If You Want to Go Fast Go Alone, If You Want to Go Far Go Together: On Context-Sensitive Group Treatment of Asylum Seekers and Refugees Traumatized by War and Terror

This thesis presents a model for understanding psychological consequences of exposure to war, torture and political violence in asylum seekers and refugees. This contextual, developmental, and culture-sensitive model is based on theoretical and empirical findings and implies framing and interpreting of life events in “the ecological environment” and throughout the life-span of a survivor. The model investigates into both sources of damage and resilience in traumatized individuals in order to frame posttraumatic impacts in a comprehensive way. Based on this model, a group treatment approach aiming at helping asylum seekers and refugees with impacts of psychological trauma and resettlement stress has been designed and applied throughout 12 years. This group treatment is phase-based and trauma-focused, it combines group psychotherapy with non-verbal therapies (psychomotor therapy, art therapy, and music therapy), it is executed within a day treatment setting, and lasts for 1 year. The approach does not exclusively focus on treatment of posttraumatic stress disorder (PTSD) and other co-morbid axis I and II disorders, but includes interventions targeting damaged core-beliefs, guilt, shame, grief, marital and systemic problems, legal issues due to procedure of seeking asylum, and other resettlement stressors. The outcome studies presented in this thesis suggest that this group treatment approach improves mental health of asylum seekers and refugees with PTSD, both on the short and on longer terms. The PTSD, anxiety, and depression symptoms are reduced upon completion of the treatment. The trend of reduction of the examined psychopathology continues up to five years after the treatment. Over an even longer period of time, up to seven years, the treatment gains are maintained but reduced in strength. Both asylum seekers and refugees can benefit from the applied group treatment,irrespective of the absence of stable living arrangements. However, positive changes in the resettlement context lead to more favorable treatment outcomes. Asylum seekers who are granted a permanent refugee status during the treatment show larger symptom reductions upon termination of the treatment than the patients whose legal status did not change in the course of the treatment.