Psychotherapy with Southeast Asian refugees: implications for treatment of Western patients.

Late one night there was a knock at our door. I wondered who might be knocking and for what reason. When I opened the door I found N., a Cambodian woman who was a patient at the refugee clinic where I volunteer. She was accompanied by her husband and her three children. N. had suffered a great deal of torture, abuse, and loss before and during the Pol Pot era. When she talked about her memories of those events, tears would come to my eyes and the eyes of the interpreters with whom we worked during our therapy sessions. Her memories were extremely painful and vivid and trying to hold all of this during our meetings often felt almost overwhelming. And now here she and her family were at our door.I asked them in with a mixture of curiosity, excitement, and dread. Her husband, who spoke English, said that N. had seen the face of her dead mother who told her that she (the patient) was in danger of being thrown into the fire. (Sometimes the Khmer Rouge had "new people" from the work site sit around a fire to hear threats and propaganda as well as to throw people into the fire after accusing them of various deeds.)"Do you mean," I asked, "that N. had been sleeping and had a dream about her mother?" "No", he said, "She had been looking out a window and suddenly the ghost of her mother appeared."We all sat down on my living room floor and I brought them some tea. N. and her husband apologized for coming to my house late. She told me through her husband that her mother had warned her that N. was not safe and that she needed to go to a place of safety.During our conversation I had asked her what she would do if she were still in Cambodia? She replied that she would go to a trusted uncle or some other relative who would talk with her. They also would ask a monk or a kru khmer (Cambodian traditional healer) to come to their house where she would await them with her relatives. The monk or kru might recite some prayers and initiate some other healing ritual with the family. He might try to contact the ghost again and other relatives might try to remember times that ghosts of their dead relatives appeared to them. Through this they would understand better why the ghost was appearing then and what they should or could do to satisfy that warning.As we talked that night and as I reflected on this experience afterwards, I had various thoughts. Was the ghost of N.'s mother a hallucination, or a dream, or some kind of flashback experience? What did this say about N.'s level of psychological disturbance? How do I understand all this and how can I be helpful to her hat did she and her husband mean that in Cambodia they and other relatives might have sat with a monk or healer and talked about ghosts of other relatives anyone had seen and talked with? Why would she do this with other relatives and what role did the monk or healer play in this? Also, why did she bring her whole family with her to my house? I know that she needed her husband to translate her language into English, but why bring the children who were old enough to stay at home by themselves? Their house was not in danger, she was. Why did she want to talk in front of her children about seeing a ghost and hearing about such a frightening warning? Finally, why did she come to my house and why so late at night? I know that she and I had established a safe and important relationship, but why had she not called her friends on the telephone? Did she not know that you do not just stop in to your therapist's house especially without calling first?This experience like many I have had working with Southeast Asian refugees raises a number of fundamental questions for me: What does healing mean for these people? What part does psychotherapy play in this process (and what aspect of psychotherapy seems to be helpful to them)? What does normal mean in terms of behavior and the nature of the self? What is the role and what are the behaviors of the healer with the individual? …