Why Therapy Fails Survivors of Torture and State Violence

Emily Johnson · 2026-07-10

Much of our perception of what "works" in therapy is tied to cultural ideas of language, trust, and safety. Psychotherapist and human rights clinician Azadeh Afsahi dives into the Western framework of suffering and restoration—and why we need to rethink mental health care for people from non-Western backgrounds. ### The Cultural Divide in Therapy When you walk into a therapy room in the United States, you're stepping into a space shaped by Western values. Open expression, verbal disclosure, and individual autonomy are prized. But for survivors of torture and state violence—many of whom come from collectivist cultures—these norms can feel alienating. Trust isn't built through words alone; it's earned through shared experience and community bonds. Forcing a client to talk about trauma before they're ready can re-traumatize them, not heal them. ### Why the Western Model Falls Short Traditional mental health care often assumes a linear path from suffering to recovery. But for those who've endured systematic oppression, recovery isn't a straight line. It's messy, nonlinear, and deeply tied to social justice. Here's what the Western model gets wrong: - **Over-reliance on verbal processing**: Many cultures value silence or indirect communication. Asking someone to "tell their story" can feel like a demand, not an invitation. - **Ignoring systemic factors**: Torture is political. Therapy that ignores power structures and historical trauma misses the root cause. - **Individual focus**: Healing often requires community, not just one-on-one sessions. Isolating a survivor in a room with a stranger can echo the isolation they experienced during violence. ### Reimagining Safety and Trust Afsahi argues that safety in therapy isn't just about confidentiality forms. It's about creating a space where cultural identity is honored. For example, in some Middle Eastern cultures, discussing family shame or honor is taboo. A therapist who doesn't understand this might push too hard, and the therapy room becomes another closed door. Instead, clinicians need to adapt—using metaphor, storytelling, or even silence as tools. ### What Needs to Change To truly serve survivors, mental health care must become more flexible. This means training therapists in cultural humility, not just cultural competence. It means integrating community healers, religious leaders, and family members into the process. And it means recognizing that for many, justice is part of healing—so advocacy and social change belong in the therapy room. > "Healing from torture isn't just about the individual's mind; it's about restoring their place in a world that broke them." ### Practical Steps for Professionals If you're a therapist or mental health worker, here are some shifts you can make: - **Ask about cultural background** before diving into trauma history. - **Use indirect approaches** like art, movement, or narrative therapy. - **Collaborate with community organizations** to build trust outside the office. - **Advocate for policy changes** that address the root causes of violence. Ultimately, therapy should be a door to freedom, not another locked room. By reimagining our frameworks, we can offer real healing to those who need it most.