Group treatment of traumatized Cambodian women: a culture-specific approach.

Over the past 20 years, nearly 150,000 Cambodian refugees have relocated to the United States. Refugees differ from immigrants in several important ways. Whereas refugees leave their countries of origin against their will because of political or religious persecution, immigrants usually decide to relocate for economic reasons. More often than not, refugees experience dangerous conditions over the course of their travels, whereas immigrants can usually plan their travel more safely (Drachman, 1995; Fong & Mokuau, 1994; Potocky & McDonald, 1995). As refugees, most Cambodians were subjected to multiple traumatic experiences before their arrival in the United States. Empirical studies reported that Cambodian women experienced the most extensive trauma (Carlson & Rosser-Hogan, 1993; Mollica, Wyshak, & Lavelle, 1987; Rozee & VanBoemel, 1989). These women were victims of physical violence, often of a sexual nature, perpetrated by their fellow citizens. They were exposed to multiple forms of emotional abuse, torture, and forced labor (Bernier, 1992; Bromley, 1987; Lee & Lu, 1989). Many witnessed the deaths or executions of their husbands, and most lost at least one, and often several, of their children. Extended kinship networks, so much a part of their cultural heritage and their everyday functioning, were destroyed. Consequently, many of these women developed serious psychosocial and psychological problems, often manifested in physical complaints. However, symptoms frequently did not appear until after initial resettlement tasks were accomplished. Only then did the awareness of the depth of losses become apparent and grief and sadness settle in (Beiser, 1988; Beiser, Turner, & Ganesan, 1989; Eisenbruch, 1991). Simultaneously, the women were faced with adjusting to the demands of a new and foreign environment. Opportunities to regain prior levels of psychosocial functioning and economic self-sufficiency were, and continue to be, hindered by postmigration stressors. Such stressors include learning a new language, adjusting to new roles, learning new skills, and entering mainstream vocational and educational programs (Bernier; 1992; Chung & Bemak, 1996; Nicholson, 1997; Pernice & Brook, 1996). Thus, difficulties stemming from both pre- and postmigration stressors are an integral part of the current experiences of dislocated Cambodian women. Many suffer from anxiety, depression, and posttraumatic stress disorder (PTSD) as well as other mental health problems (Bromley, 1987; Carlson & Rosser-Hogan, 1993, 1994; Mollica et al., 1987; Nicholson, 1997; Sundquist & Johansson, 1996). These women may need mental health services that often are underused because of language barriers and differences between U.S. and Cambodian values (Canda & Phaobtong, 1992; LeDoux & Stephens, 1992; Strober, 1994). Because there is no comparable human services system in Cambodia, most Cambodians view requesting human services as an inappropriate and shameful solution to problem solving (Bromley, 1987; McQuaide, 1989; Nicholson, 1989). Therefore, the challenge for human services practitioners is to innovate, refine, and advance therapeutic interventions that will enhance the effectiveness of service delivery for this "at-risk" population. This article describes the development and implementation of a culturally sensitive group intervention program based on the needs of Cambodian women. Many were isolated, lacked family supports, and were deprived of normal socialization and peer group relationships. Consequently, we, the group leaders - an American social worker and a bilingual Cambodian social worker - believed that a structured support group would allow the women to begin to rebuild their lives with the help of others who shared common ties to their past and to their homeland. A strengths perspective was coupled with theoretical constructs from social constructivism to enhance internal feelings of safety and security, increase feelings of empowerment, aid in the acculturation process by emphasizing both client and community strengths, and link the women with ethnic community support (Boehnlein & Kinzie, 1995; Fong & Mokuau, 1994; Strober, 1994). …