Effectiveness of Narrative Exposure Therapy Peer Counseling with African Refugees and Ugandan Nationals: An Archival Study

Abstract

Background: As populations of refugees worldwide reach record numbers due to increased conflict throughout areas of the Middle East, Southeast Asia, and Africa, it becomes increasingly important for mental health practitioners to focus efforts on how best to serve the unique needs of displaced persons, with a particular focus on the treatment of posttraumatic stress disorder (PTSD) which is experienced at elevated rates among this population (Donnelly et al., 2011). Currently, the American Psychological Association’s primary recommended treatments for PTSD include Trauma-Focused Cognitive Behavioral Therapy and Prolonged Exposure, but recent studies have suggested Narrative Exposure Therapy (NET) as a promising methodology that may be more conducive to work with traumatized refugees (APA, 2017a). In response to this research, the goal of this study is to build upon current literature examining effectiveness of NET with the population of traumatized refugees and at-risk persons.

Methods: This study was conducted at a not-for-profit organization called Hope for Women and Children Victims of Violence (HOCW), which currently has in place a peer-led NET treatment program for refugees in Uganda. Data was collected by clinicians working at HOCW who speak the multiple languages of the client population, as a part of the process of the peer-counselor NET program currently in place. Anonymous client files containing patient intake form with demographic information, vivo Event Checklist detailing traumatic exposure history, pre-intervention PTSD Checklist - Civilian Version (PCL-C), post-intervention PCL-C, client session checklist and questionnaire, and final NET satisfaction questionnaire were compiled by clinicians at HOCW, and analyzed in response to the aims of this study.

Results: Five primary findings arose from this study: 1.) Generally, African refugees have experienced a greater number of potentially traumatic events than Ugandan nationals entering treatment at HOCW, and number of traumatic exposures is positively associated with number of PTSD symptoms; 2.) Clients at HOCW report greater levels of satisfaction after completing the peer-NET counseling program than they did in 2017; 3.) Counselors continue to demonstrate high levels of treatment fidelity of NET implementation; 4.) The program continues to demonstrate ongoing and improved effectiveness in decreasing PTSD symptoms; and 5.) These effects of symptom improvement are not significantly different for Ugandan nationals than for African refugees.