Trauma Counselling (with refugees)

When you are wondering if a person is suffering from traumatic stress it is useful to think about the likelihood that the person has suffered a traumatic experience, and then remember the acronym R.A.A.

Likelihood of a traumatic experience?

One high risk indicator of traumatic stress is simply being a refugee entrant to Australia under the Humanitarian program. It has been estimated that up to 80% of refugees in this program have suffered some form of trauma.

The trauma experienced may involve a number of events: torture, imprisonment, exile, death of a family member, a dangerous journey to safety. In addition, recovery is also affected by resettlement difficulties including the English language and racism.

Traumatic stress is marked by a collection of symptoms which arise as a normal response to experiencing or witnessing the experiences which involve intense fear, helplessness and/or horror. This applies not only to refugees, but anyone who has suffered a traumatic experience.

R.A.A. ?

This is a mnemonic for the following features:

R. Re-experiencing

• flashbacks (a vivid re-experience of traumatic experiences or feelings)

• nightmares (about past traumatic events) or night terrors

• intrusive thoughts (often triggered by things which have been associated with the trauma e.g. the sight of a uniform)

A. Arousal

• Hyper-vigilance (being overly aware of the environment around you)

• concentration difficulties (difficulty focussing on one thing at a time)

• exaggerated startle response (becoming easily frightened)

• irritability (with family and friends)

• sleep disturbances (due to anxiety or nightmares)

A. Avoidance

• avoidance of anything which may remind them of the trauma (e.g. authority figures, hospital settings)

• increased isolation (feelings of alienation, distrust of crowds or public places)

• dissociative phenomena (staring out windows, excessive day dreaming, not really being present)

Other Signs

• scars

• headaches

• body aches and pains

• sadness and depression

• loss or increase in appetite

• use of self medication in the form of alcohol or other drugs

Recognition in non-English speaking adults can be more difficult due to language and cultural differences.

Children show the signs of traumatic stress in different ways according to their age and stage of development. In general, because their language skills are not as developed as adults, children express their experience through repetitive play and art.

Next time you are wondering if a person is suffering from traumatic stress, remember:

R.A.A. (Re-experiencing, Arousal, Avoidance)

General Suggestions

If you think someone may need help managing the symptoms mentioned, here are some general suggestions which may be helpful when approaching them.

Say what you have noticed that has led you to wonder if there are problems in their situation.

Let them know their feelings are not unusual, particularly if they have experienced hardships and violence before coming to Australia.

Ask if they have had any bad experiences prior or since arrival, which they may not want to talk about but think might be affecting them. (Do not ask questions such as "have you been tortured?" "Do you need counselling?")

Indicate that they can also see a doctor about non-physical problems e.g. inability to concentrate, worries, or sleeplessness. Tell them about QPASTT as a place which deals with problems that have resulted from trauma due to war, civil violence and political oppression. One can then ascertain their interest in QPASTT.

The above inquiries should not be made unless there is some time available to do so and follow up with a referral if necessary. It is also important not to offer more than can be delivered.

Copyright © 2001-2005 Chris Lobsinger
Last updated 27 September 2005