most qualitative studies, the researcher is the main tool of data collection (Yin
2013). This is to mean the role one plays as a researcher for a consistent and
valid data generation from participants is higher than other methods of study.
However, some level of guidance and direction is also important. Thus, in this
thesis project, the researcher will employ semi-structured in-depth interviews
as the main tool of data collection.
study samples for this study will be identified by using the snowball technique.
The first case will be identified by using key informants in the institute of
public health and with external connections of my supervisor.
and sampling procedure
Done/doing at least one long term therapy
with an immigrant
Living in Heidelberg
English as a working language
The study population will
be all psychotherapists that are based in Heidelberg. “By its very nature,
qualitative research is particularistic” (Yin 2011). Thus, sampling in
qualitative research basis more purpose than representativeness; and the
purpose of doing it, most of the time, is not intended for generalization. Thus,
in selecting participants for this research, the following inclusion criteria
will be employed
The other decision I had
to make was the distinction between single and multiple case study designs.
Since therapists are the main units of analysis I will be asking to generate
data, and because I believe that their experiences are not necessarily the same
and each individual case can provide unique experience, multiple case study
will be used. One another important feature of the use of multiple case study
designs is that it allows some level of comparison between the cases (Yin 2009).
As a main guide in doing
this thesis, exploratory case study design-from the three suggested types, two
of them being explanatory, and descriptive-will be used (Carla 2013). The
reason for this is that the detail provided from cases that will be explored
using in depth interviews will generate new insights into, and a better
understanding of the nature of the cases to be investigated.
In this particular study,
since the main purpose is exploring and understanding psychotherapists’
experience in working with immigrant clients by deep exploration of their lived
experiences, a qualitative research approach is considered appropriate. Among
the different guiding approaches for a qualitative study, Case study will be
applied for it allows an in-depth and intensive exploration of a lived
experiences (Yin 2009), which is an interest in this research. The main reason
for selection in this regard was not anything but purpose of the study.
Research design is the
logical sequence that connects the data to be collected with the initial
research questions (Yin 2009). Depending on the researchers’ orientation and
understanding of the concept of truth or knowledge, the methods employed followed
in connecting these two-research questions and data-varies (Hancock & Algozzine
2006). While some consider truth as one, objective and universal (positivists),
others consider it as more of subjective and context specific (constructivists)
conditions were changed to improve the working alliance with immigrant clients
in a therapeutic process?
do therapists incorporate the cultural openness to accommodate differences in
understanding clients perceived cause of problems?
belief systems (if any) were presented as a barrier in the therapeutic process?
are the different barriers in psychotherapeutic care for immigrants?
the concept of cultural openness as experienced in therapy
cultural differences that have hampered/facilitated the therapeutic process
challenges faced by therapist in working with clients
To explore real life lived experiences and challenges of Psychotherapists
working with immigrants
main objective of the study thus is,
Objectives of the study
For example, despite the high burden of mental health
problems among refugees, there is limited knowledge about how effectively
people can deliver mental health care for refugees (Whaley & Davis 2009). Among
the reported different barriers in a psychotherapy setting by care providers,
language, cultural belief systems and patterns of health seeking behavior are
worth mentioning. Except the two concepts (language and health care seeking
patterns), cultural beliefs are not so vividly clear. Thus, to better
understand these belief systems, it is worth exploring what they really
area. The rationale behind this thesis
is the importance of a better understanding a situation to better facilitate
change and improvement.
If we take the case of Germany as an example, the number of
refugees that are living in this country are no longer marginal in number
(Henke et al 2017). And this calls for a more culturally, linguistically and
medically adapted care for the existing need (Henke et al 2017). Though some
improvements have been made in this aspect, it is yet with a big room for
This belief systems also
highly influence how the psychotherapist and the client understand each other
in a therapeutic process. The positive working relationship between care
provider and care receiver is one of the most determining factors for the
success of the helping process (Elizabeth & Fross 2017). And nowadays, with an ever-increased number of
migrants in the world, the importance of cultural openness in psychotherapy and
health response has become indispensable (WHO 2015).
Different explanations of mental illness existed since time
immemorial (Bennet 2006). These explanations also vary across
societies. Even in today’s modern societies, there exists different explanatory
models for the understanding mental illnesses (Kleinman &
Benson 2006). These explanatory
models show how existing differences basing subjective beliefs about causes of
mental illness across societies may alter patterns of help-seeking and response
to treatment. Refugees help seeking behavior for example is influenced by their
identified social status and experience before coming to the host countries (Anagnostopoulos
et al. 2016). These subjective and social nature
of beliefs make diagnosis and culturally competent treatment a challenge (Baarnhielm
et al., 2014). This was shown in a recent study
done about professional’s experiences of delivering care for immigrants in 16
European countries that identified belief systems held by refugee patients as
one of hindrance factors for accurate diagnosis (Sandu et al 2013).