When Therapy Fails Survivors of Torture and Violence

Evelyn Reed · 2026-07-10

Much of our perception of what works in therapy is deeply tied to our cultural ideas of language, trust, and safety. Psychotherapist and human rights clinician Azadeh Afsahi argues that the Western framework for suffering and healing often misses the mark for survivors of torture and state violence. This is a critical conversation for mindful living professionals who work with diverse clients. ### The Cultural Blind Spot in Therapy Western mental health care is built on assumptions that don't always translate. It values verbal expression, individual autonomy, and a linear path from problem to solution. But for someone who has survived torture or state violence, these assumptions can feel like another closed door. Trust isn't built through talk; it's built through action and shared experience. Language itself can be a barrier when trauma is stored in the body, not in words. Afsahi's work highlights how the therapy room must adapt. It can't just be a space for catharsis. It needs to honor the survivor's cultural context, their history, and their unique understanding of safety. Without this, therapy risks retraumatizing instead of healing. ### What Needs to Change? Here are key shifts Afsahi and others advocate for: - **Cultural humility over cultural competence:** Therapists must acknowledge they don't know everything and stay open to learning from each client's lived experience. - **Community-based approaches:** Healing isn't always one-on-one. Group settings and community rituals can be more effective for those who've experienced collective trauma. - **Non-verbal modalities:** Art, movement, and somatic practices can bypass language barriers and access trauma stored in the body. - **Long-term commitment:** Survivors of torture often need years of consistent support, not the 8-12 sessions typical of Western models. ### The Role of Trust and Safety Trust is the foundation of any therapeutic relationship, but it's especially fragile for survivors of state violence. They've learned that institutions can't be trusted. The therapy room, as an institutional space, can feel threatening. Afsahi emphasizes that safety must be co-created. This means letting the client set the pace, respecting their silence, and never pushing for disclosure. It's about showing up consistently, without agenda. > "Healing is not a linear process. It's a spiral. You revisit the same wounds, but from a different vantage point each time." - Azadeh Afsahi This quote captures the reality: recovery isn't about fixing something broken. It's about reclaiming a sense of agency and connection. ### Why This Matters for Mindful Living Professionals As a mindfulness and well-being consultant, I see the overlap daily. Mindfulness practices can be a powerful tool, but they must be adapted. A survivor of torture may find sitting with their breath triggering, not calming. Guided imagery might feel like a loss of control. The key is flexibility. Offer choices. Let the client lead. This is where true healing begins. For professionals in the United States, this means rethinking our training and our own biases. We need to look beyond the DSM and diagnoses to see the whole person. Their story. Their culture. Their resilience. ### Conclusion The therapy room doesn't have to be another closed door. By reimagining mental health care through a culturally responsive lens, we can create spaces that truly heal. This isn't just about better techniques. It's about honoring the humanity of every survivor.