Chtereva, EH (2016) Becoming ”another brick in the wall”

269 Pages·2016·2.22 MB·English

Becoming ‘another brick in the wall’:
A thematic analysis of Central and Eastern European
immigrants' experiences of psychological distress and help-seeking
Elena Chtereva
A thesis submitted in partial completion of the requirements of the
University of the West of England, for the degree of Professional Doctorate
in Counselling Psychology
School of Psychology
Faculty of Health and Applied Sciences
University of the West of England, Bristol
This is to certify that this research report is my own unaided work.
Signature: Elena Chtereva
Date: December 2016

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Acknowledgments

I would like to thank all the participants who kindly gave their time to
take part in this study and for their willingness to share their experiences. I
would especially like to thank the community development workers and the
key members of the studied communities who made my encounter with these
individuals possible.

I am extremely grateful to my research supervisors Dr Tony Ward and
Christine Ramsey-Wade, who offered their continuous support,
encouragement, invaluable guidance and advice throughout the research
process.

I would like to thank especially Miya Bond for the proof reading, edits,
suggestions and her incredible support. I am also grateful to my personal tutor
Andrea Halewood, who taught me a great deal about how to contain my
anxiety and to continue to develop when I thought I could not. And last, but
not least, I am thankful to my family for being with me and supporting me
when I needed.

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Contents
Acknowledgments ............................................................................................................................................. 2
Abstract ................................................................................................................................................................ 6
Chapter 1: Background of the study ............................................................................................................... 8
1.1 Introduction ................................................................................................................................................... 8
1.2 Literature Review ....................................................................................................................................... 10
1.2.1 Immigration and mental health 10
1.2.2 The background of CEE countries 19
1.2.3 Central and Eastern European immigrants’ wellbeing and help-seeking 25
1.2.4 Theories of immigration and counselling psychology 29
1.2.5. Multicultural competency and social justice in counselling psychology 35
1.3 Rationale ...................................................................................................................................................... 38
1.4 Research aims .............................................................................................................................................. 41
1.5 Main research questions ........................................................................................................................... 41
Chapter 2: Methodology ................................................................................................................................. 43
2.1 Overview ...................................................................................................................................................... 43
2.2 Design .......................................................................................................................................................... 43
2.2.1 Reflexivity 44
2.2.2 Rationale for the Qualitative Methodology 49
2.2.3 Ontological and epistemological assumptions 51
2.2.4 Rationale for individual semi-structured interviews 52
2.2.5 Rationale for using thematic analysis as a research approach 53
2.2.6 Approach to quality of the research 55
2.3 Participants .................................................................................................................................................. 58
2.3.1 Recruitment 58
2.3.2 Inclusion criteria 59
2.3.3 Exclusion criteria 60
2.3.4 Participant information 60
2.4 Procedure ..................................................................................................................................................... 61
2.4.1 Ethical considerations 61
2.4.2 Consent 62
2.4.3 Confidentiality and anonymity 62
2.4.4 Distress and debriefing 63
2.4.5 Interview process 64
2.4.6 Transcription 64
2.5 Data analysis ............................................................................................................................................... 66
2.5.1 Thematic analysis 66
Chapter 3: Results ............................................................................................................................................ 69
Overarching theme 1: Immigration experience .......................................................................................... 71
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Theme 1.1: ‘Some people expected to be easier, but found it hard’ - Immigrating for ‘a better life’ 72
Theme 1.2: ‘We just accept it’ - Prejudice and discrimination 76
Theme 1.3: ‘Everything is getting on your nerves’- Experience of distress 81
Theme 1.4: ‘Everything was hard’- Adjustment to the host country 86
Overarching Theme 2: Views and meanings of mental health................................................................ 90
Theme 2.1: ‘Everything stays in the family’- Secrecy and mental health 91
Theme 2.2: ‘Crazy, mad and dangerous ‘ - Mental health stigma 95
Overarching theme 3: Help-seeking experience ......................................................................................... 98
Theme 3.1: ‘I have been trying to deal on my own’ - Self-help experience 99
Theme 3.2: ‘You seek help from your partner …’ - Support from family and friends 103
Theme 3.3: ‘Ticking the boxes was not …’ - Experiences of mental health services 108
Overarching theme 4: Addressing immigrants’ needs ............................................................................ 113
Theme 4.1: ‘It is difficult to find the right words …’ - Barriers to help-seeking 113
Theme 4.2: ‘They just don’t live, they struggle for…’ - Socioeconomic context 118
Theme 4.3: ‘People try and seek contact through …’ – Improving support 122
Summary of the findings .............................................................................................................................. 127
Chapter 4 Discussion ..................................................................................................................................... 129
4.1 Consideration of the results ................................................................................................................... 129
4.1.1 Immigration experience 129
4.1.2 Views and meanings of mental health 135
4.1.3 Help-seeking experience 139
4.1.4 Addressing immigrants’ needs 144
4.2 Contributions and implications ............................................................................................................ 151
4.4 Limitations of the research ..................................................................................................................... 156
4.5 Proposed further directions .................................................................................................................... 159
4.6 Conclusions ............................................................................................................................................... 161
References ........................................................................................................................................................ 162
Appendixes ...................................................................................................................................................... 210
Appendix 1 - Demographic Questionnaire ............................................................................................... 210
Appendix 2 - Ethical approval ..................................................................................................................... 212
Appendix 3 – Recruiting leaflet ................................................................................................................... 213
Appendix 4 – Information leaflet ................................................................................................................ 214
Appendix 5 – Consent form .......................................................................................................................... 217
Appendix 6 – Debrief .................................................................................................................................... 218
Appendix 7 – Interview schedule ................................................................................................................ 220
Appendix 8 Seven Stages of Thematic Analysis ...................................................................................... 221
Appendix 9 – An example of noting overall impressions ...................................................................... 222
Appendix 10 – An example of coding data ................................................................................................ 225
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Appendix 11 – An example of Collating Data .......................................................................................... 228
Appendix 12 – Visual map of candidate themes ...................................................................................... 232
Appendix 13 – Overview of overarching themes and themes ............................................................... 233
Appendix 14 – An example of defining themes and illustrating with excerpts ................................. 235
Appendix 15 – Excerpts from Reflective Diary ......................................................................................... 237
Appendix 16 - Journal article ....................................................................................................................... 242

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Abstract
Background: Since 2004, a large number of immigrants from Central and
Eastern Europe (CEE) have taken up residence in the UK. This study explored
how the experience of immigration impacted on the wellbeing of sixteen
participants of Central and Eastern European origin and whether they sought help
for psychological distress. Despite the increased knowledge and understanding of
help-seeking attitudes towards mental health issues of various minority groups in
the UK, the experiences of the Central and Eastern European communities remain
understudied. It is this gap, which this current study aimed to fill. It also
highlighted some of the ways in which CEE immigrants’ required support.
Method: In order to gain in-depth data, semi-structured interviews were
conducted with four male and twelve female immigrants from Central and
Eastern European countries living in the UK. Interview transcripts were analysed
using inductive thematic analysis following the seven steps outlined by Braun and
Clarke (2013), within a qualitative paradigm and a critical realist framework.
Results: Four overarching themes were identified in the analysis, which
indicated that socioeconomic factors contributed to feelings of distress within the
sample, a high level of mental health stigma was present, and complex factors
influenced help-seeking behaviour and determined immigrants’ needs. Major
factors negatively influencing immigrants’ wellbeing within the sample were
housing and job issues; prejudice and discrimination experiences; distress caused
by language difficulties, and socioeconomic circumstances. Most participants felt
that they could manage emotional difficulties themselves and held a holistic view
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of a persons’ wellbeing. Gender, culture and previous experience were significant
factors influencing decisions to seek help for emotional difficulties. A closer focus
on the political and socioeconomic context suggested that, for these participants,
deep inequalities in UK society remained despite efforts by the National
governing institutions over the last decade to eradicate these. Most participants
proposed that the best way to address their needs was to engage with their
communities first, rather than to seek help from formal services.
Discussion: The results provide a thorough description and understanding
of the participants’ experiences, meanings and needs concerning their wellbeing.
Possible practical implications for working therapeutically with this minority
group are discussed from a social justice perspective. Importantly, this includes
the recommendation to apply contextual approaches such as relational cultural
theory to current ways of working.
Conclusion: Most participants shared that settling in the UK was a stressful
process influenced by cultural and socioeconomic factors that affected negatively
their experience in the host country. Protective factors such as a good social
network, English proficiency and equal economic opportunities contributed to
positive experiences, whilst prejudice, discrimination and a lack of a culturally
sensitive service provision had negative implications on their wellbeing.
Addressing immigrants’ needs requires active engagement with these minority
communities, which ideally would include acknowledging contextual factors
affecting their wellbeing, highlighting discriminatory practices and policies, and
building intrinsic forms of resilience.
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Chapter 1: Background of the study

1.1 Introduction
This thesis explores how the experiences of immigration to the United
Kingdom (UK) influence Central and Eastern European (CEE) immigrants’
wellbeing. It considers how such immigrants deal with psychological distress,
with the aims of increasing knowledge of CEE immigrants’ experiences and
highlighting their emotional needs.

The National Institute for Mental Health in England (2003) emphasised that
ethnic minority groups tend to have poorer mental health compared to the majority of
the population. The British Psychological Society also states that researchers need to
recognise social contexts and to engage in anti-discriminatory practices that are
appropriate to the pluralistic nature of contemporary society (BPS, 2005). In addition,
it is a moral obligation for the counselling psychologists to deliver culturally sensitive
therapy to their clients (BPS, 2005; Zhang & Burkard, 2008), while increasingly
working with clients from many different cultural backgrounds.

The countries of Central and Eastern Europe have often been seen as
significantly different from Western European countries, especially during the
Cold War period. Robila (2008) asserts that CEE populations had similar
experiences under the communist regime and hence it is legitimate that they be
examined together in this study. Note that for the purpose of this study, the term
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CEE countries refers only to the Accession 8 countries that joined in 2004 (the
Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and
Slovenia) and Accession 2 (Bulgaria and Romania) countries that joined the
European Union in 2007.

Historically, after the Second World War notable numbers of Eastern
Europeans were permitted to settle in Britain, ‘many of whom were actively
recruited to work in Britain as part of an overseas workers scheme - one of the very
few episodes of a ‘guest workers’ scheme in British history’ (Migration Watch UK,
2016). The enlargement of the European Union in 2004 has brought a new wave of
immigrants from Central and Eastern Europe, which has attracted many
researchers to study their labour mobility, migration patterns and experiences, and
community cohesion (Anderson et al., 2006; Ciupijus, 2011; Friedrich, 2015;
Markova & Black, 2007; Spencer et al., 2007). It is worth noting that individuals
from Bulgaria and Romania (Accession 2) had to follow regulations and policies
that were more restrictive then Accession 8 countries until January 2014 (Fox et al.,
2012). Bulgarians and Romanians were required to apply for an Accession Worker
Card, while highly skilled A2 immigrants (for example, students, self-employed
and their dependants) could apply for a registration certificate.

While the numbers of CEE immigrants living in the UK have increased
significantly after the accessions in 2004, only a few studies specifically address
their experience s and needs concerning their mental health. One such research
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suggested (Weymouth Rethink Community Engagement Project, 2008; a project
aimed to increase engagement of people from black and ethnic minority groups
with mental health services) that in order to provide equitable services to the
immigrants from CEE, researchers need to engage actively in obtaining valid, and
meaningful accounts of immigrants’ experiences, views, values and needs.

1.2 Literature Review
This literature review covers five primary areas of inquiry. First, in order to
contextualise the present study, it considers research on the impact of immigration
on immigrants’ mental health and wellbeing. Second, information is briefly given
about CEE immigrants’ background to introduce the reader to some of the specific
characteristics of this population. Then, some findings of the existing research on
CEE immigrants to the United Kingdom are highlighted. All of these build the
case that this population’s mental health has been overlooked in the research
literature. Fourthly, theories of immigration and their relationship to counselling
psychology are considered. Finally, evidence supporting a need for multicultural
competency and a social justice approach in counselling and psychotherapy is
offered, with a brief outline of some relevant models.

1.2.1 Immigration and mental health
This section of the study presents a review of the literature on the mental
health of immigrants and their help-seeking behaviour. It also brings to attention
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