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Christine Lay, Heather Z. Lyons, Ph.D.

Perceptions and Experiences of Psychotherapy Among Forced Migrants with Limited English Proficiency

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A qualitative study was conducted to determine the perceptions and experiences of traditional western psychotherapy among forced migrants, specifically how language use in psychotherapy relates to pursuit of services. Globally, in 2016, 67.7 million persons of concern, including forced migrants, were identified with 815,608 persons in the United States (United Nations High Commissioner for Refugees, n.d.). Forced migrants consist of refugees, asylees, and asylum seekers. They have experienced traumatic events at pre- and post-migration (Man Shrestha et al., 1998; Mollica, Wyshak, & Lavelle, 1987; Nickerson, Bryant, Steel, Silove, & Brooks, 2010; Sinnerbrink, Silove, Field, Steel, & Manicavasagar, 1997; Yakushko, Watson, & Thompson, 2008), and are at a higher risk for mental health concerns than the general population (Fazel, Wheeler, & Danesh, 2005; Hinton et al., 1993; Keyes, 2000; Porter & Haslam, 2005; Steel et al., 2009). Although psychotherapy can address the mental health of all persons, many barriers may impact forced migrants obtaining such services. Current literature identifies language, including limited English proficiency, as a barrier to forced migrants seeking mental health services (Cheng et al. 2015; Wong et al., 2006). However, the literature mainly focuses on the perspectives of interpreters and clinicians, and neglects the views of forced migrant clients. This study aimed to obtain insights directly from forced migrants, which is limited in the current literature.

To determine the association between language and psychotherapy among forced migrants, a partnership was developed with Intercultural Counseling Connection (“Connection”), a Baltimore based non-profit organization providing forced migrants with group therapy and referrals for linguistically appropriate individual therapy. Focus groups were conducted until saturation was attained, meaning no new themes emerged. Saturation was met with two focus groups with a total of 16 participants, who were recruited from Connection. Participants were from seven countries of origin and spoke various languages with the languages used for the focus groups being French, Spanish, and English. French and Spanish interpreters were utilized, along with the interviewer who spoke English, to facilitate adequate discussion during the semi-structured group interviews. Questions addressed individual and cultural thoughts on psychotherapy, the impact of language, and use of interpreters. The interviewer clearly informed participants that the content of their personal psychotherapy sessions did not need to be shared. All participants were administered consent and compensated for their time and efforts with a $20 gift card.

Data from the focus groups is currently being analyzed from a Grounded Theory methodology by a research team consisting of graduate students in a clinical psychology doctoral program. Grounded Theory was created specifically for the study of social behaviors and interactions (Fassinger, 2005). It is used to organically develop a theory based on themes that emerge from data collected (Kelle, 2007). Analysis consisted of open, selective, and theoretical coding. Preliminary results indicate that participants do not perceive mental health as a focus in their countries of origin, particularly compared to physical health. Participants subsequently lack knowledge about psychotherapy. Additionally, language, including use of interpreters, was found to hinder participants’ access to and desire for mental health services.

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