Go Alone, Go Together

232 Pages·2014·2.61 MB·English

If You Want to Go Fast
Go Alone,
If You Want to Go Far
Go Together
On Context-Sensitive Group Treatment of
Asylum Seekers and Refugees Traumatized
by War and Terror
Boris Drožđek
Design and lay-out
Promotie In Zicht, Arnhem, The Netherlands
Print
Ipskamp Drukkers, Enschede, The Netherlands
© 2013 Boris Drožđek
All rights reserved. No parts of this publication may be reproduced or transmitted in any form
or by any means, electronic or mechanical, including photocopy, recording or otherwise,
without prior written permission of the author.
If You Want to Go Fast
Go Alone,
If You Want to Go Far
Go Together
On Context-Sensitive Group Treatment of
Asylum Seekers and Refugees Traumatized
by War and Terror
Als je snel wilt gaan ga alleen,
als je ver wilt komen ga samen met anderen
Over de context-sensitieve groepsbehandeling voor asielzoekers en
vluchtelingen getraumatiseerd door oorlog en terreur
(met een samenvatting in het Nederlands)
Proefschrift
ter verkrijging van de graad van doctor
aan de Universiteit Utrecht
op gezag van de rector magnificus, prof.dr. G.J. van der Zwaan,
ingevolge het besluit van het college voor promoties
in het openbaar te verdedigen op vrijdag 31 januari 2014 des middags
te 2.30 uur
door
Boris Drožđek
geboren op 19 oktober 1962
te Zagreb, Kroatië
Promotor
Prof.dr. R.J. Kleber
Copromotor
Dr. J.W. Knipscheer
Contents
Chapter 1 Introduction 7
Chapter 2 Posttraumatic Stress Disorder (PTSD) and Psychopathology in 31
Refugees: A Reflective Cross-Cultural Contextual View of Mental
Health Interventions
Chapter 3 Assessment of PTSD in Non-Western Cultures: The Need for 51
New Contextual and Complex Perspectives
Chapter 4 Evaluation of Group Therapy With Traumatized Asylum Seekers 75
and Refugees – The Den Bosch Model
Chapter 5 Group Therapy With Male Asylum Seekers and Refugees 99
With Posttraumatic Stress Disorder: A Controlled Comparison
Cohort Study of Three Day-Treatment Programs
Chapter 6 Group Therapy With Traumatized Asylum Seekers and Refugees: 121
For Whom It Works and for Whom It Does Not?
Chapter 7 Is Legal Status Impacting Outcomes of Group Therapy for 139
Posttraumatic Stress Disorder With Male Asylum Seekers and
Refugees From Iran and Afghanistan?
Chapter 8 Seven-year Follow-up Study of Symptoms in Asylum Seekers and 163
Refugees With PTSD Treated With Trauma-focused Groups
Chapter 9 General Discussion 185
Summary 203
Samenvatting 211
Acknowledgments/Dankwoord 219
About the Author 225

1
Introduction

INTRODUCTION
Introduction
Abolfazl was born 53 years ago in the city of Bamiyan in central Afghanistan. He 1
belongs to the Hazara people, a Shia Muslim ethnic minority in that country. Although
he had a good childhood, and felt protected within his large family, he was often
confronted with discrimination because of his ethnicity. In his early adolescence, the
family moved to Kabul, as his father, a trader, had more business opportunities in the
capital. He joined his father in the business, and considered himself a lucky young man.
This is where Abolfazl met his future wife and married her upon arrangements made
between his and her family in a traditional way. Soon after, their first child was born.
When the Soviet army entered Afghanistan, Abolfazl was in his early twenties.
The war started, and he decided to join the Mujahideen troupes to fight the occupation.
After the Soviet Union pulled out of the conflict in the late 1980s the Mujahideen
fought each other in the subsequent Afghan Civil War. All those years, Abolfazl was
often away from home being a soldier at the front-line. Only occasionally he would
visit his family, and 5 more children were born after his visits. When the Taliban came
into power in the late 1990s he was caught and imprisoned. The subsequent 2 years
he spent in the notorious prison in Kandahar, where he was severely tortured. For a
long time, his family did not know of his whereabouts. They thought he was killed.
Somehow, he managed to get into contact with them, and upon bribing two senior
Taliban officials, he could eventually escape from the prison. He joined his wife and 6
kids, and they left the country towards west.
The journey was long and dangerous, and Abolfazl and his family were exhausted
when they finally reached the Polish-German border. They were thousands of
kilometres away from home, but still together and hoping to find a safe haven in
Europe after many years of war and peril in Afghanistan. Since they were travelling
without valid documents, they had to swim over a river at the border in order to enter
Germany. That night while crossing the river, his wife and their 3 children drowned.
Abolfazl had no other choice than to continue his journey with the remaining 3
kids. Finally, he reached the Netherlands, a country that he had heard about as a
place where he may continue his life, or what was left thereof, in safety. He wanted
his kids to have a better life than he has had. Somehow, he always felt guilty towards
the children, because he was never home during the wars, he was marginally
concerned with their upbringing, and did not even know them well.
In the Netherlands, Abolfazl told his story in all details to the Immigration officials,
but was surprised to hear that his claim for asylum would not be honoured. Instead,
he was accused of being a war-criminal since he actively fought for the Mujahideen.
According to the Dutch law at the time, Abolfazl and his children could stay in the
country, but had to find a lawyer and fight accusations of the Dutch Immigration
Service. After 2 years, the Dutch policy changed and the accusation was declared
9
CHAPTER 1
null and void. However, Abolfazl and his family were not immediately recognized as
refugees in the Netherlands, but had to wait for an indefinite period of time as of their
asylum request to be honoured. At that time, many asylum seekers waited for more
than 6 years for legal recognition. Throughout that time, they had no opportunities to
participate in the host society, they stayed in communal reception centres, and were
not allowed to learn the Dutch language. However, the kids could go to school.
Abolfazl, in the meantime in his late forties, became a desperate and tired man.
All those years from his escape from Afghanistan, he was suffering from nightmares
and was often re-experiencing his violent past. He felt enormously guilty because of
the death of his wife and 3 kids. He should have done something to save their lives.
He also felt guilt towards his remaining children, since during all these years he did
not create opportunities for them to have a better future. Last but not least, he lost
confidence in the Netherlands, his new home, as he was originally accused of war
crimes. He did not feel safe at all. His desperation grew as he started to be ashamed
of failing as a man, husband, father, and protector. Besides, he felt bad of leaving his
ageing parents behind. As the oldest son, it was after all his duty to pay respect to his
ancestors and take care of them in times of need. This is when Abolfazl committed a
suicide attempt and was referred to a facility for psychological treatment of survivors
of war, torture and political violence. The referral was rightly as Abolfazl was indeed
diagnosed with a post traumatic stress disorder (PTSD) and a depression. But there
was more, much more, that he was suffering from in psychological ways. At the
facility, Abolfazl entered a group trauma therapy together with 4 Afghan and 4 Iranian
survivors. In the following months, the intimate, personal story of Abolfazl’s long
life-journey started to unfold in the group……….
Backgrounds
Mental health problems of survivors of man-made disasters have become a major
public health issue worldwide. Many of these individuals have been exposed to
life-threatening events in a context of war, torture or political violence in their home
countries, and were submitted to forced migration afterwards. While seeking shelter
in other countries of the world, they were confronted with harsh immigration laws and
different cultures with sets of, sometimes very different, norms and values, languages
and religions. They have lost their ways of life and their social networks. When
eventually seeking and receiving help for psychological problems, they may have
faced a difference between their own explanatory models of illness and health and
those of their helpers. They may also have been confronted with approaches to
healing that differed from those they were accustomed to and expected to have
beneficiary effects for their well being.
10