Ethical considerations in therapeutic work with asylum seekers: An exploration of therapeutic process issues
Emma Boles

NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS)

Focus Summary

Working therapeutically with asylum seekers can present particular challenges and ethical dilemmas. There is a multitude of pre- and post-migration factors that contribute to the development of psychological distress and emotional suffering in those who are seeking asylum. This can result in complexities of mental health presentations for asylum seekers, vulnerabilities to further stressors, and challenges for the recovery process.

Ethical and professional challenges which may arise during therapeutic work with asylum seekers were explored in this presentation. Issues related to duty of care, effective management of suicide risk and safety, and strategies to manage chronic hopelessness were considered. The importance of establishing achievable treatment goals and maintaining realistic therapist expectations of treatment progress were discussed. Therapeutic process issues were also explored, including building trust and safety, implications for the therapeutic relationship, neutrality versus advocacy, and therapist self-care.

Key Insights
  • Asylum seekers represent a group of people suffering immensely due to pre-migration trauma in their country of origin, trauma during the journey of migration, and the difficulty of navigating post-migration stressors.
  • Working with this vulnerable group requires the establishment of a safe and secure space (both physically and emotionally) in which to conduct therapy.
  • Education and training regarding asylum seeker issues are required for staff or professionals who work within the health care system in order to fully understand the issues they face and to assist in navigating therapeutic treatment.
Key take-outs from the ISHHR 2017 Conference (industry feedback, networking, peer presentations):

Valuable feedback and insights were received from industry peers working with asylum seekers in international settings including locally in Serbia, as well as in Turkey and Norway. It was normalising and validating to discover that colleagues are dealing with similar challenges in therapeutic work with asylum seekers, including managing chronic hopelessness and suicidality, as well as feeling the impact on the therapist.

This experience highlighted the need for collaboration both on a national and international level between therapists to share information on strategies which have been found to be effective, as well as to support one another in navigating the challenges of this demanding work.

Future goals — what’s next?

Future goals include a focus on greater collaboration with other services (including on a local level, local mental health crisis teams and external services providing health care to asylum seekers) in providing holistic mental health care. This could include providing training on navigating ethical issues in therapeutic work with asylum seekers. In addition, to collaborate with colleagues on an international level to share information and expertise in working with this vulnerable group, including specific treatment modalities and strategies which have been found to be effective with particular groups, and sharing of resources to implement these strategies.

How can local / national / international media better assist in bringing the vital issues discussed at ISHHR 2017 to light, and further encourage real, positive change and understanding?

Those reporting on issues related to asylum seekers in Australia have a direct role in forming public opinions on these issues. Our objective is to support the mental health of asylum seekers, and navigate the various challenges which exacerbate their distress. Issues which need to be brought to light on a national level in Australia include the reality of mental health presentations for asylum seekers, and the various factors which contribute to these presentations (including torture, trauma, the often-traumatic migration journey, and stress associated with having an uncertain future and separation from immediate family). However, there is also a need to highlight asylum seekers’ stories of hope, strength and resilience.

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