COUNSELING REFUGEES AND WAR VICTIMS
Introduction
Refugees are individuals who flee their country of origin in order to escape persecution due to
race, religion, nationality, political opinion, or membership in a particular social group.
Many refugees are displaced because of armed conflict where they could be directly targeted
or they could be caught in the cross fire between fighting groups.
Refugees often encounter traumatic experiences in their home countries before they move to
other countries hence they have a high rate of PTSD and other anxiety disorders.
Their lives are irrevocably altered by the death of loved ones, or by injuries, or through
surviving experiences of chronic subjection to routine harassment, persecution, and threats of
death.
Challenges of adjusting to the new life as refugees could further worsen the effects of trauma.
Refugees undergo more stress than immigrants. Refugees’ departure is often sudden and
traumatic. Families are often disrupted and some members are left behind.
They often spend years in camps before any countries accept to resettle them. Life in these
camps is often challenging e.g. there is no privacy, there is overcrowding, food is scarce etc.
refugees often worry about losing their own cultural identities and traditions
In order to have a strong therapeutic relationship with traumatized refugees, it is especially
important to establish trust and to recognize that the disclosure of traumatic experiences may
take time.
Considerations for Working with Refugees
Effects of Past Persecution, Torture, or Trauma
The pre-migration experiences of many refugees are often filled with the atrocities of war,
torture and killings, sexual assaults, incarcerations, and a continuing threat of death.
To see loved ones raped, beaten, and killed may have lasting, long-term consequences.
Refugees face high risk for mental health problems that involve PTSD, depression, and
anxiety.
Refugees often report PTSD symptoms such as nightmares, dissociation, intrusive thoughts,
and hyper vigilance.
They may have difficulty relating these experiences to a therapist.
, Women may be even more affected if they have been sexually abused or assaulted. In some
countries, sexually assaulted women are shunned and considered unfit to marry
Implications
o Since many refugees may not understand PTSD symptoms, you should help them
understand why these symptoms occur.
o Help them understand that the symptoms are normal reactions to trauma that anyone in their
situation would develop.
o Reassure them that the symptoms can be treated and are not signs that they are “going
crazy.”
o Note that refugees may hesitate to relay experiences of torture because of fear or feelings of
shame and humiliation.
o Clients should be allowed to go at their own pace in bringing up these experiences.
Safety Issues and Coping with Loss
Refugees often come from politically unstable situations. Therefore, issues of safety are
important and must be addressed.
The loss of friends, family, and status is very troubling to refugees.
Refugees often feel guilty about leaving other family members behind and may go through a
bereavement process.
Many will not be able to resume their previous level of occupational and social functioning.
It is important to identify their perception about what is lost.
Implications
o Refugees and immigrants may be suspicious about revealing personal information and
whether or not the information will be given to the government. Carefully discuss
confidentiality and the reason for the assessment.
o Since problem behaviors or mental difficulties may be seen as a source of shame for the
individual and their entire family, knowing that the information obtained will be confidential
will offer some relief.
Introduction
Refugees are individuals who flee their country of origin in order to escape persecution due to
race, religion, nationality, political opinion, or membership in a particular social group.
Many refugees are displaced because of armed conflict where they could be directly targeted
or they could be caught in the cross fire between fighting groups.
Refugees often encounter traumatic experiences in their home countries before they move to
other countries hence they have a high rate of PTSD and other anxiety disorders.
Their lives are irrevocably altered by the death of loved ones, or by injuries, or through
surviving experiences of chronic subjection to routine harassment, persecution, and threats of
death.
Challenges of adjusting to the new life as refugees could further worsen the effects of trauma.
Refugees undergo more stress than immigrants. Refugees’ departure is often sudden and
traumatic. Families are often disrupted and some members are left behind.
They often spend years in camps before any countries accept to resettle them. Life in these
camps is often challenging e.g. there is no privacy, there is overcrowding, food is scarce etc.
refugees often worry about losing their own cultural identities and traditions
In order to have a strong therapeutic relationship with traumatized refugees, it is especially
important to establish trust and to recognize that the disclosure of traumatic experiences may
take time.
Considerations for Working with Refugees
Effects of Past Persecution, Torture, or Trauma
The pre-migration experiences of many refugees are often filled with the atrocities of war,
torture and killings, sexual assaults, incarcerations, and a continuing threat of death.
To see loved ones raped, beaten, and killed may have lasting, long-term consequences.
Refugees face high risk for mental health problems that involve PTSD, depression, and
anxiety.
Refugees often report PTSD symptoms such as nightmares, dissociation, intrusive thoughts,
and hyper vigilance.
They may have difficulty relating these experiences to a therapist.
, Women may be even more affected if they have been sexually abused or assaulted. In some
countries, sexually assaulted women are shunned and considered unfit to marry
Implications
o Since many refugees may not understand PTSD symptoms, you should help them
understand why these symptoms occur.
o Help them understand that the symptoms are normal reactions to trauma that anyone in their
situation would develop.
o Reassure them that the symptoms can be treated and are not signs that they are “going
crazy.”
o Note that refugees may hesitate to relay experiences of torture because of fear or feelings of
shame and humiliation.
o Clients should be allowed to go at their own pace in bringing up these experiences.
Safety Issues and Coping with Loss
Refugees often come from politically unstable situations. Therefore, issues of safety are
important and must be addressed.
The loss of friends, family, and status is very troubling to refugees.
Refugees often feel guilty about leaving other family members behind and may go through a
bereavement process.
Many will not be able to resume their previous level of occupational and social functioning.
It is important to identify their perception about what is lost.
Implications
o Refugees and immigrants may be suspicious about revealing personal information and
whether or not the information will be given to the government. Carefully discuss
confidentiality and the reason for the assessment.
o Since problem behaviors or mental difficulties may be seen as a source of shame for the
individual and their entire family, knowing that the information obtained will be confidential
will offer some relief.
