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The Tavistock and portman, NHS Foundation Trust
A family hold a paper cut out of a house in their hands.

Working with refugees and asylum seekers

Systemic psychotherapists, David Amias and Nsimire Bisimwa talk us through their two-day workshop, An introduction to working with refugees and asylum-seekers, which provides a much-needed starting point for those who work with refugees and asylum seekers, and wish to enhance the care and support they provide.

A diverse group of people laying their hands on top of each other.

What’s the course about?

This two-day workshop offers participants an insight into what it means to be a refugee and an asylum seeker – covering psychological, social, legal and somatic perspectives.

Underpinning the ethos of the course is a desire to understand the individual and their unique experience as a refugee or asylum seeker, and use this understanding to provide specialised support. As Nsimire explains, “People’s needs must be put in a wider socio-political context, in an understanding of what has happened to them. Because, on top of being human and having mental health issues, or struggling in life, like everyone else, being unrooted, suffering multiple losses and leaving their home to live in another country brings particular, and often acute, challenges.”

With this in mind, the course has been designed with a number of key ideas in mind – including trauma, risk, resilience, identity and self-care. We asked David and Nsimire to tell us more about each area, and how they are addressed in the workshop.

1. Trauma

The course explores Trauma, Complex Trauma and Post-Traumatic Stress Disorder in the context of the refugee experience. Participants will be asked to consider the journey undertaken by refugees and asylum seekers – from the circumstances of their departure from their country of origin, to their arrival and experience in this country, which, as David explains, “can be just as traumatising as the original events that led people to escape”.

Participants will also explore ‘mind-body’ connections – the physical symptoms associated with emotional and mental stress, an idea famously expressed by Bessel van der Kolk as ‘the body keeps the score’. When experiencing a traumatic event, the brain may be unable to fully assimilate or “process” the event – leading memories of the event to get “stuck”, and prompting the brain to respond through various mechanisms, such as “psychological numbing” or shutting down of normal emotional responses to protect the person. David and Nsimire will unpack these concepts, so that participants can better understand the complex needs that refugees or asylum seekers may present with.

2. Risk Assessment

Bearing in mind the most common diagnoses in traumatised populations, participants will be invited to consider a range of risk factors which can contribute to a deterioration in the mental health of refugees and asylum seekers. These can range from factors such as social isolation, discrimination, inconsistency of support, and issues with communication, through to reminders of traumatic experiences (e.g. losing belongings or objects of importance, sustaining injuries), and anniversaries (e.g. date of arrival) or festive periods. In this way, the course seeks to equip participants with the knowledge and awareness to more effectively manage risk when working with refugees and asylum seekers. We look at pathways to receiving support for deteriorating mental health and what workers should look out for to discern when to refer for specialist help.

3. Resilience

The Tree of Life diagram.

The course also explores the idea of resilience, as part of a ‘strengths-focused’ approach. It’s “less about victimhood and more about survivorhood”, notes David. “When working with refugees, it’s very important to take a stance of appreciating that resilience and resistance, and so we teach a little about what in narrative therapy is called ‘double listening’, where we’re listening out for people’s small acts of resistance against their predicament, and connecting with their strengths”. Interventions such as the ‘Tree of Life’ and ‘Team of Life’ offer practical ways to nurture resilience, particularly in group and community contexts – and when working with children and young people. During the workshop, participants will experiment with creating their own Tree of Life.

4. Identity

The course also explores the ‘migration of identity’ which refugees and asylum seekers experience as they adjust and integrate into a host society. “Many of the young people arriving here could be described as being in an in-between, “liminal” space”, explains David. “It is a place of transition, waiting, and not knowing. Our work is about helping participants create islands of safety where refugees and asylum seekers can feel heard, contained and supported therapeutically”.

The Migration of Identity chart

5. Self-Care

Course participants will also be invited to consider the impact of vicarious trauma and discuss the importance of self-care – recognising the challenges of connecting with the experiences of people who, in David’s words, “have survived so much suffering and are here to tell the tale”. “We realise that encountering trauma can also be traumatising, and we have to attend to that and appreciate that”, he explains.

Why is the course important now?

David and Nsimire, who both work with the Tavistock and Portman CAMHS Refugee Service, are aware of a pressing need in this area, citing the Covid-19 pandemic as a cause of concern: “Refugees and asylum seekers can easily get forgotten, and even further marginalised”, explains David. “What we’re doing in this course is really highlighting the issues for refugees and asylum seekers, and appealing for a compassionate, therapeutic approach, so that they can get the most appropriate and humane care”.

“With this course you will be able to see more of the human being, rather than the label of refugee”, says Nsimire, “which can make a difference as to how we, as human beings, connect with refugees, but also what services we make available, and how we relate to them”. 

Does this sound like the course for you?

If you are engaged in work with asylum-seeking or refugee people – or if you’d like to work in this area in future, An introduction to working with refugees and asylum seekers is the ideal place to start. Participants have included voluntary workers, social workers, mental health workers, teachers, psychologists, psychotherapists and GPs.

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