Many refugees who arrive on U.S. soil finally feel safe after decades of war or torture or loss of family members. But just because they're removed from physical harm, it doesn't mean the pain is over.
That's why the Connecting Cultures clinic, based at the University of Vermont, offers mental health treatment services to refugees, offering help with everything from dealing with trauma to the stresses of adjusting to a new culture.
Ajuda Thapa was forced to flee from her home in Bhutan in the early 1990s. The Bhutanese government drove more than 100,000 people like Thapa out of the country, in a push toward ethnic cleansing.
Along with others, she ended up in a refugee camp in Nepal, where she lived for 18 years.
"The camp life is so miserable, it's very difficult to have basic needs ... not enough to eat, not enough clothes, and then the food given by the U.N. or other agencies isn't enough to feed the kids," Thapa says, speaking through interpreter Rita Neopaney, who works with Connecting Cultures.
She explains that her home in the refugee camp was made of bamboo and plastic tarps; when a strong wind came through it would destroy everything and she'd have to start all over again.
On a recent afternoon, Thapa is on an outing to the Lake Champlain Chocolates factory with about 15 other Bhutanese refugees who have settled in Vermont. All of them have been through individual trauma therapy counseling. Then they formed a sort of "alumni group" to socialize and support each other in their new lives in the United States.
Dealing with depression alone in a new country
Thapa says when she moved to Vermont with her two daughters, she was very depressed, and she didn't feel any hope for the future. She had to leave behind her son at the refugee camp for the first year, and she'd recently lost her husband; he was killed one day while he was out fetching wood in the forest.
"At first my brain is running here and there, you know, thinking a lot of things," says Thapa. "I'm not thinking about the future, and I don't have any hopes at that time ... my goal is how can I relieve from all those, and then move forward."
"When we do our treatment, we're very sensitive to giving clients control over their story. We realize that they have not asked for their story, that it's been given to them," says Karen Fondacaro, the director of the Connecting Cultures clinic, where Thapa sought treatment.
Fondacaro is a professor of psychological science at the University of Vermont, and also the founder of NESTT, New England Survivors of Torture and Trauma, which offers legal, therapeutic and social work services.
The Connecting Cultures clinic has been funded by a federal grant from the Office of Refugee Resettlement since 2009. It's served hundreds of new Vermonters over the last decade.
Fondacaro says a technique called "narrative exposure therapy" helps clients to reprocess their trauma in a safe environment.
Processing a story they didn't ask for
"Where when you're going through the trauma, you don't really have the time to experience the emotions — I always feel like it's the emotions you deserve to have felt during that time," Fondacaro says. "The way in which we do it is to let them tell us when they're ready, and to let them tell the story."
Fondacaro says most do choose to share, and she has been surprised by how many find relief after releasing their stories, either in a private session or a group setting. She says research supports this method.
But she says for many, the post-traumatic stress isn't over when they come to the United States.
"We don't even call it 'post' [traumatic] anymore because it really can be ongoing. I've worked with individuals where we'll be talking about what happened during war, and they’ll get a phone call that night, that someone has been harmed in their country. So it's not 'post.'"
Part of the therapy involves teaching breathing techniques to help people deal with anxiety, and to reduce flashbacks and nightmares.
And being in a new country brings added stresses.
"You’re making adjustments, often to a new language, new sets of expectations, dealing with very, very different relationships with your kids in schools, and the new friends they're developing, new attitudes they have," says Pablo Bose, a geography researcher with the University of Vermont who studies refugee resettlement. "So all these kinds of things make the actual adjustment very stressful in many cases."
Back at the clinic, Fondacaro says they’ve seen individuals from over 29 countries, and now have a waiting list for those seeking therapy. She says the clinic was preparing for the arrival of Syrian refugees in Vermont, but that resettlement was stalled by federal orders.
And Fondacaro says she's learned a good deal working with refugee clients, too. For one, in the past she'd heard other therapists talk about sometimes dancing with their clients, and the academic in her cringed — but now she sees the importance of finding joy.
"And if you can see joy on faces of individuals who've come in and lost babies, and they're dancing with you — that is what we now call behavioral activation, one of our best techniques for depression," Fondacaro says.
And that’s what these social groups of therapy “graduates” are all about: finding joy in daily life.
Ajuda Thapa says the support group has helped her break through the isolation and depression she first felt when she arrived.
"It helps a lot. In the group, I'm comfortable sharing and then socializing with the group," she says.
Now her life is a mix of Bhutanese traditions and foods from home, and learning English and Vermont culture. At the group outing to Lake Champlain Chocolates, she tried chocolate for the first time.
This report is part of a series called "Facing Change," which examines the shifting demographics of the region. It comes from the New England News Collaborative: eight public media companies coming together to tell the story of a changing region, with support from the Corporation for Public Broadcasting.