The March 2021 British Association for Behavioural and Cognitive Psychotherapies (BABCP) Article of the Month is from the Cognitive Behaviour Therapist and is entitled “Unaccompanied minors’ experiences of narrative exposure therapy” by Glorianne Said, Yaman Alqadri and Dorothy King

We are aware that post-traumatic stress disorder (PTSD) is a difficulty many unaccompanied asylum-seeking minors (UAM) experience (Fazel, Reed, Panter-Brick, & Stein, 2012; Huemer et al., 2009; Müller, Büter, Rosner, & Unterhitzenberger, 2019), however, we are aware clinicians may find that it is hard to prioritise PTSD treatment among so many additional social needs.

In our experience, while many UAM may acknowledge that their social circumstances are stressful, we heard how it was their PTSD symptoms that were making their day-to-day life difficult. We heard how young people struggled to sleep, to concentrate, and to interact socially without experiencing intrusive symptoms. These were among the things young people wanted to change.

So as clinicians supporting UAM, we wanted to consider how Narrative Exposure Therapy (NET), as an evidence-based PTSD intervention (Schauer, Neuner, & Elbert, 2011) could be delivered in a child and adolescent mental health setting. While setting up our initial pilot, we measured responses to this intervention using routine outcome measures (as documented in Said & King 2019), however we also wanted to hear what our clients’ experience of receiving NET was.

We are really excited and happy that this paper, two and a half years in the making, will now be available for people to read. Our hope was that by hearing clients’ own experiences of receiving a therapy such as NET, this paper could explore some of the myths and worries clinicians may have when supporting this client group.

Within this paper, we explore four unaccompanied minor’s experience of receiving NET using Interpretative Phenomenological Analysis (Smith, Flowers, & Larkin, 2009). This helped us to identify five themes, reflecting what it was like when UAM were considering to enter this therapy, what they experienced while receiving NET, what they felt they got out of NET, what they found challenging, and what would help them feel more comfortable.

We think one of the strengths of this paper is being able to provide a voice to clients who are marginalised and rarely heard due to multiple systems of oppression. We were struck by how participants were able to connect their experience of therapy to unique aspects of the NET. We learned a lot when writing this paper, with participants reminding us of the importance of being clear of the rationale for trauma-focused therapy and the value of offering such an intervention during a formative part of a young person’s life.

However, we are aware that this paper is not without its limitations. Our sample may have been too small to reach data saturation. We are also mindful of the potential impact of the interviews being done with a heterogenous client group; in some clients’ second language, without an extended period of follow up, and for participants to be aware that their treating therapist may read their comments.

We hope that clinicians reading this paper will hold onto the implications that it is possible to deliver NET, and that this intervention was welcomed by the UAM in this paper. We also believe being aware of unaccompanied minor’s context and offering such an intervention using cultural humility and alongside other psychosocial support is important. We hope that this is the start of further research into NET and its efficacy with UAM who are experiencing PTSD.  

From Andrew Beck, Associate Editor of tCBT: Why I chose this article:

One of the biggest challenges we face as therapists is providing high quality, evidence-based therapies to people whose social circumstances and situation make accessing therapy a challenge and whose day to day life means that prioritising therapy is difficult. In recent years practitioners have developed Narrative Exposure Therapy in response to the significant mental health needs of refugees and asylum seekers. This therapy has the advantage of being relative brief, relatively easy to train practitioners in, having a solid foundation in thinking about human rights and social justice and having good research outcomes. One of the most vulnerable groups clinicians in the Northern Hemisphere are likely to work with are Unaccompanied Asylum-seeking Minors. These young people are separated from families, often with no information about what has happened to loved ones, far from home, possibly not speaking the majority language of the country they are seeking help in and often housed in situations that struggle to meet their multiple and complex needs. It is a real pleasure to see the work of Dr Said and colleagues in the Cognitive Behaviour Therapist which has provided an authoritative overview of NET and looked at the experiences of young people who have accessed this therapy. This provides us with a clearer sense of how we can best meet the mental health needs of these young people and give them the best possible opportunity to thrive in their new country.