Lost in limbo: Cultural dimensions in psychotherapy and supervision with temporary protection visa holder from afghanistan

Abstract

Many people in refugee work have the view that it is important to match up therapist and client so that they are not from groups which are persecuting or fighting each other. The idea is that it is very difficult to build trust with a person from a group, which has abused you and/or your family and friends. While we would be in agreement with this view, sometimes clients can be matched with a therapist and/or an interpreter, who speak their language and are from the same country, but may be from an opposing ethnic, political or religious group. This case study is of current interest because the therapist and client are from opposing sides in the war in Afghanistan, and the therapist and the supervisor are from opposing sides in the 'War on Terror'. ('War on Terror' is a loose term coined by the US government, which refers to the current international situation where the US and their western allies are trying to prevent terrorist attacks from small groups of people who use Islam to justify their extreme ideas. The term also includes the recent occupation of Iraq and Afghanistan by the US and allies, and the terrorist attacks and fighting in those countries.) From a distance, it would appear that the matching in this case would be a recipe for disaster - yet this has not been our experience so far. In this chapter we are examining some psychosocial and psychotherapy work with a young male client from Afghanistan, living on a Temporary Protection Visa in Sydney, Australia. His extensive trauma history and emotional and physical issues are introduced in the first section of the chapter. The second section will focus on a number of cultural and political factors in the environment; the third section introduces some thoughts about politics and culture which were relevant for understanding the young man's mental state and aspects of the work with him, including transcultural issues in the therapeutic relationships. This case study includes two different cross-cultural relationships - both the relationship between the therapist and the client, and the relationship between the therapist and her supervisor. Dimensions of more overt cultural differences in these relationships include ethnicity, religion, class, education, language and gender. Less overt dimensions include ways of thinking, identity, 'flavours' and nuances in feelings, ways of understanding experience, unconscious ideas, internal relationships and images, which also are informed by culture and language. The therapist and supervisor are both working at STARTTS (Service for the Treatment and Rehabilitation of Torture and Trauma Survivors) in Sydney. STARTTS is perhaps a unique service because it has always employed a majority of workers from refugee and non-English speaking backgrounds, so that it could form strong links with refugee communities. It has developed using a combination of community development and clinical models for interventions with refugees at multiple levels of the system. (Cunningham & Silove, 1993; Aroche & Coello, 1994, 2004). Working in this multicultural staff group has provided a rich environment for ongoing discussions about culture, politics and psychotherapy 'at the coalface'. There has been close contact with the crises and events affecting the local refugee communities, and there has been experimentation working with local healers and religious people. Some of this early work has been documented. (Becker et al, 1990; Silove, Tarn, Bowles & Reid, 1991; Bowles, 1993, 1998, 2005, 2006; Nguyen, 1993; Morris et al, 1993; Bowles & Haidary, 1994; Bowles, Haidary & Becker, 1995; Nguyen & Bowles, 1998; Becker & Bowles, 2001a, 2001b, 2001c, 2004; Aroche & Coello, 1994, 2004; Bowels, Salem & Preston-Thomas, 2004; Haidary, 2000; Mehraby, 1999a, 1999b, 2001a, 2001b, 2002a, 2002b, 2002c, 2003a, 2003b, 2003c, 2004, 2005a, 2005b, 2007a, 2007b; Mehraby & Coello, 2005) The traumatising nature of the work tends to push the staff together for support. A feature of STARTTS has been the implementation of support structures, for example regular clinical supervision and encouragement to attend personal psychotherapy or other forms of self-development and anti-burnout strategies. We would like to acknowledge the clinical supervision, which both authors have received from Rise Becker, which has informed much of our thinking. © 2007 Springer Science + Business Media, LLC. All rights reserved.