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A Clinical Psychology and Health Approach Anuario de Psicología Clínica y de la Salud / Annuary of Clinical and Health Psychology, 4 (2008) 33-43 TEN NOTEWORTHY REFERENCES ABOUT IMMIGRATION: A clinical psychology and health approach María Luisa Avargues Navarro & Mª Carmen Orellana Ramírez Departamento de Personalidad, Evaluación y Tratamiento Psicológicos. Universidad de Sevilla (España). INTRODUCTION simple and unanimous, as is shown by the open debate From the 1970s onwards Spain stopped being about the association between the migration process and a mainly migrating country and became a recipient of the development of some psychopathologies. The immigrants, which brought about a big increase in findings of the studies conducted in Europe and the population over the last few years. So much so that, United States do not come to categorical conclusions according to the Observatorio Permanente de la and so the direct relationship between migration and Inmigración (The Permanent Observatory of mental health is increasingly open to question. Where Immigration), 4,274,821 foreigners had a registered they do seem to coincide is in the role that some risk residence certificate or a residence card in September factors might play in the stress related to immigration, 2008 (Ministerio de Trabajo e Inmigración, 2008), to in cultural differences or in perceived discrimination, which one has to add the large number of foreign among other variables (see Collazos, Qureshi, Antonín people in an illegal situation. and Tomás-Sábado, 2008). A number of studies make it The increase of the migrant population demands of any evident that immigration itself does not increase the risk receiving society an effort to adapt through political, of suffering from some mental diseases, but they are economic, structural, cultural and/or educational rather linked, above all, to adaptative psychological changes. Furthermore, we should not forget about the experiences during the migration process (Achotegui, adaptative task (including implicit psychological 2002). changes) for the immigrant, who faces a new situation In addition to this, we need to bear in mind which is sometimes traumatic or stressful. As stated by that in spite of the interest that the study of immigration Moya and Puertas (2008), each migrating process from a clinical perspective has aroused among implies putting at least two different cultures or professional psychologists over the last few years, there subcultures in touch, which is known as is still a long way to go. Bardají (2006) shows that there “acculturation”. Two levels can be distinguished in is an abundant bibliography about mental health and such a process, namely group acculturation, with immigration in Spain and also about many issues changes in the political, demografic or educational associated to immigration in general. But many of those fields, among others, and individual or ‘psychological’ works are either studies revising existing literature, acculturation, which refers to the psychological changes typically from international fields, or essays and other manifested by the individual as a result of the theoretical approaches for reflection and debate which, acculturation. in spite of their relevance due to their clinical For this reason, it is hardly surprising that the importance, since they often start from real migratory phenomenon has become an interesting therapeutical experiences with immigrants, show lack object of study for professional psychologists, both for of empiric support and are very general. In the same those engaged in psychosocial aspects, which deal with way, Gimeno-Bayón (2007) reviews the national the study of prejudice, racism, xenophobia, integration literature on psychotherapy with immigrants and or networks of social support, and for those interested denounces, first, the preponderance of studies in clinical perspectives, (studies on anxiety, stress, conducted from a sociological or anthropological emotional control or self-control, etc). To be precise, approach to the detriment of psychological and, even the clinical focus advocates the need to acquire better more so, from psychotherapeutical perspectives, and, knowledge of those processes implied in the second, for the lack of consensus and accuracy when relationship between health in general and immigration dealing with the conceptual definition of the terms and mental health in particular. Even more so, if we studied. In consequence, there are not many studies bear in mind that these relationships are not always analyzing samples of immigrants living in Spain Avargues & Orellana: Ten noteworthy references about immigration. A clinical psychology and health approach beyond the descriptive studies of very specific groups From all the above comes the need to keep who use some health centres or institutions which are working in this field in order not only to understand interested in the population that they deal with. causes and consequences better, but also to provide Studying the migration experience as the human professionals with tools that allow them to carry out experience that it is, implicitely entails the need to learn efficient intervention both in the immigrant group as a about the specific contextual dimension in which it whole and in those people who receive them. develops, in order to understand it thoroughly, without This review seeks to show ten references from being satisfied with the automatic translation of the scientific literature which can be useful for clinical phenomena found in other countries where migration is psychology and health professionals. It has been carried a tradition, such as the United States of America or out starting from national and international databases of France in Europe. psychology and health sciences (Psycodoc, PsycInfo, The need to increase research for purely Medline) as well as from on-line scientific literature academic reasons is evident. But what practical available to any professional. The selection of the ten usefulness does this type of specific clinical research on references shown here has been carried out on the basis immigrants provide and justify? Why study mental of the following criteria: health specifically on immigrants? Should specific Current. We have intended to select current up-to- reflection on assessment, diagnosis, treatment and date works. For this reason, most of them are therapy and so on, be adapted to the immigrant studies published over the last five years, except for population beyond the mere adaptation to the language two of them, which are earlier but are classical of the user? These questions with obvious answers do works on still current themes which may contribute not seem to be obvious if we look critically at the very important thoughtful ideas, given the situation current scene. For example, Achotegui (2008) states of present-day Spanish research. that the World Health Organization itself has no mental Context. From our point of view, as previously health programmes for immigrants. Gimeno-Bayón stated, immigration in Spain has enough of weight (2007) hints that the psychological attention to the in itself to be dealt with as a single subject theme immigrant offered by her team (Asociación Oasis de (besides the importance of studying it in its Ayuda Psicológica al Inmigrante, The Oasis environmental context). However, our work has Association of Psychological Attention to the also selected three international studies for two immigrant) was initially regarded by a number of reasons. First, as mentioned above, because there institutions as an ‘inopportune luxury to reject’. We are still few empirical studies carried out from a believe that it is important to think over these and other clinical approach which meets the parametres difficulties to develop this field of research, which required by the scientific community. Second, promotes a critical analysis not only of the current because international literature widens the situation in Spain but also of the positive and negative perspective of the main research lines associated aspects of the experience undergone in other countries with immigration currently being developed in the with more expertise on the issue. field of psychology of health and, precisely, in its In order to support this project, it might not be clinical aspect, even though they do not exhaust the banal to make, even briefly, the relationships between wide range of research lines or studies. research interest and practical interest explicit. The lack In any case, we seek to represent a collection of consideration for the psychological health of the of works which provide relevant concepts concerning immigrants may bring about consequences which migration which are especially useful for professional surpass the internalization and externalization of some psychologists interested in the subject matter. In individual problems as are the emergencies of real particular, we have intended to collect works social pathologies. An extreme case is illustrated by representive of the following lines of study and thought serious social conflicts which may be labelled as racist; that are open today, both in the national and and other forms of inter-group violence. Evidence of international spheres, with the aim of providing this are the banlieu riots in France (Achotegui, 2007) possible answers to the reader. and other more present-day uprisings lead by the The first block includes just one work, which population of immigrant origin, especially by the reviews and summarizes the main
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