Dogra, N., Vostanis, P. & Frake, C. (2007) Child mental health services: Cultural diversity training and its impact on practice. Clinical Child Psychology and Psychiatry, 12(1), 137-142. doi:10.1177/1359104507071093 Hassan, G., Kirmayer, L.J., Mekki Berrada, A., Quosh, C., el Chammay, R., Deville-Stoetzel, J.B., Ventevogel, P. (2015) Culture, Context and the Mental Health and Psychosocial Wellbeing of Syrians: A Review for Mental Health and Psychosocial Support staff working with Syrians Aff ected by Armed Confl ict. Retrieved from Geneva, https://www.unhcr.org/55f6b90f9.pdf Hodes, M., Anagnostopoulos, D. & Skokauskas, N. (2018) Challenges and opportunities in refugee mental health: Clinical, service, and research considerations. European Child & Adolescent Psychiatry, 27(4), 385-388. doi:10.1007/s00787-018- 1115-2 Hodes, M. & Hussain, N. (2020) The role of refugee family functioning in child and adult mental health. In: L. De Haene & C. Rousseau (eds.), Working with Refugee Families. Cambridge: Cambridge University Press. Kastrup, M.C. (2006) Mental health consequences of war: Gender specifi c issues. World Psychiatry, 5(1), 33-34. Minuchin, S. & Fishman, H.C. (1981) Family Therapy Techniques. Cambridge: Harvard University Press. Raval, H. (2005) Being heard and understood in the context of seeking asylum and refuge: communicating with the help of bilingual co- workers. Clinical Child Psychology and Psychiatry, 10(2), 197-217. doi:10.1177/1359104505051211 Tribe, R. & Lane, P. (2009) Working with interpreters across language and culture in mental health. Journal of Mental Health, 18(3), 233-241. doi:10.1080/09638230701879102 UNHCR (2000) The State of the World’s Refugees 2000. Oxford: Oxford University Press. van der Veer, G. & van Waning, A. (2004) Creating a safe therapeutic sanctuary. In: J.P. Wilson & B. Drozdek (eds.) Broken Spirits. The Treatment of Traumatized Asylum Seekers, Refugees, War and Torture Victims. New York: Brunner-Routledge.


Engaging and being Gill Wyse


I recently visited a friend in her home. She


greeted me, “It’s lovely to see you, come in”. I had been looking forward to seeing her and felt happy as I approached her home. My mind was occupied by thoughts about what we would talk about. I was curious about events in her life. I imagined how she would look, her voice, her smile, her laughter. Refl ecting on this encounter led me to


wondering about how I welcomed clients for a therapy session. Glenda Fredman (2007) off ers some useful signposts. She advocates that the therapist is aware of how both words and embodied actions, looks, gestures and expressions form our relationships with our clients. “We start from the premise that our meetings are more fruitful when people are involved in mutual listening, appreciation and respect rather than defending, controlling, counter-justifying or blaming”. Hedges (2010) shows us how the wisdom of Peter Lang shines out in his comments about this encounter: “When we meet a person they are giving us a gracious invitation to be with them”. It is important to clear our minds of


Matthew Hodes works as consultant in child and adolescent psychiatry, Westminster Child and Adolescent Mental Health Service, London, Central and North West London NHS Foundation Trust, and honorary clinical senior lecturer in child and adolescent psychiatry, Division of Psychiatry, Imperial College London. He has a longstanding interest in culture, refugees, and the mental health of young people.


Context 169, June 2020


distracting thoughts, as Peter Rober suggests, “Genuine curiosity means no preconceived ideas, expectations or opinions”, as we focus on our forthcoming meeting and recall our previous sessions, and to mentally review the family’s aims and how the therapy is progressing. He speaks of the therapeutic relationship being “co-authored” by the family and the therapist. Although I may imagine possible paths for the session based on what I know about the family, it is important for me to invite family members to initiate and lead the session, to fi nd space to take risks, to push beyond their comfort zone. When I prepare for a session, I refl ect on the qualities and skills I may need. My state of mind is important. I need to have openness and acceptance of the family and their struggles. I want to provide them with a friendly, warm, welcome into a safe space. I need my listening to be attentive and active, ready to validate the feelings of the family members. I need to be able to thoughtfully and kindly reframe their interactions, expressions and feelings. My inner dialogue with both my head and my heart guide my interventions and hypotheses. I walk alongside the family. I feel their pain. I empathise with their confusion, bewilderment, sadness, anger, isolation and disconnection.


I need the courage to challenge, whilst understanding their blaming and accusations, bitterness and regrets are born of fear. Beneath their anger, denial or withdrawal may lay devastating fears of being rejected, worthless or abandoned. I try constantly to monitor my pacing.


It needs to be not too fast into pain and vulnerability but fast enough to encourage change and growth. I refl ect on our closeness and distance. What is comfortable for them? When I lean forward, is this reassuring or disturbing? I must constantly monitor changes in posture, facial expression, a smile, a frown, looking away, looking tearful, leaning back, disengaging, disassociating. I wonder whether this is because of what I said, what I might have implied, what I might have triggered, how my intervention might have been perceived. If there seems to be some disengagement, I need to fi nd ways of re-connecting – curious enquiry about what meaning my comment, question, expression might have meant to them. I am a live witness of the struggles and fears of the family and also of their growing trust, their courage. I need to develop a steadfastness that will off er containment and safety for the family. I lean against the richness my own life experience has given me, my own experiences of anger, sadness, uncertainty, joy and contentment which enable me to be patient and off er understanding and compassion. When distressed families come to therapists,


they hope to fi nd a safe and secure base in the therapy room. Research shows that usually at least one person in the family feels blamed. Being aware of their anxiety and insecurity, the role of the therapist is to off er them a safe containment. Being fully present to them, our minds focused on the regrets, fears and hopes they share with us. I like to describe the therapist’s stance as a ‘relaxed concentration’, paying attention to each nuance, detecting every change, physical and psychological, encouraging, validating and challenging. Finding the right moment to intervene, the ‘therapeutic edge’. How do we ensure, as de Shazer (1988) has expressed it, that we are all playing on the same side of the tennis court and not on opposite sides. If it seems the family members need a more indirect approach, or they are becoming


17


Engaging and being


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