Contradictions in the Field of Psychotherapy
The field of psychotherapy is known for its contradictions. Over the past several decades, numerous studies have sought to prove the superiority of one model over another. Simpler psychotherapy models, which lend themselves more easily to research, are often perceived as more scientific because they are better empirically validated. Additionally, models that claim to achieve client goals more quickly have been favored by large research funding organizations, reinforcing their perceived efficacy.
Wrestling with Different Approaches
I have often found myself questioning the best approach when working with refugee clients. As a strong proponent of therapy models that prioritize social justice, such as narrative and collaborative therapies, I have also found experiential and existential approaches personally meaningful in my own therapy. My extensive training in somatic therapies has deepened my appreciation for the neurobiological foundations of trauma. I have been trained both as an individually and intrapsychically focused psychologist and as a systemically oriented couple and family therapist. Over the past two decades, I have wrestled with the contradictions in my own clinical training and thinking.
The Shift Toward Common Factors
The field of psychotherapy has made strides in bridging these divides, particularly through common factors research. Rather than seeking to establish the dominance of any single model, the common factors approach explores the shared elements across therapy models that most effectively facilitate change. This research has shown that certain factors—beyond specific techniques or theoretical orientations—are more influential in client outcomes. One of the most powerful of these is the therapeutic alliance, reaffirming the central role of relationships in healing.
Refugee Mental Health: A Different Landscape
In contrast, refugee mental health remains far removed from dominant psychotherapy debates and the privileged realm of randomized control trials. The number of mental health professionals in this field is too small for major theoretical and empirical controversies to even take shape. Clinicians working with refugee clients may instead struggle with choosing between culturally specific approaches, social justice-oriented models, mainstream psychotherapy, or universalizing neurobiological frameworks of trauma.
No One-Size-Fits-All Model
In my experience, no single psychotherapy model fits everyone. Some refugee clients, deeply connected to their cultural identity, language, and community, find healing through traditional practices such as rituals, storytelling, music, drumming, and spiritual traditions. Others experience significant relief through understanding the neurobiology of trauma, which helps them reframe their symptoms as a natural response to extreme adversity rather than as pathology. Working with clients from diverse cultural, linguistic, and belief systems has taught me that therapists must remain open to multiple tools and approaches, allowing clients to guide them toward what feels safe, manageable, and meaningful.
Permission to Be Enough
This perspective may feel overwhelming to therapists who believe they must master multiple therapy models while also accounting for the many systemic forces shaping their clients’ lives. However, this understanding also offers a permission—not every therapist needs to be perfect or trained in every model to make a difference. No therapist can work with everyone, but every therapist can work with someone. Whether trained in Cognitive Behavioral Therapy, Existential Therapy, Narrative and Collaborative approaches, or Somatic Therapies, every clinician has something to offer.
The Heart of Effective Therapy
That said, it is crucial to remember the significance of the therapeutic relationship. We must be careful not to impose our own values and beliefs about healing onto refugee clients, who may be vulnerable in multiple ways within the therapeutic dynamic. Ultimately, the foundation of effective therapy is not adherence to a specific model but the ability to build a relationship that fosters safety, trust, and collaboration.
Conclusion: Embracing Flexibility and Relationship-Centered Care
Psychotherapy for refugee clients does not fit neatly into one model or framework. Instead of searching for a single “right” approach, clinicians can embrace flexibility, cultural humility, and a willingness to learn from their clients. The common thread across all effective therapies is the strength of the therapeutic relationship. By prioritizing trust, safety, and collaboration, therapists can create a space where healing is possible—no matter which model they use.
Beyond Refugee Trauma 
Leave a comment