WORKING WITH PEOPLE FROM

REFUGEE BACKGROUNDS
1. THE COMPLEXITY OF THE REFUGEE EXPERIENCE
Who are Refugees?

The Global Refugee Situation

A refugee is a person who has been forced to

leave their country because of persecution
due to race, religion, nationality, membership
of a particular social group or political
opinion. They must be outside of their country
of origin, and unable or unwilling to return.

The UNHCR estimates that there were 16.7

million refugees and 51.2 million forcibly
displaced people in the world in 2013. The top 4
leading countries of origin of refugees in 2013
were: Afghanistan, Syria, Somalia and the
Sudan. Most refugees are located in
neighbouring countries. Of these approximately
1% was resettled in a third county in 2013
(UNHCR, 2014).

Who are Asylum Seekers?

An asylum seeker is a person who has left
their country of origin and has applied for
protection as a refugee to a government or
the United Nations High Commissioner for
Refugees.

What have Refugees been through?

Refugees commonly experience trauma,
deprivation and loss in the context of political
violence and human rights violations. Some of
these experiences include Systematic State
Terrorism, torture (used as a tool of social
control), bombings, killings, kidnappings,
sexual assault, detention, disappearances,
harassment, being forced to flee; deprivation
of food, shelter, health care; loss of family,
friends, community, safety, home,
possessions, routine, schooling, employment,
and control over their lives. Some refugees
can spend prolonged periods in difficult
conditions in refugee camps or living in the
community without status in countries of
asylum.

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Australias Response
The Australian government is a signatory to
both the United Nations 1951 Convention and
the 1968 Protocol relating to the Status of
Refugees. Australias Humanitarian Program is
divided into 2 components:
1. Off-Shore Program (Resetttlement)
2. On-Shore Program (Asylum/Protection)
In 2012-2013 Australia granted 20,019 visas
under its program (DIABP website, 2014).

Handout Trainings in the Workplace Working with People from Refugee Backgrounds

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The Complex Interaction

One way to conceptualise the complex nature of problems faced by refugees and asylum seekers in
Australia, at the individual, family and community level, is the complex interaction between the
following factors:

The impact of traumatic experiences

Seeking protection in Australia/ resettlement challenges
Normal life cycle challenges
The relationship between refugees and asylum seekers and the Australian environment
International events (see diagram below)

These factors can interact in powerful and complex ways, and the complex interface between these
factors and the psychological, cultural, educational and religious attributes of the individual, family and
community can be used to illustrate the complexity of the experience of refugee clients resettling in
Australia or seeking protection (Aroche and Coello, 1994).

Impact of Traumatic Experiences

Seeking Protection in Australia

A trauma reaction is a common response to the

feelings of helplessness, intense fear or horror
associated with the types of traumatic events
experienced in the context of political violence.
These feelings are actually part of the healing
process from trauma.

Applying for protection in Australia under the

on-shore component of Australias
Humanitarian Program, can be a protracted and
uncertain process that can impact upon people
in a variety of ways, and can replicate some of
their past traumas. Eg. prolonged uncertainty
over their protection claim, threat of return,
poverty, homelessness, detention, separation
from family, etc.

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Handout Trainings in the Workplace Working with People from Refugee Backgrounds

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Resettlement Challenges

International Events

Resettlement represents a positive step

towards the future for refugees, however most
settlement tasks involve cultural adaptation
and learning new skills and information in a
new environment, whilst coping with past
traumas and losses. Challenges may include
new language, different customs, isolation,
reduced employment options, financial
concerns, racism, new education and legal
systems, and new parenting norms.

International events will influence how refugees

and asylum seekers react to their new
environment in Australia, and may contribute to
the re-emergence of trauma symptoms.

Normal Life Cycle Challenges

Refugees, like all of us, face challenges through
the stages of the normal life cycle such as birth,
illness, death, marriage, divorce, parenting and
employment. The disruptive effects of trauma
and relocation can often render refugees more
vulnerable to the challenges associated with
the normal life cycle, while normal life cycle
problems can bring back to the surface or
complicate issues connected to trauma.

Australian Environment
The relationship between refugees and asylum
seekers and the Australian environment, which
includes the political system, the complex
network of government and non-government
service providers, the community at large and
other systems, eventually determines the
overall conditions for success in the processes
of recovery and resettlement of refugees, and
for how well asylum seekers cope with their
uncertain situation.

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Protective Factors
How well refugees and asylum seekers cope
with the complex interaction discussed in this
section will depend on individual internal and
protective factors such as those listed below
(Aroche and Coello, 1994).
Internal
Balanced, well regulated brain
Positive outlook
High self-esteem
Sense of safety
Sense of identity
External
Supportive family
Supportive school
Friends
Fun activities
Status
Resources
Reference group
Safe environment

Handout Trainings in the Workplace Working with People from Refugee Backgrounds

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2. ISSUES AND STARTTS INTERVENTIONS TO FACILITATE REFUGEE RESETTLEMENT

It is important for service providers to be aware of the complexity of the refugee experience and its
traumatic impact, in order to appreciate the types of issues and behaviours that refugee clients may
present with. Some of these behaviours that were adapted to life in a war or conflict situation can
become maladaptive, and can develop into substantive barriers to regaining control of their
environment and overcoming trauma.

The Bio-Psychosocial-Systemic Intervention Model

The bio-psychosocial model recognises the impact of trauma at the biological, psychological,
interpersonal, and social levels of the individual.
STARTTS Bio-Psychosocial Model

Trauma

Interventions

Biological
Psychological
Social

Trauma not only impacts on individuals; it also impacts on families, social support networks, refugee
communities and Australian society and institutions.
STARTTS Bio-Psychosocial Systemic Model
Mainstream Society and Institutions
Refugee Community
Support Network
Family
Interventions

Trauma

Individual
Bio
Psycho
Social

This translates into a culturally aware Bio-Psycho-Social Systemic Approach to service provision
focusing on assisting peoples RECOVERY from refugee trauma that contemplates early intervention,
secondary prevention and capacity building strategies alongside clinical interventions at individual,
family and group levels.
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Handout Trainings in the Workplace Working with People from Refugee Backgrounds

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Issues Refugee Individuals

STARTTS Bio-Psychosocial Model

Biological
Changes to the brain
Injuries, illnesses
Somatic pain, chronic pain

Trauma

Headaches
Appetite and digestive problems
Biological
Psychological
Social

Nightmares, other sleep disturbances,

terrifying memories
Not attentive, distracted
Difficulty understanding and
remembering things, confused,
difficulty with simple decisions
Being hyper-vigilant, tense
Psychological

Practical problems faced:

Frustration, anger, irritability, mood

changes

Difficulty learning
English

Emotionally numb, avoiding things

that remind them of the trauma

Difficulties finding
work

Distrustful, suspicious, wary, sensitive

to not being believed

Financial difficulties
and poverty
Legal problems

Excessive worry, fear and anxiety

Guilt, loss of self-esteem and shame
Depression, sadness, not interested in
normal activities
Post-traumatic symptoms, including
PTSD
Changed sense of self, beliefs
Disempowerment, being under or
overly compliant
Self-harming behaviours, using alcohol
or drugs to feel better
Social
Social withdrawal
Difficulties with personal relationships
Interpersonal conflict

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Handout Trainings in the Workplace Working with People from Refugee Backgrounds

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Impact of Extreme Stress on the Brain

A persons brain can be changed by their experiences. This is called neuroplasticity. Prolonged and
multiple situations of extreme stress which are associated with excessive and prolonged levels of stress
chemicals can have a negative impact on brain structure, function and physiology, and lead to
disruptions in brain self-regulation.

Post Traumatic Stress Disorder (PTSD)

Some refugee survivors of torture and trauma will have symptoms consistent with PTSD. A smaller
percentage, particular those with experiences of torture and being in captivity, may have symptoms of
Complex PTSD.
PSTD is characterised by four key symptom areas:
1. The traumatic event is persistently re-experienced through intrusive thoughts, memories,
flashbacks and nightmares.
2. Negative thinking and mood includes a distorted sense of blame on self and others,
estrangement from others, lack of interest in activities, unable to remember key aspects of
event.
3. Avoidance and numbing Avoiding thoughts, memories, people and situations that trigger
traumatic memories, numbing behaviour.
4. Persistent symptoms of increased arousal Sleeping, memory and concentration problems,
startle responses and irritability.

STARTTS Interventions - Supporting the Recovery of Individuals

STARTTS is a specialised rehabilitation and treatment service for refugee trauma survivors. STARTTS
offers free counselling services to people from refugee and refugee-like backgrounds (and asylum
seekers) to support them in the recovery and healing process, free of charge, and it doesnt matter how
long a person has been in Australia. There is a waiting list for services, but it is managed and those with
the highest needs are prioritised. Children and asylum seekers are allocated a counsellor within two
weeks.

Assessment

Short-term, medium-term and long-term counselling

Referrals to internal STARTTS programs such as psychiatry, Neurofeedback clinic, physiotherapy,

acupuncture, therapeutic and support groups, youth camps and other youth programs such as
Capoeira

Referrals to other services and support

Important note
Refugees may present with multiple and complex problems which intersect across many different
services and therefore there can be the need for good casework and referral skills. Service
provision should focus on assisting the clients recovery from their experiences.

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Issues Refugee Families

The family is the fundamental social unit across all cultures. The wellbeing of each family is dependent
on the physical and mental health of the individuals within it. Most refugee families come from
collectivist cultures where the individuals identity derives primarily from their role in the family and
community. In refugee communities the nature of extended families and kinship ties can be highly
complex.
Refugee families may be affected in many ways such as:

Family members may have been separated or killed breakup of support systems
Family breakdown
Attachment relationships altered
Change in family roles children take on increased responsibility, the power of women is
increased
Domestic violence
Intergenerational conflict altered position of children in Australian society
Unemployment and economic hardship for the family
Traumatised parents face challenges which can impact on their capacity to nurture and raise their
children:
Parenting challenges due to trauma (eg. emotional availability), culture, skills, knowledge and
disorientation
Guilt and overprotective parenting
Limited understanding of parenting norms, child protection system and laws in Australia
Poor coping skills
Mental illness

STARTTS Interventions - Supporting the Recovery of Refugee Families

Individual counselling
Families in Cultural Transition (FICT) program
Other types of groups
Referral and link-up to other services such as family support programs, community health
services, drug and alcohol services, etc

Issues Social Support Networks

Lack of social support

Isolation
Loneliness
Lack of trust in others

STARTTS Interventions Development of Supportive Social Networks

Self support groups
Youth program including youth camps and Capoeira
Other activities, eg. community gardens
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Handout Trainings in the Workplace Working with People from Refugee Backgrounds

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Issues Refugee Communities

Community relationships, structures and
institutions in the home country may have been
disrupted as a result of organised violence
perpetrated for example by rebel groups,
external forces or the government. Trauma
impacts on communities as much as it impacts
on individuals. Communities can be destroyed
by creating a state of chronic terror and alarm,
by damaging bonds of trust and connections to
families and friends, and religious and cultural
systems. Renewed conflict in the country of
origin can affect the whole community (MartinBaro, 1989).
The considerable challenges for refugee
communities in settling in Australia threaten
those connections that may exist. This may
result in:
Internal conflict and fragmentation
within the refugee community
Polarisation and distrust within the
refugee community
Distrust of authorities

STARTTS Interventions Supporting

Refugee Communities and Building
Social Capital
Building on the connections in refugee
communities that may exist and using the
strengths of refugees resilience, adaptability
and motivation, help communities overcome
their trauma, empower themselves and create
a better life in Australia.

Helpful interventions could include and STARTTS

offers many of these:
Community partnerships with community
groups and associations undertaking their
own projects, events and initiatives
Supporting the development of businesses
that benefit the community, eg. Enterprise
Facilitation
Providing expert advice on organisational,
media, legal and other issues
Assisting in processes such as strategic
planning, lobbying and advocacy
Providing links to influential people in
politics, media and academia (Aroche and
Coello, 2012, STARTTS Annual Report,
2012)

Issues Mainstream Society and

Institutions
Mainstream society and institutions are a major
part of the recovery and coping environment of
refugees resettling and asylum seekers claiming
protection in Australia. This recovery and coping
environment is sometimes more supportive than
others. Issues can be related to services not
being trained or being unsure about working
with people from refugee backgrounds,
unsupportive community attitudes, a highly
charged and politicised public debate, and
unsupportive public policies.

STARTTS Interventions Fostering a

Positive Recovery and Coping
Environment
Training of services providers, volunteers
and TAFE and university students
Community education
Events such as Refugee Week, the Refugee
Ball, community festivals
Publications such as Refugee Transitions
magazine, STARTTS website
Media stories
Lobbying and advocacy
Policy submissions

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Handout Trainings in the Workplace Working with People from Refugee Backgrounds

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3. DIFFICULTIES FACED BY ASYLUM SEEKERS

Some relevant examples of issues faced by asylum seekers and their consequences not mentioned in the
previous session can be summarised as follows:

Issues

Consequences

Helplessness and powerless over the

outcome of their protection claim
and/or being denied their freedom
A strong sense of injustice and high
expectations of life in Australia, frozen
anger (unable to express it)
Dependency on services
Hopelessness in services and workers
being able to genuinely assist

Poorer health overall

Intensification and worsening of trauma
related symptoms and behaviours (eg.
Suicide ideation and self harm, antisocial behaviours)
Further reduced prospects for a
successful and secure future due to long
periods without employment and
education

Alienation, loneliness, no family support

Decreased ability to cope with the

demands of resettlement if their
protection claims are approved

Distress - telling of their traumatic story,

witnessing the distress of others

Decreased ability to cope with being

sent home if their claim is rejected

Boredom and lack of purpose

Difficulties telling their story of

persecution for their protection claim in
a chronological and convincing way due
to the impact of trauma on memory

Strategies to Help Asylum Seekers Cope

Service provision for asylum seekers should focus on assisting them cope with their situation and
containing their emotions and trauma-related symptoms, by meeting their basic needs, addressing their
health issues, assessing the risk of suicide and self-harm, building their strengths and resilience and
encouraging activities that may positively contribute to their future. Services would not normally be
focused on assisting their recovery, as asylum seekers are not yet in a position of safety.

Services offered by STARTTS to Asylum Seekers

Individual counselling support

Group information sessions about managing trauma symptoms
Group projects such as art groups
Assessments for eligibility to the Asylum Seeker Assistance Scheme which looks at the clients
torture and trauma symptoms and the capability to work (for those living in the community)
Psychological assessments and reports on the mental health of the client for asylum seekers
detained at the Villawood Detention Centre (Carramar office only and must be referred by the
detention centre mental health team)
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Handout Trainings in the Workplace Working with People from Refugee Backgrounds

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4. WORKER SKILLS: KEY PRINCIPLES AND TECHNIQUES

It is important that professionals and volunteers appreciate that their skills and experience in their field
are relevant to working with people from refugee backgrounds. Workers need to make the link between
the refugee experience and its traumatic impact, with practical things they can do in the workplace that
promote recovery and coping skills and minimise potential triggers, and hence the risk of retraumatisation.

Know how to Identify People from

Refugee Backgrounds
It is not always obvious if a person has
survived traumatic experiences, and people
rarely identify themselves as refugees. You
can assess if your client may be a refugee by
knowing generally from which countries
people from refugee backgrounds have come
to Australia, gathering data about the age of
the client, country of birth, year of arrival in
Australia or the visa number. A little bit of
research about the country of origin and
culture will help you greatly.

Use Good Cross-Cultural Skills

Relevant to the Refugee Trauma
Context
Awareness of ones own cultural
worldview
A positive attitude towards cultural
difference
Knowledge of different cultural
practices, worldviews and the sociopolitical context which caused them to
flee
Effective cross-cultural communication

Minimise Triggers in the Work Setting

A trigger is a stimulus that provokes a memory or
reaction. Different stimuli will be a trigger for
different people. For refugee clients they may be
stimuli that remind them of war, being detained
or interrogated (eg. being questioned, authority
figures, confined spaces, closed doors, writing
things down, etc).
Meet the client at the door if possible; see
the client promptly and explain if there is a
delay
Ideally meet in the same room at a regular
time
Offer the option of a trusted person being
present
Make the room set-up less formal if
possible (ie. not sitting behind a desk)
Avoid closed-in spaces, barred windows,
bright lights
Offer choice about the door being open or
closed
Explain any room peculiarities to the client
beforehand
Minimise other triggers if possible

Be Guided by the Key Recovery

Principles
1.
2.
3.
4.

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Restore a sense of safety and control

Restore connections to others
Restore meaning and purpose to life
Restore dignity and value (VFST, 1998)

Handout Trainings in the Workplace Working with People from Refugee Backgrounds

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Create Strong Professional Boundaries

Explain simply and clearly the service
and options, your role and its limits,
when and how they can communicate
with you, and what to do if you see
each other in other settings, so they
know what to expect from the
beginning. You may need to repeat
things several times and clarify your
clients understanding. Recognise
when your clients expectations are
unreasonable.
Be friendly towards the client, but
dont be your clients friend.
Be consistent.
Only reveal your personal information
to the client if it is relevant to your
clients needs. Too much selfdisclosure can shift the focus from the
client to you.
Sensitively address boundary issues or
warning signs as they arise with your
client by re-clarifying your role and the
limits of it.
Dont take your clients reactions
personally. It isnt necessarily about
you. Its important to have a certain
amount of detachment from
unpleasant situations that may arise.
Discuss and debrief with your
supervisor and/or other colleagues
about boundary issues to help reduce
stress and get feedback and support.
Take care of yourself. Maintain good
physical, emotional and mental health
(see session 5).

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Communicate Effectively
How and what you communicate to refugee and
asylum seeker clients will have an impact on how
they trust you, and how safe and in control they
feel with you. Dont underestimate the power of
being nice. The positive connection you make
with your client can contribute in a meaningful
way to restoring their dignity and value as a
human being.
Some things that can be helpful include:
Use the principles of working crossculturally in the context of refugee trauma
Use interpreters (see box)
Use a calm voice and open body language
Take time to ease into the conversation.
Take care not to ask questions in such a
way that it appears like an interrogation
Explain simply and clearly the service and
options, your role and how any information
collected will be used so they know what to
expect
Emphasise confidentiality and its limits
Be patient and be willing to repeat
information several times. Confirm the
clients understanding
Be flexible and allow the client to lead.
Empower the client to make informed
choices
Set clear limits and dont promise things
you cant do
Actively listen
Be sincere, convey respect, care and belief

Handout Trainings in the Workplace Working with People from Refugee Backgrounds

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Use Interpreters When Necessary

Some general principles when using interpreters include:

Always use professional interpreters.

Dont assume which is the appropriate language.
Be aware of gender issues. Women may prefer a female interpreter.
Be aware of different ethnic groups and tensions within the same country.
Brief and debrief the interpreter before and after sessions. They can be affected
by the powerful stories and emotions of the clients too.
Always introduce the interpreter and explain their role.
Always ensure you inform the client that the interpreter is bound by the same
confidentiality that you are. They may be concerned about their private details
being shared within their own community by the interpreter.
Address and make eye contact with the client, not the interpreter.
Assess the interpreters ability to convey non-verbal content and the connotations
of the clients responses.
If possible request the same interpreter each time you see the client.

Provide Practical Assistance

Offers of practical assistance are highly valued amongst refugees and asylum seekers and can be very
effective at building trust, and enhancing feelings of safety and control. It is important to ensure basic
needs are met given there are many barriers to accessing services.

Help Build the Clients Strengths and Resilience and make Connections
Acknowledge the clients journey so far.
Help the client identify their strengths, how have they coped before, what have they done
well and what has motivated them.
Encourage the client to recognise that they are responsible for how they are feeling and how
they see their life. Encourage them to reframe their life focusing on their qualities and
strengths, not just the deficits.
For asylum seekers especially, it helps to keep focused on the present and what they can
control right now. Assist the client to get organised and in control of what they can.
Encourage and resource the client to do activities which are constructive and could make a
positive contribution to their future. This is especially true for asylum seekers.

Normalise the Clients Experience

Refugees and asylum seekers can feel unsafe in their own bodies, feeling as though their mind and
emotions are out of control. They may feel as though they are losing their mind and the symptoms they
are experiencing can themselves cause a lot of anxiety. You may notice that refugee and asylum seeker
clients can be emotional and overly reactive. Helping clients understand and manage their symptoms
and behaviours to make them feel safer and in control of their bodies and better able to deal with the
challenges of resettlement or seeking protection.
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Referring Clients for Counselling Support

Workers may need to refer refugees and asylum seekers for counselling support if they have distressing
symptoms that are impacting on their daily functioning. It is useful to check whether the client has seen
or is seeing a doctor or other health care professional to address their issues. The client may also ask to
be referred for counselling. Explain counselling in a way that is meaningful for the client.

Referring Clients to STARTTS

Referrals to STARTTS
STARTTS has offices in Sydney in Carramar, Auburn, Liverpool and Blacktown, and outside
of Sydney in Coffs Harbour, Newcastle and Wagga Wagga. Outreach services are offered
across many locations in Sydney, and in some regional areas such as Lismore, Armidale
and Wollongong.
Call: (02) 9794 1900 (Ask for the intake counsellor)
Email: intakegeneral@startts.org.au (Referral form available www.startts.org.au)
Fax: (02) 9794 1890 (Referral form available www.startts.org.au)
-Provide information about: demographics, refugee story, psychological and physical
health symptoms/difficulties, treatment received, social supports, and current status

STARTTS does have a waiting list, but it is managed, so that people in greatest need will be seen first.
Children are given priority. STARTTS is not a crisis service and therefore does not see clients for acute
psychotic episodes or suicide threats or attempts.
STARTTS services are free of charge. Visit our website for more information about referrals
(www.startts.org.au).

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4. VICARIOUS TRAUMA AND SELF CARE

While working with refugees and asylum seekers can be inspiring and rewarding, hearing their stories of
traumatic experiences or being exposed to their distress, can have a significant impact on you as a
worker, and can cause some reactions similar to those experienced by survivors. You therefore need to
be aware of the risks for you, what signs and symptoms to look out for, and some of the strategies to
take good care of yourself.

Vicarious Trauma
As a witness to your clients responses to past
traumatic experiences, you may experience
distress, anxiety and sadness. This is called
vicarious trauma, or trauma felt at second
hand through the experiences of another.
Vicarious trauma is normal and unavoidable.
It does not mean that there is anything wrong
with you or that you cannot do your job.
However it is important that you dont ignore
your feelings of distress. These are real and
you may need some help. Otherwise you are
at risk of burnout.

Look after your own Needs

You need to look after yourself if you are
going to be able to help your client. Accept
your own powerful reactions and know the
self care strategies that can support you to
take good care of yourself when working with
traumatised clients.

Personal Self Care Strategies

Make your personal life a priority
Eat well, exercise, get adequate sleep
and rest
Nurture all aspects of yourself
emotional, physical, mental, spiritual,
interpersonal, creative
Debrief or talk about your feelings
with someone your supervisor,
colleagues or a counsellor
This handout is designed to be used in conjunction with
STARTTS introductory workshop Introduction to Working with
People from Refugee Backgrounds given in outreach locations
around NSW. It contains key messages only and the
information has been summarised to suit a brief handout.

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Professional Self Care Strategies

Make use of supervision, consultation,
support
Exert control if possible over your workload
Find a good balance and do a variety of
tasks
Receive education or training
Set and honour reasonable boundaries

Organisational Self Care Strategies

Provide clinical supervision opportunities
Offer adequate professional development
Foster a culture in which work-related
stress is accepted as real and legitimate
Offer an Employee Assistance Program
(EAP)
Ensure adequate resources are available
Allocate time for peer support and
consultation
Assist workers to maintain realistic goals
and boundaries in their work
Structure roles around realistic case loads
and task variety
References
American Psychiatric Association (2013) Diagnostic and Statistical Manual
of Mental Disorders, 5th Ed, American Psychiatric Association
Aroche, J. and Coello, M. (1994) Towards a systematic approach for the
treatment and rehabilitation of torture and trauma survivors: The
experience of STARTTS in Australia, STARTTS
Website of the Department of Immigration and Border Protection, 2014
Martin-Baro (1989) Psychological consequences of state terrorism,
transcript of presentation at the Symposium on The Psychological
Consequences of Political Terrorism, California, sponsored by the
Committee for Health Rights in Central America.
Rothschild, B. and Rand, M. (2006) Help for the Helper: The
psychophysiology of compassion fatigue and vicarious traumatisation,
W.W. Norton & Company
UNHCR (2014) UNHCR Global Trends 2013, www.unhcr.org
Victorian Foundation for Survivors of Torture Inc (1996) Rebuilding
shattered lives, VFST Inc.

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