Academic literature on the topic 'Group psychotherapy Victoria'

Objective: To explore the relationship between English language proficiency and mental health service utilisation. Methods: In September 1993, a sample census was conducted of all mental health services in the State of Victoria, including public and private hospital wards, outpatient consultations provided by psychiatrists and clinical psychologists, and primary mental health care provided by general practitioners. Response rates ranged from 37% for monolingual general practitioners (GPs) to 96% for inpatient units. Particular emphasis was placed on patients' English language proficiency and the role played by bilingual clinicians. Results: Over 80% of inpatients received a diagnosis of either dementia or psychosis. This proportion was even greater in the case of patients with English language difficulties. The latter group of patients underutilised specialist outpatient services, and those using these services were less likely to receive psychotherapy than fluent English speakers. They utilised GPs for mental disorder at at least the same rate as other patients. There was a marked preference for bilingual GPs, with 80% of patients with poor English language skills consulting GPs who spoke their native language. Conclusion: There appears to be considerable underutilisation of specialist mental health services by patients who are not fluent in English. The liaison-consultation model of psychiatric care may be an effective way of addressing this problem, given the important role already played by bilingual GPs in the psychiatric care of those whose native language is not English.

IntroductionWhile tobacco smoking prevalence is falling in many western societies, it remains elevated among high-priority cohorts. Rates up to 95% have been reported in women whose pregnancy is complicated by other substance use. In this group, the potential for poor pregnancy outcomes and adverse physical and neurobiological fetal development are elevated by tobacco smoking. Unfortunately, few targeted and effective tobacco dependence treatments exist to assist cessation in this population. The study will trial an evidence-based, multicomponent tobacco smoking treatment tailored to pregnant women who use other substances. The intervention comprises financial incentives for biochemically verified abstinence, psychotherapy delivered by drug and alcohol counsellors, and nicotine replacement therapy. It will be piloted at three government-based, primary healthcare facilities in New South Wales (NSW) and Victoria, Australia. The study will assess the feasibility and acceptability of the treatment when integrated into routine antenatal care offered by substance use in pregnancy antenatal services.Methods and analysisThe study will use a single-arm design with pre–post comparisons. One hundred clients will be recruited from antenatal clinics with a substance use in pregnancy service. Women must be <33 weeks’ gestation, ≥16 years old and a current tobacco smoker. The primary outcomes are feasibility, assessed by recruitment and retention and the acceptability of addressing smoking among this population. Secondary outcomes include changes in smoking behaviours, the comparison of adverse maternal outcomes and neonatal characteristics to those of a historical control group, and a cost-consequence analysis of the intervention implementation.Ethics and disseminationProtocol approval was granted by Hunter New England Human Research Ethics Committee (Reference 17/04/12/4.05), with additional ethical approval sought from the Aboriginal Health and Medical Research Council of NSW (Reference 1249/17). Findings will be disseminated via academic conferences, peer-reviewed publications and social media.Trial registration numberAustralia New Zealand Clinical Trial Registry (Ref: ACTRN12618000576224).

Abstract Background There is increasing recognition of the substantial burden of mental health disorders at an individual and population level, including consequent demand on mental health services. Lifestyle-based mental healthcare offers an additional approach to existing services with potential to help alleviate system burden. Despite the latest Royal Australian New Zealand College of Psychiatrists guidelines recommending that lifestyle is a ‘first-line’, ‘non-negotiable’ treatment for mood disorders, few such programs exist within clinical practice. Additionally, there are limited data to determine whether lifestyle approaches are equivalent to established treatments. Using an individually randomised group treatment design, we aim to address this gap by evaluating an integrated lifestyle program (CALM) compared to an established therapy (psychotherapy), both delivered via telehealth. It is hypothesised that the CALM program will not be inferior to psychotherapy with respect to depressive symptoms at 8 weeks. Methods The study is being conducted in partnership with Barwon Health’s Mental Health, Drugs & Alcohol Service (Geelong, Victoria), from which 184 participants from its service and surrounding regions are being recruited. Eligible participants with elevated psychological distress are being randomised to CALM or psychotherapy. Each takes a trans-diagnostic approach, and comprises four weekly (weeks 1-4) and two fortnightly (weeks 6 and 8) 90-min, group-based sessions delivered via Zoom (digital video conferencing platform). CALM focuses on enhancing knowledge, behavioural skills and support for improving dietary and physical activity behaviours, delivered by an Accredited Exercise Physiologist and Accredited Practising Dietitian. Psychotherapy uses cognitive behavioural therapy (CBT) delivered by a Psychologist or Clinical Psychologist, and Provisional Psychologist. Data collection occurs at baseline and 8 weeks. The primary outcome is depressive symptoms (assessed via the Patient Health Questionnaire-9) at 8 weeks. Societal and healthcare costs will be estimated to determine the cost-effectiveness of the CALM program. A process evaluation will determine its reach, adoption, implementation and maintenance. Discussion If the CALM program is non-inferior to psychotherapy, this study will provide the first evidence to support lifestyle-based mental healthcare as an additional care model to support individuals experiencing psychological distress. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12621000387820, Registered 8 April 2021.

"Doctor, will I live longer if I give up alcohol and sex?" "No, but it will seem like it." The paradigm of the self as it is conceptualised in Western society includes an implicit assumption that one of the primary activities of the self is to engage in protective behaviours. This is a basic assumption in mass media promotion of healthy behaviours: 'Quit smoking' to protect yourself from lung cancer; 'Work safe' to protect yourself from injury, etc. Mass media social marketing campaigns inform the general population of the dangers to the self's existence of smoking, drink-driving, unsafe sex, over-eating, under-exercising and so on. These campaigns are based on models such as the Health Belief Model (Janz and Becker), the Fear Drive paradigm (Janis; McGuire), the Parallel Response Model (Leventhal), Thayer's Arousal Model, Roger's Protection Motivation Theory (Rogers & Mewborn; Maddux & Rogers), Ordered Protection Motivation Theory (Tanner, Hunt and Eppright) and the Extended Parallel Process Model (Witte). Fundamental to all these models is the assumption that people are motivated to protect themselves from harm. Information is provided that warns of the severity and likelihood of consequences of unhealthy behaviours. In some cases this information does motivate people to give up harmful behaviours and adopt safer options. However, worldwide, we see an increasing prevalence of diseases such as heart disease, diabetes and cancer that are related to preventable causes such as obesity, smoking and a sedentary lifestyle. To meet this challenge, the media strategy has generally focused on how to get health information across more effectively, that is, by making it more persuasive, more vivid, more salient, more imminent, more probable, and so on. Media exhortations to: 'say no to drugs', 'Quit because you can!', 'Respect yourself' etc. do not always achieve the desired change and may increase frustration, hopelessness and even depression (Henley & Donovan). It may be helpful to consider that this protection motivation paradigm does not take into account the prevalence of paradoxical behaviours, that is, behaviours that are harmful to the self (Apter). When talking about health, I think it is useful to divide paradoxical behaviours into two categories: thrill-seeking behaviours such as sky-diving and bungie-jumping where the individual enjoys the experience of being at risk without (usually) craving it; craved or 'addictive' behaviours (using the term loosely), such as smoking, binge-drinking, over-eating, drug-taking, where the individual craves a certain sensation and the gratification of the craving supersedes protective impulses. In both cases, the individual knows the behaviour is potentially harmful but chooses to engage in it. In the first case, there is a conscious choice that the enjoyment of the thrill experience outweighs the risk. The person feels in control of the decision (even if the decision is to abandon oneself to the feeling of being temporarily out of control). In the second case, there is a need to gratify the craving, regardless of the risk. The person is fully aware that it is not in their long term self-interest but feels out of control of the decision (Lowenstein). This second category of paradoxical behaviours consists of many unhealthy behaviours targeted by health practitioners. This paper discusses 1) the concept of the self in Western society; 2) the concept of paradoxical behaviour, distinguishing it from deviant behaviour; and 3) the suggestion that people may engage in addictive paradoxical behaviours to satisfy the 'empty self' (Cushman). Finally, the paper suggests that this attention to the empty self may be in a perverse way protective (though not healthy), and calls for a health promotion approach that directly addresses the needs of the 'empty self'. Concept of Self The concept of the self varies across cultures and time. Cushman (599) defined the concept of the self as 'the concept of the individual as articulated by the indigenous psychology of a particular cultural group.... the self embodies what the culture believes is humankind's place in the cosmos: its limits, talents, expectations, and prohibitions'. The Eastern concept of self extends 'beyond one's physical and psychosocial identity to include all other people in the world' (Westman & Canter 419) while the concept of self as it has developed in Western society 'has specific psychological boundaries, an internal locus of control, and a wish to manipulate the external world for its own personal ends' (Cushman 600). This Western concept of the self has been traced to Augustine's Confessions, identified by Weintraub (cited in Freeman 26) as the first reflective, autobiographical review of a life history in which selfhood is examined and understood. The concept of self encapsulates the most profound sense of cosmic place, worth and meaning. One of the aspects of the Western concept of self is a sense of mastery, of being able to act upon the world. Paradoxical vs Deviant Behaviour Apter makes a distinction between deviant behaviour, which is defined by social norms, and paradoxical behaviour, which is defined as any behaviour potentially harmful either to the individual or to society. Parachuting would be an example of behaviour potentially harmful to the individual, while celibacy, by threatening the survival of the social group, would be behaviour potentially harmful to society. Neither of these behaviours would be regarded as 'deviant'. Apter (10) calls this sort of behaviour paradoxical 'because it has the opposite effect to that which, from a biological and evolutionary point of view, one would expect behaviour to have'. While there will be considerable overlap in practice between deviant and paradoxical behaviour - child abuse, vandalism, drug and alcohol abuse, suicide, etc. would all be both deviant and paradoxical - there is a distinction in perspective between these two terms. Deviant behaviour, by definition, is always regarded by a society as anti-social (and therefore is often harmful); paradoxical behaviour is, by definition, always regarded by the individual's self-concept as harmful or potentially harmful (and therefore is also often anti-social). As our self-concept is socially learned, it is difficult to arrive at a true separation of these definitions but the following example may clarify the distinction: smoking was a widespread, socially acceptable activity in the 1950s, even glamorised by Hollywood. When the scientific evidence showed that it was harmful to the individual's health, that is, paradoxical behaviour, many people were sufficiently motivated to quit. Since the dangers of passive smoking have been highlighted and smoking is becoming regarded as socially unacceptable, that is, deviant behaviour, many more people are trying to stop, and succeeding. For many people, motivation for change is successful when an activity is recognised as both deviant and paradoxical. Social marketing campaigns have targeted these two areas for years, informing of health risks and dispelling the glamorous image. Yet, people still smoke, even when they know the health dangers and daily experience the open disapproval of others. At the extreme is the person who lies in a hospital bed with both legs amputated, being told and believing that continued smoking will result in the loss of remaining limbs, but who is still not motivated sufficiently to quit; this person is clearly exhibiting extreme paradoxical behaviour. It is useful to call this behaviour paradoxical rather than deviant because it is defined primarily by the extreme injury to the individual rather than the degree to which it departs from social norms. Why an individual would persist in such irrational behaviour is a seemingly unanswerable question. As Menninger has said, 'the extraordinary propensity of the human being to join hands with external forces in an attack upon his own existence is one of the most remarkable of biological phenomena' (cited in Apter 10). In trying to understand it, we look at three alternatives: 1) what people say their reasons may be; 2) how people defend against knowledge of risk; and 3) the role of visceral influences. Van Deurzen-Smith (165-6), an existential counsellor, gives some insight into the complexity of one of her patient's reasons for smoking: The dangers of heart disease or lung cancer had, far from making her want to give up smoking, been a real secret attraction which had been hard to give up. She had experienced smoking as playing with fire and that was highly enjoyable.... smoking in this sense had represented her experience of her body as concretely her own. Inhaling smoke was like breathing fire and feeling extra-alive; exhaling smoke was like seeing her own body's power being projected out of her mouth. Carrying cigarettes and fire on her every minute of the day used to give her a sense of oneness with the substances of the natural world; it was like possessing the secret power of some magical ritual. When smoking she was in command of the physical world, she was master of her own destiny. In other words, smoking had become an integral part of this person's self-concept. An alternative viewpoint is that smokers simply defend against knowledge of the health risks. In an examination of 'psychic defences against high fear appeals', Stuteville identified three techniques which people use to reduce fear-arousal: a) they deny the validity of the information; b) they unconsciously assert 'I am the exception to the rule - it won't happen to me'; and c) they defuse the danger by making it laughable or ridiculous. He suggested that campaigns can be more effective if they involve a threat to significant others, especially children, or are made to seem 'offensive to small group norms' (45), that is, seen as deviant rather than paradoxical. Lowenstein attempted to understand the discrepancies between what people do and what it is in their self-interest to do by postulating the operation of 'visceral factors', drive states relating to hunger, fear, pain, sex and emotions. He suggested that the need to satisfy these drives can supersede virtually all other needs, and that people consistently fail to recognise the strength of the influence of visceral factors in themselves and in others, despite all previous experience and evidence to the contrary. One of the characteristics of visceral factors is the effect of time-shortening so that immediate gratification outweighs long-term goals. Attempts to exercise self-control are made when thinking long-term and usually at the expense of short-term gratification (Lowenstein 288). Although this concept of visceral influences explains some irrational behaviour, Lowenstein made little attempt to explain why some people seem to be more at the mercy of visceral factors than others. For this, it may be helpful to explore Cushman's concept of the 'empty self'. The Hungry 'Empty Self' Cushman (600) identified the configuration of the concept of self in the United States as having developed into an 'empty self ... a self that experiences a significant absence of community, tradition, and shared meaning. It experiences these social absences and their consequences 'interiorly' as a lack of personal conviction and worth, and it embodies the absences as a chronic, undifferentiated emotional hunger'. It is this notion of emotional hunger that may have particular relevance to a discussion of paradoxical behaviours generated by cravings. Cushman referred to a strong desire for consumer products to assuage this hunger, but it may be useful when thinking of health to consider the hunger more literally, as a need to ingest substances (drugs, alcohol, food etc) and experiences (shopping, sex, speed, etc) to fill up the emptiness. Emotional hunger may lead to a number of self-destructive but self-nourishing and addictive habits, identified by Firestone as psychological defences against anxiety. Cushman identified advertising as one of the two professions responsible for healing the empty self (the other was psychotherapy), while recognising that it is also one of the professions that perpetuates and profits from the psychopathology. Perhaps the responsibility falls to social marketing which is concerned with the marketing of ideas, attitudes and beliefs, including health and safety lifestyle issues. At present, it could be said that health promotion tends to make people feel bad (Henley & Donovan), with an emphasis on the dire consequences of unhealthy behaviours. Is it reasonable to suggest that social marketing could be used to try to heal the empty self? Interestingly, this is already happening to some extent. Mental health is a priority issue and a recent mental health campaign in Victoria, Australia, 'Together We Do Better', stresses the need for community and social connection. Western Australia is exploring whether to undertake a similar campaign. The campaign includes messages relating to friendship, parenting, talking about problems, bullying, sledging, and inter-generational communication (Campaign materials). The overall aim is to work towards a more inclusive, caring, connected and tolerant society. Conclusion This paper has discussed the apparent limitation of the current paradigm in health promotion that people are primarily motivated to protect themselves by considering the prevalence of paradoxical behaviours, that is behaviours that are harmful to the self, especially those that are generated by a need to satisfy cravings. One explanation for such paradoxical behaviours is that they are motivated by visceral factors relating to physical and emotional drives. However, this does not explain why some people are more susceptible than others. Cushman's concept of the hungry, empty self, alienated from community and disconnected from social traditions and meaning, may go further to explain why some people are more susceptible to cravings than others. Social marketing could play a helpful role in healing people's sense of isolation in mental health campaigns such as VicHealth's 'Together We Do Better'. Finally, it may be more intuitive to understand apparently paradoxical behaviour as an urgent attempt to heal the empty self. This would make it in a perverse way protective, though not healthy. This way, people are seen as doing the best they can to protect themselves against the most immediate threat to the self, a sense of hollowness and isolation. If so, the fact that this need is able to supersede other major health needs suggests that it is one of the most urgent imperatives of the self. References Apter, M.J. The Experience of Motivation: The Theory of Psychological Reversals. London: Academic Press, 1982. 'Campaign Materials.' Victoria Health 'Together We Do Better Campaign'. http://www.togetherwedobetter.vic.gov.au... [accessed 26 Aug. 2002]. Cushman, P. 'Why the Self is Empty: Toward a Historically Situated Psychology.' American Psychologist (1990, May): 599-611. Firestone, R. W. 'Psychological Defenses Against Death Anxiety.' Death Anxiety Handbook: Research, Instrumentation, and Application. Series in Death Education, Aging, and Health Care. Ed. R. A. Neimeyer. Washington, DC: Taylor & Francis, 1994. 217-241. Henley, N. & Donovan, R. Unintended Consequences of Arousing Fear in Social Marketing. Paper presented at ANZMAC Conference. Sydney, Nov. 1999. Janis, I. L. 'Effects of Fear Arousal on Attitude Change: Recent Developments in Theory and Experimental Research.' Advances in Experimental Social Psychology 3 (1967): 167-225. Janz, N. & M. Becker. 'The Health Belief Model: A Decade Later.' Health Education Quarterly 11 (1984): 1-47. Leventhal, H. 'Findings and Theory in the Study of Fear Communications.' Advances in Experimental Social Psychology 5. Ed. L. Berkowitz . New York: Academic Press, 1970. 119-86. Maddux, J. E. & R.W Rogers. 'Protection Motivation and Self-efficacy: A Revised Theory of Fear Appeals and Attitude Change.' Journal of Experimental Social Psychology 19 (1983): 469-79. Lowenstein, G. 'Out of Control: Visceral Influences on Behaviour.' Organisational Behaviour and Human Decision Processes. 65.3 (1996): 272-92. McGuire, W. J. 'Personality and Attitude Change: An Information-processing Theory.' Psychological Foundations of Attitudes. Ed. A. G. Greenwald, T. C. Brock, and T. M. Ostrom. New York: Academic Press, 1968. pp. 171-96. Rogers, R. W. & C.R. Mewborn. 'Fear Appeals and Attitude Change: Effects of a Threat's Noxiousness, Probability of Occurrence, and the Efficacy of Coping Responses.' Journal of Personality and Social Psychology 34.1 (1976): 54-61. Stuteville, J. R. 'Psychic Defenses against High Fear Appeals: A Key Marketing Variable.' Journal of Marketing 34 (1970): 39-45. Tanner, J. F., J.B. Hunt and D.R. Eppright. 'The Protection Motivation Model: A Normative Model of Fear Appeals.' Journal of Marketing 55 (1991): 36-45. van Deurzen-Smith, E. Existential Counselling in Practice. London: Sage Publications, 1988. Witte, K. 'Putting the Fear Back into Fear Appeals: The Extended Parallel Process Model.' Communication Monographs 59.4 (1992): 329-349. Links http://www.togetherwedobetter.vic.gov.au/resources/campaign.asp Citation reference for this article Substitute your date of access for Dn Month Year etc... MLA Style Henley, Nadine. "The Healthy vs the Empty Self" M/C: A Journal of Media and Culture 5.5 (2002). [your date of access] < http://www.media-culture.org.au/mc/0210/Henley.html &gt. Chicago Style Henley, Nadine, "The Healthy vs the Empty Self" M/C: A Journal of Media and Culture 5, no. 5 (2002), < http://www.media-culture.org.au/mc/0210/Henley.html &gt ([your date of access]). APA Style Henley, Nadine. (2002) The Healthy vs the Empty Self. M/C: A Journal of Media and Culture 5(5). < http://www.media-culture.org.au/mc/0210/Henley.html &gt ([your date of access]).

This article explores resilience as it is experienced by refugees in the context of a relational community, visiting the notions of trauma, a thicker description of resilience and the trajectory toward positive growth through community. It calls for going beyond a Western biomedical therapeutic approach of exploration and adopting more of an emic perspective incorporating the worldview of the refugees. The challenge is for service providers working with refugees (who have experienced trauma) to move forward from a ‘harm minimisation’ model of care to recognition of a facilitative, productive community of people who are in a transitional phase between homelands. Contextualising Trauma Prior to the 1980s, the term ‘trauma’ was not widely used in literature on refugees and refugee mental health, hardly existing as a topic of inquiry until the mid-1980’s (Summerfield 422). It first gained prominence in relation to soldiers who had returned from Vietnam and in need of medical attention after being traumatised by war. The term then expanded to include victims of wars and those who had witnessed traumatic events. Seahorn and Seahorn outline that severe trauma “paralyses you with numbness and uses denial, avoidance, isolation as coping mechanisms so you don’t have to deal with your memories”, impacting a person‘s ability to risk being connected to others, detaching and withdrawing; resulting in extreme loneliness, emptiness, sadness, anxiety and depression (6). During the Civil War in the USA the impact of trauma was referred to as Irritable Heart and then World War I and II referred to it as Shell Shock, Neurosis, Combat Fatigue, or Combat Exhaustion (Seahorn & Seahorn 66, 67). During the twenty-five years following the Vietnam War, the medicalisation of trauma intensified and Post Traumatic Stress Disorder (PTSD) became recognised as a medical-psychiatric disorder in 1980 in the American Psychiatric Association international diagnostic tool Diagnostic Statistical Manual (DSM–III). An expanded description and diagnosis of PTSD appears in the DSM-IV, influenced by the writings of Harvard psychologist and scholar, Judith Herman (Scheper-Hughes 38) The Diagnostic and Statistical Manual (DSM-IV) of Mental Disorders (American Psychiatric Association, 2000) outlines that experiencing the threat of death, injury to oneself or another or finding out about an unexpected or violent death, serious harm, or threat of the same kind to a family member or close person are considered traumatic events (Chung 11); including domestic violence, incest and rape (Scheper-Hughes 38). Another significant development in the medicalisation of trauma occurred in 1998 when the Victorian Foundation for Survivors of Torture (VFST) released an influential report titled ‘Rebuilding Shattered Lives’. This then gave clinical practice a clearer direction in helping people who had experienced war, trauma and forced migration by providing a framework for therapeutic work. The emphasis became strongly linked to personal recovery of individuals suffering trauma, using case management as the preferred intervention strategy. A whole industry soon developed around medical intervention treating people suffering from trauma related problems (Eyber). Though there was increased recognition for the medicalised discourse of trauma and post-traumatic stress, there was critique of an over-reliance of psychiatric models of trauma (Bracken, et al. 15, Summerfield 421, 423). There was also expressed concern that an overemphasis on individual recovery overlooked the socio-political aspects that amplify trauma (Bracken et al. 8). The DSM-IV criteria for PTSD model began to be questioned regarding the category of symptoms being culturally defined from a Western perspective. Weiss et al. assert that large numbers of traumatized people also did not meet the DSM-III-R criteria for PTSD (366). To categorize refugees’ experiences into recognizable, generalisable psychological conditions overlooked a more localized culturally specific understanding of trauma. The meanings given to collective experience and the healing strategies vary across different socio-cultural groupings (Eyber). For example, some people interpret suffering as a normal part of life in bringing them closer to God and in helping gain a better understanding of the level of trauma in the lives of others. Scheper-Hughes raise concern that the PTSD model is “based on a conception of human nature and human life as fundamentally vulnerable, frail, and humans as endowed with few and faulty defence mechanisms”, and underestimates the human capacity to not only survive but to thrive during and following adversity (37, 42). As a helping modality, biomedical intervention may have limitations through its lack of focus regarding people’s agency, coping strategies and local cultural understandings of distress (Eyber). The benefits of a Western therapeutic model might be minimal when some may have their own culturally relevant coping strategies that may vary to Western models. Bracken et al. document case studies where the burial rituals in Mozambique, obligations to the dead in Cambodia, shared solidarity in prison and the mending of relationships after rape in Uganda all contributed to the healing process of distress (8). Orosa et al. (1) asserts that belief systems have contributed in helping refugees deal with trauma; Brune et al. (1) points to belief systems being a protective factor against post-traumatic disorders; and Peres et al. highlight that a religious worldview gives hope, purpose and meaning within suffering. Adopting a Thicker Description of Resilience Service providers working with refugees often talk of refugees as ‘vulnerable’ or ‘at risk’ populations and strive for ‘harm minimisation’ among the population within their care. This follows a critical psychological tradition, what (Ungar, Constructionist) refers to as a positivist mode of inquiry that emphasises the predictable relationship between risk and protective factors (risk and coping strategies) being based on a ‘deficient’ outlook rather than a ‘future potential’ viewpoint and lacking reference to notions of resilience or self-empowerment (342). At-risk discourses tend to focus upon antisocial behaviours and appropriate treatment for relieving suffering rather than cultural competencies that may be developing in the midst of challenging circumstances. Mares and Newman document how the lives of many refugee advocates have been changed through the relational contribution asylum seekers have made personally to them in an Australian context (159). Individuals may find meaning in communal obligations, contributing to the lives of others and a heightened solidarity (Wilson 42, 44) in contrast to an individual striving for happiness and self-fulfilment. Early naturalistic accounts of mental health, influenced by the traditions of Western psychology, presented thin descriptions of resilience as a quality innate to individuals that made them invulnerable or strong, despite exposure to substantial risk (Ungar, Thicker 91). The interest then moved towards a non-naturalistic contextually relevant understanding of resilience viewed in the social context of people’s lives. Authors such as Benson, Tricket and Birman (qtd. in Ungar, Thicker) started focusing upon community resilience, community capacity and asset-building communities; looking at areas such as - “spending time with friends, exercising control over aspects of their lives, seeking meaningful involvement in their community, attaching to others and avoiding threats to self-esteem” (91). In so doing far more emphasis was given in developing what Ungar (Thicker) refers to as ‘a thicker description of resilience’ as it relates to the lives of refugees that considers more than an ability to survive and thrive or an internal psychological state of wellbeing (89). Ungar (Thicker) describes a thicker description of resilience as revealing “a seamless set of negotiations between individuals who take initiative, and an environment with crisscrossing resources that impact one on the other in endless and unpredictable combinations” (95). A thicker description of resilience means adopting more of what Eyber proposes as an emic approach, taking on an ‘insider perspective’, incorporating the worldview of the people experiencing the distress; in contrast to an etic perspective using a Western biomedical understanding of distress, examined from a position outside the social or cultural system in which it takes place. Drawing on a more anthropological tradition, intervention is able to be built with local resources and strategies that people can utilize with attention being given to cultural traditions within a socio-cultural understanding. Developing an emic approach is to engage in intercultural dialogue, raise dilemmas, test assumptions, document hopes and beliefs and explore their implications. Under this approach, healing is more about developing intelligibility through one’s own cultural and social matrix (Bracken, qtd. in Westoby and Ingamells 1767). This then moves beyond using a Western therapeutic approach of exploration which may draw on the rhetoric of resilience, but the coping strategies of the vulnerable are often disempowered through adopting a ‘therapy culture’ (Furedi, qtd. in Westoby and Ingamells 1769). Westoby and Ingamells point out that the danger is by using a “therapeutic gaze that interprets emotions through the prism of disease and pathology”, it then “replaces a socio-political interpretation of situations” (1769). This is not to dismiss the importance of restoring individual well-being, but to broaden the approach adopted in contextualising it within a socio-cultural frame. The Relational Aspect of Resilience Previously, the concept of the ‘resilient individual’ has been of interest within the psychological and self-help literature (Garmezy, qtd. in Wilson) giving weight to the aspect of it being an innate trait that individuals possess or harness (258). Yet there is a need to explore the relational aspect of resilience as it is embedded in the network of relationships within social settings. A person’s identity and well-being is better understood in observing their capacity to manage their responses to adverse circumstances in an interpersonal community through the networks of relationships. Brison, highlights the collective strength of individuals in social networks and the importance of social support in the process of recovery from trauma, that the self is vulnerable to be affected by violence but resilient to be reconstructed through the help of others (qtd. in Wilson 125). This calls for what Wilson refers to as a more interdisciplinary perspective drawing on cultural studies and sociology (2). It also acknowledges that although individual traits influence the action of resilience, it can be learned and developed in adverse situations through social interactions. To date, within sociology and cultural studies, there is not a well-developed perspective on the topic of resilience. Resilience involves a complex ongoing interaction between individuals and their social worlds (Wilson 16) that helps them make sense of their world and adjust to the context of resettlement. It includes developing a perspective of people drawing upon negative experiences as productive cultural resources for growth, which involves seeing themselves as agents of their own future rather than suffering from a sense of victimhood (Wilson 46, 258). Wilson further outlines the display of a resilience-related capacity to positively interpret and derive meaning from what might have been otherwise negative migration experiences (Wilson 47). Wu refers to ‘imagineering’ alternative futures, for people to see beyond the current adverse circumstances and to imagine other possibilities. People respond to and navigate their experience of trauma in unique, unexpected and productive ways (Wilson 29). Trauma can cripple individual potential and yet individuals can also learn to turn such an experience into a positive, productive resource for personal growth. Grief, despair and powerlessness can be channelled into hope for improved life opportunities. Social networks can act as protection against adversity and trauma; meaningful interpersonal relationships and a sense of belonging assist individuals in recovering from emotional strain. Wilson asserts that social capabilities assist people in turning what would otherwise be negative experiences into productive cultural resources (13). Graybeal (238) and Saleeby (297) explore resilience as a strength-based practice, where individuals, families and communities are seen in relation to their capacities, talents, competencies, possibilities, visions, values and hopes; rather than through their deficiencies, pathologies or disorders. This does not present an idea of invulnerability to adversity but points to resources for navigating adversity. Resilience is not merely an individual trait or a set of intrinsic behaviours that can be displayed in ‘resilient individuals’. Resilience, rather than being an unchanging attribute, is a complex socio-cultural phenomenon, a relational concept of a dynamic nature that is situated in interpersonal relations (Wilson 258). Positive Growth through a Community Based Approach Through migrating to another country (in the context of refugees), Falicov, points out that people often experience a profound loss of their social network and cultural roots, resulting in a sense of homelessness between two worlds, belonging to neither (qtd. in Walsh 220). In the ideological narratives of refugee movements and diasporas, the exile present may be collectively portrayed as a liminality, outside normal time and place, a passage between past and future (Eastmond 255). The concept of the ‘liminal’ was popularised by Victor Turner, who proposed that different kinds of marginalised people and communities go through phases of separation, ‘liminali’ (state of limbo) and reincorporation (qtd. in Tofighian 101). Difficulties arise when there is no closure of the liminal period (fleeing their former country and yet not being able to integrate in the country of destination). If there is no reincorporation into mainstream society then people become unsettled and feel displaced. This has implications for their sense of identity as they suffer from possible cultural destabilisation, not being able to integrate into the host society. The loss of social supports may be especially severe and long-lasting in the context of displacement. In gaining an understanding of resilience in the context of displacement, it is important to consider social settings and person-environment transactions as displaced people seek to experience a sense of community in alternative ways. Mays proposed that alternative forms of community are central to community survival and resilience. Community is a source of wellbeing for building and strengthening positive relations and networks (Mays 590). Cottrell, uses the concept of ‘community competence’, where a community provides opportunities and conditions that enable groups to navigate their problems and develop capacity and resourcefulness to cope positively with adversity (qtd. in Sonn and Fisher 4, 5). Chaskin, sees community as a resilient entity, countering adversity and promoting the well-being of its members (qtd. in Canavan 6). As a point of departure from the concept of community in the conventional sense, I am interested in what Ahmed and Fortier state as moments or sites of connection between people who would normally not have such connection (254). The participants may come together without any presumptions of ‘being in common’ or ‘being uncommon’ (Ahmed and Fortier 254). This community shows little differentiation between those who are welcome and those who are not in the demarcation of the boundaries of community. The community I refer to presents the idea as ‘common ground’ rather than commonality. Ahmed and Fortier make reference to a ‘moral community’, a “community of care and responsibility, where members readily acknowledge the ‘social obligations’ and willingness to assist the other” (Home office, qtd. in Ahmed and Fortier 253). Ahmed and Fortier note that strong communities produce caring citizens who ensure the future of caring communities (253). Community can also be referred to as the ‘soul’, something that stems out of the struggle that creates a sense of solidarity and cohesion among group members (Keil, qtd. in Sonn and Fisher 17). Often shared experiences of despair can intensify connections between people. These settings modify the impact of oppression through people maintaining positive experiences of belonging and develop a positive sense of identity. This has enabled people to hold onto and reconstruct the sociocultural supplies that have come under threat (Sonn and Fisher 17). People are able to feel valued as human beings, form positive attachments, experience community, a sense of belonging, reconstruct group identities and develop skills to cope with the outside world (Sonn and Fisher, 20). Community networks are significant in contributing to personal transformation. Walsh states that “community networks can be essential resources in trauma recovery when their strengths and potential are mobilised” (208). Walsh also points out that the suffering and struggle to recover after a traumatic experience often results in remarkable transformation and positive growth (208). Studies in post-traumatic growth (Calhoun & Tedeschi) have found positive changes such as: the emergence of new opportunities, the formation of deeper relationships and compassion for others, feelings strengthened to meet future life challenges, reordered priorities, fuller appreciation of life and a deepening spirituality (in Walsh 208). As Walsh explains “The effects of trauma depend greatly on whether those wounded can seek comfort, reassurance and safety with others. Strong connections with trust that others will be there for them when needed, counteract feelings of insecurity, hopelessness, and meaninglessness” (208). Wilson (256) developed a new paradigm in shifting the focus from an individualised approach to trauma recovery, to a community-based approach in his research of young Sudanese refugees. Rutter and Walsh, stress that mental health professionals can best foster trauma recovery by shifting from a predominantly individual pathology focus to other treatment approaches, utilising communities as a capacity for healing and resilience (qtd. in Walsh 208). Walsh highlights that “coming to terms with traumatic loss involves making meaning of the trauma experience, putting it in perspective, and weaving the experience of loss and recovery into the fabric of individual and collective identity and life passage” (210). Landau and Saul, have found that community resilience involves building community and enhancing social connectedness by strengthening the system of social support, coalition building and information and resource sharing, collective storytelling, and re-establishing the rhythms and routines of life (qtd. in Walsh 219). Bracken et al. suggest that one of the fundamental principles in recovery over time is intrinsically linked to reconstruction of social networks (15). This is not expecting resolution in some complete ‘once and for all’ getting over it, getting closure of something, or simply recovering and moving on, but tapping into a collective recovery approach, being a gradual process over time. Conclusion A focus on biomedical intervention using a biomedical understanding of distress may be limiting as a helping modality for refugees. Such an approach can undermine peoples’ agency, coping strategies and local cultural understandings of distress. Drawing on sociology and cultural studies, utilising a more emic approach, brings new insights to understanding resilience and how people respond to trauma in unique, unexpected and productive ways for positive personal growth while navigating the experience. This includes considering social settings and person-environment transactions in gaining an understanding of resilience. Although individual traits influence the action of resilience, it can be learned and developed in adverse situations through social interactions. Social networks and capabilities can act as a protection against adversity and trauma, assisting people to turn what would otherwise be negative experiences into productive cultural resources (Wilson 13) for improved life opportunities. The promotion of social competence is viewed as a preventative intervention to promote resilient outcomes, as social skill facilitates social integration (Nettles and Mason 363). As Wilson (258) asserts that resilience is not merely an individual trait or a set of intrinsic behaviours that ‘resilient individuals’ display; it is a complex, socio-cultural phenomenon that is situated in interpersonal relations within a community setting. References Ahmed, Sara, and Anne-Marie Fortier. “Re-Imagining Communities.” International of Cultural Studies 6.3 (2003): 251-59. Bracken, Patrick. J., Joan E. Giller, and Derek Summerfield. Psychological Response to War and Atrocity: The Limitations of Current Concepts. 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The capacity to adapt to disability and assist others with disability may have an evolutionary origin. De Waal (1996) describes assistance to an injured group member among primates as evidence of altruistic behavior. Mother monkeys will provide additional care to compensate for injuries, and other members of the group may “babysit” injured infants, as do other young of the group. If the risk of predation is low and food is adequate, handicapped animals may live to adulthood. In human evolution, Berkson (1993) described an adult Neanderthal male with severe arm and head injuries that occurred at an early age. Apparently, this individual adapted to the injury by using his teeth to hold objects. Other conditions, such as disabling arthritis, were found in Neanderthals as well. Thus, individuals with minor or even significant impairments in primate and human societies before the evolution of modern humans, in some instances, received adaptive assistance from other members of the group. Drawing on these possible evolutionary origins of assistance to others in need, this chapter reviews the historical background of care for persons with intellectual disability and discusses environmental provisions and supports, education and skill development, normalization and self-determination, and interventions for those with co-occurring mental and behavioral disorders (psychotherapy, behavioral interventions, and psychopharmacologic treatments). The modern developmental approach to understanding learning and development began with Jean Itard, at the end of the eighteenth century. As a member of the medical staff at the Institute for Deaf Mutes in Paris, he considered the link between deafness and learning. Because of this background, he was asked to study a feral child discovered living alone in the wild in southern France. It was thought that this boy might approximate “man in the state of nature.” Because the child was mute, he entered a school for the deaf in Paris although he was not deaf. Pinel (1809), the leading psychiatrist of the time, proposed that the boy, named Victor, was not teachable. Yet Itard, during the next five years, sought to instruct Victor, using approaches established for deaf persons.