Experiences of Bosnian war-survivor refugees: Implications for counselor multicultural competence

Though literature addresses the immense mental health needs of refugee populations, a lack of exploration of the effects of war-induced traumatic experiences on refugees' current grief and loss issues, as well as a lack of consensus on quality training and education regarding refugee mental health continue to exist. Some research studies have addressed the pathological long-term effects of traumatic war experiences on Bosnian refugees' mental well-being, including posttraumatic stress disorder, and various mood disorders. However, there are many unanswered questions regarding this population, as it remains quite uninvestigated. Mental health practitioners, as well as counselor educators, need more knowledge and awareness of the traumatic experiences of Bosnian war-survivor refugees in order to enhance their multicultural competence and thus, their work with this population. Further, practitioners need to be aware of the directly expressed mental health needs of this population in order to provide culturally-sensitive services and employ effective interventions. Thus, due to the rapidly growing refugee resettlement in the United States, these underrepresented issues need to be explored in greater detail. This study's objective was to provide a more comprehensive overview of life experiences of Bosnian war-survivor refugees who are currently living in the United States. The purpose of this study was to identify war-related experiences that are related to refugees' current issues of grief and loss; to explore participants' greatest losses and coping strategies; and to investigate expressed mental health needs of the participants. Through the exploration of expressed mental health needs, participants reported on the practitioner assistance they believed would have benefited them upon arrival to the United States.;This study employed a qualitative methodology through analysis of in-depth interviews with fifteen Bosnian war-survivor refugees. Participant transcripts were analyzed using a phenomenological approach to research. Five themes emerged from data collection and analysis including; (1) traumatic experiences and greatest struggles; (2) greatest war-related losses; (3) current grief and residual emotions; (4) past and current coping; and (5) understanding and perceptions of mental health services and illness. Explanations of the themes, analyses of the sub-themes, and highlights of the relevant facets of all sub-themes are provided in great detail to assist with the development of greater knowledge of refugee war-related experiences, as well as competence in working with this population. The discussion of findings interprets the results of this study through various theoretical frameworks relating to participants' traumatic experiences, as well as grief and loss, and coping. Loss of the assumptive world, as an extension of both trauma theory and grief theory was used as a framework to discuss the results of this study pertaining to traumatic war experiences. Betrayal-trauma theory was used to relate to participants' current emotional standpoints regarding their most significant residual emotion post-war. The concept of traumatic grief was used to connect trauma and grief to the grief experienced by the participants of the study. An attachment theory perspective to complicated grief was adopted as a way of discussing parallels between this theoretical orientation and participants' views on their grieving processes. Worden's (2009) mediators of mourning were utilized in the explication of individual influences of greatest losses reported by the participants. Problem-solving model of coping, group-survivorship coping, and religious coping were used to discuss coping specifically through faith and spirituality, the most prominent style of coping observed with the study's participants.;The most significant findings of this study indicate participants' skewed perceptions and limited knowledge of mental illness. The discrepancy between their support and openness to counseling services arose as one of the most noteworthy results of the study. While all participants believe that mental health services are a necessity, they did not attribute themselves as those who need the services, even though the results of this study indicate that most continue to be affected by grief and loss issues two decades post-war. Their previous encounters with, and current knowledge of mental health services is incomplete, as many described their understanding of mental health services relating only to psychiatric facilities and their patients. Thus, the findings of this study provide significant implications for research and the practice of mental health counseling, counseling psychology, counseling education, as well as for immigration professionals who are assisting war-survivor refugees with resettlement. Namely, implications of this study emphasize a great need for mental health professionals to engage in more proactive community outreach, in order to provide mental health education and advocacy for war-survivor refugees.