Why Therapy Fails Survivors of Torture and What Needs to Change

Amanda Wilson · 2026-07-10

Much of our perception of what "works" in therapy is intimately linked to our cultural ideas of language, trust, and safety. Psychotherapist and human rights clinician Azadeh Afsahi examines the Western framework of suffering and restoration—and the need to reimagine mental health care for non-Western patients. ### The Cultural Divide in Mental Health Care When someone walks into a therapy room, they bring more than just their pain. They bring their entire worldview, shaped by language, family, and community. For survivors of torture and state violence, the Western model of mental health care often feels like another closed door. That's because it was designed for a different set of experiences. Think about it. Traditional therapy relies heavily on talk, on sitting in a quiet room and sharing your deepest fears with a stranger. But for someone who has survived state violence, silence might feel safer than words. Trust isn't given—it's earned over time, often through actions rather than conversation. ### What's Missing in the Western Approach Western therapy tends to focus on the individual. It asks, "What's wrong with you?" and then tries to fix it with techniques like cognitive behavioral therapy or exposure therapy. But for survivors of torture, the problem isn't just inside them. It's systemic. It's political. It's rooted in violence that was intentional and organized. Here's what often gets overlooked: - **Community context**: Healing doesn't happen in isolation. Many survivors come from cultures where family and community are central to identity. Therapy that ignores this misses the point. - **Cultural expressions of distress**: In some cultures, emotional pain shows up as physical symptoms—headaches, stomach issues, fatigue. Western therapy might dismiss these as "somatic complaints" instead of recognizing them as valid expressions of trauma. - **Language barriers**: Even with a translator, nuance gets lost. Words like "depression" or "anxiety" don't always translate. And metaphors that work in English might fall flat in another language. - **Power dynamics**: The therapist-patient relationship can feel like a replay of authority figures who caused harm. For survivors of state violence, that dynamic is dangerous. > "The therapy room can become another site of silencing if we don't acknowledge the cultural and political realities that shape a person's suffering." — Azadeh Afsahi ### Reimagining Care for Non-Western Patients So what does better care look like? It starts with humility. Therapists need to step back and ask, "What does healing mean to you?" instead of assuming the answer. Some practical shifts include: - **Community-based healing**: Group therapy or family sessions might work better than one-on-one talk therapy. In many cultures, healing is a collective process. - **Narrative approaches**: Letting survivors tell their own stories, in their own way, without forcing them into a clinical framework. This honors their experience instead of pathologizing it. - **Practical support**: Trauma isn't just emotional. It's financial, legal, and social. Therapy should connect people with resources—housing, legal aid, job training—not just talk. - **Flexible timeframes**: Western therapy often happens in 50-minute sessions, once a week. That might not work for someone who needs longer to build trust or who can't afford to miss work. ### Moving Forward The goal isn't to throw out Western therapy entirely. It's to expand it. To make room for other ways of knowing and healing. For survivors of torture and state violence, the therapy room should be a place of safety, not another closed door. As mental health professionals, we need to listen harder, ask better questions, and recognize that our tools aren't universal. The most important thing we can offer isn't a technique—it's genuine respect for the person sitting across from us.