Severely psychologically traumatized refugees bring difficult and highly emotional issues to therapy. Refugees have language and other cultural adjustment problems, but most of those traumatized will also suffer from a chronic posttraumatic stress disorder. At times this leads to intrusive symptoms; at other times to denial, avoidance, and psychic numbing only. The psychiatrist must maintain clinical objectivity and yet understand the phases of posttraumatic stress disorder. Committing oneself to a long-term supportive relationship, recognizing the role of current stressors in symptom development, relieving some symptoms with medication, helping with getting financial and social support, and reinforcing traditional values are helpful therapeutic approaches. Sharing the often hopeless and helpless existential feelings of the patient is essential. More psychiatrists are needed to work with the painful problems of refugees. Research is needed to determine the most appropriate and effective treatments.

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