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“I Wonder If…” : How Our Gentle Curiosity Can Confuse Refugee Clients

We are trained to pace our interventions and couch questions in tentative reflections. But this indirectness can be baffling – and actively misleading – for refugee clients. Jude Boyles is the Manager and a therapist of a Refugee Council therapy service based in South Yorkshire, offering therapy to Syrian refugees resettled via the Vulnerable Persons Resettlement Programme (VPRS). In her fourth occasional blog about this work, she explores the challenge of making the therapeutic dialogue accessible across cultures.

 

Almost two decades ago, when I asked a Kosovan client at assessment how he had found his recent experience of therapy, he shrugged and looked confused. He said he didn’t understand what I was asking and that he had seen “a nice lady” in a service who had listened to him. She had been kind and he had liked their meetings, but he needed help with his “country war problem and sleep” and hoped that he could see a doctor soon. He then asked me if I was a doctor.

Prior to our meeting, the referral said that he had seen a therapist within a small NGO for 24 sessions. It became clear as we talked that he had no idea what this process had been. He implied that the therapist was fragile, as she had talked often of how awful and shocking his experiences were. In our first session, I shared some information about sleeplessness during personal crises, hoping that this was enough for him to think that I could be a useful resource.

My work with him and other Kosovan refugees changed me fundamentally as a practitioner. Throughout our work together, whenever I asked him a question, shared some information, offered a reflection or made an interpretation, I was transparent about my thinking and explicit about what I was doing and why. It also led me to train in trauma, as I knew I needed to do something very different in the room when working with traumatised refugees.

In a session with an older Syrian refugee man recently, I tentatively referred to a particularly painful experience he had mentioned at assessment. The Arabic and Kurdish Badhini interpreting team I work with are used to gently rendering my questions to clients and I could hear the lift in my interpreter’s voice towards the end of the sentence. The client looked at me and asked if I was asking him a question. I smiled as I realised that of course I was, but in trying to be gently curious, I had just confused him!

We have learnt in our trainings to pace our interventions and be gently curious. Some of us use terms like, I wonder if and I’m sensing that. There is nothing wrong with this, unless it confuses your client or leaves them thinking that you are unsure or lacking in confidence. If clients do not understand the process of therapy or know about the various ways we facilitate these intense dialogues between us, are we being truly honest and open about the therapeutic process and the skills we are using?

Most non refugee clients have some prior knowledge of what therapy is. However, many of us are now working with refugees for whom therapy is completely new, and the very idea of talking to a professional about emotional distress a strange and even threatening concept. In our work with refugees, it is so important to be transparent about our practice and the nature of the therapeutic relationship.

I have learnt to be explicit about the way I am working at all stages of the therapeutic process, but more so at assessment. When we first meet and I take a history, I say why having insight into an individuals’ early life can help me understand them and why that might help our work together. If I am unsure, I say so: I am wondering whether to ask you more about that, but this is why I am being careful… Clients need to know they have a choice. If we are not explicit about an individual’s rights within therapy, refugees may feel that they have to answer all our questions about the past, even if they don’t understand their relevance.

Making my therapeutic practice accessible and understandable across cultures is a daily challenge for me. When I meet a client, I refer to the training I have had and the skills it has given me to assist people in distress. I’m not just a kind person asking questions that lead to helpful discussions. I negotiate all the time about what we talk about, mindful of the power I have and knowing that for some clients, talking in this way can feel unsettling at first.

For newly arrived refugees, it can be hard to make sense of this unique relationship, even when it feels containing and helpful. But there are also those for whom it makes sense immediately: I am going to tell you this. I cannot carry this burden.

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Jude Boyles

Jude is the Manager of a therapy service for the Refugee Council, working with Syrian refugees resettled via the Vulnerable Person’s Resettlement Programme (VPRS). Jude edited Psychological Therapies for Survivors of Torture for PCCS Books and published Working with Interpreters in Psychological Therapy with Routledge. She specialises in working with refugee survivors of torture/war and human rights abuses, including gender-based abuse.

In 2003, Jude established the first Freedom from Torture (FFT) rehabilitation centre outside of FFT’s headquarters in London, and managed the service for 14 years. As part of this role, she provided clinical and management supervision to therapists and managers working in the refugee field in the region and carried a caseload of torture survivors. Jude has worked as a national trainer in the field of therapy with refugee survivors of torture for 18 years but has also trained extensively in the field of domestic violence and child sexual abuse for 23 years.

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