Introduction
Methods
Multimodal co-therapy description
Set-up and first consultations
Biological approach
Institutional approach
Transcultural approach
Narrative approach
Qualitative research description
Population, data collection and analysis
Results
Age at interview | Gender | Disorder | Birth country | Mother tongue | Duration of care (months) | |
---|---|---|---|---|---|---|
n°1 | 17 | ♂ | PTSD | Guinea | Susu | > 12 |
n°2 | 18 | ♀ | Eating disorder unspecified, depression, PTSD, post-traumatic amnesia | Somalia | Somali | > 12 |
n°3 | 18 | ♂ | PTSD | Ivory Coast | Dyula | > 12 |
n°4 | 17 | ♂ | PTSD, suicidality | Burkina Faso | Mooré | > 12 |
n°5 | 22 | ♀ | PTSD, depression | Ivory Coast | French | > 12 |
n°6 | 17 | ♂ | Depression, suicidality | Mali | Soninke | < 6 |
n°7 | 20 | ♂ | Depression, social withdrawal | Guinea | Fula | > 12 |
n°8 | 17 | ♂ | PTSD, depression | Cameroun | English, French, (Banyang, Pidgin, Sawa) | 6 |
n°9 | 18 | ♂ | Depression & anxiety disorder | Mali | Soninke, (Bambara) | > 12 |
n°10 | 19 | ♀ | Externalizing disorder, PTSD | Nigeria | Urhobo, Pidgin, English, (Edo) | > 12 |
n°11 | 17 | ♂ | Psychotic depression, psychosomatic symptoms, (drepanocytosis) | Guinea | Jakhanke | < 12 |
n°12 | 16 | ♀ | PTSD | Congo Kinshasa | Lingala | 6 to 12 |
n°13 | 17 | ♂ | Anxiety disorder, dissociative disorder | Congo Kinshasa | Lingala | < 6 |
n°14 | 16 | ♀ | PTSD, depression | Ivory Coast | Koroka, (Bambara, Dyula) | < 6 |
n°15 | 18 | ♀ | Depression, PTSD | Nigeria | Pidgin | > 12 |
n°16 | 17 | ♂ | Schizophrenic disorder | Guinea | Fula | < 6 |
A safe space for unaccompanied minors | a. A secure therapeutic framework b. The interpreter prevents misunderstandings and is a reassuring link with the native country c. A support to caseworker-youth relationship |
Helpful interventions during MUCTUM therapy | a. Behavioral guidance promotes feelings of safety, self-confidence, and self-care practices b. Care providers facilitate links with the other institutions c. The work on family issues d. Cultural focus enables traditional care implementation e. Help with medications |
Narrating one’s story can “set us free” if carefully guided by care providers | a. Unaccompanied minors valued a delayed, progressive, and fractionated narration b. Care providers provide active, participative and empathetic listening to narration c. Sharing one’s story is “painful” but “sets us free” |
A safe space for unaccompanied minors
A secure therapeutic framework
" I can have problems in my life and I call Mrs. X on her number. It's really... I don't know about the others, but for me, it's not only a follow-up at the hospital, it's really a follow-up that was really very thorough (...) I improved a lot of things, like anger. I, I worked with that with Dr. Y... anger and everything.... It was something that I couldn't handle... It allowed me to... really deal with some of the things about myself that I didn't like…”
“At first, I thought it was too much. I said to myself: there are too many people. But then I realized that when there are several people, we talk more. When there are several people, we discuss more, everyone gives their opinion. That's good. That's really good. I think that... Just at the beginning… I thought it was too much, but then I saw that it's better, when there are several people, each one speaks. They also, they talked a little bit about themselves. That's good.”
The interpreter prevents misunderstandings and is a reassuring link with the native country
“With them, I was not alone, we were several. In addition, there was someone who spoke..., who interpreted, who was there, who knows me well, who knows where I come from. He knows the place, he knows my culture and everything.”
"I can explain to him what I have. I speak French but I don't really speak, there are things I don't know in French. With him, I can explain and he can understand me. I don't know how to tell you. (...) Often, when I spoke with him in my language, when I explain it to him, the explanation he gives... If it had been me, it would not be the same explanation. He knows the French language well. He explains well, in fact. He explains well compared to me and I wouldn't have explained well like him."
“I am of Somalian origin and I am in France since I was little and also when I arrived I did not see Somalian people. So when I see the interpreter every time here it was a pleasure to see a person from the same country as me (...) I felt sometimes that I spoke the same language and all that sometimes I asked questions about my country because I was little when I left my country (...) [the interpreter spoke] about the cultures of the villages, all that, all that, all the things, the food to eat”
A support to caseworker-youth relationship
"In fact, at the consultation when I go there, when they send me to the consultation, but sometimes when I arrive at the consultation, when we speak, I don't really like it, so I let my caseworker talk, as I really trust her, when we speak. After that, that's when I can talk.”
Helpful interventions during MUCTUM therapy
Behavioral guidance promotes feelings of safety, self-confidence, and self-care practices
" I am someone, I get very, very angry. Even sometimes when I speak, I get angry very, very quickly. So Mrs. Y taught me and I'm learning to breathe and not to get angry very quickly. If someone comes to get me, I will try to speak calmly to these people, so as not to be very aggressive. (...) Once she finds that the situation is very hard, she tells me that I take a breath, I drink a glass of water, that it calms me down and then I speak again. Sometimes when I'm upset or sad, even when I'm at home, I take a drink of water and my throat feels better.”
“It didn't really go away but I evolved a lot on it because before, it was due to everything I had been through, I had the feeling that I was going to be found, no matter what. So that's a little bit of what fueled that feeling too... But then I was made to understand that this is France and all... I was reassured a lot by Mrs X and Dr. Y too and uh I started to let go a little bit, they made me understand that I wasn't going to be attacked overnight in the street... Or kidnapped and everything... So that kind of... calmed me down a bit…”
Care providers facilitate links with the other institutions
"I was the one who was really struggling and uh it was really really um... The follow-up that allowed us to tighten up.... Strengthening the ties, no but... Allowed me to have… uh… a discussion with [my caseworker] because having a discussion with her was not possible...Researcher: Yes.Participant: We couldn't understand each other at all.Researcher: Yes.Participant: Because here I was really saying everything I wanted to say and who I really was… [care providers] had the ability to transmit that to another person, so that the person could understand me too…Researcher: Yes.Participant : So uh, [my caseworker] had to go through them to understand how I functioned and me too how she functioned and sometimes we had big meetings where there were people and uh... It was partly thanks to them that I was able to establish a link with my caseworker...”
“Basically, you know as I said, basically, I didn't talk to anybody. So everybody was like, how do I talk to this individual? (...) So it was complicated for them... And in the end uh... (...) So, since there are certain things that I don't want to tell them about. So I invited them to come and participate in my sessions. That way, they will hear certain things. So, when we go back [home], [if] there are certain things that they don't (...) understand or that kind of thing, they call me, we talk about it, they ask me questions. And I answer, if I feel it... I answer. And so with that, it allows them to know how (...) to talk to me, how, how to handle the situation with me.”
The work on family issues
"There were problems with the family. My mother, who was not present, left us long ago. I was with my aunt and her children. Often it was not going well. That's why I left there. There is all that, we talked about all that too, with them."
"I told all my stories to Mrs. X. In any case, she found some words. She called my mother to explain something to her. She made it clear that I don't work here, that I'm studying, that I won't have enough money, as much as she asks, that I won't be able to finance everything. So my mother, I don't know, but she has trouble understanding, my mother. She had a hard time."
Cultural focus enables traditional care implementation
"I had a dream about an old man (…) I had to get out the alms and I managed to call my mother to do that alms and since then it's been fine."
Help with medications
“Before… I was awake… every hour… I tried to sleep at night but I couldn’t sleep… I had nightmares even if the door is open. I got out at night like people who walk at night, I sleep but I got out at the beginning. As I spoke to the psychologist and the psychiatrist, it stopped, I took medicine to sleep.Researcher: OkayParticipant: And that stopped and even if I have a bad memory, a nightmare, well I still sleep but before I didn't sleep and all that.”
Narrating one’s story can “set us free” if carefully guided by care providers
UM valued a delayed, progressive, and fractionated narration
"It was a little bit each session. Just a bit, a bit… and then the whole thing and that's it. It wasn't like 'you have to tell us what you've been through right away.'”
“If we manage to empty ourselves of this, in fact we empty our heads. When I was able to clear my past with Mrs. X, she found solutions, words and things that could calm me down. (...) They know their work well and they know very well that when it goes too far, they also know how to stop the person when it goes too far. So I like that.”
“Participant: As I said earlier, I'm not someone who likes to re-explain that part.Researcher: YesParticipant: But afterwards, it was really a moment when you had to talk.Researcher: Yes.Participant: It was really. They gave me time, they let me... I think it took a year and a half before... That we really got into it. We only talked about myself, my fears, my mother. And then we really went through the process where ... well I had to explain my story to them and that was it…”
Care providers provide active, participative and empathetic listening to narration
"Participant: It was very, very, very hard. Uh to say again what I… I had experienced, uh… You had to respect… and especially that they, when you explained, they illustrated for you.Researcher: That is to say?Participant: In itself... they take examples from you or do as if I tell them, for example, I crossed the sea: they tell you: by boat, the sea? Basically, to make you really live the thing, but in an intense way so that you can free yourself once and for all, and I think it was not bad for me anyway…Researcher: Yes…Participant: Because when I said uh when I took the example of Italy with the prostitution, really it was illustrated to me... And that was really what I wanted to say. So I was led to say what I had inside me without forcing myself.For example, a person can't understand your past, he's not in your shoes, but in fact, he tries to put himself in your shoes and all that, it feels good."
Sharing one’s story is “painful” but “sets us free.”
"That's the hardest part. But once you get it all out, you feel good about your body. Plus, we open up to people and they give us ideas, advice on how to be able to deal with our past."
"It hurt and at the same time, when I was talking, that's when I was able to work on it. When I was able to talk to people where at the same time it relieves my heart and it relieves me in my head."
Discussion
Conclusion
● Commitment and reliability of care providers despite missed appointments helps build trust |
● Care providers address unaccompanied minor’s needs hierarchically (e.g. housing first) |
● An interpreter in native language is central for translation and cultural mediation |
● Supporting the relationship with the family is experienced as helpful (e.g. through phone calls) |
● Pharmacological treatment, and addressing social factors are perceived as helpful |
● Therapy focuses on trauma once primary needs have been addressed. The process may take months |
● Trauma narration is delayed, prudent, non-forced, and fragmented. If guided carefully, trauma narration is perceived as “freeing” by unaccompanied minors |