The Pain Stops Here

Like many of ASTT's clients, Meh Vivien found the center through her immigration lawyer. Other clients discovered ASTT on the Internet or through referrals from former clients, who have been known (even on public buses) to discreetly approach people they suspect are fellow survivors.

Hanscom asks Meh Vivien whether she's been dreaming. In the midst of other challenges survivors face, most new arrivals suffer from post-traumatic stress disorder (PTSD), a complex series of symptoms caused by experiencing violence or the threat of violence or witnessing it against another. The symptoms of PTSD are varied, but the most prevalent include difficulty sleeping, exaggerated startle reaction, and flashbacks triggered by everyday experiences. (One client who was tortured in the laundry of a prison has flashbacks triggered by the smell of damp clothes.)

Another symptom of PTSD is nightmares—which is why Hanscom asks Meh Vivien about her dreams. "Last night I dreamed that I had to clean toilets," Meh Vivien says, looking shocked. "I told them I was going to throw up. They just made me clean them faster." The logic of the dream defied her and left her frightened. "Why should this happen to me?" she asks Hanscom.

Hanscom assures Meh Vivien that this response to the trauma she's been through is completely normal. Later Hanscom tells me that one part of her job is to help clients learn that their strength comes from unexpected places—sometimes in the very symptoms of PTSD. The exaggerated startle, for example, means a person is on high alert so she doesn't get hurt again. Clients who recognize that PTSD is characterized by a series of physiological defenses can begin to understand that painful reactions are not just unnecessary residue from past experience but the way in which their bodies prepare to fight back. What first appears to be a weakness can be seen as a small sign of strength.

"Our clients have lost safety, trust, and the ability to impact the world," Hanscom says. But she points out that each client is also a survivor who has made it to the United States against tremendous odds. This belief is at the heart of Hanscom's program. "It's a fundamental shift in the power dynamic of therapy," she says. In the "strength based" approach, a therapist helps a client define the tools she already has to move forward, or, as Hanscom puts it, "the positive things about them before they were hurt."

The positive qualities most often cited by the survivors themselves are "spirituality and the strength of their relationship with their family," Hanscom says. "In one case, the only reason my client didn't kill himself was that he had a strong relationship with his mother." Hanscom, four other clinicians, two case managers, and two doctoral interns also work to uncover a client's talents and gifts. For example, their first step with an Olympic swimmer who'd been tortured was to help him find a pool. We all have something that helps us define who we are, says Hanscom—we're a swimmer, a mother—and because torture destroys a sense of self, the first step is to rebuild that.

Hanscom pulls and old checklist of PTSD symptoms from Meh Vivien's file and a fresh one for them to fill out together. When Meh Vivien first arrived at ASTT, her PTSD symptoms had been severe. But now, after just a few months, she no longer has flashbacks or the exaggerated startle. When Meh Vivien sees the improvement between the old checklist and the new one, she smiles.