How does the trauma of resettlement shape the mental health of refugee and asylum seekers?

Aida Alayarian

Aida Alayarian

UKCP psychotherapist Dr Aida Alayarian B.Sc., MSc. Doc.Sc., PhD is a clinical psychologist, child psychoanalyst and a qualified adult psychoanalytic psychotherapist. She is the co-founder of the Refugee Therapy Centre.

People arriving in a country of resettlement often feel an initial sense of elation, simply because they have escaped from considerable personal danger in the course of their flight.  They may have feelings of anger, fear, guilt and depression, but profound relief appears more common in the early stage after their arrival.  This initial feeling of relief is hardly long lasting and is soon replaced by anxiety and depression. People feel they have lost their social world, are separated from traditional life, beliefs and occupations; some may experience multiple losses of family and friends, home and culture; many have been tortured, persecuted and imprisoned and may face an uncertain future in exile, unable to build a new life.

People who have endured trauma can feel isolated, outsiders, and misunderstood because of the long-lasting continuing pain they are enduring. This pain, whether physical or mental, can control their ability to separate daily life in the host country from the effects of their past, leaving them feeling alone.

Across nearly all otherwise diverse experiences, refugees feel a deep sense of loss for the country and the loved ones they had to leave behind. This will be particularly strong for those who were forced to leave entirely against their will. Many will have left relatives left behind who themselves face persecution. As a result, their grief of surrendering kinship bonds will be compounded by an anxiety for the fate of their family, and the uncertainty over whether they are safe. This anxiety can manifest in physical symptoms, frightening thoughts, or erratic behaviour.

It is well known that losing a loved one is one of the most intensely painful experiences any human being can suffer. In the case of many refugee families, a primary sense of loss is experienced directly, while secondary grief of witnessing the suffering of others can also exact a severe emotional toll on both adults and children. 

The mental health stigma and discrimination

Often the meaning of words, notions and concepts are culturally dependent.  Lack of understanding of differences in perception is a major source of misunderstanding when it comes to mental health issues, especially in cross-cultural communication. That certainly affects refugees’ lives and can lead to further serious mental health problems.

It is abundantly clear that the chronic stress of struggling with material disadvantage is intensified by an environment where people are socially marginalised. This cannot be considered an individual mental health matter –  it is an illness of the system and society. Inequality and poor mental and physical health are interrelated within social and class hierarchy. The distribution of economic and social resources explains health equality and other outcomes. The importance of the social and psychological dimensions of material deprivation needs to gain greater recognition in the local, national and international literature on poverty and inform current efforts for refugees and other marginalised groups.

The need for change, best practice disseminations of long-term mental health

Throughout my professional life, I have been conscious of the need to address the critical issues of creating effective standardised information and of evidence collection processes through ongoing research. The specific objective of my own research for over three decades and in our project at the Refugee Therapy Centre is to strengthen and harmonise culturally and linguistically appropriate therapeutic interventions. By collecting data and disseminating outcomes based on clear clinical inputs and outputs, we can support the development of better psychological interventions for those who have suffered trauma.

By disseminating good practice and acquiring technical competencies, we can build a coherent intercultural therapeutic intervention based on evidence of working with those who have been tortured and its effect on their life and the lives of their family members. Most importantly, data collected on torture and other forms of human rights violations, and the medical and psychological consequences, can be made public and used for a wide array of human rights outcomes. This could include issuing medico-legal reports to support legal cases, reports on themes, holding perpetrators to account and, most importantly, to ensure that the journey of survivors of torture to rehabilitation is brought out into the open wherever possible.

We know recovery cannot be achieved through a ‘one size fits all’ approach or as a stand-alone activity.  While it may help many in the community, it has little value for someone who has no food on the table or who is living in a house with a leaking ceiling and no income. Although it is not enough, we address these issues using an intercultural psychoanalytic approach, taking into consideration the socio-economic, political and cultural context of the clients. 

How we work with this group

At the Refugee Therapy Centre, we know that to work effectively with those who have been traumatised, one must be willing to enter their experience; be empathically attuned to their terror, shame, vulnerability, rage, and loss; and embrace the disconnection and disempowerment that comes with such experiences.

Working with this reality, it is not difficult to see our own feelings (countertransference) become one of our greatest assets and greatest liabilities. Recognition, awareness and ongoing monitoring and reflection of countertransference is central to the effectiveness of our work and our own self-care.

While recognising that this is the fallout of the specialised work that we choose to do, we also know it can improve our work and develop our capacity for recognising the impact of working with both individuals and groups and help us to balance our own professional and personal needs for support and supervision. 

The accessibility to services

The Refugee Therapy Centre is a charity. Where funding is available, we are open to anyone seeking therapy to deal with the trauma they have endured. Over the years, we have developed networks with other professionals including GPs and mental health services, social services, educational organisations, refugee communities, support agencies and organisations with a view to improving the range and accessibility of services as well as disseminating good practice.

Unfortunately, in recent years all our local and central funding has been gradually cut, which led to staff cuts.  Our Trustees are working hard to find a way forward to keep these much-needed services.

Psychotherapy can offer a safe space to explore your feelings, YOU CAN LOOK FOR AN ACCREDITED THERAPIST ON THE UKCP WEBSITE

You can also find support by contacting:

In an emergency, call: 999

NHS (England), call: 111

NHS Direct (Wales), call: 0845 46 47

Refugee Therapy Center, call: 0207 561 0402

The Samaritans 24 hour helpline, call: 116 123


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