A woman sits in a therapist’s office in a western city. She fled the country after enduring months of detention, interrogation and torture by a government that sought to silence her. She got out. According to all external indicators, she is now safe.
The therapist is good. Educated. With good intentions. They ask her to rate her anxiety on a scale of one to ten. Suggest breathing exercises. They offer a worksheet on cognitive distortions.
She never comes back.
Each time I feel the same quiet grief – not because the therapist lacked compassion, but because the field lacked imagination.
I’ve heard this story, in different forms, with different details, more times than I can count. And each time I feel the same quiet grief—not because the therapist lacked compassion, but because the field lacked imagination.
Traditional Western therapy was not designed for her. And until we are honest about this, we will continue to lose people who have already survived the unsurvivable, not because of their trauma, but because of our inadequacy.
Examining our assumptions about safety and wellness
Western psychotherapy and mental health care rests on a set of fundamental assumptions so ingrained in the model that most practitioners don’t even think to question them.
Western psychotherapy relies on a set of foundational assumptions so ingrained in the model that most practitioners don’t even think to question them.
He suggests that healing is an internal process, something that happens inside one person, in a private room, between two people who meet weekly for fifty minutes. He suggests that language is the primary means of processing trauma. There is an understanding that emotions can and should be named, studied and reformulated. In this framework, security is a feeling that can be cultivated through technology.
For survivors of torture and state violence, almost every one of these assumptions is untrue.
When a person is systematically targeted by the government, imprisoned, interrogated, beaten, humiliated, sexually assaulted, simulated punishment, and dehumanized, the wound is not primarily psychological in the Western sense. It goes deeper than that.
The perpetrator was not an individual. It was a system that in many cases is still in power, still haunting those left behind, still present in the world in which the survivors must now live and explain themselves within.
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 the basic security of the world. This wound begins in their home countries, where the very governments that are supposed to protect them become the source of persecution, imprisonment, torture and terror. But for some survivors, the trauma doesn’t end when they run away.
I have worked with survivors of the Islamic Republic of Iran, the Taliban, and other oppressive regimes, believing that if they just made it to 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 ended up behind yet another closed door.
For survivors who have already experienced torture, the greatest trauma is often not simply the re-injury – it is the realization that the place they thought would protect them has become another source of fear.
Survivors describe being held in detention in the conditions they experienced as deeply traumatizing. Several reported physical abuse, psychological abuse, prolonged isolation, humiliation, threats, and treatment that replicated the very tactics they had fled.
What made this experience uniquely devastating was not only the suffering itself, but also the betrayal. They expected brutality from authoritarian regimes. They never expected to encounter violence in a country that they believed embodied freedom, justice and the rule of law.
Many have asked me, “If it can happen here, where is it safe?”
For survivors who have already experienced torture, the greatest trauma is often not simply the re-injury – it is the realization that the place they thought would protect them has become another source of fear. This second betrayal can shatter any fragile trust that remains, leaving them feeling like there is no place in the world that is truly safe.
Proposing an anchor in mental health that sticks
When someone has experienced torture at the hands of the government, they don’t just feel anxious or depressed. They lose the fundamental sense that the world is safe, that they matter, that life has meaning, that justice is real. Their governments, their communities, and sometimes even their own minds have told them, implicitly and clearly, that their suffering does not matter. It shatters the ground a man stands on. No amount of breathing exercises can solve this reality. No amount of cognitive reframing will touch that.
For this reason, I place greater emphasis on rebuilding trust, restoring agency, witnessing, and establishing relational safety before introducing any technique that requires constant internal attention.
I understand that mindfulness of trauma has been helpful for some survivors. However, in my own clinical work with survivors of torture and state violence, I do not typically use mindfulness-based interventions that require clients to focus on their bodies or maintain prolonged silence.
People who have experienced the unsurvivable do not expect salvation. They are waiting to be believed.
Here’s why: Many of the people I work with have learned this paying attention for their bodies meant the anticipation of pain. Their bodies are not perceived as safe places, but as places where unimaginable violence took place. Turning your attention inward can cause flashbacks, panic, dissociation, or overwhelming physiological arousal. Likewise, prolonged silence and silence can closely resemble solitary confinement, detention, or interrogation, making these practices feel threatening rather than regulative.
For many survivors, healing begins not with looking inward, but with discovering that another person can be around without causing harm.
People who have experienced the unsurvivable do not expect salvation. They are waiting to be believed, for someone to sit with them in their reality — not to correct, not to reformulate, not to push them towards sustainability, but to say simply and firmly: What happened to you was real. I believe you. And there is a future that belongs to you.
Via my work with ex-political prisoners and survivors of torture, I had to unlearn many of the protocols and tools I was taught. When we ask survivors to sit still, to maintain eye contact, to clearly express what they are feeling in precise language, we are often asking them to do something that their body perceives as a threat. The clinical setting itself – closed, formal, with unbalanced power – may unconsciously reflect the very environment in which they were damaged.
Often the very vocabulary of Western psychiatric care—PTSD, trauma, triggers, self-care—often does not translate. Not only linguistically, but also conceptually. Many of my clients do not consider themselves traumatized. They identify as survivors, as members of the resistance, as 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 heals. But for many of the survivors I work with—Iranians, Afghans, people from communities that don’t have a cultural tradition of discussing psychological pain with strangers—language is already a site of violence. They were interrogated. Their words were used against them. They learned the hard way that talking carries risk. And then we ask them to come into the room and talk.
In addition, the very vocabulary of Western mental health is like PTSD, trauma, triggers, self-care—often not translated. Not only linguistically, but also conceptually. Many of my clients do not consider themselves traumatized. They identify as survivors, as members of the resistance, as people who did what they had to do. Pathologizing their experience, organizing it around a diagnosis, can seem like another form of erasure, another institution that tells them who they are.
Perhaps the most underrated skill in this job is the ability to hear what has happened and not take your eyes off it.
So what does Really Work?
For most survivors of state violence, the deepest wound is the destruction of trust—in institutions, in strangers, in the basic safety of the world. Healing begins not in the therapy room, but in the slow, careful rebuilding of community: peer support, cultural spaces, shared rituals, the experience of being among people who won’t hurt, and where trust can begin to rebuild.
Every culture has its own framework for understanding suffering and recovery. For my Iranian customers, poetryHafez, Rumi, the great Persian literary tradition carries a healing power that no DSM category can touch. For my Afghan clients, communal prayer, collective mourning, the presence of elderly women are not adjuncts to treatment. They are there is treatment. Our role as practitioners is to make room for them, not replace them.
A constant, solid 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. If we don’t, we become part of the survivor resistance.
Perhaps the most underrated skill in mental health work is the ability to hear what has happened and not look away. Not for analysis or reformulation. Don’t move too quickly to hope. Remain in the truth of what is being shared. This act of constant, unwavering witness is very healing because it is the exact opposite of what the perpetrators wanted. They wanted silence. They wanted the world to look away. If we don’t, we become part of the survivor resistance.
The field of mental health is not harmful. Most practitioners who fail to deal with this population do so because they have never been taught otherwise. Our training programs, our diagnostic frameworks – they were created for a different kind of suffering, in a different world.
