Psychotherapy Motivation in Refugees: The Role of Alexithymia, Stigmatization, Self-Esteem, and Psychotherapy Expectations

Objective: Despite elevated mental health problems, refugees tend to hold more negative attitudes toward psychological help seeking than residents of receiving countries. Therefore, we examined variables expected to be related to different aspects of psychotherapy motivation (psychological distress, knowledge about therapy, and denial of psychological helplessness) in 202 German residents and 200 refugees in Germany. Method: Participants completed measures of psychotherapy motivation, together with alexithymia, stigmatization toward help seeking, self-esteem, and expectations of therapy as variables with an expected relationship with psychotherapy motivation. Results: Refugees reported higher scores of psychological distress, more denial of psychological helplessness, and less knowledge about psychotherapy than residents. Refugees further reported higher levels of alexithymia and lower expectations for interpersonal and intrapersonal change in therapy compared to residents. In a pathway model, alexithymia, perceived stigmatization, self-esteem, and expectations for interpersonal changes emerged as critical variables associated with psychotherapy motivation. Alexithymia and expectations for interpersonal change partly accounted for group differences of reduced psychotherapy motivation in refugees. Conclusions: We discuss implications for practice and future research with respect to reducing treatment barriers and providing culturally-sensitive treatments for refugees suffering from psychological distress. Clinical Impact Statement Despite elevated mental health problems, refugees reported low levels of psychotherapy motivation. Alexithymia and expectations for interpersonal change played a crucial role in accounting for the different aspects of psychotherapy motivation. This points to the necessity of more research and intervention studies regarding psychotherapy motivation in refugees.