Reflections on Refugee Work
Almost nine years ago I started my art therapy internship with resettled refugees in Albuquerque, New Mexico. That internship opened my world and set the tone and direction for the bulk of my career. It has led me to care deeply for and admire refugees, those brave enough to risk everything to save themselves and their families. Since the end of 2012 I have lived in places with few refugees and no mental health programs for anyone who may have resettled there. I have missed that work deeply, and I hope to eventually return to a place where I can do it again. But life is complex and such moves are not easy to do with a family. For now I am doing equally important work with survivors of loss and trauma in the border region of southern New Mexico.
What have I learned about the differences between art therapy with refugees and art therapy with non-refugee clients in my hiatus from that soul work? I would like to share some reflections below in regards to these differences.
Different types of openness
People acquainted with the mental health culture of the United States enter therapy with an awareness of what they are supposed to say and share. They may have resistance to this idea or they may be ready to some extent to share. With the art added into the mix, people are often thrown off of their assumptions with a sense of surprise, delight, horror, trepidation, or somewhere in between. It adds an unknown not shown on TV therapy dramas or in the treatment they may have experienced previously. It provides potential to access themselves and their inner mysteries without words.
Many people who come to the United States as refugees have limited exposure to U.S. culture, and often have no orientation to U.S. mental health culture. If they have any personal exposure to mental health treatment at all, it is often a more institutionalized and medication-oriented system: this is a situation I have seen in regards to some people from Iraq and Syria who received treatment before coming to the U.S. Even people without previous personal experience with psychiatry or psychotherapy often have a vague idea of "crazy people do that."
Explaining art therapy to clients with limited or exclusively negative understanding of psychotherapy takes finesse, validation, and a very clear idea of what psychotherapy is and does. I often talk in terms of healing the mind and heart, of helping people so that very concrete areas in their lives are improved. For example, reduction of their anxiety will help them stay in school and perform better. Or improving their mood symptoms will help them better negotiate family and other personal relationships. Or when a mother addresses her trauma and depression, she will be able to parent more effectively and her children's behavior will improve. I explain that it's often words and actions that hurt us, and so it takes words and actions to heal us.
Putting trauma sequelae in their context is also key to orienting anyone to psychotherapy that focuses on trauma. I do a lot of psychoeducation (see Treating Trauma with Art Therapy for more details), making clear to a client that while their symptoms may make them feel crazy, they are not. Their body, mind, and spirit have been affected by a crazy act of violence (or a series of acts) and we can work with words and art to reduce their symptoms, make sense of what happened, and give them back their life.
Understanding the Other
In some ways it is easier to acknowledge the otherness of refugee clients because their backgrounds and lives are usually so different from our own. It can be harder to make assumptions about how that person is experiencing their life and struggles, and it is more difficult to project our own feelings onto them than it can be with clients of similar demographics to our own. On the other hand, the term "refugee" and those who live with that label are likely to have a whole other set of projections thrown at them. People, including therapists, are confused or scared by the term, avoiding thinking too deeply about it or struggling with a great amount of pity and awe when faced with a person who is called refugee. This projection can often leave the person seeking support or treatment feeling alienated or, worse, having to take care of their provider's emotions.
Well-trained therapists are taught to practice self-awareness in regards to projection and countertransference, particularly with those we relate to or those who remind us of someone significant in our lives. When trained in cultural competency, we are taught to educate ourselves about our client's culture and ask questions before jumping to culture-based conclusions. We are educated to check in with ourselves and practice self-care when supporting clients with very difficult or jarring trauma histories. But the refugee experience can include trauma histories on an epic scale not previously dealt with by the therapist, and this can be overwhelming to metabolize. Ideas for handling intense trauma histories can be read in Imagination and Empathy in the Art Therapist.
Recently, there have been additional problems for people who fall under the term refugee, especially if they are from Syria. Xenophobic fears based on the actions of a handful of terrorists, only two of whom may have been Syrian, have led governors and others in the U.S. government to attempt to ban any of the millions of families that have been through so much from resettling in the United States. It is incredibly difficult to make it through the filters put in place by the State Department, IOM, and the Office of Refugee Resettlement to resettle in this country. Of the currently 34+ million refugees, asylum-seekers, and internally displaced persons, only 1% get resettled to a third country like the U.S. If you are from the Middle East and have even a single connection to someone identified as a terrorist or an enemy of the state (it could be a second cousin you haven't seen in years), you don't make the cut. For many refugees from the Middle East, they are now facing projections of terrorist - the very people who have had their lives ruined by terrorists - by Americans. As therapists working with refugees, we need to carefully check our own projections (these projections are likely to be far more subtle, e.g. a small uncertainty about our client's character) in this xenophobic climate and counter those projections with education and self-awareness.
Art therapy in session itself can allow space for a client's otherness (as well as their similarities to the therapist) to express itself without words getting immediately in the way. While specific art expressions are not universal across cultures, art expression itself is. It can be helpful for both client and therapist to see on paper or in clay a slice of the client's world, to have a concrete springboard to work off of. To avoid caging a refugee client in with my own cultural constructs, I will often offer an open-ended directive. One of my standard getting-to-know-you directives is "Make a picture of home, whatever and wherever home is for you."
But by the grace of God go I
What have I learned about the differences between art therapy with refugees and art therapy with non-refugee clients in my hiatus from that soul work? I would like to share some reflections below in regards to these differences.
Different types of openness
People acquainted with the mental health culture of the United States enter therapy with an awareness of what they are supposed to say and share. They may have resistance to this idea or they may be ready to some extent to share. With the art added into the mix, people are often thrown off of their assumptions with a sense of surprise, delight, horror, trepidation, or somewhere in between. It adds an unknown not shown on TV therapy dramas or in the treatment they may have experienced previously. It provides potential to access themselves and their inner mysteries without words.
Many people who come to the United States as refugees have limited exposure to U.S. culture, and often have no orientation to U.S. mental health culture. If they have any personal exposure to mental health treatment at all, it is often a more institutionalized and medication-oriented system: this is a situation I have seen in regards to some people from Iraq and Syria who received treatment before coming to the U.S. Even people without previous personal experience with psychiatry or psychotherapy often have a vague idea of "crazy people do that."
Explaining art therapy to clients with limited or exclusively negative understanding of psychotherapy takes finesse, validation, and a very clear idea of what psychotherapy is and does. I often talk in terms of healing the mind and heart, of helping people so that very concrete areas in their lives are improved. For example, reduction of their anxiety will help them stay in school and perform better. Or improving their mood symptoms will help them better negotiate family and other personal relationships. Or when a mother addresses her trauma and depression, she will be able to parent more effectively and her children's behavior will improve. I explain that it's often words and actions that hurt us, and so it takes words and actions to heal us.
Putting trauma sequelae in their context is also key to orienting anyone to psychotherapy that focuses on trauma. I do a lot of psychoeducation (see Treating Trauma with Art Therapy for more details), making clear to a client that while their symptoms may make them feel crazy, they are not. Their body, mind, and spirit have been affected by a crazy act of violence (or a series of acts) and we can work with words and art to reduce their symptoms, make sense of what happened, and give them back their life.
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| Artwork by refugee client |
Understanding the Other
In some ways it is easier to acknowledge the otherness of refugee clients because their backgrounds and lives are usually so different from our own. It can be harder to make assumptions about how that person is experiencing their life and struggles, and it is more difficult to project our own feelings onto them than it can be with clients of similar demographics to our own. On the other hand, the term "refugee" and those who live with that label are likely to have a whole other set of projections thrown at them. People, including therapists, are confused or scared by the term, avoiding thinking too deeply about it or struggling with a great amount of pity and awe when faced with a person who is called refugee. This projection can often leave the person seeking support or treatment feeling alienated or, worse, having to take care of their provider's emotions.
Well-trained therapists are taught to practice self-awareness in regards to projection and countertransference, particularly with those we relate to or those who remind us of someone significant in our lives. When trained in cultural competency, we are taught to educate ourselves about our client's culture and ask questions before jumping to culture-based conclusions. We are educated to check in with ourselves and practice self-care when supporting clients with very difficult or jarring trauma histories. But the refugee experience can include trauma histories on an epic scale not previously dealt with by the therapist, and this can be overwhelming to metabolize. Ideas for handling intense trauma histories can be read in Imagination and Empathy in the Art Therapist.
Recently, there have been additional problems for people who fall under the term refugee, especially if they are from Syria. Xenophobic fears based on the actions of a handful of terrorists, only two of whom may have been Syrian, have led governors and others in the U.S. government to attempt to ban any of the millions of families that have been through so much from resettling in the United States. It is incredibly difficult to make it through the filters put in place by the State Department, IOM, and the Office of Refugee Resettlement to resettle in this country. Of the currently 34+ million refugees, asylum-seekers, and internally displaced persons, only 1% get resettled to a third country like the U.S. If you are from the Middle East and have even a single connection to someone identified as a terrorist or an enemy of the state (it could be a second cousin you haven't seen in years), you don't make the cut. For many refugees from the Middle East, they are now facing projections of terrorist - the very people who have had their lives ruined by terrorists - by Americans. As therapists working with refugees, we need to carefully check our own projections (these projections are likely to be far more subtle, e.g. a small uncertainty about our client's character) in this xenophobic climate and counter those projections with education and self-awareness.
Art therapy in session itself can allow space for a client's otherness (as well as their similarities to the therapist) to express itself without words getting immediately in the way. While specific art expressions are not universal across cultures, art expression itself is. It can be helpful for both client and therapist to see on paper or in clay a slice of the client's world, to have a concrete springboard to work off of. To avoid caging a refugee client in with my own cultural constructs, I will often offer an open-ended directive. One of my standard getting-to-know-you directives is "Make a picture of home, whatever and wherever home is for you."
 |
| Artwork by refugee client |
The experience of a refugee is one that all of us are just a few bad circumstances away from experiencing. Many of us are non-native Americans, our families how ever many generations back emigrating here to seek a better life. My own ancestors would be considered refugees by today's standards, leaving England's oppressive church-state to practice their version of Christianity freely and without persecution.
I had a dream many years ago when I started working with refugees that still haunts me. I dreamt that the quiet fields and wild apple orchards near my childhood home were the scene of a small war: land mines were bursting open the earth, and militants were mercilessly shooting at me and some vague others. I woke up weeping for the desecration of that beautiful land, of a place once sacred to my childhood now marred with memories of heretofore unknown violence. For me this was a dream that may never come to be. But for the millions that flee their homes, communities, gardens, and favorite haunts, they lose it all. Not only may it take a generation or more for their homes to be safe again, but for many the memories of the violence and destruction may be too painful to ever consider returning. When I think of this I can only hope to offer healing and some degree of a warm welcome to those who come to my country seeking safety.
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