Challenges and facilitators in treating unaccompanied young refugees with posttraumatic stress disorder in a dissemination trial: a qualitative study with psychotherapists.

Background: Unaccompanied young refugees (UYRs) report high rates of post-traumatic stress, depression and anxiety, and low mental health service utilization. Studies have examined the experiences of psychotherapists and refugees in psychotherapy, focusing on barriers. Our stepped-care approach aims to reduce barriers through comprehensive support, such as training and case consultation for psychotherapists and interpreters, and treatment recommendations for UYRs.

Methods: A qualitative design with semi-structured interviews was employed, with 20 psychotherapists, of whom 13 were females. All psychotherapists participated in the 'BETTER CARE' project, which included trauma-focused cognitive-behavioral therapy training and case consultations. We analyzed psychotherapists' initial worries, challenges, and facilitators in treating UYRs with posttraumatic stress disorder, and compared the responses of completers' and non-completers' psychotherapists, following a mix of deductive and inductive coding.

Results: Psychotherapists expressed worries similar to those documented in the literature on barriers (such as organizational challenges, emotional stress, and uncertainty about working with interpreters) prior to participating in the project. Major facilitators were the components offered by the project, such as online training, workshop and case consultations. In addition, support from the facility and caregivers and the provision of skilled interpreters who translated accurately and transparently, as well as patients' treatment readiness and language proficiency, were seen as facilitators or, when lacking, as challenges. Completers' psychotherapists were more likely to emphasize the positive aspects of the project, a positive therapeutic alliance and patients' trusting relationship with the interpreters as facilitators. In contrast, non-completers' psychotherapists were more likely to encounter structural difficulties, such as the lack of primary caregivers, greater distances, and grief symptoms among patients.

Conclusions: Our findings indicate that enhancing the knowledge of psychotherapists, caregivers, and interpreters through specialized training is important for effective trauma treatment with UYRs. This training should result in increased patient readiness, caregiver support, and fostering a cooperative treatment environment, while also building a trusting relationship between patient, psychotherapist, and interpreter. As initial worries were largely unconfirmed, and completers' psychotherapists benefited more from the projects' offers, we recommend similar approaches.

Trial registration: German Clinical Trials Register DRKS00017453. Registered on 11 December 2019.