Reflections on Trauma Systems Therapy for Refugees (TST-R): A Commentary on Dr. Franco’s Paper

Working with refugee children and their families presents formidable challenges to therapists as children who are fleeing the atrocities of war or the perils of a traumatizing and persecuting environment present with a host of emotional and somatic reactions including panic attacks, flashbacks and dissociation (Trowell, 2008). The violence these children have witnessed or been subjected to and the losses they have sustained have obliterated their sense of safety in the world. Adding to the trauma they experienced in their home countries that led to them fleeing from home are the traumas many of them experience during the relocation. These traumas can include witnessing the death of family members or of other individuals who are fleeing with them, being subjected to sexual violence and kidnapping, being forced to perform free or low-cost labor, recruitment for sex trafficking and enlistment in gangs (DeHoff et al., 2017; Kaplin et al., 2019). Other dangers include lack of food, being exposed to the elements, traveling long distances under highly unsafe conditions and facing health risks (Clauss-Ehlers, 2019). Trauma can also occur in the dangerous, unsanitary and overcrowded refugee camps where the children have to wait for months for their cases to be processed. As Montgomery (1998) reported in a large study with refugees from the Middle East, the most frequent incidents of violence occurred when children lived in refugee camps outside the home country. Many children continue to be traumatized even after being admitted to the host country, as they find themselves having to adjust to a very different and hostile culture with limited support. All this occurs while they are experiencing what Papadopoulos (2008) calls the “inexplicable gap” (p. 18), which is the loss of a sense of continuity and belonging they were not aware they had. In her paper, Dr. Franco gives a painful account of the case of Maria, a seventeen-year-old adolescent who experienced emotional neglect and abandonment as well as sexual, physical and emotional abuse from early on. To protect the confidentiality of an adolescent like Maria and also, out of respect for the kind of traumas such an adolescent has endured, the case of Maria is not an actual case but a composite one that is derived from the vast experiences Dr. Franco has had in working with traumatized children and adolescents. In serving as an evaluator and a supervisor at the Asylum Project of Adelphi University I have come across the cases of several children and adolescents who have experienced the kind of unfathomable experiences that Dr. Franco presents in the case of Maria. It is impossible when reading about such a case not to feel rage at what happened to her and at all she had to face and not to wonder how thirty sessions could be of any help to her. Maria’s history is marked by sexual violence and also by an ongoing absence. She is a girl who was abandoned at a young age by her mother and was left in the care of her abusive stepfather. It is not clear how the decision was made for her to travel as an unaccompanied ten-year-old minor from Central America to the US, whether her mother asked for Maria to join her, whether other relatives felt that this would be safer for her, or whether Maria took it upon herself to find her mother. Maria was also abused during her