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PART I – A CONCEPTUAL FRAMEWORK

4. THE REFUGEE/IMMIGRANT SITUATION

This chapter explains the terminology “refugee/immigrant situation”, i.e.

the outer processes of change and the accompanying inner changes that the refugee, the traumatized and/or tortured refugee, the immigrant and their children may go through. It describes how the refugee/immigrant situation can cause, influence or complicate presented symptoms and difficulties.

Throughout the presentation of the framework, the expression refugee/immigrant situation is used to describe how the outer processes of change that the person goes through in moving to a new country may affect the inner world. Within the terminology is included the outer processes of change and the accompanying inner changes.

OUTER PROCESSES OF CHANGE

In leaving or fleeing a country and coming to another, the person experiences many outer changes, such as country, climate, landscape, environment, culture, ethnic/racial differences, religion, language, employment, politics. He/she may have come from a certain level of society, socioeconomic conditions and education in the country of origin, and have or be offered different ones in the new country. The way the new country functions and the people in it are also outer differences encountered by the individual (Garza-Guerro, 1974; Kristal-Andersson, l976; Mostwin, l976). Within the terminology, the refugee/immigrant situation also encompasses:

· the outer reasons the person came to the new country (gradual or sudden, planned or not), and their influences on the inner world;

· how the person meets and deals with the outer changes he/she is confronted with in the new country;

· how the person is received in the new country.

ACCOMPANYING INNER CHANGES

Accompanying inner changes are defined as the conscious and unconscious effects of these outer processes on the inner world and how they influence the person’s life. In starting out in the new country, the refugee/immigrant situation is based on each person’s unique and different experiences of the reality of the outer changes. At first, these can be based on reality, the person’s experience of that reality, or even an exaggerated experience of reality or fantasy. How the individual contends

with the refugee/immigrant situation can also be based on other aspects of the framework.

The following case excerpts describe how the refugee/immigrant situation can cause or complicate presented symptoms and difficulties. In Case 4.1, the conflicts between mother and daughter are influenced by the mother’s refugee/immigrant situation.

Case 4.1

An immigrant family, 21 years in Sweden, from a Middle East country with a warm climate; the mother, age 42, is a housewife; the father, age 49, a factory worker; they have 2 children, a daughter, 19 years old, and a son, 17 years old. Reason for treatment: violent conflicts between the teenage daughter and her mother. Form of treatment: family therapy, once a week. Duration: 3 months.

Case excerpt (from session 1, beginning of treatment):

The daughter explains to the therapist when asked why she gets so angry with her mother: “I fight with my mother because I have to help her with almost everything, I do all the shopping.” T: “Why do you have to do all the shopping?” P: “She won’t go out 7 months of the year. It’s too cold for her, she says, and she is afraid of slipping on the ice. It’s always been like this. I can’t be who I want to be. My friends feel sorry for me. I am my mother’s carer…and I don’t want to be.” T: “Do you feel you have to be?”

P: “What will happen to my mother without me?” T: “Let’s talk about that…”

In Case 4.2, the symptoms for which the individual sought treatment are complicated by the refugee/immigrant situation.

Case 4.2

Amale refugee, age 55, 15 years in Sweden, a businessman, married;

his wife, age 45, is a secretary; they have 2 children, 13 and 17 years old.

Reason for treatment: aggressivity. Form of treatment: individual support work, once a week. Duration: 6 months.

Case excerpt (from session 4, after one month of treatment):

P: “I decided to take the bus today and leave my car. But on my way here, I just got angry at the bus driver. He asked me where I was going. I told him, and he said he didn’t understand. Could I repeat my destination?

I got angry. Don’t you understand Swedish? I screamed. An old lady sitting there looked scared. I said the street name again. I paid, but I felt myself shaking inside. I have been in this country 15 years. I am a successful businessman and the bus driver doesn’t understand a simple phrase I say in Swedish. All right, maybe I have a slight accent, but so what. No one usually complains about it. Then, is it me or him?” T: “Does it matter?” P: “Yes, I know I speak Swedish well.” T: “Then why does it matter so much?” P: “Why do I constantly have to be reminded that I am a foreigner…should I show everyone my Swedish passport?” T: “Do you

think you have to?” P: “Sometimes I feel that way.” T: “When do you feel you that way?” P: “I’ll have to think.” T: “Take your time, it could be important for you to understand what brings your anger on.”

Case 4.3 describes how the refugee/immigrant situation can complicate the reason for which the individual is in treatment, especially when he/she has not yet worked through traumas experienced in the homeland.

Case 4.3

A female traumatized refugee, age 41, 12 years in Sweden, a home-language teacher, lives in a small city in the north, married; her husband, age 45, is an engineer; they have 2 children, 18 and 20 years old.

Homeland traumas: her husband was imprisoned and tortured on several occasions before they fled. She experienced severe physical abuse the last time her husband was seized. Reason for treatment: severe depression, unable to continue her work. Form of treatment: individual psychotherapy, once a week. Duration: 2 years.

Case excerpt (from session 12, after 4 months of treatment):

During the first month of psychotherapy, she returned to her teaching job, but three months afterwards she went into a severe depression once again and could not cope with her home or work life. She explained that she became depressed again when she saw the television news reports on the recent series of threats and violence directed at refugees by a small group of neo-Nazis in Stockholm She explained to her therapist:

P: “The people here have always been friendly and kind to me and my family. But I am afraid that it could happen here, too.” T: “What has happened in Stockholm is terrible, but it has not happened here.

Throughout the years you have been here, has anyone showed racist attitudes towards you or your family?” P: “No, we are accepted here by everyone.” T: “Then could it be your own fear inside you, rather than the reality of life here, that could have brought back the depression?” P: “But if it happened in Stockholm, it can happen here too.” T: “Perhaps, but don’t you think your friends and neighbors would stand up for you, if someone said or did something like that?” P: “Yes, I think so.” T: “I am not trying to convince you that it can’t happen here, too. Just as anyone could get hit by a car in Sweden. But most people don’t, because the drivers are careful, despite all the cars.” P: “You mean that most people are not racists, in spite of the recent events?” T: “I believe so.” P: “I hope so.” T: “Me, too…but worrying about it does not help you or anyone else.” P: “No…my children are angry with me.” T: “Can you tell me more about that?” P: “They tell me that we went through a lot worse in our own country and that we have nothing to be afraid of here. They can’t stand seeing me depressed.” T: “You told me that after they seized your husband the last time, you were so severely abused yourself, that you were hospitalized, then deeply depressed until you and the family could

flee your country.” P: “Yes.” T: “Could the recent events in Sweden be reminding you of everything that happened to you before you fled?”

P: “Yes…” T: “You were abused just like the people on the television news.” P: “Yes. I was in hospital two weeks because of it.” T: “What did they do to you?” P: “They came into the house…” (The woman continues with a detailed description of the event, and finally realizes that it is the memory of this and other atrocities endured in the homeland, rather than her life now in Sweden, that brought on the depression.)

The cases above provide some examples of how the refugee/immigrant situation seems to influence the individual’s symptoms, problems and difficulties, and the various aspects of the framework.

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