Psychological Therapies for Survivors of Torture: A Human-Rights Approach with People Seeking Asylum

Citation

Astor, B. (2018), "Psychological Therapies for Survivors of Torture: A Human-Rights Approach with People Seeking Asylum", International Journal of Human Rights in Healthcare, Vol. 11 No. 4, pp. 312-314. https://doi.org/10.1108/IJHRH-09-2018-077

When Jude Boyles (2017b) started work with survivors of torture in 1999, she “looked in vain for a practical book that would […] prepare me for the challenges of therapy with survivors who are living in poverty and under threat of return” (p. v). Almost two decades later, now an experienced therapist in this field, she has edited, Psychological Therapies for Survivors of Torture: A Human-Rights Approach With People Seeking Asylum (Boyles, 2017c), to provide a theoretical and practical resource for psychotherapists working with this vulnerable client group.

The authors of this volume include psychotherapists trained in a range of psychotherapeutic traditions (Chapters 1–4, 6–13 and 16), social workers (Chapter 17), interpreters (Chapters 14 and 15) and survivors of torture themselves (Chapter 5). Each author brings insights from their personal experience and particular therapeutic tradition, and some focus on particular issues (e.g. work with unaccompanied minors, Chapters 7 and 13). As such, readers can select chapters most relevant to their work, or read from start to finish to develop a rich, multi-faceted understanding of psychotherapeutic work with this client group.

Most contributors explicitly state their “human-rights approach” in work with this population. This is based on the understanding that asylum seekers often have urgent needs beyond psychological support. The “prevalence of depression, anxiety and Post Traumatic Stress Disorder (PTSD) is higher among people seeking asylum than in the general UK population” (Boyles, 2017a, pp. 11-12), but clients may also be homeless, destitute, and at risk of exploitation due to their legal status and pending asylum cases. Consequently, the authors argue that therapists working with this population must provide support beyond that usually expected of a therapist. This includes taking the role of advocate and “supporting the client in the asylum process to work towards being granted some form of asylum in the UK” (Salter, 2017, p. 147). It also means providing practical support, such as explaining letters, making phone calls and “‘getting involved’ outside the therapy room” (Roberts, 2017, p. 253).

Although the book presents a compelling case for taking a “human-rights approach”, it lacks a discussion of the psychological implications of crossing psychotherapeutic boundaries, which traditionally discourage getting involved in the client’s life outside of the therapeutic context (Dryden and Reeves, 2013). In the preface, Boyles (2017b) notes that she has experienced disapproval from colleagues when taking this approach, and in Chapter 6, Whitehouse (2017) considers that “it may not feel immediately comfortable for a psychotherapist to be in this advice giving or signposting role” (p. 115). Both authors justify the ‘human-rights approach’ as an ethical imperative because of the lack of services to meet their clients’ desperate non-therapeutic needs. Nevertheless, there are ethical reasons for maintaining these boundaries, for instance, to ensure that the client does not become too dependent on the therapist and to ensure that the therapist does not become too influential in the client’s life (Dryden and Reeves, 2013). Whilst these risks are arguably less urgent than the threats of homelessness or deportation, they are not insignificant and could prove powerful counter-arguments to the “human rights approach” as it is presented in this book. The book’s argument would be strengthened if such predictable challenges were addressed.

The book fulfills its aim to provide practical guidance for psychotherapists working with survivors of torture. Therapists and interpreters give extremely detailed discussions of every aspect of therapy, from how to arrange waiting rooms so that clients and interpreters will not form relationships outside of the therapeutic context (Chapter 14), to discussing safeguarding procedures if there is a risk of suicide or self-harm (Chapter 7). In addition to personal experience and psychotherapeutic theory, most authors draw on contemporary trauma literature (e.g. Herman’s, 1992 Trauma & Recovery, and Van der Kolk’s, 2014 The Body Keeps the Score). As such, they tend to favour a holistic approach, which takes into consideration both physical and psychological factors, and makes use of therapies beyond talk therapy (e.g. sand tray activities, 151).

In addition to practical details, many of the authors emphasize that with this population it is particularly important for therapists to be aware of factors such as: sociopolitical context, power dynamics and the intersectional roles of both client and therapist. For instance, in Chapter 4, Rajeshwar (2017) discusses the way race and ethnicity can influence the therapeutic relationship. Drawing on her personal experience from both sides of the therapeutic relationship, first as the client of a white therapist, and second as a therapist with a Sri Lankan client, she presents a nuanced discussion of the way race influences the therapeutic relationship, and a self-reflexive consideration of her own intersectional position as a second generation British Tamil woman. She offers theoretical frameworks and practical tools that therapists can use to address dynamics of race in the therapy room, including a list of questions to explore the client’s understanding of race. The book includes similar, thought-provoking discussions of gender (Chapter 6) and sexuality (Chapter 10).

Finally, both therapists (e.g. McKinnon in Chapter 2) and clients (e.g. Kakooza in Chapter 5) stress how important it is for anyone working with asylum seekers to learn about the sociopolitical factors leading them to seek asylum, and how the asylum application process works in the UK. The book itself, in particular the Glossary (vii-xiii), gives an introduction to relevant international human rights law and the UK asylum system, and could be a valuable reference tool for psychotherapists working with this client group.

This book provides new insight into the circumstances and needs of a particularly vulnerable and neglected client group. The authors demonstrate how existing trauma literature applies to work with this population, and suggest novel adaptations of both theory and practice. In their advocacy of a human rights approach, they are radical and brave. Anyone working with survivors of torture seeking asylum is sure to find this book to be a valuable resource.