The following case report aims to give the reader an illustration of the concepts presented later in this chapter. It is written in the therapist’s first-person perspective, a form that may appear unusual in a scientific publication. However, the eminent influence of the therapist’s authentic personality on the therapeutic process is conveyed more accurately that way. When treating traumatized immigrants, authenticity, personal commitment, and appreciation are crucial, so the author requests that this uncommon form be allowed by the reader.

Ceylan was a 32-year-old married woman from Syria and was referred to our outpatient clinic by her GP. She lived with her husband and two daughters (2 and 6 years old) in a rural Swiss village, where the family was accommodated by the immigration authorities. Ceylan had arrived in Switzerland 2 years earlier, and the family was still waiting for its case to be decided by the immigration authorities. Her husband Awar had escaped from the Kurdish areas of Syria some 2 years earlier, leaving his wife and two daughters with her parents in their remote home, a small village near the Turkish border. Awar later helped to organize the journey for his wife and daughters from Syria to Switzerland, a dangerous and confusing experience for Ceylan in the hands of facilitators.

At the time of referral, Ceylan could speak only a few words in German, and in the referring letter, the GP erroneously stated that her mother tongue was Arabic. In fact, she had learned only a little Arabic in school, and her mother tongue was instead a Kurdish dialect. The first appointment with her was therefore somewhat disappointing because the Arabic interpreter we had retained was not much help. Direct communication with her was hardly possible, and only the husband, who had learned a little more German in the meantime, could give me some information about her problem. As the GP had already mentioned in his referring letter, Ceylan was perceived as constantly sad, exhausted, uncommunicative, absentminded, forgetful, and confused. With her agreement – which was, in spite of the nebulous situation, very clearly given – I arranged a second appointment with a female Kurdish interpreter. The presence of the husband at the second appointment was a matter of course to both of them (as it seemed to me).

In the second appointment – which was later followed by many more – I explored some parts of the family’s story. Both Awar and Ceylan came from the same Kurdish village in Syria near the Turkish border. Their families had been – like many others – settled there for generations and spread across the border between the two countries. They lived a spare and rural life in the mountainous Kurdish area, cultivating their own land and raising some cattle and sheep. Awar and Ceylan were relatives and had known each other since they were children; however, the two of them had freely made the decision to marry, which they related with pride. Like most of the villagers, Awar was a supporter of the Kurdish party, which was antagonized by the Syrian police and army. Most probably, he was an active member of the party, which is intimately allied to the militant PKK at the Turkish side of the border and works mainly covertly. He was arrested several times by the police and experienced beatings and ill treatment by state officials. To escape from further imminent detentions and even more violent treatment, he decided to immigrate to Switzerland, where some distant relatives already lived. For certain reasons, he was advised by friends to conceal his real identity when entering Switzerland and to register under a false name. This decision was a momentous mistake, as he realized later, because authorities refused at first to reunite him with his wife and children when they made it into Switzerland 2 years later. Only after the disclosure of his real identity was the family allowed to live together in an apartment assigned to them. This initial name deception, however, made Awar particularly suspicious to the immigration authorities and prolonged the procedure for granting the right for asylum. It was eventually decided only 4 years after his arrival in Switzerland, and Awar was not recognized as a refugee in legal terms.

Awar reported his wife to have started being altered in her mood and behavior only several months after her immigration. At first, he said, she was glad: happy to see her husband and joyful with her daughters. Only as time passed did she become increasingly peculiar, neglecting her housework, being erratic with her children and irritable, ill humored, sad, and weepy. She could (or would) not explain the reasons for her behavior to her husband, but obviously she suffered from it and was looking for help. Ceylan was a somewhat obese, pale woman, neatly dressed in Western style, rather shy, but not completely incommunicative. Initially, she merely answered questions I felt it was appropriate to ask and did not talk much spontaneously. But then, she gradually opened up, and it seemed to me that she started to like the kind of conversation we continued to have. From the very start of this therapy, I had different ideas about what could have happened to her and what could have been her experiences. However, I did not at all urge her to talk about specific issues but left it completely up to her to choose the subjects of the sessions. I felt unsure about what was psychologically and culturally appropriate for her to talk about and also realized that the situation – a male Swiss doctor and a Kurdish peasant woman sitting together in a room and having a conversation for 50 min – must be completely unfamiliar to her. Fortunately, our female interpreter was present, too, and helped to ease the situation.

During the first year of therapy in which I had appointments with her every 2 weeks, Ceylan mostly spoke about her feelings of insufficiency as a mother. Especially with her elder, now 7-year-old daughter, she had a lot of difficulties, because the girl (who was severely traumatized, as I guessed immediately and could confirm only much later from the story Ceylan told me) did not obey her and had severe learning problems in school. Ceylan felt responsible for her daughter’s problems and asked me for advice. Together with the GP and a local social worker, I organized for her daughter to receive support from a child psychologist and for both of her children to visit with a neighboring Swiss family for lunch 3 days a week. She accepted these arrangements because they unburdened her somewhat and she realized that her children cheered up subsequently. Nevertheless, Ceylan’s condition fluctuated considerably during the first year of treatment. Sometimes she was very depressed and desperate, and sometimes she seemed more self-confident and vigorous. Her husband was deeply worried about his wife’s condition and supported her therapy. After several months of treatment, he agreed to have only the female interpreter and the therapist in the session with Ceylan while he remained in the waiting room. Often, Ceylan proposed that he (and sometimes also the two daughters) join us for the last 5 or 10 min of the session. Only much later, Ceylan revealed to me that she was always a little distressed by this setting as her husband used to question her after the sessions about the things we discussed.

Some 6 months after the beginning of our therapy, the family’s claim for asylum was initially rejected. Not surprisingly, this decision caused a major relapse in Ceylan’s condition. It took one more year to await the appeal court’s decision, which assigned the family a temporary visa because of Ceylan’s impaired mental health. The court argued that, given her current impaired health condition, it would not be reasonable to send Ceylan back to her home country where no proper medical treatment was available. The court decision was mainly based on the description of Ceylan’s health condition that I had communicated to the authorities in an expert report. So in Ceylan’s view, I had saved the family by writing the “right” letter, but in fact, it was Ceylan who unintentionally saved her family from expulsion through her illness. Fortunately, she did not fully realize the paradoxical implication of the authority’s decision, but I realized at once the imminent dead end of this situation: the very moment that I declared Ceylan to be cured, the immigration authority would send the whole family back to their home country.

The granting of a regular, although only temporary, visa to the family had a remarkable effect on them: Awar was now entitled to work legally and to have his driver’s license, and Ceylan felt visibly relieved. After a short time, Awar found a job as a handyman in a nearby spa resort, and Ceylan now had to function much more on her own as a housewife. Even after 2 years of treatment, she still felt unable to travel alone the 50 km from her home to my office. She would have to take a bus, then to change to a train, and finally to walk five blocks. She felt uneasy traveling on her own for several reasons; however, I knew one particular reason for her reluctance: Ceylan was illiterate. Only when her daughters went to school in Switzerland did she pick up the Roman alphabet and slowly learn to read and write in German. Because her husband now had to work when she had appointments with me, she simply had to jump into the cold water, as it were, and come to my office on her own. Initially, this necessity troubled her a lot, but then she visibly took some pride in her new daring. She also had learned to ride a bicycle in the meantime (something she never had the chance to practice in her home country), joined the local women’s gymnastic club, and even attended the (mixed!) swimming lessons we organized in our treatment center. Around that time, she came to the appointment one day and proposed to me to continue the sessions without the interpreter. Indeed, she had learned to speak German fairly well now and communication was possible in a sufficient manner. Not astonishingly, the conversation changed in many ways after that. The subjects became much more personal, and she addressed different topics we had never discussed before: Ceylan wanted to talk about life in Switzerland, asking me about local traditions, family values, and religious practices, and even wanted to learn about delicate issues like contraception, dating and sex in adolescence, and marriage customs. I felt that by talking about all of these issues, she was in fact exploring me, and I prepared for something more to come.

Finally, after more than 3 years of continuous therapy, she started to tell me about traumatic and haunting experiences she had had in her home country before she left. After her husband had escaped to Switzerland, Ceylan lived with her small children (then a newborn baby and a 4-year-old daughter) with her parents in their farmhouse. One day, when her parents were away for work in the fields, three unknown men – civil officials of the military police – arrived suddenly at her door. They immediately entered the house and rudely asked for her husband. She said that he was abroad and that she had not seen him for some time. The policemen laughed at her and started beating and groping her. While both of her children were in the room, they forced her to undress, and they raped her brutally. They left her humiliated and injured but not without threatening her and her family with further troubles in case the family did not comply with the police. Ceylan was deeply frightened and scared not only by the horror she had just experienced but also by the imminent danger she was in now. If her father or husband were to find out what had happened to her, she would probably be outlawed and expelled by her own family. Ceylan confided in her mother and told her everything. Together, they managed to conceal the crime from the rest of the family. Ceylan was sick for several weeks; she had suffered from gynecological injuries and had to be treated at home. Fortunately, she recovered passably and could endure the adventurous escape together with her two children to Switzerland.

When Ceylan started to talk about these traumatizing experiences, she seemed to be determined that she wanted to tell it all. I did not have to persuade or urge her to do so. I was the witness, and she was the actor. When she was recalling her trauma over the next three sessions, she experienced deep pain, shame, and disgust and suffered from flashbacks and intensified nightmares between the sessions. However, it was doable, and she regained self-control and felt relief by the end. We could subsequently address some related issues such as sexual problems she had with her husband and her general anxiety towards male officials. She still did not want to tell her husband about her trauma. In my opinion, he already knew everything but did not want to embarrass her, and so they both remained silent about her secret.

Based on an amendment to the immigration law, the family could apply for a permanent visa after they had lived in the country for 5 years and were independent from welfare for more than 1 year. Proudly, Ceylan presented me a folder full of testimonials and letters of support written by dozens of neighbors, supporters, and friends from her new home village. This was a remarkable achievement because the village where they used to live was known as a rather conservative and close-minded area. Awar had gained a good reputation as a hardworking man, and Ceylan was well known among the women in the village because she had joined the local gymnastic club. After almost 5 years of treatment, Ceylan’s family was given a permanent resident status. Her mental health condition was almost completely normalized. I ended our therapy and continued to see her once or twice a year for a follow-up.