Broken Promises and Lost Dreams: Navigating Asylum in the United States

Relational ethics in immigrant families: The contextual therapy five-dimensional framework

Contextual family therapy offers a unique explanatory and clinically valuable framework to address complex multigenerational processes in families of immigrants who experience cumulative migration-related traumas. In this paper, we offer a new extended, specific conceptualization of immigrant families' generational dynamics using existing literature within the five-dimensional contextual therapy framework illustrated with a clinical example. We highlight the importance of social and relational justice, loyalty, entitlement, and parentification in transgenerational processes in addressing manifestations of these traumas that are frequently overlooked in clinical practice with different generations of immigrant families. Clinical guiding principles include acknowledgment of the social nature of situational injustices and their consequences for relational justices, exploration of loyalty conflicts (familial, cultural, and national), active dialogue of mutual care, exoneration, and stimulating constructive entitlement through active giving. This paper contributes to further development of contextual therapy theory and provides practical guidance for clinicians working with international migrants including second and third generations.

Rethinking mental healthcare for refugees

After several years of downturn in new resettlement, the United States is projected to admit 125,000 refugees in the current fiscal year. Refugee communities have known risks of developing mental health problems due to high rates of exposure to war and conflict-related trauma and chronic stressors associated with displacement and resettlement. In this commentary, we examine limitations in the current system of mental health care available to newly arriving refugee communities and make recommendations for expanding and redesigning services to better meet the needs of culturally diverse refugee communities. This includes drawing on public health and prevention frameworks to implement a continuum of services including basic services and security, trauma-informed prevention services to meet the needs of individuals, families and communities and specialized clinical care for those that need it. Across all services, we recommend robust engagement and partnership with refugee community leaders to design and deliver programs.

Ambiguous loss of home: Syrian refugees and the process of losing and remaking home

This constructivist-interpretive study examines social-relational dimensions of change and loss following experiences of political terror, war and forced migration from the perspective of Syrian refugee men and women who were presently living in Jordan (n=31). A process model derived from the analysis theorizes four dimensions of ambiguous loss (safety and security, social connections and identities, connection to place, and dreams and imagined future) and to capture the cyclical process of losing and remaking a sense of home in displacement. Our findings underscore a more complex set of processes that remain outside the array of supports and services provided by many current practices and policies with displaced populations generally, and Syrian refugees specifically. Thus, the findings highlight the need for ecological, integrative policies, interventions and services that support refugees' attempts to remake the multifaceted and stable phenomenon that is home as they transition into new communities.

A Scoping Review of Social Support Research among Refugees in Resettlement: Implications for Conceptual and Empirical Research

This study reviewed social support research with refugees in resettlement by assessing the scope of scholarship and examining methodological approaches, definitions, theoretical frameworks, domains, and sources of support. The scoping review followed a systematic approach that retained 41 articles for analysis. The findings indicate that refugee resettlement studies seldom conceptualizes social support as a central focus, defines the concept, draws from related theory, or examines multifaceted components of the construct. The review nevertheless yielded promising findings for future conceptual and empirical research. The analysis identified a wide range of relevant domains and sources of social support, laying the foundation for a socio-ecological model of social support specific to refugee experiences in resettlement. The findings also indicate an imperative to examine and theorize social support vis-à-vis diverse groups as a main outcome of interest, in connection to a range of relevant outcomes, and longitudinally in recognition of the temporal processes in resettlement.

Predictors of psychological distress in Syrian refugees with posttraumatic stress in Germany

Syria has been the main country of citizenship of refugees in Germany since 2013. Syrians face numerous human rights violations in their country that can be accompanied by the experience of potentially traumatic events, loss and displacement. Along the migration process, refugees are exposed to various factors that can have an impact on mental health. The aim of this study is to investigate sociodemographic, war- and flight-related as well as post-migration factors as predictors of posttraumatic stress, depression, somatization and anxiety in Syrian refugees with posttraumatic stress symptoms based in Germany. Data were based on the baseline sample of the "Sanadak" randomized-controlled trial. A total of 133 adult Syrian refugees participated in the study. A questionnaire covered sociodemographic and flight-related questions as well as standardized instruments for symptoms of PTSD (PDS-5), depression (PHQ-9), somatization (PHQ-15), anxiety (GAD-7), generalized self-efficacy (GSE), religiousness (Z-Scale), social support (ESSI) and mental health stigma (SSMIS-SF). Linear regression models were executed to predict mental health outcomes. Sociodemographic predictors (i.e., female sex, higher education) and flight-related predicting factors (i.e., variability of traumatic events) have a negative impact on mental health in Syrian refugees with posttraumatic stress symptoms in Germany. Mental health stigma predicts worse mental health outcomes. Post-migration factors have a major impact on mental health, such as low income, lack of social support, low life satisfaction or a strongly felt connection to Syria. Somatization is an important manifestation of mental distress in Syrian refugees with posttraumatic stress symptoms. Our study showed a range of factors predicting the mental health of Syrian refugees with posttraumatic stress symptoms. Measures to foster mental health could be securing financial security, promoting gender equality and tailored psychosocial programs addressing mental health stigma, loss and social support networks.

Traumatized Syrian Refugees with Ambiguous Loss: Predictors of Mental Distress

Refugees from war zones often have missing significant others. A loss without confirmation is described as an ambiguous loss. This physical absence with simultaneous mental persistence can be accompanied by economic, social or legal problems, boundary ambiguity (i.e., uncertainty about who belongs to the family system), and can have a negative impact on mental health. The aim of this study was to identify sociodemographic and loss-related predictors for prolonged grief, anxiety, depression, post-traumatic stress disorder (PTSD) and somatization in treatment-seeking Syrian refugees with post-traumatic stress symptoms in Germany experiencing ambiguous loss. For the present study, data were based on the treatment-seeking baseline sample of the “Sanadak” randomized-controlled trial, analyzing a subsample of 47 Syrian refugees with post-traumatic stress symptoms in Germany experiencing ambiguous loss. Sociodemographic and loss-related questions were applied, along with standardized instruments for symptoms of prolonged grief (ICG), anxiety (GAD-7), depression (PHQ-9), PTSD (PDS-5) and somatization (PHQ-15). Linear regression models were used to predict mental health outcomes. Having lost a close family member and higher boundary ambiguity showed a statistically significant association with higher severity in prolonged grief. The overall model for somatization reached statistical significance, while no predictor independently did. Boundary ambiguity showed a statistically significant positive association with depression, while the overall model showed no statistically significant associations. Boundary ambiguity and missing family members seemed to be important predictors for prolonged grief. These findings support the importance of reunification programs and suggest an inclusion of the topic into psychosocial support structures, e.g., including psychoeducational elements on boundary ambiguity in support groups for traumatized individuals and families experiencing ambiguous loss. Further research is needed for a more detailed understanding of the impact of ambiguous loss on refugee populations.

A Phenomenological Study on the Experience of Syrian Asylum-Seekers and Refugees in the United States

Violence in Syria has displaced an unprecedented number of people from their homes. While couple/family therapy (C/MFT) scholars have explored migration experiences, particularly among refugees, there is still limited research using a bioecological framework. This exploratory study examined the experiences of Syrian asylum-seekers and refugees living in the United States using a qualitative phenomenological approach. Twelve Syrians (n = 8 men, n = 4 women) between 20 and 52 years of age (M = 35.8, SD = 10.7) were interviewed about their experiences across three stages of resettlement: (1) pre-resettlement, (2) resettlement/migration, and (3) post-resettlement. Findings suggest that the effects of conflict-induced displacement and resettlement permeate across multiple ecologies. These range from the individual and his or her interpersonal relationships to their larger community and society. C/MFTs should account for contextual factors while becoming familiar with the sociopolitical impact of displacement and resettlement in their clinical work with this population.

Strength, solidarity, strategy and sustainability: A counseling psychologist’s guide to social action

The roles of counseling psychologists vary by setting, population, and circumstances. Yet, social justice can be a unifying force beyond the boundaries of daily responsibilities. No matter how insightful or profound counseling psychology theories or practice are, if they are focused on individual change alone, they will never sufficiently address injustice. Injustice and the inadequacy of traditional, individually focused paradigms present tensions between counseling psychologists’ work to help individuals cope with life’s challenges and inadvertent (or intentional) support of systems that perpetuate oppression. This paper explores this dichotomy, avenues for moving to action, and personal sustainability in the face of professional fatigue. Experiences as a counselor and counseling psychologist, as well as research, shape the way I see advocacy and activism and have given rise to strategies I have found helpful. A resulting framework for developing a “personal social action plan” is represented by four pillars: Strength, Solidarity, Strategy and Sustainability (S-Quad). National and local challenges across the globe reflect enormous differences in contexts, needs, politics, and resources. Yet, sharing strategies for social action, activism, and advocacy can provide seeds for optimism and action toward justice and positive change.

A Phenomenological Study of Family Experiences of Resettled Iraqi Refugees

Using a cross-sectional, phenomenological design, this qualitative study sought to explore Iraqi refugees' experiences of family relationships resettled in a northeastern city in the United States after the start of the 2003 war. Participants' experience of family relationships was situated within the context of their displacement, which included fear and uncertainty during displacement, and experiences of safety and isolation during resettlement. Themes related to family relationships were as follows: shared experiences of losses; increased trust between family members; shifts in communication and gender roles; and constructing a family legacy. Findings from this study indicate that family relationships play a central role in making meaning of forced displacement and resettlement experiences, which have significant clinical implications for family therapists working with refugees.

Transnational Intersectionality in Family Therapy With Resettled Refugees

In this article, we discuss incorporating the transnational intersectionality framework in family therapy with resettled refugees. Transnational intersectionality is an extension of the framework of intersectionality which helps to better understand complexities of power and oppression across national contexts and their influence on refugees' lives. Adopting this framework alerts family therapists to: (a) develop critical awareness of refugee's transnational contexts; (b) understand differences in experiences of social identities across contexts; (c) acknowledge postmigration factors of oppression affecting resettlement; and (d) critically reflect upon therapist-interpreter-client intersectionalities. This shifts our conceptualization of therapy with refugees to actively consider transnational contexts which refugees uniquely occupy. We describe the framework and provide two case illustrations to highlight its usefulness.