Psychoanalyst Henry Krystal discussed the core experience of trauma as a surrendering to the inevitability of death and destruction. A new psychological theory, Kohutian Self-Psychology, offers a new treatment modality, in which Empathic Attunement is used. Kohut theorised that trauma represented the loss or absence of a self-object and the consequent affect overstimulation and self-fragmentation, leaving the self vulnerable to further trauma. The therapist needs a reliable grasp of the client’s culture and lived experience to assist his/her expression of past trauma.
Migrants and refugees often bring a sense of loss and separation from their homelands, and some refugees from war-torn countries have had traumatic experiences. Reaching this complex group poses a therapeutic challenge, in view of the barriers to pathways to care, including the pathoplastic effect of culture on symptom formation and expression, differing patterns of health-seeking, and issues concerning transference, countertransference and the use of trained interpreters and bilingual workers.
This presentation will discuss the theoretical underpinning of trauma and its management in a cross-cultural context, with reference to self-object theory and my clinical experience as a psychotherapist in dealing with Burmese migrants and Karen refugees from the Thai-Burma border.