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The burden of mental health problems among asylum seekers and refugees is very high. Experiences of adversity before migration, and potential exposure to torture and trauma during migration, can affect mental wellbeing and increase vulnerability to mental health problems. These stressors can be compounded in host countries by political, legal and societal stressors. In the UK, the current hostile asylum system and anti-migration rhetoric have been documented as severely undermining asylum seekers’ and refugees’ integration and overall wellbeing.  

A range of therapeutic approaches have been developed to support asylum seekers and refugees experiencing mental health problems. However, there is a lack of clarity about how therapy can be delivered effectively across different cultural backgrounds (between the therapist and client) and to asylum seekers and refugees from diverse communities. To better understand this, it is important to consider practitioners’ experiences of providing therapeutic care and the barriers they experience in providing therapy to asylum seekers and refugees. 

This study, conducted by academics at Birkbeck, University of London and co-authored by Cornelius Katona (Helen Bamber Foundations’ Honorary Director of Medical and Research) involved semi-structured interviews with six UK-based therapists about their experiences of working with people seeking asylum and refugees, in particular those from Ethiopia or Eritrea. This was because the study formed part of a larger project exploring the therapeutic experiences of Ethiopian and Eritrean refugees and people seeking asylum. The interview data were analysed using Interpretative Phenomenological Analysis (IPA), which examines how individuals make sense of their experiences in detail.  

Three key themes emerged, reflecting the challenges practitioners faced when working with asylum seekers and refugees: personal, clinical and systemic. 

Personal: The participants described feelings of frustration and powerlessness about the limitations of their role in the face of their clients’ problems.  

“I can’t do anything about that [systemic challenges such as “failed asylum” applications] I can’t do more and I would love to be able to, as I said earlier, wave magic wands and change how things are. I can’t do that. That’s the biggest challenge; the frustration around that” 

Participants also discussed how working in an environment that is “hostile” towards refugees and asylum seekers affected them personally. 

Clinical: Therapeutic progress was sometimes hindered by differences between therapists’ and clients’ understandings of the goals of therapy. The challenges experienced here not only lie in the therapeutic methods used, but also in the differing understandings of trauma and the role of therapy. 

Systemic: The hostile asylum environment, immigration uncertainty, restrictive policies and negative political rhetoric directly affected both clients’ mental health and the therapeutic process. Hostility and insecurity in the wider asylum system intruded on the therapeutic space, impacting their sense of how effective therapy could be.  

Practice implications: 

The findings call for a rethinking of a therapeutic approach that considers people within the context of the systemic issues they face. In practice, this would involve integrated therapeutic services for people seeking asylum seeker and refugees, such as the Model of Integrated Care at provided at the Helen Bamber Foundation or services that working closely with organisations that provide practical support, such as legal advice and material assistance, to ensure co-ordinated care.  

Read the full study here, for full findings and implications published in Counselling Psychology Quarterly.