Kenneth E. Miller, Ph.D.


Department of Psychology Office Phone: (909) 607-3757
Pomona College FAX: (909) 621-8623
550 Harvard Avenue email: ken.miller@pomona.edu
Claremont, CA 91711 Mobile phone: 510-326-7111

      
1994 Ph.D. in Clinical Psychology from the University of Michigan
1991 MA in Clinical Psychology from the University of Michigan
1985 BA with majors in Government and German Literature, from Cornell University

 Professional Positions
2005-current Associate Professor of Psychology, Pomona College
1999-2005 Assistant (1999-2004) and Associate (2005-2006) Professor of Psychology, San Francisco State University
1997-1999  Clinical Director, Bosnian Mental Health Program, Chicago, Illinois
1996-1999 Adjunct faculty member, Department of Psychology, University of Illinois at Chicago
1996-1999  Program Evaluation Consultant, Midwest Hispanic AIDS Coalition
1995-1996 Post-doctoral Fellow in Prevention Research, Department of Psychology, University of Illinois at Chicago
1994-1995 Post-doctoral Fellow in Prevention Research, Department of Psychology, Arizona State University

Publications
 Miller, K. (In press). Refugee children. University of Chicago Companion to the Child. Chicago: University of Chicago Press.

Miller, K. E., Omidian, P., Rasmussen, A., Yaqubi, A., & Daudzai, H. (In press). Daily stressors, war experiences, and mental health in Afghanistan. Transcultural Psychiatry. Abstract

Miller, K E.., Omidian, P.,Kulkarni, M., Yaqubi, A., Daudzi, H., & Rasmussen, A. (In press). The validity and clinical utility of Post-traumatic Stress Disorder in Afghanistan. Transcultural Psychiatry.

Miller, K. E., Kushner, H., McCall, J., Martell, Z, Kulkarni, M., & Laurel, D. (In press). Growing up in exile: Psychosocial challenges facing refugee youth in the United States. In J. Hart (Ed.), Years of Conflict: adolescence, political violence and displacement. Oxford: Berghahn Books.

Miller, K. E., Kulkarni, M., & Kushner, H. (2006). Beyond trauma-focused psychiatric epidemiology: Bridging research and practice with war-affected populations.  American Journal of Orthopsychiatry, 76, 409-422. Abstract Paper     

Miller, K. E., Omidian, P., Quraishy, A.S., Nasiry, M.N., Quraishy, N., Nasiry, S., Karyar, N.M., & Yaqubi, A.  (2006). The Afghan Symptom Checklist: A culturally grounded approach to mental health assessment in a conflict zone.  American Journal of Orthopsychiatry, 76, 423-433. Abstract  Paper

Omidian, P., & Miller, K. E. (2006). Addressing the psychosocial needs of women in Afghanistan. Critical Half, 4, 16-21. 

Miller, K. E., Martell, Z., Pazdirek, L., Caruth, M., & Lopez, D. (2005). Interpreting in psychotherapy with refugees: An exploratory study. American Journal of Orthopsychiatry,75, 27-39. Paper

Miller, K. E. (2004). Lessons from the field: Working with refugees in refugee camps and conflict zones. The Community Psychologist (37), 38-40.

Miller, K. E. (2004).  Beyond the frontstage: Trust, access, and the relational context in research with refugee communities.  American Journal of Community Psychology, 33, 217-227. Abstract paper

Miller, K. E. , & Rasco, L. M. (Eds.). (2004). The mental health of refugees: Ecological approaches to healing and adaptation. Mahwah, NJ: Lawrence Erlbaum Publishers, Inc.

Miller, K. E., & Rasco, L. M. (2004). An ecological framework for addressing the mental health needs of refugee communities.  In K. Miller & L. Rasco (Eds.), The mental health of refugees: Ecological approaches to healing and adaptation (pp. 1-64). Mahwah, NJ: Lawrence Erlbaum Publishers, Inc. Link to Chapter 

Rasco, L. M., & Miller, K. E. (2004). Innovations, challenges, and critical issues in the development of ecological mental health interventions with refugees. In K. Miller & L. Rasco (Eds.), The mental health of refugees: Ecological approaches to healing and adaptation (pp. 375-416). Mahwah, NJ: Lawrence Erlbaum Publishers, Inc.

Hubbard, J., & Miller, K. E. (2004).  Evaluating community-based mental health and psychosocial interventions in refugee communities.  In K. Miller & L. Rasco (Eds.), The mental health of refugees: Ecological approaches to healing and adaptation (pp. 337-374).  Mahwah, NJ: Lawrence Erlbaum Publishers, Inc. Link to Chapter 

Miller, K. E., Worthington, G., Muzurovic, J., Tipping, S., & Goldman, A.  (2002).  Bosnian refugees and the stressors of exile: A narrative study. American Journal of Orthopsychiatry, 72, 341-354.  Paper

Miller, K. E., Weine, S., Ramic, A., Brkic, N., Djuric Bjedic, Z., Smajkic, A., Boskailo,  E., & Worthington, G. (2002). The relative contribution of  war experiences and exile-related stressors to levels of psychological distress among Bosnian refugees.  Journal of Traumatic Stress, 15, 377-387.  Abstract Paper

Weine, S., Razzano, L., Ramic, A., Brkic, N., Miller, K., Smajkic, A., & Djuric-Bjedic, Z. (2000). Comparing the clinical profiles of Bosnian refugees who have presented for mental health services versus those who have not. Journal of Nervous and Mental Disease, 188, 416-421.

Miller K. E. (1999). Rethinking a familiar model: Psychotherapy and the mental health of refugees. Journal of Contemporary Psychotherapy, 29, 283-306. Abstract Paper

Miller, K. E. (1998). Research and intervention with internally displaced and refugee children. Peace and Conflict: Journal of Peace Psychology, 4, 365-379. Abstract

Banyard, V., & Miller, K. E. (1998). The powerful potential of qualitative research in community psychology. American Journal of Community Psychology, 24, 485-505. Special issue: Qualitative Methods In Community Psychology (K. Miller & V. Banyard, Guest Eds.).  Paper

Miller, K. E. (1996). The effects of state terrorism and exile on indigenous Guatemalan refugee children: A mental health assessment and an analysis of children's narratives. Child Development, 67, 89-106. Abstract

Miller, K. E., & Billings, D. (1994). Playing to Grow: A primary mental health intervention with Guatemalan refugee children. American Journal of Orthopsychiatry, 64, 346-356. Abstract

Miller, K. E. (1994). Jugando Para Crecer: Técnicas creativas para la promoción de la salud mental infantil (Playing to Grow: Creative Techniques for the Promotion of Children's Mental Health). In Farías, P. & R. Miranda (Eds.), Experiencias del Refugio Centroamericano: Perspectivas de Salud Mental (pp. 95-104). San Cristóbal de las Casas, Mexico: Colegio de la Frontera Sur.

Miller, K. E. , King, C., Shane, B., & Naylor, M. (1992). Suicidal adolescents' perceptions of their families' environments. Suicide and Life-threatening Behavior, 22, 226-239. Abstract

Intervention and Instructional Manuals
Miller, K., Billings, D., Adkins, M., Beitel, M., Bembenutty, H., Burden, E., Fierstien, J., Freels, J.,  Fuller, D., Irizarry, A., Kaloustian, A., Kaye, J., Miller, V., Moroschan, M., Scherer, C., Tourek, M. (1993).  Playing to Grow: Creative education workshops for children.  A written guide.  Ann Arbor, MI: OCSL Press.

Miller, K. (1995).  Children’s mental health: An introductory workbook for child mental health workers. Dysart, AZ: Migrant Education Program.

Miller, K. (1999).  Program evaluation for HIV/AIDS prevention services: A manual for community organizations.  Chicago: The Midwest Hispanic AIDS Coalition.

Consultancies
CHAD/SUDAN:
 - Evaluation consultant to the program evaluation team at the Program for Survivors of Torture in collaboration with the Hebrew Immigrant Aid Society, for a refugee camp-based mental health intervention with Sudanese refugees in Chad (2006-2007).

IRAQ:
  - Psychosocial Trainer, Columbia University's Mailman School of Public Health, "Supporting Civilian Victims of War" project, Erbil, Iraq (summer, 2006)

SRI LANKA:
  - Program Evaluation Consultant, UNFPA (The UN Population Fund), of project aimed at increasing local, regional, and national capacity to address psychosocial wellbeing

  - Psychosocial Trainer, Center for Psychosocial Care, Ampara, Sri Lanka (July, 2006)

AFGHANISTAN
  - Research Consultant, American Friends Service Committee, Kabul, Afghanistan (ongoing)
   
GUATEMALA
-  Evaluation Consultant, psychosocial program for youth, ASECSA (July-Dec, 1991)

MEXICO
-  Psychosocial Trainer, Centro de Investigaciones del Sureste (CIES), provided training in child-focused intervention in Guatemalan refugee camps (1992).

-  Mental Health Consultant, The Women's Group of San Cristobal, Chiapas.  Provided training in group interventions with survivors of domestic violence (1992)

USA
-  Program Evaluation Consultant, Afghan Community Health Partnership, Fremont, CA (2005)
   
-  Psychological Consultant, Boalt Hall School of Law, Human Rights Clinic, University of California at Berkeley, Berkeley, CA (2000-2004)
 
-  Mental Health and Program Evaluation Consultant, Bosnian Community Wellness Program, San Francisco, CA (1999-2001)

-  Program Development and Evaluation Consultant, Midwest Hispanic AIDS Coalition, Chicago, IL (1997-1999)

-  Educational and Mental Health Consultant: Migrant Education Program, Dysart, AZ (1994-1995)

Selected Conference Presentations and Invited Talks
 Miller, K. (May, 2006). Culture and context in the assessment of mental health in Afghanistan. Invited presentation, workshop on "Culture, Life Course, and Mental Health" at University of Chicago.

Miller, K. (May, 2006). War experiences, life stress, and mental health in Afghanistan. Invited presentation to the International Mental Health Interest Group, University of California at San Francisco.

Miller, K., & Omidian, P., Quash, A.S., Nazify, M.N., Quash, N., Nazify, S., Kara, N.M., & Yoruba, A. (Nov, 2005). Measuring mental health in Afghanistan: Development of the Afghan Symptom Checklist. International Society of Traumatic Stress Studies, Toronto

Miller, K., & Omidian, P. (April, 2005). The Afghan Symptom Checklist: A culturally grounded approach to mental health assessment in a conflict zone. Invited presentation to the annual meeting of the Western Psychological Association, Portland, OR.

Miller, K. (June, 2003). The Afghan Community Wellness Center: Addressing refugee wellbeing through a university-community partnership. Presented as part of a symposium on "Navigating the complexity of university-community partnerships" (K. Miller, Chair), 9th Biennial Meeting of the Society for Community Research and Action, Las Vegas, New Mexico.

Miller, K., Kushner, H., Martell, Z., McCall, J., Laurel, D, Brent, K., Westheimer, J., Kulkarni, M., Lopez, D., Williams, M., & Ortega, D. (May, 2003). Growing up in exile: Psychosocial challenges facing Southeast Asian, Afghan, and other refugee youth in the United States. Invited presentation to the Refugee Studies Programme at the University of Oxford, Oxford, England. presentation (click to download)

Miller, K. (February, 2002). Interviewing torture survivors seeking asylum. Invited presentation to the International Human Rights Law Clinic, University of California at Berkeley. presentation (will open as a new window)
Miller, K., & Worthington, G. (August, 2001).  Assessing inter-coder agreement in the coding of narrative data.  Presented as part of a symposium on "Qualitative Methods in Community Research: Methodological Issues and Challenges" (K. Miller, Chair), at the annual meeting of the American Psychological Association, San Francisco, CA presentation  (PDF file will open as new window)

Miller, K., Pazdirek, L., Silber, Z., & Caruth, M. (August, 2001). Interpreting in psychotherapy with refugees: The interpreter's experience.  Presented as part of a symposium on "Interpreting in Refugee Mental Health Settings" (K. Miller, Chair), at the annual meeting of the American Psychological Association, San Francisco, CA. presentation (will open as new window; close to return to this page)

Silber, Z., Pazdirek, L., Caruth, M., & Miller, K. (August, 2001). Complex Emotional Reactions within the Therapist/Client/Interpreter Triad. Presented as part of a symposium on "Interpreting in Refugee Mental Health Settings" (K. Miller, Chair), at the annual meeting of the American Psychological Association, San Francisco, CA. presentation (will open as new window, close to return to this page)

Miller, K. (August, 2001). Enhancing the fit: Matching services to the needs and values of refugee communities. Presented as part of a symposium on "Psychosocial Assistance to Refugees: Interventions, Ethics, and Social Reconstruction" (K. Miller, Chair), at the annual meeting of the American Psychological Association, San Francisco, CA. presentation (will open as new window; close to return to this page)

Miller, K. (June, 2001).  The role of qualitative methods in research with refugee communities.  Presented as part of a symposium on "Qualitative Approaches to Researching Refugee Communities" (K. Miller, Chair), at the biennial meeting of the Society for Community Research and Action (Division 27 of the American Psychological Association), Atlanta, Georgia.

Zahir, G., Kakar, K., Zahir, M., & Miller, K. (June, 2001). Psychosocial Challenges Facing Afghan Women Refugees in the United States. Presented as part of a symposium on "Qualitative Approaches to Researching Refugee Communities" (K. Miller, Chair), at the biennial meeting of the Society for Community Research and Action (Division 27 of the American Psychological Association), Atlanta, Georgia. .

Capella, E., Rasco, L., & Miller, K. (June, 2001). Community-Based Interventions for Refugee Children: Theory and Evaluation. Roundtable presentation & discussion held at the biennial meeting of the Society for Community Research and Action (Division 27 of the American Psychological Association), Atlanta, Georgia.

Miller, K. (Sept., 2000).  From clinic to community: Ecological approaches to refugee mental health.  Invited presentation to the 3rd Annual International Conference of the Disaster Mental Health Institute, on "Refugee Mental Health".  Rapid City, South Dakota.  Click here for an updated version of this presentation.

Miller, K., Worthington, G., Muzurovic, J., Goldman, A., Tipping, S., & Muzurovic, J. (August, 2000). Bosnian refugees and the experience of exile. Presented at the 108th Annual Meeting of the American Psychological Association, in Washington, DC. poster  (requires Microsoft Word to open)

Miller, K., Worthington, G., Muzurovic, J., Tipping, S., Goldman, A., & Muzurovic, J.  (August 2000). Older refugees and the crisis of exile. Presented at the 108th Annual Meeting of the American Psychological Association, in Washington, DC

Miller, K., Weine, S., Ramic, A., Brkic, N., Djuric Bjedic, Z., Smajkic, A., Boskailo,  E., & Worthington, G. (Nov., 1999). The relative contribution of war events, social isolation, and daily activities to levels of PTSD and depression among Bosnian refugees. Presented at the 15th Annual Meeting of the International Society for Traumatic Stress Studies, Miami, FL.

Miller, K. (September, 1999). Language and the experience of exile. Invited address to the 1999 Pennsylvania Refugee and Immigrant Consultation, Philadelphia, PA.

Miller, K. (September, 1999). The value of a comprehensive approach to mental health work with political refugees. Invited address to the 1999 Pennsylvania Refugee and Immigrant Consultation, Philadelphia, PA.

Miller, K. (November, 1998). Challenges in psychotherapy with Bosnian refugees in Chicago. Presented at the 14th Annual Meeting of the International Society for Traumatic Stress Studies, Washington, DC.

Miller, K. (October, 1998). Healing the wounds of war: Responding to the mental health needs of Bosnian refugees in the United States. Invited address to the 1998 Pennsylvania Refugee Consultation, Philadelphia, PA.

Miller, K. (May, 1996). The value of discrepant findings: On combining qualitative and quantitative strategies in our research endeavors. Presented at the Annual Meeting of the Illinois Psychological Association, Chicago, IL.

Miller, K. (March, 1995). "Children and political violence: New directions for research and intervention". Presented as part of a symposium on "Children and political violence" (K. Miller, Chair), at the Biennial Meeting of the Society for Research in Child Development, Indianapolis, IN.

Miller, K. (June, 1993). The Children and Family Violence Project: A community-based domestic violence intervention in San Cristóbal de las Casas, Mexico. Presented at the Fourth Biennial Meeting of the Society for Community Research and Action (Division 27 of the American Psychological Association), Williamsburg, VA.

Miller, K. (June, 1993). Methodological issues in cross-cultural mental health research with children. Presented at the Fourth Biennial Meeting of the Society for Community Research and Action (Division 27 of the American Psychological Association), Williamsburg, VA.

Miller, K., & Billings, D. (May, 1993). Playing to Grow: A primary mental health intervention with Guatemalan refugee children. Presented at the Annual Meeting of the American Orthopsychiatric Association, San Francisco, CA.

Review Work

- Journal of Traumatic Stress (Editorial Board)
- American Journal of Community Psychology (Ad hoc Reviewer)
- Social Science and Medicine (Ad hoc Reviewer)
- Journal of Health Care for the Poor and Underserved (Ad hoc Reviewer)
- American Journal of Orthopsychiatry (Ad hoc Reviewer)
-Guest editor (with Vicki Banyard), American Journal of Community Psychology, for special issues on "Qualitative Methods in Community Psychology" (1992) and "The Role of Values in the Community Psychology Classroom (in preparation)
-Co-editor (with Lisa Rasco) of The Mental health of refugees: Ecological approaches to healing and adaptation (2004, Lawrence Erlbaum Publishers, Inc.)

Membership in Professional Associations

Grants, Awards and Other Professional Activities
Spring 2007 Hirsch Research Initiation Grant for post-production of documentary film: "Unholy Ground: Life, Death, and Survival in a Sri Border Lankan Village"
Spring 2007 Faculty Research Grant, Pomona College, for production of documentary film: "Unholy Ground: Life, Death, and Survival in a Sri Border Lankan Village"
Spring 2005 NIMH-RIMI Fellowship in Research on Health Disparities
Pending R34 Proposal to the National Institute of Mental Health, for a study entitled "The ESL Classroom as a Refugee Mental Health Setting"
2004-2006 Co-author of funded proposal for the Afghan Community Health Partnership from the California Endowment ($230,000)
Summer 2004 The Afghan Wellness Questionnaire: A Field Study in Kabul Afghanistan. Grants provided by the Society for the Psychological Study of Social Issues and the College of Behavioral and Social Sciences at San Francisco State University.
Spring, 2002 NIMH M-RISP Faculty Development Award
Fall 2000 University Mini-grant Award for Spring semester, 2001, San Francisco State University
2000-2003 Co-author of funded proposal for the Bosnian Community Wellness Project in San Francisco, from the California Endowment ($550,000)
Fall 2000 Release Time Award for Spring semester, 2001, San Francisco State University
Fall 1999  Summer Stipend Research Award for Summer, 2000, San Francisco State University
Fall 1999  Release Time Award for Spring semester, 2000, San Francisco State University
1999  Silver Circle Award Finalist for Excellence in Undergraduate Teaching, University of Illinois at Chicago
1997 Silver Circle Award Finalist for Excellence in Undergraduate Teaching, University of Illinois at Chicago
1994 Award for Trailblazing Community Work and Outstanding Contribution to the Clinical Psychology Program,  University of Michigan
1991  Dissertation grant from the Institute for Intercultural Studies
1991 Dissertation grant from the Society for Psychological Study of Social Issues
1992 Dissertation award from the Rackham Graduate School, University of Michigan


Daily stressors, war experiences, and mental health in Afghanistan.
Miller, K., Omidian, P., Rasmussen, A., Yaqubi, A., & Daudzai, H. (In press, Transcultural Psychiatry)

Research on the mental health of war-affected populations has focused heavily on the psychological sequelae of exposure to war-related traumatic stress. However, organized violence typically generates or exacerbates highly stressful social conditions such as poverty, unemployment, family violence, and social isolation due to the devastation of traditional social networks. Such variables are stressful in their own right, and may also delete people's coping resources for dealing constructively with the effects of prior exposure to war-reared traumatic stress. The aim of this study was to examine the relative contribution of ongoing daily stressors and prior exposure to war-related traumatic stress to current mental health  We also sought to examine whether level of daily stress related to "daily stressors" (referred to elsewhere as "daily hassles" moderated the relationship between war exposure and mental health status.  Working in Afghanistan’s capital city of Kabul, the authors assessed the prevalence and relative salience of 26 daily stressors in a sample of 320 adults (160 women and 160 men). We also used hierarchical multiple regression to examine the relative contribution of daily stressors and war-related experiences of violence and loss to several mental health outcomes including depression (HSCL-Depression), anxiety (HSCL-Anxiety), PTSD (IES-R), impaired functioning (WHODAS II), and a culturally specific measure of general psychological distress (Afghan Symptom Checklist). As hypothesized, daily stressors were a better predictor than war experiences of depression, anxiety, impaired functioning, and general distress. Level of daily stress also moderated the relationship between war experiences and PTSD, which unexpectedly was significant only under conditions of low daily stress. This suggests that under conditions of high daily stress, people are highly focused on issues of basic survival, while under conditions of low daily stress, there is a greater vulnerability to post-traumatic stress responses. The study’s implications for research and intervention in conflict and post-conflict settings are considered.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Beyond Trauma-focused Psychiatric Epidemiology: Bridging Research and Practice with War-affected Communities
Miller, K., Kulkarni, M., & Kushner, H.(2006). American Journal of Orthopsychiatry, 409-422.


The past 25 years have witnessed a surge of interest in the mental health effects of political violence and forced migration. The dominant focus of research in this area has been on the assessment of post-traumatic stress disorder (PTSD) and other disorders of Western psychiatry. That focus, which the authors refer to as trauma-focused psychiatric epidemiology (TFPE), has been of limited utility to practitioners, who are concerned with a variety of pressing issues other than the prevalence of PTSD symptoms in the communities they serve. They need to know about local idioms of distress and help-seeking behaviors; they need to be able to identify local mental health priorities, and to understand the effects of violence not just on individuals but on families and communities; they need to understand the effects of the structural violence which so often forms the context in which acts of political violence occur; and they need to be familiar with effective intervention strategies. The neglect of these issues in the research literature, which is the result of the nearly hegemonic influence TFPE in this area, has led to a troubling gap between research and practice with war-affected populations. The core assumptions of TFPE and its paradigmatic roots in logical positivism and the biomedical model of contemporary psychiatry are explored, and an alternative framework, social constructivism, is presented. The authors suggest that a constructivist framework can serve as a bridge between researchers and practitioners by helping to refocus research efforts in ways that are both conceptually and methodologically more attuned to the needs of war-affected communities and the organizations working to address their mental health needs. Constructivist approaches to addressing critical issues of concern to practitioners are described, drawn from the small but growing number of studies that have been conducted, partially or wholly, within a constructivist framework

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Afghan Symptom Checklist:
A Culturally Grounded Approach to Mental Health Assessment in a Conflict Zone

Miller, K., Omidian, P., Quraishy, A.S., Nasiry, M.N., Quraishy, N., Nasiry, S., Karyar, N.M., & Yaqubi, A.  (2006). The Afghan Symptom Checklist: A culturally grounded approach to mental health assessment in a conflict zone.  American Journal of Orthopsychiatry, 76, 423-433.

 ABSTRACT

This paper describes a methodology for developing culturally grounded assessment measures in conflict and post-conflict situations. A mixed-method design was used in Kabul, Afghanistan to identify local indicators of distress and develop the 22 item Afghan Symptom Checklist (ASCL). The ASCL contains several indigenous items and items familiar to western mental health professionals. The ASCL was pilot tested and subsequently administered to 324 adults in eight districts of Kabul. It demonstrated excellent reliability (alpha = .93) and good construct validity, correlating strongly with a measure of exposure to war-related violence and loss (r=.70). Results of the survey indicate moderate levels of distress among Afghan men, and markedly higher levels of distress and impaired functioning among women, and widows in particular.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Bosnian Refugees and the Stressors of Exile: A Narrative Study

 Miller, K., Worthington, G., Muzurovic, J., Tipping, S., & Goldman, A.(2002). American Journal of Orthopsychiatry 77), 341-354.

This study utilized semi-structured interviews to examine exile-related stressors affecting Bosnian refugees in Chicago. Participants were 28 adult Bosnians, current or former clients in a mental health program serving the area's Bosnian refugee community. The interviews covered three areas: life in pre-war Bosnia, the journey of exile, and most centrally, life in Chicago. The use of a narrative approach allowed participants to identify and explore those exile-related stressors most salient within their community. Primary sources of exile-related distress included social isolation and the loss of community, separation from family members, the loss of important life projects, a lack of environmental mastery, poverty and related stressors such as inadequate housing, and the loss of valued social roles. The implications of the study's findings for community-based, ecological grounded interventions with refugees are considered.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Beyond the Frontstage: 
Trust, Access, and the Relational Context in Research with Refugee Communities

Miller, K. (2004). American Journal of Community Psychology, 33, 217-227.

This paper examines the role of trust and the concept of access as they affect the relational context in which community research, and research with refugee communities in particular, is conducted. It is argued that gaining authentic ("backstage") access to refugee communities, as well as other communities with a self-protective insularity, depends on the relational context that develop between researchers and community members. Goffman’s metaphor of frontstage and backstage behavior is used to illustrate the complexity and importance of developing of relations of trust, and thereby gaining “backstage” access, in communities that are generally closed to outsiders. Throughout the paper, key points are illustrated with examples drawn from the author's research with refugees from Guatemala, Bosnia, and Afghanistan. The paper also examines the puzzling lack of discussion regarding issues of trust, access, and the relational context in the literature on refugee mental health. Explanations for this apparent inattention are sought in the influence of the prevailing scientific paradigm that guides most research with refugees, and that shapes the values of the field's "gatekeepers", the editors and reviewers of scholarly journals.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Relative Contribution of War Experiences and Exile-related Stressors to Levels of Psychological Distress Among Bosnian Refugees

 Miller, K., Weine, S., Ramic, A., Brkic, N., Djuric Bjedic, Z., Smajkic, A., Boskailo, E., & Worthington, G. (2002). Journal of Traumatic Stress.

 ABSTRACT The present study examined the relative contribution of two exile-related variables--social isolation and daily activity level--as well as war experiences of violence and loss, to levels of PTSD and depressive symptomatology in 2 groups of Bosnian refugees, one a clinical and the other a non-clinical community group.  As hypothesized, degree of exposure to war-related violence was highly predictive of level of PTSD symptoms in both groups; in addition, social isolation was significantly related to PTSD symptomatology in the community group. Also as predicted, depressive symptomatology was accounted for primarily by the exile-related stressors.  The two groups differed, however, with respect to the particular exile-related variable that was significantly associated with level of depressive symptoms. Whereas for the clinic group, level of daily activities was highly predictive of scores on the measure of depression, and social isolation was not, the reverse was true for community group. For the clinical group, which experienced a significantly greater number of interpersonal losses than the community group during the war, additional variance in depressive symptomatology was accounted for by experiences of war-related loss. Exposure to war-related violence was not associated with level of depressive symptoms in either group. Differences between groups with regard to the salience of specific stressors are considered, as are the implications of the study's findings for psychosocial interventions with refugees.

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

Rethinking a Familiar Model: Psychotherapy and the Mental Health of Refugees.

 Miller, K. (1999). Journal of Contemporary Psychotherapy, 29, 283-305.

This paper examines with a somewhat critical eye the primary role that psychotherapy and other clinic-based services currently play in addressing the mental health needs of political refugees in the industrialized countries. Two factors are considered which suggest that refugee mental health needs might be better served with a variety of community-based interventions. The first factor concerns the pervasiveness of psychological distress within refugee communities, coupled with the reluctance of many refugees to utilize formal psychological and psychiatric services. This calls into question both the adequacy and appropriateness of clinical-based services as cornerstones of our response to the mental health needs of refugees. More precisely, it suggests the need to complement such services with a variety of culturally grounded, community-based strategies that do not require attendance in formal mental health settings. Second, recent findings have shown consistently that a considerable amount of the distress reported by refugees is related not to prior exposure to violent events, but rather to a constellation of exile-related stressors such as the loss of one's community and social network, the loss of important life projects, changes in socioeconomic status and related concerns about economic survival, the loss of meaningful structure and activity in daily life, and the loss of meaningful social roles. It is suggested that while psychotherapy can play an important adjunctive role in helping confront these exile-related stressors, they may most effectively be addressed through targeted community-based interventions. Examples of such community-based interventions are briefly described, and suggestions are offered for community-level strategies that might be explored. The paper concludes by emphasizing the complementary nature of clinical and community-based programs, and by suggesting that psychotherapy might best be conceptualized as one component of a more comprehensive approach to addressing the mental health needs of refugees communities.
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Research and Intervention with Internally Displaced and Refugee Children

 Miller, K. (1998). Peace and Conflict: Journal of Peace Psychology, 4, 365-379

This article examines the G. Machel Study, The Impact of Armed Conflict on Children (1996), with a focus on the mental health of internally displaced and refugee children. Observations of the Machel Study are located within the context of the current psychological literature on refugee and displaced children and families. Gaps in our current knowledge that might be the focus of future research efforts are considered, and several issues are identified that are not discussed in the Machel Study, but that are particularly salient for psychologists working in this area.
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Effects of State Terrorism and Exile on Indigenous Guatemalan Refugee Children: A Mental Health Assessment and an Analysis of Children's Narratives.

 Miller, K. (1996). Child Development, 67, 89-106

Examined the mental health and psychosocial development of 58 Guatemalan Mayan Indian children (aged 7-16 years) living in 2 refugee camps in Chiapas, Mexico. Assessment instruments and semi-structured interviews were utilized to gather phenomenological data from Ss regarding developmental, sociocultural, and political topics. Results show minimal evidence of psychological trauma in this sample, and various factors are suggested to account for this finding. A positive relationship between Ss' mental health and the physical and mental health status of their mothers was found. A strong association between depressive symptomatology in girls and poor health status in their mothers was also found. Qualitative data from the interviews are presented, focusing on Ss' understanding of why their families fled Guatemala, the nature and causes of the violence, and their thoughts and feelings regarding the prospect of returning to Guatemala in the future.
 
 
 
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Playing to grow: A Primary Mental Health Intervention with Guatemalan Refugee Children.

 Miller, K., Billings, D. (1994). American Journal of Orthopsychiatry, 64, 346-356

Describes a mental health intervention program undertaken in Guatemala, focusing on the mental health and psychosocial development of Guatemalan refugee children. The program uses a variety of expressive arts techniques to assist children in safely and creatively exploring salient issues related to the experience of growing up in exile, including individual and collective drawing, sociodrama, and role-playing. The goals of the intervention include providing the children with expressive arts techniques through which to share their thoughts and feelings, creating a supportive context in which they can examine positive aspects of their homeland and culture, and facilitating the development of children's capacity for creative thinking and activity.
 
 
 
 
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

Suicidal adolescents' perceptions of their family environment.


Miller, K., King, C., Shain, B., & Naylor, M. (1992). Suicide and Life-Threatening Behavior, 22, 226-239

15 suicidal adolescents (SADs [mean age 14.93 yrs]), 14 age-matched psychiatric controls (PCTLs), and 14 age-matched normal controls (NCTLs) rated their families on cohesiveness, adaptability, parent-adolescent communication, parental caring, and parental overprotectiveness. SADs rated their families as the least cohesive and most rigid of the 3 groups, suggesting that adolescent suicidal behavior may occur when isolation is experienced within an inflexible family system. SADs and PCTLs rated their families as similarly dysfunctional along the remaining variables, and as more dysfunctional than families of NCTLs. It is suggested that several characteristics commonly attributed to families of suicidal adolescents may actually be general risk factors for adolescent psychopathology, rather than for suicidal behavior specifically.