Interview with InPsyc- Feb 2012

InPsych interview: February 2012

Working with African refugees: An opportunity for reconnection

Over the last decade, approximately 13,000 refugees have been resettled in Australia each year, and in recent years nearly 30 per cent of these are people who have come from Africa. Most African refugees have fled war, famine and displacement from their home country, and many have experienced protracted stays in refugee camps in conditions of extreme deprivation without adequate medical care. Counselling psychologist Dr Jill Parris MAPS works at the Ecumenical Migration Centre where her work focuses on the family relationships of humanitarian entrants from the Horn of Africa. In this interview with InPsych she shares her insights into working with this population.

How did you come to be involved with the Horn of Africa communities and what is your role?
After retiring from working in management of counselling and welfare services at Relationships Australia and the Wesley Mission five years ago, I decided that I would love to give back to Africa, the continent of my birth from where I migrated 30 years ago. I still remember vividly what it was like to leave my birthplace and choose to make Australia my home, and sometimes I still miss Africa.

For many years I put aside my connection to Africa as I got on with building a new life in my adopted home, however when I returned to study the choice was clear: I needed to find a project that would support my fellow Africans whose settlement needs I could understand. I chose to work with people from the Horn of Africa because it offered me the opportunity to reconnect with people who shared some aspects of my life and culture and the experience of displacement that I, my parents and my parents’ parents had known.

Knowing that most African people relate strongly to their communities I decided to explore the possibilities of community cultural development as a method of intervention. As I was interested in comparing counselling with community development, I took up a position as a therapist working with the humanitarian entrants from Africa at the Ecumenical Migration Centre (EMC), which is part of the Brotherhood of St Lawrence.

People are usually referred to EMC to negotiate their transition into Australia. Relationships have often been severed by war and displacement and people seek help dealing with family reunification. Most Africans come from collective societies which have a very different cultural understanding of what family means. An example is that the oldest child often spends many childhood years with grandparents. When the relationship between grandparents and child is severed by migration this causes great difficulty to the new family unit in Australia, which now includes a child who had not been part of the family. When such issues come to the attention of the wider service network, they are often referred to the EMC for support.

What are some immediate and/or longer term wellbeing and mental health issues confronting people settling in Australia from African countries?
The stresses of adapting to the expectations of Australian society, struggling with learning English and the difficulties of finding meaningful work makes assimilation difficult and can result in depression and strong feelings of alienation.

Many people arrive and simply wish to put trauma behind them and build new lives. It is important that we respect this and do not ‘medicalise’ settlement. On the other hand, a number of settlers have complex mental health issues (covering the full range of mental disorders) because of years of displacement or simply because such issues have not been diagnosed or treated before coming to Australia.

There is a strong perception that there is a persistent problem with violence among young Sudanese boys. The experience I have had of these youth is that they have faced issues of racism and misunderstanding in Australia. Because the issue was so pressing I developed a game, ‘Sweet and sour settlement’, as a training tool to be used in schools and with people in the field.

What is your approach to working with these issues?

In general, working with settlers requires a capacity to offer a transitional space where practice, informed by western counselling theory, is translated and combined with practical support for clients in negotiating mainstream Australian service systems. The aim is to help clients build towards stable and durable family relationships in the Australia context.

I see myself as a cultural anthropologist who has an understanding of counselling practice, the Australian service system and the transitional issues faced by newly arrived humanitarian entrants (ethnicity, trauma, dislocation, culture, family and community structure etc), and I employ flexible practices to help clients negotiate these.

What cultural differences are there in working with African settlers who have a mental illness?
When working with these people it is important to understand the cultural imperatives in relation to the illness. For most African settlers the family of the person with a mental illness needs to be fully involved in treatment. They expect to be told how to respond to the person and require clear simple advice about management. Do not expect the family to allow the person with a mental illness to live independently; rather encourage the family to support the person to take responsibility.

What has the experience of working with members of the African community meant for you as a person and as a psychologist?
The experiences of the past five years have been profound. Firstly I have come to admire the resilience and tenacity of many of the people I have had the privilege of meeting. I have been horrified by the brutality man is capable of and I have come face to face with the ravages of trauma on the soul.

At a deep personal level, each person has brought to our relationship an expectation that I take time to show respect – respect for them and for my own place in society. This they have done by not engaging with the business at hand before enquiring about my family and their wellbeing. This formal process which begins each encounter has helped me to reconnect with what I hold important in terms of heritage, place and belonging. I find that I need to manage my personal boundaries with clients well. Clients often find it difficult to be on time, which makes setting and keeping appointments difficult. Supporting clients with settlement issues requires me to accompany them to meetings that I would not usually attend as a psychologist working in a western style practice. When I see people in their homes I am careful to clarify my role, not as a friend but as offering a specific professional counselling service.

Importantly the work has connected me with what I believe in as a person – the right of every human to respect and dignity.

Lastly, this work has confronted me with my own prejudice and the need to take time to do more than practice empathy. I make judgments and then often need to rethink them. I have found that the communities with whom I work challenge me to rethink beliefs I was not aware I held. Now I know that the only certainty is change.

How would you advise APS members who might be considering working in a professional role in such a setting?  
I would advise anyone wanting to work in this role to take time to consider his or her decision. This work is rewarding but it is also challenging on a number of levels. Working with people, many of whom have faced profound trauma, is of itself traumatising. It takes a courageous soul to support those facing their horrors and keep smiling. Many families need help on the practical rather than, or as well as, the psychological level and it is difficult to do one part of the work without the other.

The work is complex as people negotiate all aspects of settlement. You may find yourself involved in practical issues such as a parent’s need to provide lunch for a child going to school. At the other end of the scale you may need to help with the difficult task of helping people renegotiating relationships in the light of the expectations of a new and very different culture.

Having said this, it is wonderful to see this country through the eyes of another and to travel with people who have a thirst for productive settlement. Sharing in the wealth of cultural difference is exhilarating and enriching.

Reflecting on your experiences of the strengths and difficulties of working as a psychologist with people who have experienced (and fled) war, conflict and trauma, is there a take-home message for us as psychologists here in Australia, and as global citizens?

This may sound trite, but my main message is treat others, as you would like to be treated. We live in a world where the powerful take from the powerless and then judge them for seeking asylum.

Some other important considerations are:

  • It is always important to think about what you might have done in similar circumstances.
  •      When working with trauma make sure that your client is psychologically safe before even   beginning to think about talking about it.
  •      Always be ready to hold firm boundaries and ground experiences in the present.
  • Take very great care of yourself.

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