Running head: ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 1

Adlerian Approaches and Developmental Adaptations Among the Bosnian Population

A Literature Review

Presented to

The Faculty of Adler Graduate School

______

In Partial Fulfillment of the Requirements for

The Degree of Master of Arts in

Adlerian Counseling and Psychotherapy

______

By

Dzenita Subasic

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Chair: Rachelle Reinisch, DMFT

Reader: Meg Whiston, PhD

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December 2018

ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 2

Abstract

The purpose of this literature review is to show the importance of cultural competency in a way that connects Adlerian approaches with the Bosnian Muslim culture. The Bosnian Muslim culture and the distinctive concepts and techniques of Adlerian theory are examined. Given the lack of research on the Bosnian refugees’ resettlement process, the information in this review is used to demonstrate the environmental factors, ethnic identity, and mental health of the Bosnian culture. Through a variety of Adlerian approaches, a Bosnian refugee can benefit by learning about themselves through encouragement and empowerment; therefore, this increased knowledge will improve the Bosnian refugee’s sense of belonging.

Keywords: refugee, Bosnian Muslims, Adlerian, Individual Psychology

ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 3

Acknowledgments

This work is dedicated to my strong, courageous, Bosnian husband, mother, father, and brother, Meris, Hedija, Ahmet, and Haso. My acknowledgement would be incomplete without thanking the biggest source of my strength – these four incredible individuals. I thank them for providing the support that allowed me to reach this stage in my life. It would not have been possible without the immeasurable support, unconditional love, and constant encouragement each person has provided throughout this process. They have cherished with me every great moment and encouraged me whenever I needed it. You all gave me the courage to pursue my goals and inspired me to create a voice for the Bosnian culture, which instilled within me a deep- rooted sense of empathy toward others. This literature review is also dedicated to all refugees who experienced such unsettling events in their journey to safety. I honor your courageousness.

ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 4

Table of Contents Bosnian Refugees in the United States ...... 5 Bosnian Experience and Cultural Competence...... 7 The Dayton Agreement ...... 10 Children of the Refugees ...... 11 Third Culture Kids ...... 12 Mental Health Challenges ...... 13 Adlerian Techniques with Children ...... 13 Mental Health Assessments ...... 14 Social Meaningfulness ...... 15 Dissociation...... 16 Environmental Considerations ...... 17 Bosnian Women and Mental Health ...... 18 Islamic Roles ...... 19 The Invisible Muslim ...... 21 Adlerian Psychotherapy and Individuality...... 22 Adlerian Family Therapy ...... 23 Family Atmosphere ...... 24 Birth Order ...... 24 Multicultural Counseling ...... 25 Self-Development through Adlerian Concepts ...... 25 Social Interest...... 26 Lifestyle ...... 27 Life Tasks...... 29 Mistaken Beliefs ...... 31 Private Logic ...... 31 Creative Self...... 32 Connections and Discussion ...... 32 Encouragement ...... 33 Expressing Encouragement with Refugees ...... 34 Empathy ...... 34 Expressing Empathy with the Bosnian Population ...... 35 Summary ...... 36 Recommendations for Future Research ...... 36 Limitations of Adlerian Psychology ...... 37 Strengths of Adlerian Psychology ...... 37 References ...... 39

ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 5

Adlerian Approaches and Developmental Adaptations Among the Bosnian Population

The Republic of Bosnia and Herzegovina declared independence in 1992 and broke away from Yugoslavia and triggered a conflict that resulted in the largest massacre in Europe since the

Holocaust. The 1992–1995 genocide in Bosnia and Herzegovina required many Bosnians to resettle to other parts of Europe and the United States, with each person having to adapt to a new world and their surroundings. Nearly half the population of Bosnia and Herzegovina was displaced (Lippman, 2015). Unlike immigrants who choose to leave their country, Bosnians became refugees in order to survive while struggling to build a new life. Countless Bosnians faced numerous traumatic events because of the war, including the destruction of communities and the loss of families – displaced from a war-torn country (Matsuo et al., 2014). Many witnessed the death of loved ones, lost family members, experienced mass rape, endured psychological trauma, physical suffering, remained exposed to dead bodies, and encountered merciless imprisonment (Craig, Sossou, Schnak, & Essex, 2008). The impact of the war left many individuals with difficulties to adjust to the new surroundings. Some individuals needed to deal with mental-health related concerns through numerous adjustments and difficulties with their identities. Mental health professionals must increase multicultural competency when working with the refugee population. Specifically, an increased awareness of the Bosnian culture and the impact of immigration can foster improved therapeutic outcomes. Working with refugees through the lens of Individual Psychology offers a framework connection.

Bosnian Refugees in the United States

In March 1992, Bosnia declared its independence (Al-Ali, 2002), although much of the

Bosnian Serb population rejected the results of the election. This rejection of the election outcome essentially resulted in the outbreak of war a month after declaration (Al-Ali, 2002). In ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 6

1995, the war ended after three years of brutal and inhuman conflict with The Dayton Agreement

(Bal, 2012). The genocide in Bosnia and Herzegovina created significant damage to the country and it is estimated that at least 250,000 citizens were killed (Craig et al., 2008) and more than two million people were forced to flee the country during the war and after. Many of the people forced to flee the country became refugees.

Resettling in the United States is not an easy process, and many refugees experienced numerous mental and physical health problems. In the United States, St. Louis, Missouri was one of the cities Bosnians preferred for relocation. Many Bosnian families preferred to move to

St. Louis due to available job opportunities in the 1990s as well as the lower cost of living

(Matsuo et al., 2014). At present, anywhere from 50,000 to 60,000 Bosnians call St. Louis their home, making the Bosnian language the second most-spoken foreign language in the city

(Cheah, Karamehic-Muratovic, & Matsuo, 2013). Nevertheless, in the United States, refugees can apply for permanent residency after living in the country for about one year.

Many refugees from Bosnia, Croatia, Serbia, and Kosovo have resettled in the United

States. According to Craig et al. (2008), roughly 10,000 individuals resettled to the southern states. Clemetson (2017) reported 9,000 Bosnians were located in the impoverished communities in the north side of Chicago during the resettlement. Furthermore, Snyder, May,

Zulcic, and Gabbard (2005) reported 3,500 Bosnian refugees who migrated to Bowling Green,

Kentucky.

According to Plante, Simicic, Andersen, and Manuel (2002) resettlement refers to learning a new language and adapting to the community and its cultural values, many of which are greatly different from their Bosnian culture of origin. This causes psychological stressors because of experience with poverty, difficulty with shelter, language barriers, loss of family and ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 7 community, and unemployment (Craig et al., 2008). The overall experience of the war directly resulted in conditions that led people to experience trauma and emotional suffering.

Bosnians experienced significant transformations of legal residency when arriving to the

United States. The United States allowed Bosnian refugees to gain employment, travel throughout the country to find acceptable living conditions, and were also encouraged to become

U.S. citizens after about 1-5 years of residence (Franz, 2003). In Franz’s (2003) sample study, women’s participation in low-skill labor seemed to be the only choice for many families in the short-term and long-term. On the other hand, many of the male refugees worked in harsh conditions. Generally, both male and female Bosnian refugees worked in lower-level positions than what they held in Bosnia, and discrimination in employment continues to be one of the most problematic hurdles for refugees to return to their homes (Hadzic, 2007). The individuals who return to Bosnia often face discrimination and fail to find jobs.

Bosnian Experience and Cultural Competence

Bosnia-Herzegovina is located on a peninsula in the southeastern portion of Europe

(Snyder et al., 2005) known as The Balkans and is part of the former Yugoslavia. This peninsula is comprised of the republics of Bosnia-Herzegovina, Croatia, Kosovo, Montenegro, Macedonia,

Serbia, and Slovenia (Snyder et al., 2005).

According to Snyder et al. (2005), it is imperative to approach Bosnian families and children with cultural competency. Cultural competence is a fundamental obligation for working with diverse individuals in order to provide quality care (Alizadeh & Chavan, 2016). Snyder et al. (2005) stated it is important to be respectful and mindful of tradition when entering a Bosnian home. For example, guests must remove their shoes when greeted at the door and be willing to accept Bosnian coffee (often times strong coffee) or other beverages and pastries. Bosnians ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 8 enjoy traditional music and folk dances, especially with cultural celebrations. According to

Snyder et al. (2005) it is essential to respect older adults and safeguard children.

Most Bosnian families abide by a strict set of roles and rules such as keeping issues private, and they will not speak publicly on any issue that may bring shame upon the family

(Snyder et al., 2005). According to Synder et al. (2005), mental health services were available in

Bosnia; however, mental health services were stigmatized by the Bosnian culture, which has continued with Bosnian families as they resettled to different countries. Bosnian Muslims, particularly males, display a positive appearance with family roles and view helplessness as a symbol of weakness (Snyder et al., 2005). Additionally, Al-Ali (2002) stated Bosnian refugees displayed a sense of positivity toward the people that persisted in Bosnia. For example, Bosnian refugees would often send money and donate to Bosnian communities.

Therapists ought to consider that developing cultural competencies is a lifetime expedition, and when therapists work with Bosnian families, they should respect cultural values and family relationships, which may involve altering how therapists view relationships. Overall, a Bosnian Muslim wants to be accepted and therapy can do just that:

Social services must aspire to restore the psychological health and dignity of these

families and children, who have seen the worst side of human nature. Helping them

establish a positive self-image is critical to their success. While the genocide of family

members and violent acts can never be forgotten, surrounding Bosnian Muslim refugees

with a network of positive, supportive services can help them establish a solid foothold in

the United States. (Snyder et al., 2005, p. 626)

Many cultures around the globe have dealt with the worst side of human nature, and some still experience the unfortunate aftermath within current and past communities. When working ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 9 with immigrant families, the therapist must be mindful of the developmental changes that the clients are experiencing since migrating from their heritage culture and keep in mind that language barriers will emerge when communicating with the Bosnian families.

The overall meaning for cultural competence is not only the knowledge, attitudes, and skills necessary to work effectively in intercultural circumstances, but also the eagerness to understand, and the readiness to accept, that there are many world views (Phillips, 2009). When immigrants seek therapy, the cultural competence of the therapist will have an impact on the counseling experience and how immigrants view therapy in general. According to Rogers-Sirin,

Melendez, Refano, and Zegarra (2015), the importance of culturally-competent therapy has been strongly accentuated. In 1992, the American Counseling Association (ACA) published 13 specific multicultural competencies endorsed by the ACA, and multicultural training has become mandatory; however, insufficient information exists regarding immigrants’ mental health needs

(Rogers-Sirin et al., 2015). There are many barriers that immigrants experience, such as lack of information on how to obtain services and navigate their new environment (Rogers-Sirin et al.,

2015).

Immigrants cope with many barriers as they leave friends, family, and well-known cultural norms behind them. According to Roger-Sirin et al. (2015), immigrants are adjusting to a new language, culture, and social environment, and in some cases, they experience prejudice and discrimination. Sue (2010) discussed discrimination and microaggressions (i.e., indirect, subtle, or unintentional discrimination against people of a racial or ethnic minority) and stated they can be confusing for the client as they may be unclear about the racism. The client frequently questions why they are treated in a certain way and wonder if it is just something in their heads. In addition to awareness of the barriers immigrants may encounter, greater emphasis ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 10 should be placed on the stages of migration, scattering and loss of family members, and war stressors (Phillips, 2009). Increased competence ensures that the therapist will have a better understanding of the client, which contributes to a more helpful, productive, and proficient therapeutic process.

The Dayton Agreement

The Dayton Agreement ended the Bosnia Conflict and has been mentioned as a prospective model by Western politicians around the globe, especially for those presently looking particularly at Syria, Ukraine, and Iraq (Gilbert & Mujanović, 2015). The general framework for the agreement was for peace, and it was signed by the presidents of the countries involved in the conflict: Bosnia-Herzegovina, Serbia, and Croatia; however, the agreement was negotiated and proposed by the European Union (especially Great Britain, France, and Germany) with the assistance of United States and Russia (Hadzic, 2007).

The Dayton Agreement is associated with the end of the Bosnian War, but it did not bring stability and rehabilitation to the country (Bal, 2012). For many individuals living in, or immigrating from, Bosnia and Herzegovina, the agreement is viewed as the political directive of inequality (Gilbert & Mujanović, 2015). Nevertheless, according to Hadzic (2007), freedom of movement has remained possibly the most positive aspect of the Dayton Agreement. Now, almost 20 years since the Dayton Agreement, an assortment of endeavors have been in place to assist families. The challenge today is selecting the families who most need the assistance

(Mayne, 2015).

According to Hadzic (2007), the United Nations refugee agency (UNHCR) reported that more than one million of the two million citizens who escaped their homes in Bosnia in 1992 returned by 2004. These numbers may be far from the actual indicator of what is happening in ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 11

Bosnia. Many of the registered refugees have returned only to go back to their place of asylum due to the destruction and the living conditions of the country (Hadzic, 2007). Achieving a maintainable return for refugees remains a concern.

Despite two decades of argument within the politics of Bosnia, there seems to be potential positive outcomes because of recent attention. Serbian leaders who were involved with the events of the war have been recently sentenced to life in jail. This attention provided an opportunity for reevaluation about what happened to Bosnia and what the country can become

(Gilbert & Mujanović, 2015). A great sense of hope for all Bosnian individuals may come as new debates and ideas are formulated.

Children of the Refugees

Children of the Bosnian refugees experience many barriers. Many Bosnian Muslim families had to redefine the norms of social and relational behaviors and interactions.

Exposure to the violence of the war resulted in developing significant trauma and the children may not be psychologically developing in a social environment (Snyder et al., 2005). Downs,

Moore, McFadden, and Costin (2000) explained that Bosnian children frequently have difficulty trusting others, building relationships with other children, or doing well in school and experienced developmental delays (as cited in Snyder et al., 2005).

According to Snyder et al. (2005), Bosnian children often felt torn between their Bosnian culture and the American influences. These acculturation pressures often become impractical expectations when forming a new system of beliefs, customs, and values often because of the pressure children face when they integrate and attempt to fit in with the dominate culture (Snyder et al., 2005). Children of Bosnian families typically grew up with common beliefs and traditions. Franz (2003) found that Bosnian Muslim parents reported having strict rules, ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 12 especially for their adolescent daughters, to safeguard them from “immoral influences” (p. 73).

One of these rules is that a daughter should stay home with the parents until she is married.

Children learn English faster than their parents and often serve as translators, which can change the power dynamic in the homes (Clemetson, 2017). Family roles often flip as it was typical that the children became fluent in the English language much sooner than the parents, and correspondingly, grew accustomed to the new culture. As a result of this dynamic, children developed a weakened regard for the authority of the older adults (Snyder et al., 2005).

Third Culture Kids

Growing up cross-culturally is becoming more common. Children who have consumed a substantial quantity of their child-development years in a country that is different than their parents are referred to as third culture kids (Davis, Edwards, & Watson, 2015). This term also includes children from military, missionary, or business families. Pollock and Van Reken (1999) defined third culture kids as:

an individual who, having spent a significant part of the developmental years in a

culture other than the parents’ culture, develops a sense of relationship to all of the

cultures while not having full ownership in any. Elements from each culture are

incorporated into the life experience, but the sense of belonging is in relationship to

others of similar experience. (p. 21)

Third culture kids typically engage with three cultures at the same time such as their passport country, the host country, and their cultural heritage, and this dynamic is common with Bosnian refugees (Pollock & Van Reken, 1999). A third culture kid is often portrayed as an individual who is able to implement multicultural situations and feel comfortable with those who have also been cultivated across cultures. Living cross-culturally can be a rewarding experience, which ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 13 encompasses other languages and cultures. This experience provides feelings of security within the environment; however, third culture kids frequently experience significant emotional disturbances, sporadic relationship transitions, and problems developing self-identity. These experiences can also create feelings of frustration and anxiety when transitioning between various cultures much different from their own (Adler, 1981; Davis et al., 2015). Many Bosnian children, teens, and young adults feel uncomfortable answering questions about where they are from because it challenges the individual to determine how they fit into society.

Mental Health Challenges

Children and adolescents experience vulnerability in managing and processing grief because they partake in so little power over their circumstances and are dependent on their parents to help them navigate through new experiences (Davis et al., 2015). Counselors who work with third culture kids must require effective techniques where integration of identity and unresolved grief is addressed. Counselors should be aware of these concerns (i.e., identity and grief) as the population of multicultural children continues to precipitously increase (Davis et al.,

2015). The lack of applicable mental health services for children can be a major concern for many families (Dillman & Bratton, 2014). The utilization of Adlerian concepts and techniques may be a beneficial and a supportive option for counselors working with Bosnian families.

Adlerian Techniques with Children

Adlerian play therapy (AdPT) can be used with young children and is a commonly-used play-based approach (Dillman & Bratton, 2014). In 1994, Terry Kottman developed AdPT through the combination of Individual Psychology practices. Interventions are effective in managing a child’s behaviors in many aspects of a child’s life, and without intervention, a child’s behavior tends to worsen over time (Meany-Walen, Kottman, Bullis, & Dillman Taylor, 2015). ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 14

A child’s play is crucial to their holistic development. Play gives the child a way to naturally express themselves and it demonstrates to the therapist their cognitions, emotions, and neurological development (Dillman & Bratton, 2014). Meany-Walen et al. (2015) examined externalizing behaviors as an indicator of adult psychopathology and suggested interventions ought to begin at an early age. Play therapists continue to establish effectiveness in working with children, but effectiveness varies depending on the child’s difficulties.

Adlerians embrace the concept that all individuals are unique. That is, individuals want to belong and connect with others while creating goals that influence their behaviors (Meany-

Walen et al., 2015). Within Adler’s work, he emphasized the importance of childhood experiences and how these experiences affect an individual’s adult years (Adler, 1981; Meany-

Walen et al., 2015). Although AdPT is comparable to additional major theoretical approaches in play therapy, the counselor engages with the child using various toys that will help children explore the view of self, others, and the world to foster a change negative attitudes and beliefs.

Play is a natural language for children, which allows communication between the therapist and child (Dillman & Bratton, 2014). Through the use of Adlerian play therapy, children are able to find their voice, connect, and discover social belonging.

Mental Health Assessments

Research on the mental health of refugees demonstrates common findings with adult refugees experiencing symptoms of post-traumatic stress disorder (PTSD) and depressive disorders, as well as numerous symptoms of anxiety, dissociative experiences, and somatic distress (Miller, Worthington, Muzurovic, Tipping, & Goldman, 2002). Refugee children commonly reflect outcomes similar to the adult refugee population (Miller et al., 2002).

ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 15

Social Meaningfulness

Social roles and social activities contribute to the shaping of an individual’s identity, and social roles affect a sense of well-being. A mental health professional can assist by working toward understanding and identifying the post-migration stressors, and their effects, on refugees’ well-being. The stressors of social isolation, lack of social support, discrimination, and unemployment is ongoing throughout post-migration, which has been linked to depression, anxiety, and war-related trauma (Miller et al., 2002). According to Miller et al. (2002), social isolation as the source of distress among refugees has received the greatest attention. Upon arriving in their country of asylum, refugees find themselves further isolated because of a lack of established communal feeling and the demands to master their new setting. According to Cheah et al. (2013), the openness and positive attitude of the new community is beneficial, especially if the community offers the refugees opportunities for participation and acceptance.

Social isolation among refugees has to do with the background of violence, displacement, and the assorted obstacles that inhibit a sense of community in a country of asylum. According to Snyder et al. (2005), unlike immigrants who leave their countries for different motivations, refugees leave in order to survive, which leads to rebuilding lives under many social stressors.

Social stressors could include the lack of communal feeling, which limits their opportunities for supportive connection with others who share their cultural background and the experiences of war (Miller et al., 2002). Miller et al. (2002) discovered that in pre-war Bosnia, the majority of

Bosnians described a network of valuable connections that included family, friends, coworkers, neighbors, and acquaintances with whom they had frequent interaction. Additionally, unresolved grief can have a significant impact on the mental health of a refugee because refugees leaving ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 16

Bosnia often times left behind loved ones or family and friends who have been killed (Snyder et al., 2005).

Social roles have been affected by the war due to loss of spouses, lack of social support, and the inability to find meaningful employment. According to Miller et al. (2002), the loss of daily structure and activity was a reported, common theme for Bosnian refugees who found significant loss in their social roles; however, the interfamilial roles appeared to be strong and in low conflict. Miller et al. (2002) reported that the Bosnian families were highly supportive of each other as they processed their new environments together. In many cases, parents become dependent on their children to help navigate the language and community that surrounded the family.

Dissociation

Dissociative occurrences are typical for individuals experiencing trauma and can be mistaken for psychosis (Palic, Carlsson, Armour, & Elklit, 2015). Palic et al. (2015) defined dissociation as disruption in the normal integration of identity, awareness, and behavior. This disruption includes the loss of information and the inability to control the mental process that otherwise is available consciously within the individual and results in gaps and disconnection to the self and world (Gusic, Malesevic, Cardena, Bengtsson, & Sondergaard, 2017). Palic et al.

(2015) focused on the development of pathological dissociations in regard to traumatic experiences and noticed this was an important process to assess with the refugee population.

Refugees represent some of the most severely traumatized populations; therefore, the assumption is that there is a high possibility of dissociative pathology. Additionally, there is a correlation of severe dissociation and negative self-image, depressive mood, and symptoms of detachment for war-traumatized refugee children and adolescents (Gusic et al., 2017). Palic et al. (2015) ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 17 believed in the importance of accurate identification for severe dissociation in refugees with

PTSD and found that overall high dissociation was prevalent of Bosnian refugees, even after 15 years of resettlement. Screening for dissociations should be considered in establishing care and treatment plans when working with traumatized refugees of all ages (Palic et al., 2015).

Environmental Considerations

Refugees are often times relocated in profoundly different surroundings with requirements to navigate their environments much differently than when in their previous countries of origin (Miller et al., 2002). Refugees are required to adapt to a new language, new set of cultural values and practices, and accessing resources to navigate their settings. According to Miller et al. (2002), an imperative element to mastering one’s environment involves learning a new language, which entails an immersion in an English as a second language (ESL) course.

Yet, ESL courses are not intended to accommodate the problems of individuals who are experiencing impaired memory and poor concentration, which is very common among refugees

(Miller et al., 2002). The inability to communicate or understand what is communicated to refugees can be troubling because they are survivors of extreme violence and feel specifically anxious and alert in their surroundings (Miller et al., 2002). The genocide is never forgotten; however, surrounding Bosnian refugees with supportive social services can aid in the integration in the new environmental (Snyder et al., 2005). Overall, many refugees had to become proficient in the diverse responsibilities and abilities that are required to succeed in their new environment.

Mental health professionals can continue to praise their abilities and offer social services as needed.

ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 18

Bosnian Women and Mental Health

While many Bosnian individuals experienced displacement, women were susceptible to the gender-based violence that occurred. Craig et al. (2008) explained that the women were used as instruments of cultural genocide and were raped during the conflict and while in the refugee camps. Correspondingly, women reported higher results on anxiety and depression scales and developed posttraumatic stress disorder at twice the rate of men (Craig et al., 2008). During the war, many women were displaced and sent to designated locations away from their partners.

Married women waited for months to reunite with their partners and struggled to adapt to the new environments (Kopinak, 1999).

A major contributor of exhibited depressive symptoms was correlated with the female gender. According to Schmidt, Kravic, and Ehlert (2008), during the war, most of the individuals who were driven from their homes were women, and they reported high rates of posttraumatic stress due to this dislocation. Schmidt et al. (2008) compared PTSD and self- concept with women who were internally displaced, although with a much higher standard of living, in areas such as Croatia. The results of this comparison indicated that long-term psychopathology among war refugees does not result from war-related stressors alone, but also from the continued effect of current living conditions. Craig et al. (2008) specified that a psychological diagnosis such as depression is related to the physical and emotional impairment.

In the refugee population, a diagnosis of depression can explain behaviors such as attachment issues, isolation, lack of pleasure in activity, and difficulty within a communal network.

According to Kopinak (1999), the challenges women faced affected their well-being and resulted in sleep disturbances, digestion difficulties, anxiety, and depression. Overall, these symptoms continue to be the leading source for disability factors in refugee women. ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 19

Franz (2003) furthered that female Bosnian refugees adapted to host environments like

Vienna and New York City much earlier than males because women remain influenced by traditional role models. The role of a woman in Bosnia allowed for vulnerability, which gave room for the women to ask questions and ask for help; however, it was not accepted for men to be vulnerable (Franz, 2003). The roles appeared to overlap much like they did when they were living in Bosnia. That is, women were expected to care for the family traditions instead of the family income. This expectation gave the women the impression that traditional care is more important than self-fulfillment. Women were also able to adapt to the demands of resettling despite the unfortunate events they had experienced from the trauma of the war. Additionally,

Al-Ali (2002) reported that women were much more resourceful and looked for jobs (e.g., cleaning homes) in order to improve language skills and essentially make connections within their new country. Franz (2003) indicated that the women’s families were an enormous motivator in the struggle to progress within the new surroundings. For numerous Bosnian individuals there was a sense of relief when they moved to the United States after living in several other countries as refugees (Matsuo et al., 2014). In the United States, there was an opportunity for safety, a chance to rebuild a new future, and the possibility of avoiding another deportation. Essentially, there was much appreciation for the opportunity of peace.

Islamic Roles

The genocide occurred due to Serbia’s desire to ethically cleanse the territory and retain

Serbian control. According to Ali and Lifschultz (1994), many villages were completely destroyed in their entirety and involved specific forms of assault in order to develop terror through the nation. Concentration camps were utilized throughout Bosnia as a way to bring about the destruction of the Bosnian culture and people. The country’s buildings, mosques, ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 20 monuments, architects, and libraries with extraordinary books and manuscripts were also part of the destruction as it was the goal to eradicate the Bosnian culture and its Muslim religion.

Nevertheless, the Catholic churches, communities, and symbols of Catholicism were unmarked and untouched throughout the Bosnian cities. Ali and Lifschultz (1994) stated many Bosnian walls (of buildings that were left standing) had statements such as “this is Serbia” that indicated that there was no such thing as Bosnia. Serbian nationalists did what they could to extinguish the

Bosnian heritage and organize a reconstruction of Bosnia according to their beliefs and aspirations.

The remainder of the world watched the events of the Bosnian genocide without taking any action to bring the massacre to an end (Ali & Lifeschulz, 1994). Even the Bosnian military was unable to defend the nation as the plan for the Serbian ethnic cleansing succeeded with the other nations failing to intervene. As stated by Ali and Lifschultz (1994),

the Western powers had made their position unmistakably transparent: they would not

intervene in the war to defend Bosnia; they would not permit Bosnians to defend their

country themselves, or allow others to join in their defense; and they would compel them

to surrender, accept defeat, and accede to the internationally legitimized carve-up of their

country. (p. 369)

This lack of Western intervention allowed a much easier Serbian take over.

Islam is not only a religion, but it is also a culture. According to Roudi, Islam is the fastest growing religion around the globe, and Muslims reside in various diverse countries cultures (as cited in Alizadeh, 2012), and Muslim culture is not solely based on Islamic traditions. Roudi explained that people encounter barriers with their mental health if they focus on the perfectionist self. Through the realization of this, the person is then able to give others ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 21 their courage, energy, and love because of the Islamic belief of God being with them and inside their hearts (as cited in Alizadeh, 2012). Rudi concluded that Islam, as it relates to Adlerian therapy, involves the individual’s ability to manage life throughout his or her youth.

The Invisible Muslim

Bosnian immigrants are Europeans who dress in Western clothes, and the majority of

Bosnians are Muslim (Al-Ali, 2002). Matsuo et al. (2014) explained that due to a European background and skin color, this often presented as “invisibility” in any and all social situations.

When asked how Bosnians defined their identity, some Bosnian refugees articulated the ways in which they adapted to their new surroundings while still preserving their own culture. Many indicated that they are considered a blended culture because of the security of their own culture along with the acceptance of the American culture (Matsuo et al., 2014).

Bosnians are secular Muslims with their religion embedded into their identity through individual beliefs and values. Al-Ali (2002) discovered that Bosnian Islam is different from other parts of the world, and Bosnians are as much European as they are Muslim. Bosnian

Muslims often do not wear the traditional hijab or the full body coverage attire; therefore,

Bosnians appear to blend in with the dominate culture (Matsuo et al., 2014). With their

European look, Bosnians blend with the predominant culture, which makes many individuals uncomfortable talking about their religious beliefs for fear of discrimination, particularly due to the events of the terrorist attacks on September 11, 2001. Resettlement to the United States has a predetermined set of barriers for Bosnian Muslim refugee families. With the occurrence of 9/11,

Bosnian Muslims encountered hostility within their communities (e.g. disagreements about building mosques; Snyder et al., 2005). For many individuals, Islam remained a structure for ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 22 ethnic identity instead of a symbol of spiritual belonging (Al-Ali, 2002). Many wondered if

Islam would ever be viewed as a positive faith in the United States.

Although many Bosnian individuals suffer from loss and distress as a result of tragic events, they seem to adjust to the new country with their Islamic beliefs intact, even though that is not the dominate religion in most resettlement countries (Matsou et al., 2014). Bosnians continue the family bonds and take responsibilities within the roles of a faithful Muslim, which can carry forward as a strength within therapy; however, Bosnians may hold differing views regarding Islam.

Adlerian Psychotherapy and Individuality

Individuals often begin therapy to gain better understanding of their own behaviors and their responses to the behaviors. Adler referred to his therapy as Individual Psychology (Stein &

Edwards, 1998), and although Adler’s psychology is named individual, the essence of the approach is social. Adlerians perceive and understand clients within their social surroundings and asses the ability for social interest (Manaster, 1987). Adler’s interventions are for an individual client, couples, families, and schools. Adler believed that the ultimate goal of psychotherapy was to help people provide the social evolution of the human race (Stein &

Edwards, 1998). Adlerian individual psychotherapy, brief therapy, couples therapy, and family therapy allow for progress in the reforming of perceived values, feelings, and behaviors, which aid in personal positive growth.

Stein and Edwards (1998) spoke about how Individual Psychology provides individuals with an opportunity to interoperate life in their unique, creative, and dependent way. The

Adlerian technique utilizes Socratic dialogue to encourage confidence, self-worth, and ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 23 significance as a result of forming positive relationships. The positive relationships ultimately place the responsibility for behavior and success upon the individual (Manaster, 1987).

The overall goal in Individual Psychology is to remove negative and obstructive beliefs and behaviors, acquire skills, and take on tools that will allow the client to become more empowered. According to Stein and Edwards (1998), the overall goal for practitioners of

Adlerian psychotherapy is to serve the client in a way that fosters the development from a somewhat functioning person into a further functioning individual. That is, the client would exist in a more cooperative, courageous, and contributing way in order for the person to become his or her best self. Furthermore, the therapist believes that the ultimate goal is not to improve the client’s life, but the therapist will work to improve the quality of life for each social aspect in the client’s life such as their relationship with their family, friends, community, and work (Stein

& Edwards, 1998).

Adlerian Family Therapy

In Adlerian theory, the emphasis is on the importance of the individual’s family as the original influence on a developing personality (Dinkmeyer & Dinkmeyer, 1983). Adlerian family therapy is arranged in a way that includes the entire family with a focus on the psychological movement and transactions between family members in order to identify goals

(Dinkmeyer & Dinkmeyer, 1983). Adlerian concepts are compatible with the values and views of a variety of ethnic and cultural groups (Herring & Runion, 1994). Adlerian therapists influence psychological movement, work with family communication, support goals, manage resistance, and utilize encouragement, and Adlerian therapists process these with families in a variety of ways that includes a focus on both the individual and the system.

ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 24

Family Atmosphere

The focus of family atmosphere includes the communication and connection among the family members, what that connections means, and why it means what it does (Dinkmeyer &

Dinkmeyer, 1983). At the beginning of therapy, the therapist is able to focus on the lifestyle of each member and the meaning behind his or her movement (Dinkmeyer & Dinkmeyer, 1983).

Movement will often reveal roles and lifestyles. Adler identified a number of family atmospheres that lead to the development of family values and behaviors (Rice, Ashby, &

Preusser, 1996). According to Rice et al. (1996), a “faulty family value” was developed through parental expressions that led to mistaken beliefs and attitudes (p. 248). The therapist is able to explore and highlight examples for the family so they can increase awareness of their development and understanding of their feelings.

Birth Order

An Adlerian family therapist will be aware of the influence that birth order places on the family (Dinkmeyer & Dinkmeyer, 1983). According to Dinkmeyer and Dinkmeyer (1983) birth order does not determine personality, but birth order does influence personality. Individuals decide how they will perceive their position. The firstborn may aspire to hold high achievement

(Eckstein & Kaufman, 2012), and the second born often demonstrates the desire to get ahead of, or catch up with, the first born (Dinkmeyer & Dinkmeyer, 1983). The middle child tends to have neither the advantages of first or youngest born and appears to be sociable; however, the middle child feels like they do not belong (Eckstein & Kaufman, 2012). The youngest child is often dependent, and an only child does not struggle for a position and may be dependent on parents or insensitive to the needs of others (Dinkmeyer & Dinkmeyer, 1983).

ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 25

Multicultural Counseling

The flexibility of Adlerian concepts and techniques coincides with many of the values that cultural groups hold (Herring & Runion, 1994). A variety of techniques are suitable for the client to express their values in an open and safe environment. The use of family constellations can be useful when conducting therapy with multicultural families. The process of sharing information about siblings is used as a means to gain rapport valuable insight into the views of the self, others, and the world (Herring & Runion, 1994).

Self-Development through Adlerian Concepts

As increasing numbers of families migrate to the United States clinicians must be prepared to interact with people of diverse cultural backgrounds who are experiencing barriers with self-identity. Refugees experience more pathology and underprivileged well-being then that of the majority culture (Kopinak, 1999). Through Adlerian techniques and concepts an individual who battles with self-identity can find value in how they view themselves, others, and their world. The Adlerian view is holistic view in the sense that the whole person functions throughout uncovering the values and assumptions they hold, occasionally, without awareness.

The war demonstrates that many of the individuals within Bosnian populations were required to move from place to place, which created difficult implications for self-identify. Most

Bosnians were required to “blend” with each new culture where they chose to immigrate. The blending with the majority of the population was easy for most individuals, as the physical appearance of Bosnian individuals was similar to that of the host countries. In order to gain awareness of the individual’s experience, practitioners may benefit from exploring the experience of pre-migration, arrival, and post-migration periods. In order to gain deeper awareness, the practitioner may consider posing questions that are opened-ended and culturally ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 26 sensitive using a conversational tone (Kopinak, 1999), asking the client if there is a mutual understanding of the narrative, and repeat and verify what the client is saying.

Social Interest

A great attribute of Adlerian therapy is social interest. A secondary translation for social interest is also known as the German term Gemeinschaftsgefūhl, which means a communal feeling. Throughout time, social interest can support a personal narrative of accomplishment in the expression of personal struggle (Disque & Bitter, 1998). If the person has developed social interest, he or she is likely to feel belongingness and empathy toward others. Kopinak (1999) believed that to resolve war trauma, gain support systems, become accustomed to a new culture, and find acceptance, a representation of belonging must exist for the new culture as this plays a factor in maintaining positive health.

Social interest indicates that the person is able to contribute to the community with helpful movement that recognizes acceptance for all people (Stein & Edwards, 1998). There are many ways a client and a therapist can participate in social interest. Social interest can point out the essential meaning of how an individual moves throughout a social context and how this can have a social effect within the community by means of understanding, empathizing, and assisting others (Alizadeh, 2012).

Lemire (1998) argued that social interest plays a significant role in creativity and allows the individual to embody healthy adaptive behavior. When an individual is participating in social interest, a practitioner may then be able to consider that a client achieved psychological wellness. According to Franz (2003), Bosnian refugees did not receive social support, but many individuals were highly motivated to socially integrate by improving their language skills in order to survive. Cultural connections have a positive impact on an individual’s adjustment to a ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 27 new environment, and refugees rely on social support during times of transition. When working with a Bosnian immigrant or refugee there has likely been a loss of trust and belonging, and individuals build relationships in order to feel that they belong. Due to the feelings of inferiority and discouragement that the Bosnian refugees experienced in the past, it led to the avoidance of relationship building and resistance to continue building any further relationships (Franz, 2003?).

Individual strengths of Bosnian refugees are apparent and included strategies utilized to adapt from the hardships of the war. Individual strengths demonstrate resiliency, adaptably, and flexibility (Kopinak, 1999). Furthermore, in accordance to the Islamic religion, there is a synchronization of social interest that is essential for this to be replicated into the universe.

Alizadeh (2012) argued that there is a common aspect of community in regard to the Islamic religion with further explanation of how within most rituals and prayers a communal practice is implemented. Nahjoflasaha further explained that there was much emphasis on community and the care of others, and if there is no sense of attention to the community, that person is viewed as a non-believer (as cited in Alizadeh, 2012). The community is viewed as a family where it is most beneficial to attend to the welfare of others. Overall, social interest allows the person to be socially interested in the welfare of the community and models to others what is possible in life through the basis of a moral and ethical code not only for the self, but also the community.

Lifestyle

Lifestyle may be defined as one’s individuality and their display of movement (Croake,

1975). A lifestyle assessment usually occurs within the first three stages of treatment (Stein &

Edwards, 1998). The Adlerian practice of assessing the individual’s lifestyle involves the client discussing their family constellation, atmosphere, and birth order (Bitter, 2007). ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 28

Family constellation is a system with a focus on parents and the children and offers a detailed description of the birth order in ones’ family to understand the individual’s view of life

(Ansbacher & Anbacher, 1964). An individual’s approach to striving to feel significant or to belong may be part of a lifestyle. If the individual understands his or her lifestyle, then behaviors construct awareness. Croake (1975) explained that Adler believed unique personalities contribute to the creative self-compared to all others. Including lifestyle assessments in therapeutic practice can be an effective tool used to establish connections to unique attributes and attitudes.

Alfred Adler utilized lifestyle assessment to focus on the person and assist the person to adapt to the demands of the social world (Ansbacher & Ansbacher, 1964). When people are striving for superiority they are in a continuous struggle to adapt to different situations in order to overcome inferiority (Disque & Bitter, 1998); however, Bitter (2007) clarified that feelings of inferiority are normal for both children and adults when they are striving for immediate goals.

In the lifestyle assessment, the therapist gathers early recollections or early memories.

Borden (1982) stated that when gathering early recollections, there is a technique that can be used to discover the preoccupations that have been developed by the client. Borden (1982) reported that a child six years and older is able to recollect early memories because their lifestyle is articulated by that time. Early childhood can be the favorable time to work with a child as he or she attempts to find a place within the family and world. According to Bitter (2007), early recollections reflected the client’s individual story of life through past experiences, and they are used to enhance the future life story. Borden (1982) clarified that early recollections can help the client understand the direction of the movement in life through the convictions of thoughts and behaviors. Disque and Bitter (1998) summarized that the use of Adlerian narrative therapy ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 29 merges two perspectives in a holistic manner. For instance, the client is able to see the self through present-day life stories and gain increased awareness of strengths and abilities as they move forward.

While utilizing this positive narrative approach, another technique that can be utilized is the question. Dreikurs used this technique in order to differentiate the presenting problem or symptom from one that is emerging from a mental conflict (as cited in Bitter, 2007). The question is “What would you be doing differently if you didn’t have these problems or symptoms?” Or “How would your life be different?” Bitter (2007) explained that if the answer to the question is that life would not be different, or that getting rid of the symptom or the presenting problem is the solution, it should then be noted that the problem could be psychological. Bitter (2007) stated that when the problem resolution is to avoid the demands of life tasks, the avoidance could indicate that the person is in withdrawal. Bitter (2007) stated that about 20 years after the question was used, the solution-focused therapists transformed the question into what is now known as the miracle question. This is typically a question used to create desired outcomes for the client, which can then become the focus of therapy and can often lead the client to address what he or she is. On the other hand, the question challenges the client to assess movement and coping strategies. Overall, assessing life tasks in therapy creates possibility to gather personal perspectives on development, gender, culture, and personal movement throughout the life experience (Bitter, 2007). Generally, life tasks tell the practitioner whether the person is moving forward or is experiencing withdrawal.

Life Tasks

Adler’s theory of life tasks includes the three tasks of life. The three tasks represent ways of coping and finding solutions through social tasks, love-marriage tasks, and occupational tasks. ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 30

Mosak and Dreikurs (2000) later argued that there were two additional life tasks such as coping with oneself and developing spiritually. Adler believed that in order to contribute social interest in regard to a full sense of belonging and to achieve a communal goal, one must partake in the life tasks. When solving the life tasks, it is essential to connect the life tasks to mental health in order to assess dysfunction (as cited in Bitter, 2007).

Social tasks include upholding friendships through building connections with others in the community. The social task speaks to the responsibility that one has to others and to the individual’s need to feel like they belong. Dreikurs reported that to accomplish the social task, one must capture universal problems (as cited in Baruth & Manning, 1987). The marriage task

(also known as intimacy or sex) refers to close relationships with others. Baruth and Manning

(1987) explained that the marriage task requires a large demand of interest between two individuals. The occupational task signifies how the individual is contributing to the communities where they reside. Dreikurs considered the occupational task the most important task, because Dreikurs believed that any kind of work that is useful to the community could be considered for this task (as cited in Baruth & Manning, 1987). The occupational task also includes, but is not limited to, volunteering in the community, caring for children, and daily living tasks. Ultimately, the occupational task aids in survival as it allows a person to enhance the community.

Each of these life tasks require the development of psychological capabilities for friendship, belonging, self-worth, and support. Since the Bosnian war, many opportunities to complete the life tasks ripped away from these individuals. The primary distress sources included family member separation, social isolation, poverty, inadequate housing, lack of environmental mastery, and the loss of community, social roles, and life projects (Matsuo et al., ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 31

2014). Many Bosnians continue to find difficulties in rebuilding and developing each of the capabilities within the life tasks, and addressing the impact of physical, psychological, and emotional loss is a significant component in treatment goals.

Mistaken Beliefs

Mistaken beliefs can be uncovered through the use of assessment techniques such as early recollections. According to Dinkmeyer, Lingg, and Kottman (1991), early recollections are utilized to examine a client’s lifestyle. The memories do not determine behavior but reflect the client’s current view of self, others, and the world. While gathering early recollections, clues about mistaken beliefs can be present within the recollections. Counselors attempt to identify the mistaken beliefs and bring them to the client’s awareness in order to help the client see how the false ideas are interfering with their social functioning (Dinkmeyer et al., 1991). As the awareness increases, it can lead to a change in the individual’s private logic.

Private Logic

Private logic involves a set of beliefs that make sense to the individual but may not make sense to others. According to Adler, these beliefs were formed at a young age as the individual was trying to understand the environment; however, the child was not able to form an appropriate belief, so biased perceptions were formed in order to function in a variety of circumstances. Dreikurs outlined private logic as unconscious ideas, concepts, and goals the individual acts on (as cited in Nystul, 2001). Private logic plays a major role in the individual’s actions, thoughts, and emotions (Dreikurs-Ferguson, 2001). Throughout the process of developing private logic, the individual holds on to these formed beliefs, which represent the family atmosphere. As children mature, private logic can deceive them into thinking what may have worked as a child could also work as an adult for things such as basic needs (Nystul, 2001). ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 32

Lemire (1998) explained that private logic is the way an individual interprets the self and the world and leads the person through life. If the client is resistant to changing private logic, the client could feel threatened (Nystul, 2001). Insight into an individual’s lifestyle provides meaning and understanding of private logic (Dreikurs-Ferguson, 2001).

Creative Self

The concept of the creative self gives the individual responsibility for their personality.

The practitioner teaches the client that they cannot blame others for their existing conditions.

Edgar (1985) argued that Adler’s discussion of creative self became a central concept that was in dispute with Freudian concepts. Lifestyle is a direct determination of how people secure distinction within the universe:

Adler’s metaphor, the “creative self” is the home of both the picture and the artist. As

artists create, they participate with and are “changed” by that which they have created, in

a recursive live movement (Adlerian term) or a co-drift (the constructive term). The

creative power of the self results in literally a self created by self. This relationship is

like a “conversation,” out of which arise definition of self, other, and world. It is a

pattern of interactive, recursive, and mutually defining co-drift. (Master, 1991, p. 447)

The creative self gains power through the practice of participation and observation. Equally,

Edgar (1985) stated the creative power becomes an evolving force to the decision-making process while the person works through the possibilities in life.

Connections and Discussion

When clients are diagnosed with a mental health disorder, practitioners are able to engage with a client in a variety of ways. The therapeutic relationship is a significant indicator of ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 33 positive outcomes (Clark, 2016). A reputable psychotherapist will respect the differences in each unique person and work through barriers with encouragement and empathy.

Encouragement

Psychopathology may be viewed negatively and often represents discouragement.

Discouragement can arise in many forms such as negative thinking or pathological conditions that lead the client to behave in a negative manner (Dreikurs-Ferguson, 2001). On the other hand, encouragement is a passageway for the therapist. The therapist must attain great patience and have a free-flowing process that is used “to inspire or to instill courage in the client” in order for the client to be engaged in the community (Main & Boughner, 2011, p. 269). Adlerian therapy promotes encouragement as it improves relationships with others. Encouragement allows individuals to get along with others and it enhances a feeling of belonging.

Alfred Adler and Rudolf Dreikurs were psychiatrists whose theoretical work has influenced practitioners in understanding individual behaviors. Rudolf Dreikurs gave much insight into the topic of encouragement and his ideas have been widely utilized (Dreikurs-

Ferguson, 2001). There was much attentiveness to educate the client on prevention and symptom resolution through encouragement. According to Ansbacher and Ansbacher, Alfred

Adler viewed encouragement as the foundation of psychotherapy, and the courage that the client possesses is a driving force to make progress within the community (as cited in Main &

Boughner, 2011).

Main and Boughner (2011) focused on the actions of encouragement and how this became consciously known by family therapists. That is, the client desires the courage to change and not so much the information that is provided in therapy. Main and Boughner (2011) discussed that the process of encouragement brings out confidence within clients in a way that ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 34 gives them assurance to carry out skills outside of therapy. Encouragement can be expressed and varied across diverse groups such as gender, racial groups, culture, and age groups. Dreikurs

(1985) has argued that encouragement is fundamental in building a child’s self-confidence and the ability to learn. Overall, research provides preliminary evidence for the benefits that encouragement offers for all individuals including the refugee populations (Dreikurs, 1985).

Expressing Encouragement with Refugees

Mental health professionals should be aware of what specifically brought the client into therapy as well as what is important to explore with the refugee (Sveaass & Reichelt, 2001).

Frequently, refugees are involved with services that will assist their families in adapting to their new society. Sveaass and Reichelt (2001) suggested that there should be an evaluation of readiness for therapy. Furthermore, it is suggested that the provider must be aware of the culture and encourage the client to have the power to create the space that is needed at the present moment. According to Warr (2010), the prominent theme in research was the way refugees demonstrate resilience. Refugees possess enormous strength despite the trauma and are able to adapt to extreme circumstances. This can be expressed to the client as a strength when beginning therapy as it will allow encouragement as well as empathy.

Empathy

Beginning in the 1960s empathy was portrayed as a therapist trait and put forward as a base skill, and today, empathy is known as an interactional piece in therapy that is a key component to research and the overall therapy relationship (Elliott, Bohart, Watson, & Murphy

2018). Adler explored the concept that many of the common human experiences illuminate empathy in everyday social interactions. Empathy is essential in understanding the emotions and connotations of all personalities (as cited in Clark, 2016). Empathy is interpersonal and ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 35 unidirectional and provided by one person to another person (Elliott et al., 2018). According to

Hammond (2015), empathy is a progression of both grasping attentions and thoughts and then responding sympathetically to another person’s experience. The capability to identify with a person is essential within empathy. Clark (2016) discussed Adler’s reference to empathy, which is the ability to identify with another person in a way that displays a practitioner who will “see with the other person’s eyes, hear with his ears, and feel with his heart” (p. 164). Adler found that the connections people formed were present in many different domains and levels and enhanced interactions (Hammond, 2015). In order to have successful treatment, a diverse practitioner will exhibit open communication and be involved in the therapy process as his or her authentic self (Clark, 2016).

Expressing Empathy with the Bosnian Population

Brown and Cehajic (2008) argued that people can feel emotions from interpretations of their cultural background even if they have had no personal involvement of the actual actions that occurred with the intergroup. Therefore, it was hypothesized by Brown and Cehajic (2008) that there is collective guilt and shame that can be felt when a cultural community has been mistreated. Through empathy, both collective feelings of guilt and shame with the Bosnian population may assist in restoration. The type of empathy for the Bosnian population experiencing guilt and shame in this matter may be a noteworthy consideration. Brown and

Cehajic (2008) believed that the feelings of guilt may be correlated with the individual’s tendency to place the self into the group of victims. These feelings of guilt demonstrate the belief of true victimization and is a caring attribute in nature; however, it may affect the ability to cope with the guilt and shame within the present time. Brown and Cehajic (2008) concluded that the feelings of guilt and shame are associated with the desire to make amends with past events, ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 36 and the use of educational teachings and interventions can be utilized in a therapeutic setting in order to develop cultural empathy in a more positive light. Empathy may repair attitudes and also increase the restoration of forgiveness (Brown & Cehajic, 2008).

Summary

Individual Psychology offers a way for a variety of individuals to understand themselves better and make healthy connections for overall positive mental health outcomes (Bitter, 2007).

The therapeutic process includes establishing a respectful relationship and aims to develop the client’s sense of belonging. In regard to multicultural individuals, the therapist utilizes a holistic demonstration of adaptability for those individuals who have resettled from their country of origin. Establishing cultural competency is a fundamental matter while working with diverse communities in order to create a safe, understanding, and collaborative space. When a family presents with a worldview that is different from that of the therapist, the therapist must incorporate open dialogue and understanding. Mental health professionals who are meeting the needs of displaced people must have the knowledge and skills to effectively work among them.

The ability to experience positive health and functioning for individuals who were exposed to war trauma appears to be in positive interactions through personal, psychological, and cultural means (Kopinak, 1999). Human beings are social, desire social connection, and strive for significance as a natural part of the human condition (Bitter, 2007). Adlerian therapists can help individuals increase the understanding of their strengths and barriers in ways that can promote positive and healthy connections within their communities.

Recommendations for Future Research

There is a meaningful amount of research in first generation Bosnian immigration.

Mental health professionals could benefit with knowledge of strengths and barriers the second ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 37 generations of immigrants possess, not only with the Bosnian population, but the many other war-torn countries that presently exist. According to Miller and Rasco (2004), there is a need to collect and explore refugee experiences as their voices appear to be absent. It may be beneficial to further look into ways to achieve better understanding of refugee experiences in regard to pre- migration and post-migration. Another focus for future research could center on the loss of social roles among refugees that exemplifies significant implications for mental health interventions and the maintenance of distress within their current communities (Miller et al.,

2002). Future research could also focus on culturally appropriate trauma interventions that can facilitate change and address the losses that were endured in order to improve health. Studies can be conducted to better understand the experiences, attitudes, and perceptions of the individuals who escaped the war and what that entails for the generations to come.

Limitations of Adlerian Psychology

Adlerian therapy and approaches consist of the exploration of childhood occurrences, which may be difficult for someone who is not interested in exploring family history, childhood experiences, early memories, and/or dreams. Adler’s work lacks empirical research (Petersen,

2005). According to Petersen (2005) Individual Psychology has been criticized as directive as it is trying to direct clients toward community feeling by having clients be active and happy members of society. Adler preferred to educate and practice in contrast to organizing a definite systematic theory, making some of his written arrangements challenging to follow (Petersen,

2005).

Strengths of Adlerian Psychology

Adlerian therapy is holistic in nature and allows the client to explore, discover, and operationalize individual strengths with an understanding of how these strengths can aid the ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 38 community (Ansbacher and Ansbacher, 1964). Adlerian therapy has many different styles that can be suitable for a client’s learning and interactions (i.e., individually or in groups). Adlerian therapy can assist clients with personal growth through encouragement, it is applicable to diverse populations, and it does not consider individuals as predisposed to anything. Above all, the therapist can promote confidence, pride, and self-worth, which in turn, can build conviction in building healthy relationships in many aspects of the clients’ lives. ADLERIAN APPROACHES AMONG BOSNIAN POPULATIONS 39

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