Group Treatment With Multiethnic Groups 2008

September, 10th, 2007Hans Rohlof, M.D.

Group Treatment with Multiethnic Groups

September, 10th, 2007 Hans Rohlof, M.D.2 GROUP TREATMENT WITH MULTIETHNIC GROUPS

Content lecture

• Literature about group therapy with multiethnic groups

• Our experience with multiethnic group therapy• Outcome of group therapy


Literature Group Therapy with Multiethnic Groups(1)

• Rather scarse• Davis (1984): Mixed groups with African

Americans: attention for as well sociocultural position as personal issues.

• Tsui and Schultz (1988): Asian clients in Caucasian groups: different perceptions of power, authority, interpersonal boundaries and family process.


Literature Group Therapy with Multiethnic Groups (2)

• Vasquez & Han (1995): divers ethnic minorities: therapeutic factors of validation, empowerment, mutuality and self-empathy.

• Warriner (1978): warnings about dangers of thinking as race as the most distinguishing characteristic of individuals in multiethnic groups.


Literature Group Therapy with Multiethnic Groups (3)

• Matsukawa (2001): • Exploration of ethically derived values• Observe and understand nonverbal and symbolic

forms of communication• Explore cultural transferences and counter-

transferences• Help examine ethnic or racial prejudices


Literature Group Therapy with diverse groups of Refugees: Dutch literature

• Santini et al (1999): integrative multidimensional group therapy

• van Emmerik et al (1999): psychoeducation, existential problems. Three themes: coping with trauma symptoms, acculturation, self care.

• Tonk (2004): thematic, flexible, non-verbal.


Literature Group Therapy with diverse groups of Refugees: international literature

• Entholt et al (2005): two groups of children, n=15 and n=11. First group CBT-group (6 weeks), second waiting list. PTSD symptoms significantly decreased. Follow-up after 2 months: no change.

• Otto et al (2003): Cambodian patients refractory to medication (n=5/5). Sertraline alone or combination with 10 sessions of CBT-group (psychoeducation and relaxation): significant difference in outcome (effect size 0,82).


Refugees as patients

• Traumatisation: PTSS about 40 % (NL), (normal population: 1-2 %)

• Losses and forced migration. Depression about 50 % (NL), (normal population: 7,6 % year, 19 % life prevalence)

• Acculturation. 'Liminal' vulnerability in people in change: culture, language.

• Social marginalization and isolation. Living in asylum centers, juridical procedures, unemployment in refugees with status (50 %), lack of social support.


Arbeidsparticipatie

• Werkloosheid (1.1.2004):

0

5

10

15

20

25

30

35

40

autocht Turken ex-Joegsl I ran Somaliërs

werkloosheid


Book: 'Group therapy with refugees''

• two theoretical and reviewing chapters• nine chapters with descriptions of specific groups:

one psychoeducation, three day clinical, one clinical, two ambulant, two adolescent groups

• one concluding chapter



Description of possible effective items of group therapy with refugees(1)

• Mutual support• Mutual respect • Mutual identification• Group psycho-education• Group exercises


Group exercises



• Most groups very heterogeneous• Focus needed for identification• Most used focus: acculturation: probably more

positive and less harmful • Focus on traumatization probably too harmful, too

insecure, too complicated (different political/ethnic groups)



• no protoprofessionalisation: psychoeducation needed

• information about symptoms, about mental health care, about treatment

• informed consent



• group rules and confidentiality: complicated by:• paranoid symptoms from traumatization• fear of gossip (small ethnic groups)• fear of stigmatization• much attention to confidentiality!



• Somatization and psychologization• Next to verbal group therapy: relaxation exercises,

psychomotor therapy, other nonverbal techniques. • Turning passive into active



• Influence of social/juridical problems:

• good cooperation with social workers, lawyers, wellfare institutes etcetera.

• look out for negative attitude against group therapists, wrongly seen as representatives of other institutions (ministry of justice, vocational and wellfare services)

• education about racism, discrimination,

• education about building relationships with native people.



• Working with interpreters:• Complicated in group therapy: without is better• Two (maybe three) interpreters is maximum a

group can handle• Translating interpreters, not interpreters who are

treating or consulting



• Gender specific or gender mixed?• In cultures of origin less confidentiality in mixed

gender groups• Taboo items better expressed in gender specific

groups• Male behavior and female behavior reinforced in

specific groups• Training in inter gender relation building possible

in mixed gender groups



• multi-ethnic or mono-ethnic groups:• mono-ethnic much identification• multi-ethnic groups many opportunities, but

problems according to Matsukawa (2001) :• 1. need to clarify different norms and values• 2. help in understanding nonverbal and symbolic

ways of communication• 3. need to clarify cultural (counter) transference• 4. investigate and control of racial prejudices



• Exposure in groups:• No evidence for effectiveness of group exposure• Common avoidance probably also not good• Talking about horrible details produces many

uncontrolled emotions in different group members• Talking about experiences together with reactive

coping behavior better than stories alone


Conclusions

• Many effective items in group therapy with refugees

• Precautions important• Making choices important• More research needed about the overall effect of

group therapy with refugees. • Group therapy with PTSD patients has low

evidence of effectiveness (Foy, in Foa et al, 2000), but refugees seem to profit more.

Consult our website www.centrum45.nl for further information.

Health & Medicine

Group Treatment With Multiethnic Groups 2008