Refugees and asylum seekers who have experienced trauma: Thematic synthesis of therapeutic boundary considerations

IF 3.2 3区心理学 Q1 PSYCHOLOGY, CLINICAL

Clinical psychology & psychotherapy Pub Date : 2023-09-02 DOI:10.1002/cpp.2894

Niamh Davoren, Alice McEleney, Santhi Corcoran, Phelim Tierney, Dónal G. Fortune

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引用次数: 0

Abstract

Objective

Therapeutic boundaries are limits to appropriate behaviours within a therapist–client relationship (e.g. related to accepting gifts, self-disclosures, therapist neutrality and advocacy). Therapeutic boundary considerations are fundamental in the care of refugees and asylum seekers. Research on the experiences of therapists navigating such boundaries is sparse and warrants further exploration. The aim of this qualitative systematic review was to thematically synthesise literature regarding therapists' (psychologists, psychotherapists, counsellors) experiences of implementing flexible therapeutic boundaries with refugee and asylum seeker clients and determine how such applications have been helpful for therapeutic interventions.

Method

Six databases were searched. Following full-text screening, 21 papers were included in the analysis. Boundary theory underpinned the analysis.

Results

Three major themes were developed: (i) Changes to Therapeutic Practice & Therapeutic Intervention, (ii) Re-Conceptualisation of Therapy as ‘Clinical Political’ and Re-Conceptualisation of Therapist Identity and (iii) Careful Monitoring of Personal Boundaries—Not becoming ‘Hardened’ or ‘Haunted’. Papers described how, when used in a reflective, considerate way, flexible therapeutic boundaries can strengthen the therapist–client alliance and positively impact therapeutic interventions. Many therapists acknowledged making conscious efforts to re-conceptualise therapeutic work with refugee and asylum seeker clients from advocacy standpoints. However, systemic constraints, and lack of guidance, made this difficult to navigate and contributed to therapist burn-out.

Conclusions

Boundary considerations manifested as interpersonal, structural and cultural changes to practice. These have implications for clinical practice and developing guidelines on boundary practices with refugees and asylum seekers. Future research should explore promoting therapist well-being and training needs for therapists supporting this population.

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经历过创伤的难民和寻求庇护者：治疗边界考虑因素的专题综述

目标治疗界限是对治疗师-客户关系中适当行为的限制（例如，与接受礼物、自我披露、治疗师中立和倡导有关的限制）。治疗界限对难民和寻求庇护者的护理至关重要。有关治疗师在处理这些界限时的经验的研究很少，值得进一步探讨。本定性系统综述旨在对有关治疗师（心理学家、心理治疗师、辅导员）对难民和寻求庇护者客户实施灵活治疗界限的经验的文献进行专题综合，并确定此类应用对治疗干预的帮助。方法搜索了六个数据库。经过全文筛选，21 篇论文被纳入分析。边界理论是分析的基础。结果形成了三大主题：(i) 治疗实践与amp; 治疗干预的变化，(ii) 将治疗重新概念化为 "临床政治 "和治疗师身份的重新概念化，以及 (iii) 谨慎监控个人界限--不要成为 "硬化 "或 "困扰"。论文介绍了灵活的治疗界限在以反思和体贴的方式使用时，如何能够加强治疗师与客户之间的联盟，并对治疗干预产生积极影响。许多治疗师承认，他们有意识地从倡导的角度出发，对难民和寻求庇护者客户的治疗工作进行了重新构思。然而，系统性的限制和缺乏指导使其难以驾驭，并导致了治疗师的倦怠。结论边界因素表现为人际、结构和文化方面的实践变化。这些都对临床实践以及制定难民和寻求庇护者边界实践指南有影响。未来的研究应探讨如何促进治疗师的福祉，以及治疗师在支持这类人群时的培训需求。

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来源期刊

Clinical psychology & psychotherapy PSYCHOLOGY, CLINICAL-

CiteScore

6.30

自引率

5.60%

发文量

106

期刊介绍： Clinical Psychology & Psychotherapy aims to keep clinical psychologists and psychotherapists up to date with new developments in their fields. The Journal will provide an integrative impetus both between theory and practice and between different orientations within clinical psychology and psychotherapy. Clinical Psychology & Psychotherapy will be a forum in which practitioners can present their wealth of expertise and innovations in order to make these available to a wider audience. Equally, the Journal will contain reports from researchers who want to address a larger clinical audience with clinically relevant issues and clinically valid research.