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Confronting refugee trauma through an American therapist’s lens is possible, difficult and fulfilling

By Dena Khalafallah, Medill, Immigrant Connect

Sometimes Virginia Jreisat needs to tap the feet of the person she’s talking to to remind them that their body is in the room. It’s a device the professional counselor uses when talking with refugees whose trauma is so brutal that they need to do something mindful or to talk about something off topic to ground themselves in the present.

“There are children from Syria who know what the drones sound like, and will relay that to their therapist. They’ll be like, ‘oh, I know when it’s coming.’ You’re talking about six or seven year olds who know what military warfare sounds like,” said Jreisat. “It’s implausible because we don’t have to face any of those realities.”

In private practice, Jreisat counsels white, middle class Americans, which she described as being a stark contrast from her previous experiences counseling refugees from the Ivory Coast, Iraq, Syria and Burma.

Mental health counselor Virginia Jreisat. (Photo credit: Brighter Pathways LLC

Methods for treating trauma are fairly universal regardless of cultural context—even if it may seem paradoxical that Western mental health professional can provide treatment to seriously traumatized refugee populations.

“Unfortunately, in our culture, because we speak English, we are not used to having to switch our language. We expect the world to kind of learn ours,” Jreisat said.

Being of Jordanian descent, Jreisat said she felt connected to her Arab clients.

“I speak Arabic. We could engage in dialogue—we weren’t missing each other’s jokes. I was, you know, reading their body language because I grew up in a similar culture. For me, it was this kind of easier flow of information.”

The language barrier between Jreisat and her other refugee clients was “pretty overwhelming,” and required further effort and translation resources.

Jreisat added that language barriers should not discourage other therapists from working with refugees.

“I don’t think that there’s a heritage necessity,” she said. “I think that you just have to really empathize with the population that has been so ignored, and so politically crucified in a lot of ways. You have to be able to deal with the fact that you can reach these people. You can hear their stories.”

Researchers are still grappling with identifying and treating the specific traumas associated with refugee communities, and learning to distinguish those experienced in Western societies from those that have become systemic in unstable regions.

“The field is only beginning to understand the full impact of armed conflict, displacement, and resettlement on children’s development and overall well-being, however, the present literature indicates promising initiatives in individual treatment methods, family therapy, and group work in schools and other community settings,” according to a 2009 report by an American Psychological Association task force charged with addressing the psychosocial effects of war on refugee children and families who now live in the U.S.

Dr. James Garbarino, a psychology professor at Loyola University of Chicago, pointed to the privilege first world therapists show when it comes to refugee communities. American therapists can experience vicarious traumatization upon hearing refugees’ traumas.

“People are very afraid or self-protective. They can feel overwhelmed if they start to deal with this stuff and so, rather than gravely encounter it, they put it aside. That’s what I would connect to… privilege,” Garbarino said.

In the future, Jreisat hopes to further research trauma reactions, create culturally sensitive assessment tools and therapeutic standards, and quantify the psychological refugee experience for future analysis and advocacy efforts.

“There were multiple times I had to take breaks while I was at my internship to go cry,” Jreisat said. “Because the things that you hear are just incomprehensible and there’s a person sitting across from you, telling you, this legitimately happened to me and you’re the first person who’s asked me.”

Stomaching refugee horror stories is not an easy job, and American privilege makes it no easier. “You get a lot of what feels like secondary stress from it,” Jreisat said. “It just seems so inhumane and so impossible and we have a luxury here in the West and that’s not being exposed to these things unless we actively seek them out.”

“It’s so easy to not pay attention. And when you don’t pay attention, you don’t have to sit with those uncomfortable feelings of guilt,” said Jreisat.

Jreisat ventured that mental health professionals tend to avoid having to work with vulnerable population.

“I think people get so uncomfortable with refugees because it forces us to look at our own lives and put it into perspective. In the U.S., we live in a huge bubble. I think privilege is the only way to put it. We are privileged in literally every single category.”

The refugees Jreisat treated, she said, dealt with trauma in three phases: experiencing the conflict at home, fleeing or relocating, and resettlement. The traumatic refugee resettlement experience is further exacerbated by the likelihood that they are not welcomed with open arms by their resettlement communities, and may even be sent back because of the rhetoric and legislative actions by the Trump administration.

“We don’t have to deal with these people because we don’t want to, that’s literally being said,” Jreisat said.

Jreisat describes two reactions her clients have in sharing their experiences, she said. The first reaction is that they are completely numb when recounting the traumatic experiences.

Some of Jreisat’s clients would not blink or cry as they were describing horrific events. They had completely shut down emotionally. Their “ability to feel anything in their body has shut down for survival because that is how they got through the situation,” said Jreisat.

The other reaction is that their mind and body relives the trauma through stages of flashbacks as they’re telling Jreisat their stories, she said. The client starts to get elevated and have a distant look in their eyes. Jreisat describes this reaction as going into “auto pilot mode.” Their memories are so vivid they feel as if they are back in the moment. This is the situation in which she may tap their feet to remind them that their body is in the room.

“There are universals to working with trauma patients and one of those is meeting your client where they’re at if your client isn’t ready to talk about something that’s happened to them,” Jreisat said.

Even though there is a cultural overlay when counseling refugees, Garbarino added, “there may be some things that are specific, but the more specific manifestations are things that are universal.

“They haven’t recognized it for what it is, and that leads directly to why you need certain kinds of talking therapies for people who have trauma,” he added. ‘Meditation is often a very important tool in dealing with trauma because it gives you the emotional space to do it.”

Although the work is challenging, Jreisat said counseling refugees is “very beautiful” and pointed out her clients’ resilience.

“Sometimes you don’t need to understand someone to show you care,” she said. “Sometimes people just need to talk and feel that they’re being listened to.”

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