Virtual Therapy With Resettled Syrian Refugees

Like most therapists, I have always offered therapy face to face. However, in the last few weeks of the pandemic, I have had to change the way I am working to ensure that I can continue to offer therapy and support to resettled Syrian refugees from home. In my first few calls to the clients on my caseload, almost all of them seemed at ease with this change, whereas I felt quite anxious. For Syrian refugees whose families are scattered around the world, long phone and video calls to friends and families abroad are the norm.

As the weeks pass, I have found myself increasingly comfortable with offering therapy in this way. I have found that I am listening more intently, trying to catch slight changes in tone, and I am more attuned to pauses, breathing changes and hesitancies. My interpreters are working harder to render every nuance in the narrative, given that they too have lost many of the cues in our clients’ body language.

I was initially anxious that establishing rapport with new clients would be harder but have been reassured at how quickly a three-way connection has been established. One new client said, “I do want to see you both but it’s also liberating not to see you when I think of some of the things we are going to talk about, because you know what happened to me don’t you”. He is a torture survivor and perhaps therapy through the phone was less intimidating or exposing for him.

I have been impressed by our clients’ abilities to adjust to the current situation, but not surprised. Many are pragmatic and reflect on the resources they built in the years they lived under threat during Syria’s relentless war. One client remarked that at least she knew that there was, “an end to this, unlike the war”. She remembered being too afraid to leave her house in Syria as she listened to the sound of bomb strikes and rapid gunfire. She laughed and said, “if all we have to do to stay safe is stay inside, then this feels like something we [my family] can do easily”.

For others it has been hard. Families living in poverty and under stress, or women in violent relationships, are finding it exhausting and overwhelming. Clients traumatised by past events have been de-stabilised and their mental health has deteriorated. My role is to do all I can to equip them to manage worsening symptoms, remind them of their resources and normalise their responses, exploring what will help them stay mentally healthy during these times.

A few families are spring planting if they have a garden, and many are focusing on established family rituals and prayer. I have gently reminded some to avoid negative social media images, as well as limiting world news to once or twice a day.

Re-negotiating therapeutic aims in the light of the pandemic is crucial, and I was reassured when one client decided to suspend our work together and just have a monthly check-in. Despite the current context, I remain committed to ensuring that my conversations with clients remain meaningful and that I’m exploring themes clients want to talk about. I am also trying to create openings that enable clients to externalise their fears, as well as providing opportunities for people to ask questions they might feel unable to raise elsewhere, knowing they have an interpreter they can trust.

I feel the pressure to be as useful as I can. I have found myself sitting in my office at home worrying about how helpful I am being. The risk is that I move to the default position of suggesting strategies to encourage a client to stay healthy, when there might be deeper and more painful conversations that need to happen beyond managing the pandemic and its restrictions day to day. I need to trust that many of my clients can continue our work together in spite of the situation we are in.

An older refugee with a chronic health problem said that this situation didn’t feel so different for him. “You stay inside to stay safe. It is not hard. We were already isolated here. This feels easier as we are all going through it, including you two.”