Complex Trauma within Refugee Populations

Complex Trauma within Refugee Populations

The Role of a Clinical Psychologist in Refugee

Proceedings

The Role of a Clinical Psychologist in Refugee

Proceedings

Presentation OverviewPresentation Overview

The Legal Questions. Why are Psychologists Useful in this Arena.

The Referral Process. How to Structure an Assessment. Complex Trauma and Worldview-Why are they so important?-Case Examples.

Key things that make for a helpful report.

Where to from here.

The Legal Questions. Why are Psychologists Useful in this Arena.

The Referral Process. How to Structure an Assessment. Complex Trauma and Worldview-Why are they so important?-Case Examples.

Key things that make for a helpful report.

Where to from here.

United Nations Definition of a

Refugee

United Nations Definition of a

Refugee Refugees are people who owing to a well

founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside of the country of their nationality and is unable, or owing to such fear, is unwilling to avail themselves of the protection of that country; or who, not having a nationality and being out side of their former habitual residence as a result of such events, is unable or, owing to such fear to return to it.

Refugees are people who owing to a well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside of the country of their nationality and is unable, or owing to such fear, is unwilling to avail themselves of the protection of that country; or who, not having a nationality and being out side of their former habitual residence as a result of such events, is unable or, owing to such fear to return to it.

The Legal QuestionsThe Legal Questions

Legal Refugee Categories-Quota Refugees vs Asylum Seekers.

The process for asylum seekers. The determination of claim process-Refugee Status Branch.

Appeals-Immigration and Protection Tribunal.

Protected Persons. Humanitarian Appeals.

Legal Refugee Categories-Quota Refugees vs Asylum Seekers.

The process for asylum seekers. The determination of claim process-Refugee Status Branch.

Appeals-Immigration and Protection Tribunal.

Protected Persons. Humanitarian Appeals.

Why are psychologists useful?

Why are psychologists useful?

We provide critical evidence of psychological damage arising out persecution, torture or cruel inhumane and degrading treatment.

We provide critical information about the psychosocial consequences of persecution or torture at an individual, family and community level.

Assist with the gathering of the facts-provide expertise that lawyers, Refugee Officers and IPT members don’t have.

Provide context for a refugees behaviour/responses to the refugee process.

Risk analysis, address the issues of harm at multiple levels.

Assist the refugee to provide a coherent narrative of their claim within a non-threatening environment- Detectives of the Human Soul?

We provide critical evidence of psychological damage arising out persecution, torture or cruel inhumane and degrading treatment.

We provide critical information about the psychosocial consequences of persecution or torture at an individual, family and community level.

Assist with the gathering of the facts-provide expertise that lawyers, Refugee Officers and IPT members don’t have.

Provide context for a refugees behaviour/responses to the refugee process.

Risk analysis, address the issues of harm at multiple levels.

Assist the refugee to provide a coherent narrative of their claim within a non-threatening environment- Detectives of the Human Soul?

The referral processThe referral process Lawyer directed or the lawyer communicates on behalf of the RSB.

Decoding the brief and agreeing the assessment parameters.

The importance of the written brief. Scope of Practice Issues-the problems of operating on the fringes, and how to manage this.

Identify what supports you need and what are appropriate assessment tasks/tools given the back ground of the claimant.

Lawyer directed or the lawyer communicates on behalf of the RSB.

Decoding the brief and agreeing the assessment parameters.

The importance of the written brief. Scope of Practice Issues-the problems of operating on the fringes, and how to manage this.

Identify what supports you need and what are appropriate assessment tasks/tools given the back ground of the claimant.

How to Structure an Assessment

How to Structure an Assessment

All the usual rules apply. Multi-modal. Always be transparent about the limitations.

To test or not to test. Symptom validity.

All the usual rules apply. Multi-modal. Always be transparent about the limitations.

To test or not to test. Symptom validity.

Complex TraumaComplex Trauma The DSM-IV PTSD diagnosis arose out of notion of trauma

being a discrete or circumscribed event-prototypes come from work in the area of combat, disaster and rape.

Does not recognise the diversity of symptomatic manifestations of prolonged or repeated trauma which can be seen in refugee/asylum populations (Herman, 1997).

Chronically traumatised people can present very differently-cultural and linguistic complexities and chronic trauma can result in profound and severe personality changes.

Persecutors/discriminators survive by denying, blaming, minimising the impacts or severity of the trauma suffered by their victims-trauma becomes a way of life for victims and can be socially sanctioned within their country of origin. The can create a environment within which repeated traumatisation occurs across all levels of daily living.

The DSM-IV PTSD diagnosis arose out of notion of trauma being a discrete or circumscribed event-prototypes come from work in the area of combat, disaster and rape.

Does not recognise the diversity of symptomatic manifestations of prolonged or repeated trauma which can be seen in refugee/asylum populations (Herman, 1997).

Chronically traumatised people can present very differently-cultural and linguistic complexities and chronic trauma can result in profound and severe personality changes.

Persecutors/discriminators survive by denying, blaming, minimising the impacts or severity of the trauma suffered by their victims-trauma becomes a way of life for victims and can be socially sanctioned within their country of origin. The can create a environment within which repeated traumatisation occurs across all levels of daily living.

Complex Trauma .....Complex Trauma .....

Trauma has a social and historical dimension that needs to be understood at the individual and sociopolitical level.

The personal story is embedded in the story of the larger system of family, community, social and moral norms.

Beliefs held by individuals influence the family as a whole.

Trauma symptoms and psychological damage expressed by one family member can act as a daily and constant reminder of the trauma experienced by the family as a whole.

Trauma has a social and historical dimension that needs to be understood at the individual and sociopolitical level.

The personal story is embedded in the story of the larger system of family, community, social and moral norms.

Beliefs held by individuals influence the family as a whole.

Trauma symptoms and psychological damage expressed by one family member can act as a daily and constant reminder of the trauma experienced by the family as a whole.

WorldviewWorldview

Lens through which a person reads their reality, a filter through which phenomena and reality is perceived and comprehended.

Way of defining what can be known and done. Includes assumptions that may be unproven or

unprovable. Worldview beliefs encompass views on nature of

reality, social relations or guideline for living. Highly relevant to an individuals perception or

harm and the issue of an internal protection alternative.

Highly stable-can be superordinate to other sources of information.

Lens through which a person reads their reality, a filter through which phenomena and reality is perceived and comprehended.

Way of defining what can be known and done. Includes assumptions that may be unproven or

unprovable. Worldview beliefs encompass views on nature of

reality, social relations or guideline for living. Highly relevant to an individuals perception or

harm and the issue of an internal protection alternative.

Highly stable-can be superordinate to other sources of information.

FARC in ActionFARC in Action

QuickTime™ and a decompressor

are needed to see this picture.

Case Illustration- Olivia, Anna and Patty

Pero.

Case Illustration- Olivia, Anna and Patty

Pero. Anna had been in NZ for 5 years on a visitors visa as

wife of a foreigner who had a work permit. The relationship ended and she and her infant child were at risk of being forced to return to Colombia.

Anna’s mother Olivia was granted refugee status and successfully applied for Patty to join as a resident.

Patty was 23 years old, had effectively been living life of fugitive in isolation in Bogota while Olivia was applying for refugee status. She had severe PSTD and depression as a result of a bombing and her family being persecuted by FARC since 1982.

Olivia’s lawyer requested assessment of Patty to assist in Anna’s claim. Anna was not presenting with psychological disorder but Olivia and Patty very affected and presenting with psychological conditions as a result of their experiences of persecution and an involvment in a bombing in.

Anna had been in NZ for 5 years on a visitors visa as wife of a foreigner who had a work permit. The relationship ended and she and her infant child were at risk of being forced to return to Colombia.

Anna’s mother Olivia was granted refugee status and successfully applied for Patty to join as a resident.

Patty was 23 years old, had effectively been living life of fugitive in isolation in Bogota while Olivia was applying for refugee status. She had severe PSTD and depression as a result of a bombing and her family being persecuted by FARC since 1982.

Olivia’s lawyer requested assessment of Patty to assist in Anna’s claim. Anna was not presenting with psychological disorder but Olivia and Patty very affected and presenting with psychological conditions as a result of their experiences of persecution and an involvment in a bombing in.

Case Illustration…Case Illustration…

Issues of complex trauma and worldview highly relevant to this case.

Focus of assessment became how the impact of complex trauma on the family had impacted Anna’s fears of persecution in Columbia and her ability to cope with separation from Olivia and Patty and return to Colombia.

Issues of complex trauma and worldview highly relevant to this case.

Focus of assessment became how the impact of complex trauma on the family had impacted Anna’s fears of persecution in Columbia and her ability to cope with separation from Olivia and Patty and return to Colombia.

Key things that make for helpful report

Key things that make for helpful report

Remain impartial-Code of Conduct for High Court Witness applies.

Ensure that the you have answered the brief. Provide a clinical formulation separate to the your

opinion. A good formulation can become a voice for the voiceless. Be transparent about the limitations to your findings. Just because a person doesn’t meet a DSM-IV or ICD-10

criteria it does not mean that have not been persecuted or tortured.

Take a cautious approach to interpreting inconsistencies, especially when dealing with a collective voice.

Recommendations about the need for further assessment or treatment-be prepared to actively liaise with the lawyer/other parties to ensure this occurs.

Remain impartial-Code of Conduct for High Court Witness applies.

Ensure that the you have answered the brief. Provide a clinical formulation separate to the your

opinion. A good formulation can become a voice for the voiceless. Be transparent about the limitations to your findings. Just because a person doesn’t meet a DSM-IV or ICD-10

criteria it does not mean that have not been persecuted or tortured.

Take a cautious approach to interpreting inconsistencies, especially when dealing with a collective voice.

Recommendations about the need for further assessment or treatment-be prepared to actively liaise with the lawyer/other parties to ensure this occurs.

Where to from hereWhere to from here

Its a lonely place at the moment. Skills acquired in the forensic or medico legal arena generalise well to this work.

BUT there are key differences which require some careful thought, lots of good supervision and self care.

Our society has competing perspectives about refugees-be prepared to be challenged about the role you play.

Its a lonely place at the moment. Skills acquired in the forensic or medico legal arena generalise well to this work.

BUT there are key differences which require some careful thought, lots of good supervision and self care.

Our society has competing perspectives about refugees-be prepared to be challenged about the role you play.

Recommended ReadingsRecommended Readings Instanbul Protocol. Professional Training Series No.

8/Rev.1. United National New York and Geneva, 2004. Becker, D. (1995). The deficiency of the concept of post

traumatic stress disorder when dealing with victims of human rights violations. In R. J. Kleber, C. R. Figley, & B. P. R. Berthold (Eds.), Beyond trauma: Cultural and societal dynamics (pp. 99-131). New York: Plenum Press.

Hernandez, P. (2002). Trauma in war and political persecution: Expanding the concept. American Psychological Association, 72(1), 16-25

Koltko-Rivera, M. E. (2004, March). The psychology of worldviews. Review of General Psychology,8(1), 3-58. American Psychological Association.

Martin-Baro, I. (1989). Political violence and war as causes of psychological trauma in El Salvador. International Journal of Mental Health, 18, 3-20. WebBridge/MasseyLink | Bibliographic Links | Library Holdings

Herman, J. (1997). Trauma and Recovery. New York: Basic Books.

Instanbul Protocol. Professional Training Series No. 8/Rev.1. United National New York and Geneva, 2004.

Becker, D. (1995). The deficiency of the concept of post traumatic stress disorder when dealing with victims of human rights violations. In R. J. Kleber, C. R. Figley, & B. P. R. Berthold (Eds.), Beyond trauma: Cultural and societal dynamics (pp. 99-131). New York: Plenum Press.

Hernandez, P. (2002). Trauma in war and political persecution: Expanding the concept. American Psychological Association, 72(1), 16-25

Koltko-Rivera, M. E. (2004, March). The psychology of worldviews. Review of General Psychology,8(1), 3-58. American Psychological Association.

Martin-Baro, I. (1989). Political violence and war as causes of psychological trauma in El Salvador. International Journal of Mental Health, 18, 3-20. WebBridge/MasseyLink | Bibliographic Links | Library Holdings

Herman, J. (1997). Trauma and Recovery. New York: Basic Books.