An Interpretative Phenomenological Analysis of Refugees' Experiences of Psychological Therapy for Trauma

Abstract

Background: Guidelines for the treatment of Post-Traumatic Stress Disorder recommend 8-12 session of trauma-focused CBT or EMDR, however there is an extensive body of literature criticising the PTSD paradigm and usefulness of recommended therapies in treating PTSD in the 'real world', particularly with the complex presentations of refugees . Alternative models for 'complex' PTSD have been proposed, as have transtheoretical phased stages for treatment. To date there has been no research into refugees' experience of trauma-therapy. Leaving a significant gap in understanding of how trauma therapy works. Aims: With this gap in the research in mind, and in line with the current focus on service user involvement in research, this study aims to investigate refugees' experiences of trauma-therapy. Methodology: Semi-structured interviews were conducted with six refugees who were coming towards the end of trauma-therapy with a specialist trauma service. The transcripts of the interviews were then analysed using Interpretative Phenomenological Analysis (IPA). Results: Six master themes emerged from analysis: 'Therapy as a light in a dark place', 'Rebuilding a shattered sense of self', 'A changing relationship with the world and others', 'Escaping the past to pursue a future', 'A journey from sceptic to convert' and 'From an unknown mystery to a known mystery'. These master themes along with the subordinate themes are expanded into a narrative account of participants' experiences. Implications & Conclusion: Amongst numerous implications for clinical practice the need for support to engage in therapy, thorough explanation of therapy and pre-empting of possible conflicts and difficulties arising were identified. Allowing time to build a therapeutic relationship, the usefulness of the PTSD construct for individuals and the importance of the 'non-specific' factors of therapy in addition to the teaching of techniques to manage symptoms were also found to be of importance. This study has made an important contribution to knowledge about refugees' experiences of therapy for trauma.