Trauma focused-cognitive behavioral therapy training effectiveness in promoting professional development of psychotherapists working with unaccompanied minors in Greece: a non-blinded randomized control trial

Submitted: May 15, 2024
Accepted: August 22, 2024
Published: August 27, 2024
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The need to develop psychotherapists’ skills to respond to current treatment challenges, such as addressing trauma due to the refugee crisis, is increasing. However, there is a dearth of evidencebased training for psychotherapists who work with refugees, especially in frontline countries. A randomly selected sample of 80 clinicians working with unaccompanied minors (UAMs) in Greek accommodation centers nationwide participated in an intensive trauma-focused cognitive behavioral therapy (TF-CBT) training (n=44) or a control-group (n=36) and completed the Professional Quality of Life Scale, the Work and Meaning Inventory and a questionnaire to assess knowledge and therapeutic skills, in pre-andpost measurements. Clinicians with 1-3 years of experience with refugees reported higher burnout (p=0.012, M=25.78 vs M=22.04) and secondary traumatic stress than those with less than a year (p=0.014, M=22.03 vs M=18.04). Positive meaning at work increased in both groups at post-test (TF-CBT group: p=0.019, M=15 vs M=13.6, and control group: p<0.001, M=15.17 vs M=13.42). The TF-CBT training group outperformed the control group in knowledge and skills (p=0.021, M=10.15 vs M=8.75) and identified a lower number of children with post-traumatic stress disorder symptoms (p=0.009, M=6.94 vs M=4.33) post-training. This study provides preliminary evidence on TF-CBT training effectiveness in equipping psychotherapists to work with UAMs, while their professional quality of life warrants further research.

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Abdul-Hamid, W., Karki, C. B., Hughes, J. H., & Morgan, S. (2021). The need for trauma therapy for victims of man-made trauma compared to those of natural disaster: Α survey of health professionals. Psychiatria Danubina, 33(1), 13-17.
Anastasiou, T., Yotsidi, V., Tatsi, C., Bakalou, E., & Kalantzi, A. (2024). Implementing trauma-focused cognitive behavioural therapy (TF-CBT) to unaccompanied minors in Greece: Study protocol of a randomized controlled trial and evaluation of the TF-CBT training to mental health professionals. Tropical Medicine & International Health, 28(S1), 271, 572.
Apostolara, P., Adamakidou, T., Mouta, E., Vus, V., Malliarou, M., Mantzorou, M., & Papathanasiou, I. V. (2023). Burnout and depression of Greek healthcare professionals working in refugees’ reception centers and accommodation programs. Polski Merkuriusz Lekarski, 28(3), 40-46. DOI: https://doi.org/10.36740/Merkur202303107
Asfaw, B.B., Beiersmann, C., Keck, V., Nikendei, C., Benson-Martin, J., Schütt, I., & Lohmann, J. (2020). Experiences of psychotherapists working with refugees in Germany: Α qualitative study. BMC Psychiatry, 20, 1-8. doi: 10.1186/s12888-020-02996-0 DOI: https://doi.org/10.1186/s12888-020-02996-0
Asgary, R., & Segar, N. (2011). Barriers to health care access among refugee asylum seekers. Journal of Health Care for the Poor and Underserved, 22(2), 506-522. doi: 10.1353/hpu.2011.0047 DOI: https://doi.org/10.1353/hpu.2011.0047
Avieli, H., Ben‐David, S., & Levy, I. (2016). Predicting professional quality of life among professional and volunteer caregivers. Psychological Trauma: Theory, Research, Practice, and Policy, 8(1), 80-87. doi: 10.1037/tra0000066 DOI: https://doi.org/10.1037/tra0000066
Baumann, B. L., McGuier, E. A., Rounds, J. L., Rumbarger, K. M., & Kolko, D. J. (2023). Comparing in-person and synchronous online training for an evidence-based treatment. Administration and Policy in Mental Health and Mental Health Services Research, 50(6), 936-945. doi: 10.1007/s10488-023-01294-7 DOI: https://doi.org/10.1007/s10488-023-01294-7
Bourke, M. L., & Craun, S. W. (2014). Coping with secondary traumatic stress: Differences between U.K. and U.S. child exploitation personnel. Traumatology: An International Journal, 20(1), 57-64. doi: 10.1037/h0099381 DOI: https://doi.org/10.1037/h0099381
Bradley, S., Drapeau, M., & DeStefano, J. (2012). The relationship between continuing education and perceived competence, professional support, and professional value among clinical psychologists. Journal of Continuing Education in the Health Professions, 32(1), 31-38. doi: 10.1002/chp.21120 DOI: https://doi.org/10.1002/chp.21120
Bryant, R. A., Nickerson, A., Morina, N., & Liddell, B. (2023). Post-traumatic stress disorder in refugees. Annual Review of Clinical Psychology, 19, 413-436. doi: 10.1146/annurev-clinpsy-080921-080359 DOI: https://doi.org/10.1146/annurev-clinpsy-080921-080359
Bunn, M., Khanna, D., Farmer, E., Esbrook, E., Ellis, H., Richard, A., & Weine, S. (2023). Rethinking mental healthcare for refugees. SSM-Mental Health, 3, 100196. doi: 10.1016/j.ssmmh.2023.100196. DOI: https://doi.org/10.1016/j.ssmmh.2023.100196
Butler, L. D., Carello, J., & Maguin, E. (2017). Trauma, stress, and self-care in clinical training: Predictors of burnout, decline in health status, secondary traumatic stress symptoms, and compassion satisfaction. Psychological Trauma: Theory, Research, Practice, and Policy, 9(4), 416-424. doi: 10.1037/tra0000187 DOI: https://doi.org/10.1037/tra0000187
Cherepanov, E. (2023). Refugees from countries with complex political contexts: Politically informed approach to health and mental health services. Frontiers in Public Health, 11. doi: 10.3389/fpubh.2023.1323259 DOI: https://doi.org/10.3389/fpubh.2023.1323259
Chipalo, E. (2021). Is trauma focused-cognitive behavioral therapy (TF-CBT) effective in reducing trauma symptoms among traumatized refugee children? A systematic review. Journal of Child & Adolescent Trauma, 14, 545-558. doi: 10.1007/s40653-021-00370-0 DOI: https://doi.org/10.1007/s40653-021-00370-0
Chu, W., Wippold, G., & Becker, K. D. (2022). A systematic review of cultural competence trainings for mental health providers. Professional Psychology: Research and Practice, 53(4), 362. https://dx.doi.org/10.1037/pro0000469 DOI: https://doi.org/10.1037/pro0000469
Cieślak, R., Shoji, K., Douglas, A. J., Melville, E., Luszczynska, A., & Benight, C. C. (2014). A meta-analysis of the relationship between job burnout and secondary traumatic stress among workers with indirect exposure to trauma. Psychological Services, 11(1), 75-86. doi: 10.1037/a0033798 DOI: https://doi.org/10.1037/a0033798
Cohen, J. A., Mannarino, A. P. (2008). Trauma-focused cognitive behavioural therapy for children and parents. Child and Adolescent Mental Health, 13(4), 158-162. doi: 10.1111/j.1475-3588.2008.00502.x DOI: https://doi.org/10.1111/j.1475-3588.2008.00502.x
Courtois, C. A., & Gold, S. N. (2009). The need for inclusion of psychological trauma in the professional curriculum: A call to action. Psychological Trauma: Theory, Research, Practice, and Policy, 1(1), 3-23. doi: 10.1037/a0015224 DOI: https://doi.org/10.1037/a0015224
Della Rocca, B., Bello, R., Carbone, M., Pezzella, P., Toni, C., Sampogna, G., Tarsitanim L., Luciano, M., & Fiorillo, A. (2024). Promoting mental health and preventing mental health problems in child and adolescent refugees and asylum seekers: A systematic review on psychosocial interventions. International Journal of Social Psychiatry, 70(4), 653-666. doi: 10.1177/00207640231214964. DOI: https://doi.org/10.1177/00207640231214964
Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175-191. doi: 10.3758/bf03193146 DOI: https://doi.org/10.3758/BF03193146
Finch, J., Ford, C., Lombardo, C., & Meiser‐Stedman, R. (2020). A survey of evidence based practice, training, supervision and clinician confidence relating to posttraumatic stress disorder (PTSD) therapies in UK child and adolescent mental health professionals. European Journal of Psychotraumatology, 11(1). doi: 10.1080/20008198.2020.1815281 DOI: https://doi.org/10.1080/20008198.2020.1815281
Foka, S., Hadfield, K., Pluess, M., & Mareschal, I. (2021). Promoting well-being in refugee children: An exploratory controlled trial of a positive psychology intervention delivered in Greek refugee camps. Development and Psychopathology, 33(1), 87-95. doi: 10.1017/S0954579419001585 DOI: https://doi.org/10.1017/S0954579419001585
Frank, H. E., Becker-Haimes, E. M., & Kendall, P. C. (2020). Therapist training in evidence‐based interventions for mental health: A systematic review of training approaches and outcomes. Clinical Psychology: Science and Practice, 27(3), 20. doi: 10.1111/cpsp.12330 DOI: https://doi.org/10.1111/cpsp.12330
Genç, E. (2022). The effectiveness of trauma treatment approaches in refugee children and adolescents: A systematic review. Children and Youth Services Review, 141, 106602. doi: 10.1016/j.childyouth.2022.106602 DOI: https://doi.org/10.1016/j.childyouth.2022.106602
Heinonen, E., & Nissen-Lie, H. A. (2019). The professional and personal characteristics of effective psychotherapists: A systematic review. Psychotherapy Research, 30(4), 417-432. doi: 10.1080/10503307.2019.1620366 DOI: https://doi.org/10.1080/10503307.2019.1620366
Hensel, J., Ruiz, C. S., Finney, C. A., & Dewa, C. S. (2015). Meta‐Analysis of risk factors for secondary traumatic stress in therapeutic work with trauma victims. Journal of Traumatic Stress, 28(2), 83-91. doi: 10.1002/jts.21998 DOI: https://doi.org/10.1002/jts.21998
Hemsworth, D., Baregheh, A., Aoun, S. & Kazanjian, A. (2018). A critical enquiry into the psychometric properties of the professional quality of life scale (ProQol-5) instrument. Applied Nursing Research, 39, 81-88. doi: 10.1016/j.apnr.2017.09.006 DOI: https://doi.org/10.1016/j.apnr.2017.09.006
Höhne, E., van der Meer, A. S., Kamp-Becker, I., & Christiansen, H. (2022). A systematic review of risk and protective factors of mental health in unaccompanied minor refugees. European Child and Adolescent Psychiatry, 31, 1-15. doi: 10.1007/s00787-020-01678-2 DOI: https://doi.org/10.1007/s00787-020-01678-2
Jensen‐Doss, A., Cusack, K., & De Arellano, M. A. (2007). Workshop-based training in trauma-focused CBT: An in-depth analysis of impact on provider practices. Community Mental Health Journal, 44(4), 227-244. doi: 10.1007/s10597-007-9121-8 DOI: https://doi.org/10.1007/s10597-007-9121-8
Jensen, T. K., Braathu, N., Birkeland, M. S., Ormhaug, S. M., & Skar, A.-M. S. (2022). Complex PTSD and treatment outcomes in TF-CBT for youth: A naturalistic study. European Journal of Psychotraumatology, 13(2), 2114630, doi: 10.1080/20008066.2022.2114630 DOI: https://doi.org/10.1080/20008066.2022.2114630
Kjellenberg, E., Nilsson, F., Daukantaitė, D., & Cardeña, E. (2014). Transformative narratives: The impact of working with war and torture survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 6(2), 120-128. doi: 10.1037/a0031966 DOI: https://doi.org/10.1037/a0031966
Kim, Y. J. (2017). Secondary traumatic stress and burnout of North Korean refugees service providers. Psychiatry Investigation, 14(2), 118. doi: 10.4306/pi.2017.14.2.118 DOI: https://doi.org/10.4306/pi.2017.14.2.118
Kirmayer, L. J. (2012). Cultural competence and evidence-based practice in mental health: Epistemic communities and the politics of pluralism. Social Science & Medicine, 75(2), 249-256. doi: 10.1016/j.socscimed.2012.03.018 DOI: https://doi.org/10.1016/j.socscimed.2012.03.018
Lewey, J. H., Smith, C. L., Burcham, B., Saunders, N. L., Elfallal, D., & O’Toole, S. K. (2018). Comparing the effectiveness of EMDR and TF-CBT for children and adolescents: A meta-analysis. Journal of Child and Adolescent Trauma, 11(4), 457-472. doi: 10.1007/s40653-018-0212-1 DOI: https://doi.org/10.1007/s40653-018-0212-1
Mavratza, T., Adamakidou, T., Apostolara, P., Fasoi, G., Mantzorou, M., Mantoudi, A., Drakopoulou, Μ., & Misouridou, E. (2021). Professional quality of life in Greek health professionals working with refugees and migrants. Materia Sociomedica, 33(2), 94. doi: 10.5455/msm.2021.33.94-99 DOI: https://doi.org/10.5455/msm.2021.33.94-99
Mette, J., Robelski, S., Wirth, T., Nienhaus, A., Harth, V., & Mache, S. (2020). “Engaged, burned out, or both?” A structural equation model testing risk and protective factors for social workers in refugee and homeless aid. International Journal of Environmental Research and Public Health, 17(2), 583. doi: 10.3390/ijerph17020583 DOI: https://doi.org/10.3390/ijerph17020583
Mikkonen, K., Helminen, E., Saarni, S., & Saarni, S. (2024). Learning outcomes of e-learning in psychotherapy training and comparison with conventional training methods: Systematic review. Journal of Medical Internet Research, 26, e54473. https://www.jmir.org/2024/1/e54473 DOI: https://doi.org/10.2196/54473
Misouridou, E., Mangoulia, P., Pavlou, V., Kasidi, K., Stefanou, E., Mavridoglou, E., Kelesi, M., & Fradelos, E. (2021). Reliability and validity of the Greek version of the professional quality of life scale (ProQOL-V). Materia Sociomedica, 33(3), 179-183. doi: 10.5455/msm.2021.33.179-183 DOI: https://doi.org/10.5455/msm.2021.33.179-183
Motamedi, M., Lau, A. S., Lind, T., Lui, J. H., Rodriguez, A., Smith, A., & Brookman-Frazee, L. (2021). What educational strategies and mechanisms facilitate EBP use? A mixed methods examination of therapist perceptions within a system-driven implementation of multiple EBPs. Implementation Research and Practice, 2. doi: 10.1177/2633489520982903 DOI: https://doi.org/10.1177/2633489520982903
Moutsou, I., Georgaca, E., & Varaklis, T. (2023). Psychotherapeutic and psychosocial interventions with unaccompanied minors: A scoping review. Healthcare, 11(6), 918. doi: 10.3390/healthcare11060918 DOI: https://doi.org/10.3390/healthcare11060918
Münz, D., & Melcop, N. (2018). The psychotherapeutic care of refugees in Europe: Treatment needs, delivery reality and recommendations for action. European Journal of Psychotraumatology, 9(1). doi: 10.1080/20008198.2018.1476436 DOI: https://doi.org/10.1080/20008198.2018.1476436
Nelson, M. M., Shanley, J. R., Funderburk, B. W., & Bard, E. (2012). Therapists’ attitudes toward evidence-based practices and implementation of parent-child interaction therapy. Child Maltreatment, 17, 47-55. doi: 10.1177/10775595124366 DOI: https://doi.org/10.1177/1077559512436674
Nickerson, A., Bryant, R. A., Silove, D., & Steel, Z. (2011). A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clinical Psychology Review, 31(3), 399-417. https://doi:10.1016/j.cpr.2010.10.004 DOI: https://doi.org/10.1016/j.cpr.2010.10.004
Oberg, C. & Sharma, H. (2023). Post-traumatic stress disorder in unaccompanied refugee minors: Prevalence, contributing and protective factors, and effective interventions: A scoping review. Children, 10(6), 941. doi: 10.3390/children10060941 DOI: https://doi.org/10.3390/children10060941
Orlinsky, D. E., Messina, I., Hartmann, A., Willutzki, U., Heinonen, E., Rønnestad, M. H., Löffler-Stastka, H., & Schröder, T. (2024). Ninety psychotherapy training programmes across the globe: Variations and commonalities in an international context. Counselling and Psychotherapy Research, 24(2), 558-571. doi: 10.1002/capr.12690 DOI: https://doi.org/10.1002/capr.12690
Pemberton, J. R., Conners-Burrow, N. A., Sigel, B. A., Sievers, C. M., Stokes, L. D., & Kramer, T. L. (2017). Factors associated with clinician participation in TF-CBT post-workshop training components. Administration and Policy in Mental Health and Mental Health Services Research, 44, 524-533. doi: 10.1007/s10488-015-0677-2 DOI: https://doi.org/10.1007/s10488-015-0677-2
Posselt, M., Deans, C., Baker, A., & Procter, N. (2019). Clinician wellbeing: The impact of supporting refugee and asylum seeker survivors of torture and trauma in the Australian context. Australian Psychologist, 54(5), 415-426. doi: 10.1111/ap.12397 DOI: https://doi.org/10.1111/ap.12397
Puchalska-Kamińska, M., Czerw, A., & Roczniewska, M. (2019). Work meaning in self and world perspective: A new outlook on the WAMI Scale. Social Psychological Bulletin, 14(1), e30207. doi: 10.32872/spb.v14i1.30207 DOI: https://doi.org/10.32872/spb.v14i1.30207
Ray, S. L., Wong, C., White, D., & Heaslip, K. (2013). Compassion satisfaction, compassion fatigue, work life conditions, and burnout among frontline mental health care professionals. Traumatology, 19(4), 255-267. doi: 10.1177/1534765612471144 DOI: https://doi.org/10.1177/1534765612471144
Rief, W. (2021). Moving from tradition-based to competence-based psychotherapy. BMJ Mental Health, 24, 115-120. doi: 10.1136/ebmental-2020-300219 DOI: https://doi.org/10.1136/ebmental-2020-300219
Rizkalla, N., & Segal, S. (2020). Refugee trauma work: Effects on intimate relationships and vicarious posttraumatic growth. Journal of Affective Disorders, 276, 839-847. doi: 10.1016/j.jad.2020.07.054 DOI: https://doi.org/10.1016/j.jad.2020.07.054
Rønnestad, M. H., Orlinsky, D. E., Schröder, T. A., Skovholt, T. M., & Willutzki, U. (2019). The professional development of counsellors and psychotherapists: Implications of empirical studies for supervision, training and practice. Counselling and Psychotherapy Research, 19(3), 214-230. doi: 10.1002/capr.12198 DOI: https://doi.org/10.1002/capr.12198
Shannon, P. J., Vinson, G. A., Cook, T., & Lennon, E. (2015). Characteristics of successful and unsuccessful mental health referrals of refugees. Administration and Policy in Mental Health and Mental Health Services Research, 43(4), 555-568. doi: 10.1007/s10488-015-0639-8 DOI: https://doi.org/10.1007/s10488-015-0639-8
Steger, M. F., Dik, B. J., & Duffy, R. D. (2012). Measuring meaningful work: The work and meaning inventory (WAMI). Journal of Career Assessment, 20(3), 322-337. doi: 10.1177/1069072711436160 DOI: https://doi.org/10.1177/1069072711436160
Sualp, K., Okumuş, F. E. E., & Molina, O. (2021). Group work training for mental health professionals working with Syrian refugee children in Turkey: A needs assessment study. Taylor & Francis Online, 45(3-4), 319-335. doi: 10.1080/01609513.2021.1953283 DOI: https://doi.org/10.1080/01609513.2021.1953283
Tribe, R., Sendt, K., & Tracy, D. K. (2017). A systematic review of psychosocial interventions for adult refugees and asylum seekers. Journal of Mental Health, 28(6), 662-676. doi: 10.1080/09638237.2017.1322182 DOI: https://doi.org/10.1080/09638237.2017.1322182
Unterhitzenberger, J., Eberle-Sejari, R., Rassenhofer, M., Sukale, T., Rosner, R., & Goldbeck, L. (2015). Trauma-focused cognitive behavioral therapy with unaccompanied refugee minors: A case series. BMC Psychiatry, 15, 260. doi: 10.1186/s12888-015-0645-0 DOI: https://doi.org/10.1186/s12888-015-0645-0
Unterhitzenberger, J., Wintersohl, S., Lang, M., Konig, J., & Rosner, R. (2019). Providing manualized individual trauma-focused CBT to unaccompanied refugee minors with uncertain residence status: A pilot study. Child and Adolescent Psychiatry and Mental Health, 13, 22. doi: 10.1186/s13034-019-0282-3 DOI: https://doi.org/10.1186/s13034-019-0282-3
Valenstein-Mah, H., Greer, N., McKenzie, L., Hansen, L., Strom, T. Q., Stirman, S. W., Wilt, T. J., & Kehle-Forbes, S. M. (2020). Effectiveness of training methods for delivery of evidence-based psychotherapies: A systematic review. Implementation Science, 15, 40. doi: 10.1186/s13012-020-00998-w DOI: https://doi.org/10.1186/s13012-020-00998-w
Yotsidi, V., & Anastasiou, Th. (2022). Effectiveness of trauma-focused cognitive behavioral therapy for children and adolescents and its application to the case of unaccompanied refugee minors. Greek Journal of Cognitive-Behavioral Research & Therapy, 8(1), 17-30 (in Greek).

How to Cite

Yotsidi, V., Anastasiou, T., Doulgeris, K., Theodosiou, P., & Richardson, C. (2024). Trauma focused-cognitive behavioral therapy training effectiveness in promoting professional development of psychotherapists working with unaccompanied minors in Greece: a non-blinded randomized control trial. Research in Psychotherapy: Psychopathology, Process and Outcome, 27(2). https://doi.org/10.4081/ripppo.2024.796