Disclosure and silencing: A systematic review of the literature on patterns of trauma communication in refugee families

This systematic review aimed to explore the effects of different degrees of parental disclosure of traumatic material from the past on the psychological well-being of children in refugee families. A majority of studies emphasize the importance of the timing of disclosure and the manner in which it takes place, rather than the effects of open communication or silencing strategies per se. A pattern emerged in which the level of parental disclosure that promotes psychological adjustment in refugee children depends on whether the children themselves have been directly exposed to traumatic experiences, and whether the children are prepubescent or older. The process of trauma disclosure is highly culturally embedded. Future research needs to address the culturally shaped variations in modulated disclosure and further explore how modulated disclosure can be facilitated in family therapy with traumatized refugee families.


Theoretical article
The "World Tehnique" (or the Erica method).
N ¼ 1 A case study is presented.
The authors argue for the necessity of challenging the strategies of silence and denial often seen in traumatized refugee families. Angel, Hjern, & Ingleby, 2001 Families from Bosnia-Herzegovina relocated in Sweden.
Quantitative study using structured clinical interviews and observations of the children to assess their mental health.
Each family was interviewed twice by child psychiatric staff. The interviews involved structured questions both about symptoms according to DSM-III-R and about parents' attitudes towards talking with their children about the events they had experienced.
N ¼ 99 School-aged Bosnian refugee children living in Sweden.
For children who had experienced much stress, a significant pattern of associations emerged in which talking about their experiences seemed to exacerbate the negative effects.
Azarian-Ceccato, 2010 Descendants of survivors of the Armenian genocide currently living in California.
Qualitative study aimed at exploring the intergenerational transmission and reverberations of trauma narratives within a community of descendants of survivors of the Armenian genocide.
Ethnographic investigation of narrative renditions of the Armenian genocide recounted in both public and private venues.
N ¼ 11 Great-grandchildren of survivors of the Armenian genocide aged 12-28 years.
Describes the role of collective memory and the ways in which trauma narratives become collective stories within a community. Refugee families from a wide range of countries relocated in Denmark The study examined children's narrative responses to identify migration-specific representational markers of attachment quality.
The study used a narrative attachment measure adapted for use with refugee children: The Attachment and Traumatization Story Task.
N ¼ 18 children in refugee families, ages 4-9. A clinical sample of 10 children without a history of direct exposure to war or organized violence and a community sample of 8 children who fled with their families from their home countries due to war, organized violence, and persecution.
For the children who were born in the home country and had a history of direct trauma exposure, there seemed to be an association between a child being classified as "secure" and open parental communication on migrationspecific stressors.
The article describes a new dialogical approach to family therapy with refugee families.
Analysis of written notes made during and immediately after sessions by the therapist.
N ¼ 2 A case study describing a mother and her 11-year-old son. The study concludes that the timing and manner in which trauma was disclosed to children appear to be associated with the children's ability to play creatively. The study also concludes that "modulated disclosure" seems to be positively associated with the child's ability to play creatively. Montgomery, 1998 Middle Eastern refugee families seeking asylum in Denmark.
The study explored the mental health of asylum-seeking refugee children.
Structured interviews with parents. The study employed a social constructionist perspective in which a distinction was made between "stories told" (i.e., what the child is told explicitly) and "stories lived" (i.e., the child's sense of what has happened).
In-depth qualitative interviews with all family members.
N ¼ 14 members of 3 different families.
The study suggests that when there are contradictions between "stories told" and "stories lived" it creates a situation of uncertainty and ambiguity, which can cause confusion, powerlessness, and action paralysis within the family unit.

Montgomery, 2010
Refugee families from the Middle East relocated in Denmark.
Quantitative study aimed at assessing the longterm trajectory of psychological problems in refugee children through a 9-year follow-up study. The study divided the participants into 4 groups: (1) spared ¼ continuing low level of symptoms; (2) reacting ¼ increasing level of symptoms; Parents and young refugees were interviewed separately using structured questionnaires focusing on family structure, parents and young refugees' social situation and health, the child's exposure to stressful events and indicators of social adaptation. Futhermore the young refugees The study explored the impact of culture on the transmission of trauma using a comparative design with children in two age groups from two different cultural groups.
The Child Behavior Checklist and questionnaires measuring the family history of trauma, parental and family characteristics and the Family Environment Scale. Furthermore semistructured interviews were designed to cover key aspects of the intergenerational transmission of trauma including intrafamily communication.