Working with Refugees of Sexual Violence
When working with refugee women who are survivors of sexual assault, social workers face somewhat of an ethical dilemma. Social workers may be wondering how to help refugees of sexual violence. As workers in the healing profession, social workers seek to provide clients a safe space to talk about and work through traumatic experiences with the perspective that repression of these issues and emotions will lead to further psychosocial damage.
Additionally, “ethical principles charge social workers with the responsibility of pursuing social change, particularly with and on behalf of vulnerable and oppressed individuals, leaving social workers with the task of preventing systemic harm to survivors.1”
How to Help Refugees of Sexual Violence: Understanding and Promoting Client’s Agency
These aspects of the social worker’s role seem to call on clinicians to encourage raped women to speak out about their experiences, despite the possibility of re-victimization, social stigma, family strife, and feelings of guilt and shame that revealing the trauma might cause.
Thus it is vital that the clinician strive to meet the client’s needs as she conceptualizes them, promoting clients’ agency and strength without imposing the clinician’s own perceptions of the situation onto the client: “Helpers need to keep in mind that each victim is a world unto herself and that the raped woman’s evaluation of the situation must be respected.
Consideration of the victim’s sociocultural, personal, and psychological makeup is of main concern.2”
It is vital that social workers attempt to understand the sociocultural and political context in which sexual crimes occurred, the society’s reactions to them, and the client’s own internalized feelings and perceived options regarding the crime, constituting a basic understanding of the status of women in their cultural environment that will clinicians to effectively work survivors of rape and sexual violence.
How to Help Refugees: Culturally Competent Methods
Clinicians working with rape survivors in post-conflict areas may need to look outside the western theoretical concepts of talk therapy and support groups in order to more effectively assist in the healing process in a way that is respectful of the client’s own perception of the situation and perspectives on healing; “copying models of intervention without in-depth examination of their applicability to a given social setting might not only inflict additional pain and problems but might also imprison helpers in unrealistic and non-applicable theories and methods.2”
Research has shown that as with most rape victims, the refugee women are reluctant to talk about the experience. Many of them will not talk about it.
The doctor may see physical evidence of sexual violence.
The social worker may see behavioral evidence. But until a trust relationship is established, the refugee woman will never reveal the true source of her pain. When and if she does, we must be careful that our response continues to earn her trust… Healing must take place in harmony with the rape victim’s culture, not necessarily, in harmony with American culture3.”
Studies show that the refugee community is a key emotional and social support system for refugee women living in the United States and can be instrumental in helping women to process and work through a number of issues.4
However, “it seems that asking for support from group members is only possible in the case of non-sensitive issues” due to the group’s function as a preserver of dominant cultural norms and ideologies.
Since issues and events related to women’s experience of sexual violence are a taboo in many societies, the refugee group is not an appropriate setting for women to discuss these experiences.
How to Help Refugees of Sexual Violence: Best Practices
Based on the information presented here, a number of recommended practices for treatment of refugee survivors of sexual violence arise.
- It is important to explain and ensure understanding of confidentiality between client and clinician. Because western psychiatric methods are only recently beginning to take hold in many international populations, many refugee women will be unsure of what to expect from the therapeutic setting. Reassuring these clients about the complete confidentiality of everything that is shared in the therapeutic encounter will encourage the opening of a safe space in which even the most sensitive matters can be discussed, without fear of a negative reaction or response from their community.
- In order for the client to be assured of client-clinician confidentiality, a relationship of trust must be established. Trust-building activities and purposeful self-disclosure might be helpful in the beginning stages of the relationship to establish rapport and gain the client’s confidence.
- If an interpreter is needed to work with a refugee client, it is preferable that the interpreter be someone outside of the client’s immediate refugee group. This will help to create the confidential safe space, as the client would likely feel unable to share her experiences surrounding sexual violence in the presence of one of her community members. When client and clinician are in a confidential setting free from the dominant cultural ideology and taboo surrounding rape in many cultures, the client will be more likely to feel able to disclose her story.
- When/if the client is able to disclose the story of her experience with sexual violence, narrative therapy can be of great value. Narrative therapy is a useful methodology in drawing upon the client’s ability to externalize her problems and suffering, and thus, extricate herself from the web of guilt, shame, and blame she is likely experiencing. Narrative therapy will build upon the client’s existing strengths, such as her religion and her perception of being a passive recipient of external agents while allowing her to tell her story in a safe space and attribute new meaning to the events of her life.
- Practitioners should allow ample time for the narrative of sexual violence to be disclosed and processed in a narrative therapy framework in a single session. Many women experience relief simply from telling someone about their experience with rape, but tend to terminate therapy if the clinician “continues to confront them with their traumatic experiences over and over again.4”
- Once the issue of sexual violence has been confronted, practitioners should not attempt to spend a great deal of time focusing on it, but transition instead to moving forward by working with the client to regain her sense of identity outside of the trauma. This means the clinician should employ an empowerment framework to allow the client to gain a sense of control and identity over her life and the continued transitions involved in the refugee resettlement process. Assisting clients to become connected to community events, activities, and groups will be of great benefit in this pursuit.
- Connecting clients to self-help groups will allow women to connect with one another and others in the area while regaining a sense of community and identity in a strengths-based and encouraging environment. The nature of a group will allow the women to experience the self-esteem derived from mutual aid – the experience of helping oneself by helping others – among the many other positive therapeutic factors of a group setting.
1Patterson, D, Greeson, M, Campbell, R. Understanding rape survivors’ decisions not to seek help from formal social systems. Health & Social Work. 2009;34(2):127-136.
2Shalhoub-Kevorkian, N. Towards a cultural definition of rape: dilemmas in dealing with rape victims in Palestinian society. Wmn’s Studies Intl Forum. 1999;22(2):157-173.
3Duany, J, Duany, W. War and women in the Sudan: role change and adjustment to new responsibilities. Northeast African Studies. 2005;8(2):63-82.
4Tankink, M, Richters, A. Silence as a coping strategy: The case of refugee women in the Netherlands from South-Sudan who experienced sexual violence in the context of war. In Drozdek, B, Wilson, JP, editors. Voices of trauma: treating survivors across cultures. New York (NY): Springer; 2007. p. 191-210