Moroccan Women In Psychotherapy2009


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Moroccan Women In Psychotherapy2009

  1. 1. Moroccan women in the Netherlands in psychotherapy
  2. 2. Content lecture <ul><li>Numbers: population </li></ul><ul><li>Backgrounds </li></ul><ul><li>Clinical vignettes </li></ul><ul><li>Conclusions </li></ul>
  3. 3. Population in NL, in 1000s (1.1.2007) (C.B.S., 2007) 1,432 845 587 Western ‘allochtoon’ 1,738 723 1,015 Non-Western ‘allochtoon’ 13,184 ‘ Autochtoon’ (Dutch) 16,354 Total Total Second generation First generation
  4. 4. Population in NL, in 1000s (1.1.2007) 390 264 126 Indonesia 74 27 46 Latin Am. 312 91 222 Asia 192 72 119 Africa 129 51 79 Neth.Ant. 333 147 186 Surinam 329 161 168 Morocco 369 173 195 Turkey Total Second gener First gener origin
  5. 5. Prognosis population (2015) 1,525 870 655 Western ‘allochtoon’ 1,930 894 1.036 Non-western ‘allochtoon’ 13,141 ‘ Autochtoon’ (Dutch) 16,595 Total Total Second generation First generation
  6. 6. Moroccans in the Netherlands (1.1.2007) (1 st and 2 nd generation) 329 total 159 females 170 males
  7. 7. Use of mental health care by migrants (Dieperink et al) 59/1000 2004 28/1000 1990
  8. 8. Use of mental health care by migrants (Dieperink et al)-2 <ul><li>Lowest use: </li></ul><ul><li>Moroccan women </li></ul><ul><li>Highest use: </li></ul><ul><li>Moroccan men </li></ul><ul><li>Explanations: percieved mental health, help-seeking behaviour (stigma), referral policy of general doctors. In males: more forced admissions. </li></ul>
  9. 9. Cultural aspects in Moroccan women in psychotherapy <ul><li>Education level differences with their partners </li></ul><ul><li>Influence of extended family and social group in decision making </li></ul><ul><li>Support of family members </li></ul><ul><li>Somatization </li></ul><ul><li>Influence of folk beliefs (demons, magic, evil eye) </li></ul><ul><li>Taboo items: abortion, homosexuality </li></ul><ul><li>Secondary gain: illness benefits </li></ul>
  10. 10. Educational level differences <ul><li>Difference in upbringing: boys more freedom than girls </li></ul><ul><li>Girls put much effort in prolonged education </li></ul><ul><li>Result: women higher level of education than men </li></ul><ul><li>Even higher difference between women brought up in NL with men from Morocco. In those relation also cultural differences. </li></ul>
  11. 11. Influence of group <ul><li>Group (family, social/ethnic group) gives support but also exerts control on behavior. </li></ul><ul><li>Traditional role models (woman as mother, head of household) are more pronounced </li></ul><ul><li>Divorce, choice for profession rather than having children discouraged. </li></ul><ul><li>Risk on expulsion in case of uncommon decisions </li></ul>
  12. 12. Somatization <ul><li>Not higher than in comparable groups (social and educational level) </li></ul><ul><li>Difficult to treat </li></ul>
  13. 13. Influence of folk beliefs (Hermans, 2007) <ul><li>Not spontaneously uttered in psychotherapy </li></ul><ul><li>Demons ( jnun ): own world, sometimes connection with human world. Treatment: exorcism. </li></ul><ul><li>Magic ( siher ): often because of jealousy, malignancy (husband, stepmother). Treatment: contramagic </li></ul><ul><li>Evil eye ( l ayn ): need of protection, specially with young children. </li></ul>
  14. 14. Taboo items <ul><li>Not spontaneously told. </li></ul><ul><li>Discussions about it only in trusting therapeutic relationships. </li></ul><ul><li>Virginity till marriage only for women </li></ul><ul><li>Homosexuality great taboo item </li></ul>
  15. 15. Illness benefits (secondary gain) <ul><li>Difficult to detect </li></ul><ul><li>In cases of bad improvement </li></ul><ul><li>Institutional or personal rules about letters to others, statements et cetera are important. </li></ul>
  16. 16. Clinical vignette 1 <ul><li>25-year old university student </li></ul><ul><li>Poor family: no respect for education </li></ul><ul><li>Identity problems: not Dutch, not Moroccan, not real muslim. </li></ul><ul><li>Guilt feelings about relationship with teacher </li></ul><ul><li>Psychodynamic therapy directed on building new identity </li></ul>
  17. 17. Clinical vignette 2 <ul><li>32 year old woman, married, two children </li></ul><ul><li>Bad relationship with husband (‘disappeared husband’) but no possibilities for marriage counseling </li></ul><ul><li>Fear for jnun . </li></ul><ul><li>Social support, but with restrictions: constant discussion with family about good and bad. </li></ul><ul><li>Demand for medication for somatic complaints </li></ul><ul><li>Supportive psychotherapy </li></ul>
  18. 18. Conclusions <ul><li>Psychotherapy feasible </li></ul><ul><li>Knowledge about social, cultural and ethnic background necessary </li></ul><ul><li>Psychotherapy as a learning experience from both sides </li></ul>