A woman sits in a therapist’s office in a Western city. She fled her country after surviving months of detention, interrogation and torture at the hands of a government that wanted to silence her. You’ve succeeded. It is safe now by all external standards.
The therapist is nice. learner. Good faith. They ask her to rate her anxiety on a scale from one to ten. They suggest breathing exercises. They present a worksheet on cognitive distortions.
She never comes back.
Each time, I feel the same quiet sadness—not because of the therapist’s failure to empathize, but because of a failure of imagination in this area.
I’ve heard this story, in different forms, and in different details, more times than I can count. And each time, I feel the same quiet sadness—not because of the therapist’s failure to empathize, but because of a failure of imagination in this area.
Traditional Western treatment was not designed for her. Until we are honest about it, we will continue to lose people who have already survived the unsurvivable, not because of their trauma, but because of our incompetence.
Examine our assumptions about safety and healing
Western psychotherapy and mental health care rely on a set of fundamental assumptions so embedded in the model that most practitioners never think to question them.
Western psychotherapy relies on a set of foundational assumptions so embedded in the model that most practitioners never think to question them.
Healing is assumed to be an internal process, something that happens within one person, in a private room, between two people who meet weekly for fifty minutes. It is assumed that language is the primary means of processing trauma. There is an understanding that emotions can and should be named, examined and reframed. In this context, safety is a feeling that can be developed through technology.
For survivors of torture and state violence, almost all of these assumptions fail.
When someone is systematically targeted by the government, imprisoned, interrogated, beaten, humiliated, sexually assaulted, subjected to mock execution, and stripped of their humanity, the wound is not primarily psychological in the Western sense. And it goes deeper than that.
The perpetrator of the crime was not an individual. It was a system that in many cases is still in power, still oppresses those left behind, and still exists in the world within which survivors must now inhabit and explain themselves.
When betrayal returns to a place that was supposed to be safe
For most survivors of state violence, the deepest wound is the destruction of trust in institutions, in strangers, and in basic safety in the world. This wound begins in their countries of origin, where governments that intended to protect them become a source of persecution, imprisonment, torture and terrorism. But for some survivors, the trauma doesn’t end when they escape.
I have worked with individuals who survived the Islamic Republic of Iran, the Taliban, and other oppressive regimes, believing that if they could reach the United States, they would finally be safe. They believed they had arrived in a country built on democracy, due process, and human rights—a place where the rules would finally be different.
Instead, some found themselves behind another closed door.
For survivors who have already been tortured, the greatest harm is not simply being hurt again, but realizing that the place they thought would protect them has become another source of fear.
Survivors described their detention under extremely painful conditions. Many reported physical abuse, psychological abuse, prolonged isolation, humiliation, threats, and treatment that mimicked the same methods by which they fled.
What made this experience uniquely devastating was not only the suffering itself, but also the betrayal. They expected cruelty from authoritarian regimes. They never expected to be subjected to abuse in the country they believe stands for freedom, justice and the rule of law.
Many have asked me: “If this can happen here, where is the safety?”
For survivors who have already been tortured, the greatest harm is not simply being hurt again, but realizing that the place they thought would protect them has become another source of fear. This second betrayal can break any fragile trust remaining, leaving them feeling like no place in the world is truly safe.
Provide an anchor in mental health care that carries
When someone survives torture at the hands of the government, they don’t just feel anxious or depressed. They lose their basic sense that the world is safe, that they matter, that life has meaning, and that justice is real. They have been told, implicitly and explicitly, by their governments, their societies, and sometimes even their own minds, that their suffering does not matter. It leads to the destruction of the ground on which a person stands. There is no breathing exercise that addresses this fact. It is not affected by any cognitive reformulation.
For this reason, I place greater emphasis on rebuilding trust, restoring agency, witnessing, and creating safety in relationships before introducing any approach that requires sustained inner attention.
I realize that trauma-sensitive mindfulness has been helpful for some survivors. However, in my clinical work with survivors of torture and state violence, I generally do not use mindfulness-based interventions that ask clients to focus on their bodies or remain in prolonged silence.
People who have survived the unsurvivable do not wait to be saved. They are waiting to be believed.
Here’s why: Many of the people I work with have learned this interest To their bodies means anticipating pain. Their bodies are not experienced as safe places, but as places where unimaginable acts of violence have occurred. Directing attention inward can trigger flashbacks, panic, dissociation, or overwhelming physiological arousal. Likewise, prolonged silence and stillness may closely resemble solitary confinement, detention, or interrogation, making these practices appear threatening rather than regulating.
For many survivors, healing begins not with looking inward, but with discovering that another human being can exist without causing harm.
People who have survived the unsurvivable do not wait to be saved. They are waiting to be believed, for someone to sit with them in their reality—not to fix it, or remake it, or nudge them toward flexibility, but to simply and firmly say: What happened to you was real and I believe you. And there is still a future that belongs to you.
during practical With former political prisoners and torture survivors, I have had to unlearn many of the protocols and tools I was trained on. When we ask survivors to sit still, maintain eye contact, and express how they feel in precise language, we are often asking them to do things that their bodies perceive as threatening. The clinical setting itself – closed, formal, and unbalanced power – can unconsciously reflect the very environments in which they were harmed.
Western mental health care vocabulary—such as PTSD, trauma, triggers, and self-care—is often not translated. Not only linguistically, but conceptually. Many of my clients do not consider themselves traumatized. They define themselves as survivors, resistors, and people who did what they had to do.
In Western therapy, language is everything. Talk therapy is based on the premise that talking about suffering is healing. But for many of the survivors I work with — Iranians, Afghans, and people from communities that don’t have a cultural tradition of discussing psychological pain with a stranger — language is already a site of violence. They were interrogated. Their words were used against them. They have learned, in the most brutal way, that speaking up carries risks. Then we ask them to come into the room and talk.
Beyond that, the vocabulary of Western mental health care itself PTSD, trauma, triggers, self-care– It is often not translated. Not only linguistically, but conceptually. Many of my clients do not consider themselves traumatized. They define themselves as survivors, resistors, and people who did what they had to do. Turning their experience into an illness, organizing it around a diagnosis, may feel like another form of erasure, another institution telling them who they are.
Perhaps the most underrated skill in this business is simply the ability to hear what happened and not look away.
so what He does actually work?
For most survivors of state violence, the deepest wound is the destruction of trust in institutions, in strangers, and in basic safety in the world. Healing begins not in the therapy room but in the slow, careful process of rebuilding community: peer support, cultural spaces, shared rituals, the experience of being among people who do not cause pain, and where trust can begin to be rebuilt.
Each culture has its own frameworks for understanding suffering and restoration. For my Iranian customers, hairHafez, Rumi The great Persian literary tradition holds a healing power that no DSM category can touch. For my Afghan clients, group prayer, communal mourning, the presence of elderly women – these are not complementary to treatment. they We are treatment. Our role as practitioners is to make room for them, not replace them.
Continuous, unwavering testimony is deeply healing, because it is the exact opposite of what the perpetrators wanted. They wanted silence. They wanted the world to look away. When we don’t, we become part of the survivors’ resistance.
Perhaps the most underrated skill in mental health care is simply the ability to hear what has happened and not look away. Not for analysis or paraphrasing. Don’t move too quickly toward hope. Stay in the truth of what is being shared. This act of sustained and unwavering witness constitutes profound healing, because it is the exact opposite of what the perpetrators wanted. They wanted silence. They wanted the world to look away. When we don’t, we become part of the survivors’ resistance.
The field of mental health is not insidious. Most practitioners who fall short in dealing with this population do so because they were never taught otherwise. Our training programs, our diagnostic frameworks – they are designed for a different kind of suffering, in a different world.
