Psychotherapy with refugees-Supportive and hindering elements.

Globally, nearly 80 million people are forcibly displaced. Being a refugee can impact one's mental health profoundly. Although specific approaches for psychotherapy with refugees have been developed, this study is the first to investigate psychotherapy with refugees in Brazil. Semi-structured interviews were conducted with 18 psychotherapists in Brazil and analysed using consensual qualitative research and thematic analysis. Supportive and hindering elements in psychotherapy with refugee patients in Brazil were identified at eight different levels: the patient, the therapist, their relationship, the setting, the psychotherapeutic approach, the context of the patient, the context of the therapist and the societal context in Brazil. Hindering elements in the therapy include missing preparation for the integration of refugees, lack of interpreters, patients' mistrust and therapists feeling untrained, helpless and becoming overinvolved. Supportive elements include a trusting therapeutic relationship, therapists' cultural humility and structural competence, patients' societal inclusion as well as working with groups and networks. This study shows that in light of the enormous structural challenges for the mental wellbeing of refugee patients, therapists' flexibility and the reliance on collective work and networks of support is crucial. Future research might investigate in more detail notions of collectivity-based mental healthcare in intercultural therapy settings.