Using psychotherapy to treat traumatized refugees

Oct 27 2017

They are suffering from nightmares, flashbacks, depression, or anxiety disorders: refugees coming to Germany from conflict areas are frequently traumatized. 'Realistic estimates state that up to 40 percent of refugees have mental problems. Hence, for the period since 2015, we are talking about several hundred thousand people who are in real need of psychological support,' says Professor Dr. Frank Neuner from Bielefeld University. The psychologist is one of the team responsible for developing 'Narrative Exposure Therapy' (NET). It has been applied over the last 15 years in conflict zones from East Africa to Sri Lanka. What is special about this therapy is that it shows success after only a few sessions. In a new 'research_tv' program at Bielefeld University, Frank Neuner talks about NET and explains the consequences of leaving refugees without treatment.

'I believe that a large part of the general population is willing to accept that we now need to invest substantially in dealing with these traumatized refugees and that the state must make money available for this,' says Frank Neuner. 'Due to the threats in their home countries, many refugees will be staying with us for a long time. By helping them now, we shall be warding off problems that will otherwise confront us unavoidably in 20 or 30 years time.'

Neuner designed and tested NET together with Dr. Maggie Schauer and Professor Dr. Thomas Elbert from the University of Konstanz. By working with this method, hundreds of child soldiers, victims of political violence, and war refugees have been able to process their traumatic experiences.

The key principle of NET is a highly valued practice in every culture: telling stories. 'Whenever we have gone through an emotional experience, we try to tell stories. This is how we try to make what we have experienced comprehensible to others,' says Neuner. 'Refugees have experienced a whole series of traumatic events. We talk together with them about their entire life history and build up a kind of autobiography that enables them to embed the single traumatic experiences in a meaningful context and work out the significance they have in their own personal lives.' Together with their therapist, traumatized persons work their way repeatedly and chronologically through the negative and positive events in their lives. 'The idea is to historicize the traumatic events. This permits closure, so that they no longer threaten the present.'

To deliver therapy to people in crisis zones, Neuner together with colleagues from the University of Konstanz and further supporters founded the aid organization 'Vivo'. It is training lay therapists in countries such as Sri Lanka, Ruanda, Uganda, and the Congo. Unlike Germany, the health systems of these countries do not provide access to professional therapists. 'However, even Germany does not have enough therapists to treat all the refugees with traumatic disorders. Many people in Germany already have to wait months for a treatment slot with a therapist,' says Neuner. 'One step towards a solution could be to give NET training to refugees and migrants here in Germany and to employ them within a stepped care model supervised by psychotherapists. However, the German legal situation does not permit this at present.'

NET is already being practiced by professional therapists in Germany. Bielefeld University's psychotherapy clinic is applying the method in therapy studies not only refugees with but also with survivors of child abuse, rape victims, and former members of the German military. The scientific further education centers at Bielefeld University and the University of Konstanz are qualifying psychologists, medical doctors, and psychotherapists to work with NET.