering services and support for a person to assimilate and become a productive and well functioning citizen.
Differing Frameworks with Similar Techniques Since countries become responsible for the new citizens admitted as refugees, many countries have witnessed that when there is an increase of people entering with refugee status there is a parallel crisis in meeting their needs (Kelley, 1994). The need for expansion and relevant services offered to refugees is because of the extremely vulnerable position refugees are in and the things they are exposed to that contributed to their resettlement. According to Walter & Ahearn (2012) “refugees are likely to have exposure to political violence, separation from family in countries of origin, and experiences of trauma both before and during the process of immigration to the United States,” making the need for services the rule and not the exception (p. 362). Although the trends of refugees entering the country have been down in recent decades, statistics from the U.S. Department of Homeland security reported that 74,602 refugees entered the U.S. in 2009, an increase of 24% from the previous year (as cited in Walter & Ahearn, 2012). This shows that regardless of current trends, the numbers of refugees can flex rapidly as political allegiances and global climates change, illustrating the need for practitioners to be competent and ready to work with refugees at any time. Since refugees have such unique circumstances the therapeutic approach used and the attitude of the practitioner is very important. Kelley (1994) assessed the use of systemic and postsystemic approaches in working with refugees and created an integrated model to address their needs. Kelley (1994) found that a systemic approach is useful because “psychotherapeutic work with refugees must involve their families as well as their legal, social, and economic situations” (p.
541). This systems approach views the behavior and problems in context, focusing on problems arising because of the interaction of the systems rather than on problems within a person. This aligns with best practice found in Kelley’s (1994) search of the literature, noting that problem-focused approaches are more useful for refugee populations than are uncovering therapies. This approach focuses intervention of systemic and interpersonal factors rather than intrapsychic factors and is less intrusive for refugees who suffer from posttraumatic stress disorder (PTSD), allowing them to see problem resolution and recognize it was something over which they had no
control. While a systemic approach may relate more to a case management and counseling role, Kelley (1994) ties this idea with parts of postsystemic therapy with a narrative technique. Postsystemic therapies address more of the intrapsychic, specifically through constructivist theory, believing that the client’s reality is constructed in their mind and their interaction with others. By using the narrative approach, therapists and clients create change by “co-authoring” a new reality through dialogue (p. 541). Elbert (2004) notes that since “oral tradition is a common element among many cultures… narrative approaches seem ideally suited to cross-cultural applications” (p. 580). While systemic approaches and problem solving help their current lives become more manageable, postsystemic approaches can help clients to move on from past problems that are unsolvable but must be dealt with. A last study took the use of narrative therapy further, linking it with exposure therapy to target refugees with PTSD, one of the top three mental disorders prevalent among refugee populations due to their high exposure to trauma (Elbert, 2004).
Elbert (2004) explains, “in exposure therapy, the patient is requested to repeatedly talk about the traumatic event in detail while re-experiencing all emotions associated with the event” (p. 580). By coupling this approach with narrative techniques, the client focuses not on a single defining event of their life, but on constructing a narration of their life from birth to the present. This approach reduces symptoms from the habituation of emotional responses in exposure and by replacing a fragmented reality with a full narrative of one’s
life.
Implications for Social Work In working with refugee populations, building rapport in the therapist/client relationship will be of the utmost importance, as many refugees may have legitimate trust issues based on corruption or trauma they have experienced in their home countries. Cultural competency and learning how to work with this unique population who may have experienced too much change too quickly allows social workers to bring stability and help refugees regain identity in their new setting.
References
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, 579-587
Kelley, P. (1994) Integrating systemic and postsystemic approaches to social work practice with refugee families. Families in Society. 75, 517.
Walter, J. A. & Ahearn, F. L.(2012). Displaced people. Encyclopedia of Social Work (20th ed.). Washington, DC: Oxford University Press. Retrieved from: http://www.oxfordreference.com.ezproxy.etsu.edu:2048/view/10.1093/acref/978 195306613.001.0001/acref-9780195306613-e-110#