FAQ about Psychotherapy with East Africans

East Africans often have experience with multiple traumas and issues that affect their ability to address mental health issues. I believe that together we can work to fix this “crack in the sky” of their world.

It is often difficult for an East African to trust a western psychologist because traditional western techniques can be frightening to these clients. Most are overwhelmed and nervous about discussing their problems. Many have experienced war trauma and or torture, some are illiterate in their native languages or have poor understanding of mathematics. Frequently, they have been separated from loved ones and they are helpless to help those still facing life-threatening situations. Perhaps most difficult of all, seeking help from a psychologist or having any mental illness means that they are “crazy” which is a terrible stigma personally, religiously, and culturally. Because this stigma is huge, I have to work hard to reassure my clients that I understand this stigma.

This is why I am very careful about asking emotionally laden questions. I give my clients permission to have their emotions in my office. I also work to help my clients use their strengths, including their religious faith to deal with their emotions and their traumatic memories. I have developed a technique that often helps my clients decrease the intensity of their flashbacks.

To be able to work well with East Africans I have to work well with their interpreter. My interpreters often have traumatic histories of their own and because of this may have strong emotional reaction to my clients’ stories. This requires me to take care of everyone in the room. I also must teach each interpreter how to work with me so that we have clear and accurate communications.

I believe it is my job to understand my clients; not their job to understand me. Few Americans can comprehend the trauma clients went through in Africa during the war and of in refugee camps. Even after escaping these camps, East Africans often continue to experience difficulties because their families are still in danger in Africa. Many come from cultures where their families have been persecuted from generation to generation. I know I could not have lived through what they have. Their strength and resilience leave me in awe. It is my job to find out what has helped my clients survive and to build trust with them by being honest and kind.

There can be a dramatic difference between East Africans healing and western psychologists healing. This is especially true if a client suffers with psychosis. If I suspect someone is hallucinating, I will ask if my client sees things that other people do not see or hears things that other do not hear or smells things that no one else smells. I do not usually use the word hallucination with East African clients because that word is hard to interpret. I ask questions until I know that the client is hallucinating not just having a flashback. I usually will ask what they think is going on. This often leads to a discussion of Jinn and their belief that they have a Jinn or their family’s belief that they have a Jinn. Then I suggest to them (gently) that often Western medication can help them feel better and not be so disturbed by the sounds, smells, visions happening to them. Many of my Somali clients use traditional spiritual healing practices to deal with psychosis. I respect that and at the same time urge them to consider getting some Western medication which can also help.

Most of my East African clients have gone through life changing experiences. Many of them (though not all) feel thankful to the US for providing them freedom. Reminding them (if accurate) that their coming to the US is a miracle for them, can be helpful. I use the word miracle if that concept is helpful for the client. I also explain that if the miracle of safety occurred for them why couldn’t that happen for their family members who are still in danger. This way of imaging a more hopeful future for family members can be very helpful way to decease worry. I always try to have my East African and other refugee, immigrant and asylee clients feel better about themselves by the end of the session. I do this in two ways – the first is helping them remember their true strengths. The second is doing something tangible for them like completing the N-648, or an assessment they can send to SSI, or a plan on how to deal with a PCA denial, or a simple way they can learn how to spell their name. Or sometimes if we have done all of the above a chance to talk to me about their homeland or something that has happened in their new homeland that brings them hope.