Book reviews -- Counseling and Therapy with Refugees: Psychological Problems of Victims of War, Torture and Repression by Guus van der Veer

This volume brings to the mental health professional the author's experiences and insights in treatment of refugees. The frustrations and problems of both the professionals and refugees are documented, with the hope that the book will provide a basis for better understanding and treatment in the future.

Although the author attempts to address the problems of refugees in general, his specific examples are drawn primarily from those fleeing to the West from Southeast Asia. Therefore, issues of cultural differences, racial tensions, and culture conflict are germane. It is also important to emphasize that these refugees are not voluntary immigrants and that many of them do not desire to become part of the host culture.

A number of important issues are central to dealing with refugees. First, the refugee's ability to cope in Western society is related to the quality and type of his or her experiences in the old country. Second, do conceptual models exist that may be appropriate for working with this group? Finally, can the presentation of individual cases reflect general problems faced by refugees?

Most refugees from war and oppression share various common experiences, including abuse of power on the part of totalitarian regimes, imprisonment, maltreatment, torture, death, violence, and victimization. Other experiences include political repression, detention, physical and psychological torture, terror, and the separation and disappearance of friends and relatives.

Individuals' reactions to these experiences vary, and the fact that many refugees do not seek help in dealing with their traumatic experiences is no indication that they do not need help. In turn, mental health professionals may not be able to deal adequately with such experiences, especially when language problems and cultural differences present barriers to understanding. In addition, refugees from non-Western cultures may be unfamiliar with Western notions of mental health and may not have the vocabulary adequately to describe their mental problems.

Van der Veer presents five conceptual models in working with refugees: (1) the psychiatric approach, (2) the psychodynamic model, (3) the family therapy approach, (4) the learning theory perspective, and (5) the cognitive model. He describes the utility and limitations of each approach and presents individual cases.

For example, the usefulness of the family therapy perspective is related to an evaluation of the refugee's symptoms against the background of his or her primary social environment, which may include the family as well as roommates and friends who have become close to the client in the country of exile. Interaction with people close to the refugee can provide insight into current problems. Its limitation lies in the lack of a theory about the consequences of trauma and uprooting for families, in addition to the difficulty in assessing the role of family members who may live far away and be unavailable for information.

Individual case presentations described in this book provide valuable material for the mental health professional. Cases cover such behaviors as suicide and discuss victims of sexual violence and other traumatic experiences. Other issues include the special problems of refugees who have requested political asylum but have not yet been grated it as well a special concerns related to gender and age group.

Burnout is a possible consequence of working with difficult populations. Therapists can become depressed and discouraged, which may show in such symptoms as cynicism and an indolent attitude toward clients. Countertransference can be another issue; the therapist may listen to horror stories from the client that evoke impulses he or she cannot easily integrate. Defense mechanisms may then be brought to bear so that the therapist can repress, project, and deny the stories if they trigger unresolved inner conflicts.

Most lacking in this book is discussion and exploration of native (Southeast Asian) models of mental health and mental illness, including diagnosis and treatment. What did they do in the old country? Can therapeutic models from the native cultures be integrated into Western forms of treatment?

Present-day America is a diverse society. Narrow, ethnocentric perspectives do not fit the current reality. The basic message of this easy-to-read volume is that cultural sensitivity is a necessity; effective mental health workers cannot rest on traditional models. With the ease of communication, mobility, and transportation, very few modern societies can afford to ignore the issues brought about by the movement of populations.

Harry H. L. Kitano School of Social Welfare University of California, Los Angeles Los Angeles, California

Copyright Family Service America Mar 1994
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