Nooria Mehraby · 70 min
A former Afghan refugee who fled under Soviet-era persecution became one of Australia's foremost clinicians in refugee trauma, and her story proves that healing others can be its own path to healing.
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Nooria Mehraby left Afghanistan in 1987 as a doctor, forced to flee Soviet occupation and state persecution. She walked out of her country with her young children, her mother, and a smuggler who abandoned them at the border, taking everything she owned. After five and a half years working in Pakistani refugee camps, treating 60 to 70 patients a day with almost nothing, she resettled in Australia in 1993 with no credentials, no extended family, and no home.
Rather than requalify as a doctor, Nooria took a job as a bicultural counselor at STARS (Service for the Treatment and Rehabilitation of Torture and Trauma Survivors). She expected it to be temporary. She stayed for 30 years. Working with survivors of torture and displacement, she discovered something that had eluded her in medicine: a way to process her own loss while helping others rebuild theirs. Her lived experience as a refugee combined with three decades of clinical practice has made her one of Australia's foremost experts in refugee mental health.
Nooria's story is about what happens when you lose everything, including the person you were. It is about learning that the symptoms refugees carry, nightmares, flashbacks, isolation, are not signs of weakness but normal responses to extraordinary events. And it is about finding an integrated sense of self, not by erasing the past but by holding the old identity and the new one together. For anyone rebuilding after displacement, loss, or trauma, her work offers both understanding and a concrete path forward.
“it's really okay not to be okay because sometimes we don't seek help”
“I found my own healing in the healing of others.”
“refugees are more at risk of mental illness. Statistics shows that there's 30% high chance of PTSD or post-traumatic stress symptoms, 20 to 40% high chance of depression, 15 to 30% of anxiety”
The hero, today
Refugees experience multiple waves of trauma: from the violence that forced them to leave, through the perilous escape, in camps or temporary countries, and then again in resettlement, and Nooria's work at STARS treats all of these layers together. The symptoms refugees present with, nightmares, flashbacks, isolation, hopelessness, are normal reactions to extraordinary events, not signs of weakness or mental illness, and this reframing alone can reduce the shame that stops people seeking help. Clinicians working with refugees need to educate themselves about the client's context, create a non-judgmental space, be aware of their own cultural biases, and most importantly, let the client be the expert on their own culture and what helps them heal. Nooria adapted CBT with an Iraqi client by using her Islamic beliefs: reframing unwanted thoughts as whispers from Satan, explaining dissociation as a mercy from Allah, and replacing relaxation tapes with Quranic verses, proving that evidence-based treatment can honour a person's worldview. Refugees arrive with no job title, no extended family, no social status from their old life, and rebuilding identity means finding small ways to reclaim agency and dignity, like the pharmacist who started teaching Dari, or the midwife trained as a bilingual educator, while keeping the cultural parts of themselves they refuse to let go. Only one-fifth of refugees in Australia seek professional help, largely because of stigma, distrust, and lack of awareness, and Nooria's message is direct: mental health support is as necessary as seeing a cardiologist for a heart problem, and the organisations exist to help.
Yes. Nooria Mehraby is a real person who shared their own story in their own words. Kintsugi Heroes is a not-for-profit that shares first-person stories of overcoming adversity, told with the person's consent.
Kintsugi Heroes, a registered Australian not-for-profit. Every story is shared with the hero's own consent and reviewed under Kintsugi Heroes' trauma-informed content standard before it goes public.
Refugees experience multiple waves of trauma: from the violence that forced them to leave, through the perilous escape, in camps or temporary countries, and then again in resettlement, and Nooria's work at STARS treats all of these layers together.
The symptoms refugees present with, nightmares, flashbacks, isolation, hopelessness, are normal reactions to extraordinary events, not signs of weakness or mental illness, and this reframing alone can reduce the shame that stops people seeking help.
Clinicians working with refugees need to educate themselves about the client's context, create a non-judgmental space, be aware of their own cultural biases, and most importantly, let the client be the expert on their own culture and what helps them heal.
Emma Bellamy-Dodd (Host) · 00:16
Hello and welcome to From There to Here, the podcast where we get real about what it takes to build a new life Far From Home. I'm your host, Emma Belamy, and today my guest is Nooria Mehrabi. Nooria is originally from Afghanistan, but in 1987, due to the ongoing conflict that was going on at the time, she was forced to leave her beloved country. She first sought refuge in Pakistan, where she spent several years working as a medical doctor caring for refugees and as a lecturer before resettling in Australia in 1993. Having walked the path of displacement herself, Nuria brings a deep-lived understanding of the trauma, loss, and resilience that shape the refugee experience. But there is more than her personal story. She offers decades of clinical expertise in supporting refugees who have endured trauma. She is a senior clinician and clinical trainer at the Service for the Treatment and Rehabilitation of Torture and Trauma Survivors . Nouria has also published extensively, lectured at leading universities, and was even named Australian Muslim Professional of the Year in 2015. In short, she is a force to be reckoned with in this space, and I'm honored to have her on the podcast. So yeah, I hope you will enjoy and learn from our conversation. Nouria, merhabi. I'm excited to have you on the podcast. As someone who spent 36 years supporting refugees as a clinician, researcher, lecturer, and clinical trainer, but also as a former refugee herself. You combine both a lived experience and clinical expertise in refugee trauma, which not many people do. So it's a real privilege to have you on the show. Thank you for being my guest.
Nooria Mehraby (Guest) · 02:44
Thank you so much, Emma, for providing me and giving me this opportunity to be one of your guests in this show. And I'm really looking forward to share my experiences with you, if it can be any help for others.
Emma Bellamy-Dodd (Host) · 02:56
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Nooria adapted CBT with an Iraqi client by using her Islamic beliefs: reframing unwanted thoughts as whispers from Satan, explaining dissociation as a mercy from Allah, and replacing relaxation tapes with Quranic verses, proving that evidence-based treatment can honour a person's worldview.
This conversation includes a doctor forced to leave, walking the border with a smuggler, treating 60 patients a day in refugee camps, arriving in australia with nothing, what she lost when she left afghanistan and choosing counseling over medicine.
I'm sure it will. I'm sure it will. So let's actually start with your personal story because it's highly intertwined with what you do professionally. As I said before, you began supporting refugees, you experienced the challenges of being one yourself. So can you take us back to the context that forced you to escape your country?
Nooria Mehraby (Guest) · 03:18
Sure. When we fled Afghanistan, it was a time that Russians were still in Afghanistan, with communist regime backed by the Russian. During that time, they had systemic state terrorism targeting different people, specifically middle and upper educated people as an enemy of the revolution. So tens of thousands and hundreds of Afghans were imprisoned, tortured, disappearance was very common on that time. So it was really, really a risk for people who were educated and As a medical doctor and professional, being lectured at university, my life and the life of my husband, who's a doctor as well, it was at risk. So we had no choice but fleeing with our two very young children from Afghanistan to save our lives.
Emma Bellamy-Dodd (Host) · 04:13
And so you actually paid smugglers to escape the country because that was the only way for you to leave. And For many of us, it's very hard to imagine what a smuggling journey looks like. So would you mind describing a little bit what your escape was like for you?
Nooria Mehraby (Guest) · 04:32
Many refugees don't leave their country with passport and visa in their hands, and it was the case for millions of Afghans who fled Afghanistan. We were also in that category. First of all, I must say that Afghans are very patriotic people, and the decision to leave your country is not an easy decision for an Afghan. Not many Afghan leave their country for a better life, as maybe in case with migrants and other group of people. So it was the case with us. If we hadn't had that fear of being killed and prosecuted, we would have not left Afghanistan. Yes, we paid a smuggler who took all of our belongings and some of our documents and jewelry and everything. So he first took my husband, and then a week later he took us. Unfortunately, he left my husband in the middle of nowhere and short of food and water and everything. And luckily, with the help of some local people, he was able to escape to Pakistan. And a week later, he— the smuggler, we traveled with him with my two young children, my mom, and myself. So it was a very tough journey and we had to walk from time to time, use animals, being on a track and uneven. And I had to wear traditional clothes, so blend in with local people because usually smugglers, they have a link with the government but also with the opposition group. So that's why they know all this illegal way how to get people out, smuggle people out of the country. So that was the case with this person as well. So it was a very, very prolonged journey and very, very stressful. Smangalar had promised us that he would give whatever he took from us when we reach Pakistan, but he left us in the border and we never saw him. He never came back. So I lost like things that were very precious to me, like my wedding photos, for instance, or things that were gifted from my dad. Or people that were significant in my life. Small things, but very precious and very sentimental piece of memory. Yeah. So that was our story, which is, can be similar to other refugees as well. We were not the only one that we had experienced such a terrible and dangerous and prolonged journey. Many thousands and hundreds of other people, even gone through worse circumstances than this.
Emma Bellamy-Dodd (Host) · 07:11
Yeah, but it doesn't remove the difficulty of it, right? Even if it's a common, unfortunately, experience among refugees, it's still incredibly painful to have to restart your life from scratch and be depossessed of your possessions. So to get into the context of what your life was like in Pakistan, You arrive, you have nothing, and you have to rebuild your life. One thing that is going on for you is that you are able to practice medicine at several refugee camps over there. And in fact, you actually saw 60 to 70 patients per day there while also teaching medicine at university. So it was a very, I imagine, intense period of your life where you had to work a lot to rebuild your life. And when you reflect back on this period of your life, how does that make you feel?
Nooria Mehraby (Guest) · 08:11
Yes, it is, was very unique experiences. And obviously at personal level, we had to start our life from scratch and with losing everything. And then in professional level, yeah, I did work in different refugee camps. But I had to travel 2 hours from each side to reach the camp. At the beginning, I was the only female doctor amongst the camp's population, which were 5,000 people. But later on, they recruited a couple of more doctors. So yeah, I used to see 60 to 70 patients per day in a really under-resourced clinic with not having enough resources, just some pincers, antibiotics, and medication for malaria. And if you're lucky, we have some vitamins and so on. And then the experience itself is, I would count it as inspiring and rewarding. I was always touched with the enormous capacity of refugees or Afghan refugees, their capacity for survivors, and being in those circumstances. As I said, it was overcrowded, like even disease like tuberculosis, like for sadly it was 70% of tuberculosis was detected in women because of overcrowding. Crowded circumstances, malnutrition, multiple pregnancies, and so on. And then children were dying in front of our eyes because we couldn't simply vaccinate them. They were dying because of all those preventable diseases that could have been prevented by vaccinations. So it was a very tough job. It's rewarding, but at the same time, it's sad to see people suffering like that. And to share the pain of your patients or your clients. And one of the interesting things during nearly 6 years that I worked in refugee camps, I never prescribed any medication for depression or anxiety because people were in a survivor stage. And so trauma wasn't past, it was ongoing. They didn't have time to think about anything else, but they had to survive, like find food, shelter, even drinkable water. And wood and stuff like that. So on that time, even though mental health was addressed with some kind of really basic level by organizations like UNHCR, MSF, or Save the Children, Management Science for Health, where I used to work, and then other AIDS organization, but it wasn't the primary concern. So it was overlooked on that time. And also it was very low rates of suicide despite that level of trauma. It could be related to Afghan Islamic belief that suicide is forbidden in Islam and their strengths in resilience. And again, just kind of not having time to think about anything but to survive. Wow.
Emma Bellamy-Dodd (Host) · 11:25
Yeah, that must have been quite an awful experience. But yeah, as you say, it's rewarding. So you stayed in Pakistan for 3 years?
Nooria Mehraby (Guest) · 11:35
No, no, it's 5 and a half. So close.
Emma Bellamy-Dodd (Host) · 11:38
5 and a half. Yeah. So it's quite a long time. But then at some point you applied for a refugee visa to resettle in Australia. And so once it got approved, you resettled in Australia in 1993. And You had to rebuild your life again, once more from scratch. So what was the hardest thing about it?
Nooria Mehraby (Guest) · 12:02
For me, the loss of my homeland, Afghanistan, the Afghanistan that I have in my picture, not what you see on TV today. The beautiful country, the mountains, the spring flowers, smells of flowers, taste of fruit. It's different here. It's not the same. And the freedom, the peace, Afghans themselves as nationality, as ethnic groups, because Afghans are very dignified and proud people and they have certain cultural things like Afghan generosity, hospitality. I mean, we still keep this with us in Western countries because that's very much embedded in us, but just there are things because of trauma Even has an impact on a broader culture, on the way it is. What I see in television, it's not what we had in Afghanistan. Like, we had educated women, we had universities together, and we had women work as top-level jobs, like ministerial level, being a Senate, being a member of parliament, doctors, engineers, lawyers. Judges. I hope you don't mind me saying this. My own sister, at the age of 17, she got a scholarship to go to USA and do her year 12. And my dad, who was a high court judge and an Islamic scholar, he allowed my sister to go. And she stayed for a year in an American family who looked after her because they sponsored her. And she did her year 12. So we didn't have what we have today here, which is really, really Heartbreaking. When I look at TV, when I look Afghanistan the way it is today, I say to myself, it's nothing left to lose. Basically nothing left to lose. In addition to that, obviously separation from my extended family and also losing quite a significant number of my extended family due to war or natural death or separation. And it has been really, really difficult. And I believe with family members scattered around the world, life can never be the same as it was before. And losing my extended family is one of my greatest losses, I would say, because we are from a collective culture and family becomes a part of your identity. And when you don't have that in the host country, then it's a loss or fragmentation of a part of your identity.
Emma Bellamy-Dodd (Host) · 14:49
Yeah, so it was grieving what you lost externally, but also internally. It was also grieving a part of yourself, a part of your identity. And so tell me about your transition to mental health, because you could have requalified as a doctor in Australia. But you decided not to. You decided to start new studies to become a refugee-focused clinician. And yeah, what is it that sparked the interest for this new profession?
Nooria Mehraby (Guest) · 15:26
So obviously we had to go back to study medicine again or sit for the exams. At that time, I had 3 young children and we didn't have any extended family here to support us. So my husband and I, we discussed it, we spoke about it, and we made decision together. I choose to wait for a while and he can go first and study. And then initially I looked for a job that was close to my heart. So I was looking for somewhere that I can work with refugees. And then I found this job as a bicultural counselor at STARS. And at the new start stage, I wasn't thinking I'm gonna be here for 30 years, but yes, it's just a transformation, which I'm happy about it actually, because I thought I'm gonna go back and study medicine after my husband gets his qualification, which he did, but I never went back and I never left STARS except like I had second jobs as a lecturer in different universities in New South worlds, but I never left SARS in the last 30 years. So at the beginning, known in the community as a doctor, and I was a bicultural counselor. So I worked mainly with people from my own community. And so people would come to me and they, they don't have much concept of counseling. So they were new. It was really hard and challenging for them to see me in a new role. So they used to come and ask me for, for instance, medical advice or prescription or medication and so on. And I had to explain my role over and over again, which was very disappointing. It was frustrating. There were times that I felt that my hands were tied up, like I could no longer use my hands. I could no longer prescribe medication. So it was quite frustrating, but as time passed, And I entered the inner world of survivors. I learned so much from their strengths and their enormous capacity to survive and healing the body transformed to healing the soul. And I found my own healing in the healing of others. Yeah. So that's why I stayed and I never left and I never went back to study medicine because I just found this more fascinating and more interesting.
Emma Bellamy-Dodd (Host) · 17:54
And I assume that you could connect as well with what they were going through because you had been through it yourself. So there was a— yes, yeah, the lived experience was there.
Nooria Mehraby (Guest) · 18:04
It is there. It is. Although it's not always easy to listen to the horrific experience of the survivors from your own country, but when clients achieve their therapeutic goals and things change, it's an inspiring and rewarding process. Yeah, I wouldn't give that to the world, honestly. But when I see a difference in my clients, it's very inspiring, very unique experiences. And, and I'm very, very glad and happy that I stayed and maintained what I was doing at Stars.
Emma Bellamy-Dodd (Host) · 18:37
I can tell. I can tell. So actually, let's discuss about the mental health issues that refugees face in your practice. For the refugees who are listening to us today so that they know that they are not alone, but also for those who have no idea about what the refugee experience is like and would like to understand the psychological consequences of being a refugee.
Nooria Mehraby (Guest) · 19:04
Sure. So unfortunately, refugees are more at risk of mental illness. Statistics shows that there's a 30% high chance of PTSD or post-traumatic stress symptoms, 20 to 40% higher chance of depression, 15 to 30% of anxiety, and prolonged grief reaction is 33% higher in refugees in comparison to general population. It doesn't mean because refugees are weak or something is going on. It's because they had experienced really extraordinary traumatic experiences through their lives. So being a refugee myself, and I've worked so long with refugees, when we could come to a new country, we have our traumatic baggage that is from when things happen in country of origin, when we were back home, on the way when we flee, but also in refugee camps, life is not getting any easier. For refugees. And then when we come to the new country, we have that past traumatic package. And then here we're facing lists of other challenges. For instance, like we need to establish our life again from zero. We need to find accommodation, find job, learn a new language, adjust to a new culture, meet a new culture that is a culture in transition. Position is constantly challenging and sometimes can be quite frightening and quite anxiety-provoking as well. And then some of us that we don't have visa, not having that valid visa is another kind of challenge. And also all normal life challenges that we would experience. So it's a serial of challenges and then it's our past experiences as well. And then that can, we can present with serial symptoms. Like sometimes maybe we have nightmares that are similar to what we had experienced before. Sometimes we get this kind of like rewind movie, all those really scary thoughts or experiences that's coming back. Sometimes we feel sad, we feel like crying, we're grieving from inside. Sometimes we want to totally isolate ourselves. Ourself and be somewhere. Sometimes we feel worthless and hopeless. Sometimes we avoid certain things we don't want to see, we don't want to talk, we don't want to touch, we don't want to hear certain stuff. Sometimes we feel so overloaded with the intensity of challenges that we face, and plus our baggage from our past. Sometimes even We may feel that life is not worth it. We may have some thoughts to end up our life. Sometimes we may be so frightened and afraid to even engage in any conversation, maybe afraid of authorities. We see a police on the streets, we are afraid. So kind of these are few examples that I'm giving. So these are our normal reaction. With what had happened to us. Luckily, here in Australia, there are systems that can help, including our organisation STARS, who we are specialized in assisting refugees. But there are other organizations as well that people can get help. But what's important, it's not that they're going crazy, it's not that they're going mad. It is just the circumstances and their reaction to that. Can be supported and helped either with just talking, medication combination, or a lot of other ways that it is. So it's really important that we seek help if we have any of these symptoms or combination of those symptoms.
Emma Bellamy-Dodd (Host) · 23:03
And I love what you say about that it's a normal reaction to extraordinary events, right? It's, it's a normal thing to be experiencing. But let's actually talk about Startz, the company where you provide your services, to understand a little bit what's the approach when you get someone with so many layers of difficulties.
Nooria Mehraby (Guest) · 23:25
At Startz, we move behind the symptoms. It's not we just treat psychological problems. We look at a person as a whole, and also we take into account the social, political, cultural environment where these experiences took place. We looked also because refugee trauma not only affects individual, it affects family, community, their support network. So we look this as a whole. We're providing a holistic approach, which I would summarize it quickly. So we have three framework of service provision: STARS, They are different but complementary, so it's not opposing each other but kind of supporting each other. So first thing, as it's stated by Arooj and Coelho, refugee experiences a complex interaction between torture, trauma, exile, migration, and resettlement problems. It happens in the broader context of Australian society. It's affected by national international events, but also it takes place in normal life cycles. But people also come with their protective factors and with their risk factors. So what does it mean when refugees arrive in a new country? They're facing multiple stressors. And when these stressors are interacting with one another, one area, when it's not working, can have adverse effect on that other area. For instance, If somebody cannot concentrate because of the trauma that they have faced and impacted on concentration and memory, then this person may not be able to learn English, then cannot find job or go for education that will affect the normal life cycle. At the same time, we really look also in the environment where refugees are. So basically, as much as the environment is supportive supportive and positive. If we foster a positive recovery environment for refugees, then we get better outcome of treatment. But obviously, anything that happens internationally will destabilize our clients. Unfortunately, specifically in the last few years, we had witnessed with many international crises that has not only affect a specific community that they are directly impacted by that crisis, but also other refugee communities because it triggers and reminds them of their past experiences. So people also come with their protective factors and then they have risk factors. So what we do in our approach, enhance their protective factors and reduce their stress factors. But also people reaction or this complex interaction depends on a person's characteristics, like how the brain is regulated, level of trauma, education, what support they have here in Australia. So multiple factors can have impact. So not everyone is dramatically affected or reacting. So we look at this complex interaction and try to unpack it. And then second service provision, we look at the impact of trauma on biological, psychological, and social level, which is biopsychosocial interventions, which many trauma rehabilitation centers are using. As well, because I mean, it's well known neuroscience says trauma has impact on biological level. It has impact on the structure of our brain, but also on the chemistry of our body. We need to bear in mind when it comes to refugee trauma, people also had experienced direct trauma at biological level with physical injury to the body as well as psychological injury. For instance, they've been tortured, they've been injured, and giving electric shocks, beating up with cables, amputations, disabilities, and so on. So it's physical injury to the body as well as psychological injury. And plus also chronic trauma, chronic level of cortisol level put us at risk of physical problems. Higher, like cardiovascular diseases, diabetes, cancers, arthritis, and so on. So that's why we look at the level of trauma on these levels, and then we provide our intervention accordingly. So in biological level, then psychological level, obviously we look at presenting problems. It's not only PTSD symptoms. PTSD is a part of the problem, not the whole. Our clients have got far more complex presentation. So they have complex presentation, PTSD symptoms, comorbidity of PTSD like depression, anxiety, but also loss and grief is a very compound and a very defined characteristic of being a refugee. You can't find any refugee without loss. If lucky enough, loss of the homeland is One of the losses that no refugee can escape. And also like with refugees, their assumption world is shattered because usually we think that life is predictable and safe and we plan a future for ourselves. We've planned a future for our children, but that assumption world is broken because there's no plan. Refugee life is always uncertain. They don't know what's what's going to happen in a minute. And then the third level is social river. Our refugee experiences taught us not to trust anyone. I remember during Russian occupation, they kind of implemented a systemic state terrorism in a way that spies of the government were everywhere. You couldn't trust anyone in the community. Like, a brother will be with the government, another one will be with the opposition. I always give this example, even in my trainings. I was in first year of uni, 17 years old, when the Russians occupied Afghanistan. We were 300 classmates in class. Every morning when I went, one or two people were disappeared or a lecturer wouldn't turn up. And we didn't have the courage, we didn't have the bravery to ask where this person was, because as soon as you ask, then you would be targeted. So they would punish a group of people to teach a lesson to others and kind of force to silence and polarize the community. That's why it's often difficult for refugees to trust others, and specifically those who had experienced direct torture, because the purpose of torture is not to kill the body, to kill the soul, to fragment the person, to kill the identity, dignity, and pride of the person. As research in polyvagal theory and neuroscience says, we really need some social connection. So that's why we try to enhance that area and work on that level. So it's on biological, psychological, and social level. The third framework is Refugee experiences doesn't take place in a vacuum. Recovery also cannot take place in a vacuum. We will need to work holistically. That's why we work with individual, with family, with broader refugee community and broader Australian society to help community and to help individual. So that's our holistic approach. Obviously, with each level we use different interventions. So I can just summarize if you want me to.
Emma Bellamy-Dodd (Host) · 31:20
Yeah, yeah, yeah, go for it.
Nooria Mehraby (Guest) · 31:22
With individual approaches, we are very much client-focused Rogerian approach, and we use stage-oriented approach as was proposed by Pierre Jeannet in '80s, and then later on with Judith Herman. And we use different modalities in different stage, which I mean, it's going to be quite boring if I list all of them, but Establishing safety is the first stage of working with trauma survivors because we need to provide a safe environment, engage with our clients with mutual respect, with a non-judgmental attitude that we are with them, not against them, because always refugees are targeted and discriminated and humiliated. But we need to provide this space for respect in a specifically and culturally appropriate way and engage our clients. But also we need to make sure that our clients are safe in the external environment. For instance, the child is not having any issue of child protection, a woman is not in domestic violence, or there's not any immediate risk for somebody. So we need to make sure it's got a shelter to live or it's got food. So kind of refer them to different organization to get support, but also safety for them within their bodies. Because all those symptoms that refugees have, for instance, flashbacks, dissociations, or intrusive thoughts, they feel that they've lost control of their body. And sometimes they interpret it as being mad, as being crazy. They're ashamed to talk to other people about it. So we At the beginning, we try to teach them to have some, by relaxation, grounding techniques, so they can have more control of their body and they feel safe within themselves and then safe in the therapeutic relationship with us, obviously with mutual respect. We invest quite a lot on developing rapport and developing appropriate therapeutic relationship with our clients. And then We would go to exposure therapy, which is remembering or revisiting traumatic memories. And then the third would be social connection. But it's easy to say than that. It's not all the time that it's happening in this kind of stage 1, stage 2, stage 3, because sometimes in a very first session, a client would just disclose very intense trauma. So maybe on that stage 2, We try to kind of contain it a bit until we resource the client enough to be able to have control over the symptoms and work with the traumas. And we use different therapeutic modalities in different stages from neurofeedback and biofeedback, advances in neuroscience to CBT, DBT, EMDR, and narrative exposure therapy, art therapy. It depends. On decline in circumstances. So I don't want to list all of this, but that's what we do. And also we provide quite a lot of group intervention to enhance social support for refugees and provide culturally appropriate group interventions for them, whether it's self-support groups or it's a specific targeted on a specific symptoms like nightmares or grieving loss Or it's a response to an international crisis because often we found it useful when there is an international crisis to provide group interventions for our clients because they can hold together on those circumstances and they're like reacting or grieving for the same reason. So that's quite useful as well.
Emma Bellamy-Dodd (Host) · 35:09
And to make it concrete, can you give me an example of a case that particularly marked you, someone that you can share with us? And explain what the approach was.
Nooria Mehraby (Guest) · 35:21
So I can give you an example which was published in one of my articles. I think it's culturally adopted CBT. This was published and I have permission from the client so I can talk about it. So I had an Iraqi client, a female Iraqi client who had lost two sons during attack to Baghdad in 2023. They used to live in Baghdad, but my client, when war broke, my client convinced her husband that they should go to Basra because she felt that Baghdad was the capital and it was more at risk, and her extended family were in Basra. So as soon as they left, maybe not too far from the house, unfortunately rocket attacked it, and then 2 of her sons were killed on that, and 2 survived. So they made it later on to Basra, but at the same time, their family home there was also attacked. So even if they had stayed, maybe none of them would have survived anyway. They went to Jordan, arrived in Australia, and then so allocated to me, and unfortunately she lost another son in a car accident here in Australia. And it was a very devastating, uh, understandably devastating experience. But at the same time, in addition to obvious grief, Klein thought that she was punished by God because she was still grieving for these two sons that she had lost. And then practicing Muslim, and she had fear of God because she had one surviving son, and she had fear that he would die, would be killed as well. So I kind of provided safety for the client. I provided an environment that she could talk without me being judgmental, but also try to, in a culturally appropriate way, try to restructure her thoughts, but at the same time used some of her Islamic beliefs. For instance, Muslims believe that if unwanted thoughts are— it's called Arabic word, is waswasa, which basically it's like unwanted thoughts that comes from Satan. And then so when she had those thoughts, she could stop it because she considered this that it was coming from devil, you know. But also in Islamic belief that life indeed joy and happiness, everything is coming from Allah because we are born in the time we die is predetermined. We have limited control over it. So even exploring on that topic was kind of helping the client to understand the whole context, but also helping in restructuring the client to understand what would have happened if had stayed there, I mean, literally she would have not had any of her children and her husband with her, possibly, because the house was completely smashed. So using that one and kind of trying to name even different parts of the brain, like she named amygdala. I did a drawing to educate her on fight-flight response because she was dissociated quite often. So she named different parts of the brain the way that she wanted. For instance, for her, amygdala was like a devil or Satan. So she named the amygdala because the amygdala would bring all these unwanted thoughts or sometimes completely disconnect her. But at the same time, we went through the education because one of the things she was feeling guilty that she, she couldn't remember what happened to her sons because just like people retrieved the pieces of the body and she couldn't remember that. So one of the things was explaining this concept of dissociation as a response, a survival response, and as a coping mechanism. But at the same time, it was something that was created by Allah to prevent us from intense pain when the time is so hard, but later on comes. So just restructuring the toes in a very culturally appropriate way.
Emma Bellamy-Dodd (Host) · 39:44
Wow. I love that, how you used her religious belief to reframe her experience. So it's really a creative adaptation of CBT to fit their world, to fit the client's beliefs and values.
Nooria Mehraby (Guest) · 40:00
Yeah, it is. And instead of like listening to relaxation tape, she would listen to the Quran, but specific verses from the Quran that's from protection, from safeguarding. When her son was leaving home, because she was so anxious for her son to leave home, she would read that verses from the Quran and pray, and that gave her sense of safety and protection that she left her son in the hands of God to safeguard him and protect him. So I would ask her to say "Allah" in whole breath, and then when she was exhaling She would say, "Who?" Which, "Allahu" means "Allah exists" or "God exists." So that was the practice that I used with her. Wow. And I published an article out of that.
Emma Bellamy-Dodd (Host) · 40:47
Yeah. And I've read it and it was really, I thought it was really, really interesting. I'm actually gonna share the link in the show notes so that people can read it. So Give me 4 tips or 4 things that clinicians need to do in order to be culturally relevant with the diverse communities of refugees that they see in practice.
Nooria Mehraby (Guest) · 41:12
First of all, I should say that refugees are the most diverse group of clients. So at SARS, we provide services to 179 different countries, people from 179 different countries. And they collectively speak 177 different languages, believe it or not. And then also a large proportion of SARS employees are also coming from refugee or non-English speaking backgrounds themselves, that they enrich the service with their linguistic and cultural diversity. So collectively we speak over 65 languages amongst our staff. Most of us are more more than bilingual, so we can speak several languages, which is really unique. And as soon as we speak another language, even it introduces two different cultures, you know, in the session. So it's taking into account principle of cross-cultural approaches is not an exception. It is a norm and it's in our day-to-day practice. And it's very likely for any helping professional who are working with refugees to encounter this on a daily basis. Overall, we take into account cultural safety and cultural competency. So with cultural safety, we're guided by our clients and we should provide an environment that is emotionally, spiritually, physically, and psychologically safe for our clients. And our clients are the one that can identify their needs, and we are guided by that. And also, they are the one that can tell us whether we have met their needs or not. And cultural competency— we, we need to have a certain knowledge about our clients without generalizing. Specifically, it's really important that, for instance, if you have a client from Afghanistan, so it's really important that a central knowledge of the social political environment that's happening now, but also in the past, because this all contributes to what clients present. So it's really important, but from a reliable source. But we don't want people to memorize like 179 different crime groups. So just some sort of knowledge that have— that we can use as a reference. But our clients themselves are the greatest source of information on their own unique culture. So We need to be aware of our own culture, our biases, our prejudice, whether— and also sometimes we have unconscious biases that we are not even aware of it. We need to have a good self-reflection with ourselves. And then also we need to go with a position of not knowing and be prepared to learn with the attitude of curiosity and learning from our clients because they are the one that can guide us and teach us in a culturally safe way. And then seeing whether what we are using is appropriate and tailors to their worldview. We don't have to follow their worldview. We can learn from them and we can be in their journey and they can follow their own way. We need to be aware of our own cross-cultural countertransference. For instance, for somebody whose sexual orientation is not accepted in the broader culture of the community, may not be as easy for someone else to come out. Maybe that person feels more safe if that's kept underground. Or for instance, sometimes we feel that it's a patriotic society. Some clients are coming from collective cultures. There's certain expectations and roles in the family— who is the head of the family— but this This is something that is within their culture. So if a man is the lead of the family, meaning that man needs to provide safety, security, financial, and a woman can focus on education and kind of raising children. But it's up to them, not us, to judge this. So we need to be aware of our own cross-cultural cultural transference as well. So yeah, that is really, really important that we learn from our cultures, be sensitive, respectful, and ask for clarification if you're not sure. And in the bottom, we're all human beings and we, our humanity is the biggest culture we share.
Emma Bellamy-Dodd (Host) · 45:43
So I see 3 main things here. One, the need to educate yourself about the client, but without making assumptions, without imposing labels. Labels onto them, requiring some curiosity for them to give you the source of information that you need. Then it's about creating a safe space where they can trust you, a non-judgmental space. And the other one is being aware of your cultural standpoint and being reflexive about how your own bias may affect the way you see them and their presentations.
Nooria Mehraby (Guest) · 46:24
Yeah, great summary and great point. Yeah. It's really important when we say be aware, but also it's not only aware, but also how this impacts my interaction with my clients or my clients' interaction with me, you know? So that's really important, a reflective practice. Or when I'm in a session and I do something that I would not normally do, I always ask myself, what happened to you, Nuria, rather than what happened to client. Because sometimes it's my own, but something triggered in me. And also, as we said, it's important to have some knowledge about different cultures, but equally important not to generalize it, because otherwise we are alienating a group of people, we're stereotyping, we are othering them. So, which is not a healthy practice, we shouldn't, you know, because— but also we need to remember that each culture is divided into subculture in subgroups in each person. Each person is a unique characteristics of different intersection from identity, from education, sexuality, social connection, interests, lobbies, sports, everything. We all have our own unique, even within our own families. We were 4 siblings, 2 brothers and 2 sisters. My sister and I, we were completely different, completely different in day-to-day life. And so are my two brothers. So that's why we are all unique. And that's really important that we treat each individual as a unique person and try to learn from that client and tailor our practice accordingly to the needs of our client.
Emma Bellamy-Dodd (Host) · 48:06
Do you have any last example about a way in which you practice that differs from the mainstream approach to a very Western technique and, you know, like something a bit unconventional that most people would be a bit surprised about?
Nooria Mehraby (Guest) · 48:25
One of the things is a big number of our clients are not even familiar with the concept of counseling. They don't understand what's cancelling aids, you know. So that's why even introducing this concept is different. You know what I mean? I use clients' strengths. I use things that clients, which I mean, it's in general as well, it can happen. It's not only me. So it's kind of, I always ask my client what helped him survive and I focus on that, what helped them survive. And I use that as a strength with my Muslim clients. With my clients who are practicing, I use spirituality in their treatment as well. The example that I gave, we try to make it more adjustable for them, for our clients. I can give you another example. Again, this I have permission. Has been published, this one as well. I had a client who was a pharmacist and he was from Afghanistan, imprisoned during Russian occupation for 5 years. He was severely tortured. His torture included beating up with electric cables and giving electric shocks, mock execution, confinement. Eventually, under Amnesty International, he was released. So When I saw him, created safety for the client, but at the same time, I tried to adjust and use my interventions to tailor to his worldview because that was his strengths. For instance, he was given 25 to 30 electric shock per day, and then He was told, "Where is your Allah to rescue you?" But today he told me, "How did you survive?" He said, "That Allah that they humiliated me rescued me." So when the client said this, obviously that was a big source of strength for that, and I used that. For instance, to increase in memory and concentration, Muslims believe that God has 99 names. What I did with him, that he's— because his memory wasn't good, he couldn't concentrate. He started to remember God's name. He started from like 5 and then it increased and increased. And that was like practice, like counting exercise for him to practice and memorize that. And then prayer was helping them. And then I also use that exercise for breathing that I spoke before. Yeah. So different approaches with different people.
Emma Bellamy-Dodd (Host) · 51:07
I really like this idea to ask someone how they survived and really take that as a tool for assisting their recovery.
Nooria Mehraby (Guest) · 51:18
Yeah. We are very much strength-based because we believe that looking at the intensity of trauma that they had experienced, there's always something that helped them maybe. Somebody very significant in their life, you know, somebody that was very kind of important person and guided them in their life, their religious, a hobby, something else, you know, that they've lost it, disconnected, and we try to connect them back to them.
Emma Bellamy-Dodd (Host) · 51:48
Yeah. I think it's very meaningful to do that. Nuria, do you have final words of wisdom for the refugees and and perhaps some migrants as well, who have experienced traumatic events and are struggling with mental health issues?
Nooria Mehraby (Guest) · 52:07
First of all, as I mentioned before, their reaction is normal reaction to all this abnormal experience that they encounter. So it's really okay not to be okay, because sometimes we don't seek help. And also, I know issue of trust, issues of stigma associated with mental health, lack of awareness of services. These are the things that prevent refugees and migrants from accessing mental health. But it's like if we had a kidney problem, we would go and see our doctor. If we had a heart problem, we'd see a cardiologist. So it's the same. It's not that they're going mad or crazy, but they need support, and it's okay to seek help, and there are organizations. Fortunately, in Australia, we are lucky that we have these services, and often they are free of charge, including SARTs, and they can seek help to have better control of their life and build their life here in Australia, and we are here for them.
Emma Bellamy-Dodd (Host) · 53:13
It's particularly important advice because only one-fifth of refugees actually seek professional help in Australia. So I think we have a lot of work to do into normalizing that it's okay to seek help and it's okay to have those responses to traumatic events. Do you have a book or any other piece of content that you would like to recommend to our audience?
Nooria Mehraby (Guest) · 53:39
There's a book by Khaled Hosseini, Kite Runner. It's a movie and a book, and I would highly recommend that. Then also There is a serial that was produced by SBS after 11th of September, and it's called Tales from a Suitcase: The Afghan Experiences. I'm featured in one of the episodes. It's not because I'm featured, but I think it's quite good. And it's a book is written after that, as like from that context, and I have a chapter in that book as well. It's the same title, Tales from a Suitcase: An Afghan Experiences. And then In terms of movies, No Other Lands, I think it's quite strong documentary. And in terms of professional, I would recommend a book written by Dr. John Adnan. It's called Rewire Your Brain. Dr. John Adnan has written, I think, at least 16 books that I can count so far. And we were fortunate because he did workshops for us. He's highly known and regarded brain-based therapist. And this book is very simple. It, it, everyone can read it and it talks about seeds for the brain, which is 5. So basically the first is S, which is enhancing social connection. E is education. The other E is exercise. I mean, education is wherever that we learn or challenge our brain. Learning a new language and instruments or anything, and exercise as much as we can in our capacity, from 10 minutes walk to whatever we do. D is not like this kind of Weight Watchers diets, but have a good balanced diet. And the other, S is sleep. So it's really good even for ourselves to practice what we are preaching, but also we use it with our individual clients, but we use it in groups as well. And then also Also a book written by Dr. Judith Herman, Trauma and Recovery. I would recommend these ones.
Emma Bellamy-Dodd (Host) · 55:37
Well, you have many references, but I will put all of them on the show notes for people to check them out. So I have two last questions to ask. When I say the word refugee, what does it evoke in you? What are the first words that come to mind?
Nooria Mehraby (Guest) · 55:53
Yeah, I mean, first of all, It comes to my mind their incredible resilience in stress and their enormous capacity for survivors. But at the same time, it's sad, it's heartbreaking, giving me feeling of injustice, unfairness, and how in a blink of an eye, a life of a person can turn upside down and you become uprooted and how, how much trauma I mean, extraordinary trauma, not normal kind of just the small kind of trauma, extraordinary trauma and multiple losses that refugees are facing. But yet they are great survivors. So I feel that refugees are not a burden on Australian society or any other Western countries. They, they enrich Australia with their wealth of experiences, their knowledge in, I mean, culture and linguistic kind of aspects of it, even though on the surface they may look empty-handed. But if we give them an opportunity, they will be great contributors to Australian society despite all the adversity that they have gone through.
Emma Bellamy-Dodd (Host) · 57:19
Yeah, no, it's important to say that they have so much to give to the society they are going into. So my last question, I usually ask a question that revolves around a sense of belonging and identity, but I'm going to take advantage of the fact that I have a clinician in front of me to ask a more specific question. So how does being a refugee impact your your identity? And the reason why I ask this question is that I interview a lot of migrants on the show. And so I want to be sensitive to the fact that their experience can be very different, you know, when you have to leave your country and there is no home to return to. And especially when you arrive in a country where the political climate might be hostile to you And yeah, I feel that it makes it so much more difficult to rebuild a sense of self and belonging in those circumstances. So how can one do that?
Nooria Mehraby (Guest) · 58:26
I mean, refugee experience has a profound impact on identity. With most of our clients, including myself, their identity ties to their homeland and their extended family, their collective culture, their social status and education, their family life, and their specific skills and status in the society. So overall, refugees are constantly in cultural transition, in identity transition as well, you know. So constantly they have to redefine their culture as they transit in different places. For instance, when they're in first country of asylum, when they're coming to their second country of asylum. So it's constantly culture in transition. And sometimes when we are meeting a new culture, it is very challenging and can be anxiety-provoking. And so for refugees, it becomes like a fragmented identity. For instance, if, if there is a midwife— I'm just giving an example— a midwife who was helping delivering baby, for her to be a helping profession, it becomes one of her identity, or helping profession. And then kind of everything else, like not having extended family, not having that circle that she used to have and then everything that kind of interacts in compounds with that identity, it doesn't exist anymore or fragmented. It's no longer here in this new country. So it is an identity crisis. It's an impact on identity. And sometimes somehow, because for people to just kind of blend in quickly, they may integrate very quickly and want to just kind of completely forget their whatever identity they have because they want to assimilate so quickly, which is not a healthy way to do. And sometimes they, on the other hand, they may be challenging, like it's cultural bereavement, it's challenging to accept some of the changes in the host country. So it's, it's multiple level, it's fascinating, it's a lot. So I'm not sure if we can cover everything, but to make it kind of shorter, it's really important that we help people to maintain and keep things that are really important and compose their identity, to support them in that, to keep their cultural heritage. And even talking about them, getting them to tell me what is so significant in your culture, what are the celebrations that are significant in your culture and supporting them in even restoring that. Like here, we, with our groups, we have all this celebration that happens for Eid, Ramadan, New Year's, Assyrian New Year, Diwali for our Hindu clients, whatever happens. So they have those cultural elements, but also to rekindle them in something that still gives them some role, where even if it's voluntarily for this client that I give example. Instead of being a midwife, which is not possible because she had to study all over again, she could be channel as a bilingual educator in family planning. Something to give her some leading, something that she hasn't lost it completely. And their dignity, restore their pride. And also we should do it in a way that they should be proud of their heritage, not to dismiss this because this is a part of them, a part of their identity, while trying to integrate into the new society. Link them with people of the new society as well so they learn the new culture, new environment. But identity is like— I've heard it so many times from my clients that they say, I'm not the same person, because their identity evolves towards certain characteristics '56, that doesn't exist anymore. How many doctors, engineers, lawyers are taxi drivers in Australia? And how hard would it have been for somebody on such a high social status back home to be in that? Because that is a part of their identity, not to have that one, you know. So that's challenges, a part of being a refugee. Yeah.
Emma Bellamy-Dodd (Host) · 1:02:54
I, you know, I think it is actually quite interesting to ask ourselves the question of how we might feel about ourselves when all the layers of our identities are, yeah, taken away suddenly. When you meet someone, you ask them things about themselves, their work, their position, but it's hard when you don't have any of these labels to define yourself. So how do you actually define yourself when you have none of that?
Nooria Mehraby (Guest) · 1:03:23
Yeah, everything is taken, like things that comprise each person's Identity, everything is taken. That's why a session, I ask people what were important to this. What is— because sometimes also they have some of them, but they don't see it anymore because the main one, the significant one, are taken away from them. So I asked them in the session, honestly, our clients are the biggest teacher and the biggest therapist themselves, because we can ask them and learn from them. What were things that were important to the person? But what are things that still, with some extent, exist? If not, how we can do this to reconnect and rebuild to that sort of identity? Like this client that I spoke about, my Afghan client, because he was such a leading person, like being in helping profession, being— and then he eventually started teaching in one of the Afghan school, he start to teach religion in Dari language, which give him this leadership, you know, some voluntary job, something that kind of give them some connection to their past identity and rebuild a new identity, or not completely, but we don't want them to be a new identity, we want an integrative identity. But as you said, like, if if all of this are taken away from us, what's left? Yeah.
Emma Bellamy-Dodd (Host) · 1:04:50
And I think it's a process to rebuild what it means to be yourself. And I really like what you said about not giving up on the past self, on the old identity. It's really about working on integrating this past and present self or the old and new self.
Nooria Mehraby (Guest) · 1:05:10
Yeah, integrating it, which is really, really And like I've lived 30, I don't know how many, 33 years in Australia. I'm kind of well-established refugees, but there are certain aspects of my cultural identity that I never want to give up. Like Afghan hospitality, the way we treat guests, some of a very unique kind of aspects of our culture. I never want to give up. And I won't because that's so embedded in me. And so is in other Afghans. When we have group intervention, we ask them at the end of the year to bring a dish to share. They go like there's no tomorrow, like all these big dishes coming on the table. And that, that feels so good because they are introducing their culture to a broader Western society. This is what we treat people This is where we feed people and that's our traditional symbolized things that are unique in this culture. Yeah.
Emma Bellamy-Dodd (Host) · 1:06:12
And I love, I think that's one of the positive aspects of migrating to another country is that you get to reflect on the aspects of your culture that you want to preserve and that you want to make salient parts of your identity. And you can discard the things that don't really align with who you are.
Nooria Mehraby (Guest) · 1:06:31
Yeah. And we are so lucky that we are in Australia with such diverse cultures, whether they're migrants, whether they're refugees. I think we're really, really lucky to have such a diverse and multicultural society that feels to some extent inclusive, which is something that we need to do with refugees, that we, we need to find a meaningful integration for them that makes them inclusive and makes them welcome. So they are not impacted by a negative.
Emma Bellamy-Dodd (Host) · 1:07:05
Yes, that can become a protective factor.
Nooria Mehraby (Guest) · 1:07:08
Yeah, exactly.
Emma Bellamy-Dodd (Host) · 1:07:10
So for those who would love to get in touch with you and keep up to date with everything that you are doing at START, where can they find you and contact you?
Nooria Mehraby (Guest) · 1:07:20
Oh, all right. So On Facebook, they can find us with www.facebook.com/starsnewsouthwales. On Instagram, they can find us at www.instagram.com/starsnewsouthwales. And LinkedIn, www.linkedin.com/company/stars. On a personal level, I work at STARS, and they can always approach me.
Emma Bellamy-Dodd (Host) · 1:07:48
Great. Well, Nuria, thank you so much for sharing everything that you shared with me today. I feel that there was a lot to discuss and a lot to cover. And I know that you have written incredible materials for people who want to know more about the work that you do. I really recommend checking out the articles that you've written because I think that they are very accessible as well because they're quite short. At least the ones that you sent to me. So I think that people would really gain a lot from reading them. So yeah, really recommend that. Yeah.
Nooria Mehraby (Guest) · 1:08:23
Thank you so much. It's short because I was a columnist in Psychotherapy in Australia and the focus of the column was interface or differences. So that's why they're one page short, focus on differences. Yeah.
Emma Bellamy-Dodd (Host) · 1:08:35
Which is good for people who lack time like me. So, you know, it's a really good thing. So thank you so Thank you so much, Nouria, for everything that you shared.
Nooria Mehraby (Guest) · 1:08:43
Thank you. My pleasure. I really enjoyed my time with you and I hope you got what you wanted to. I really appreciate that you've given me this opportunity to be in your podcast and I'm looking forward to see it.
Emma Bellamy-Dodd (Host) · 1:08:57
Yeah.
Nooria Mehraby (Guest) · 1:08:57
Thank you so much. Me too. Thank you.
Emma Bellamy-Dodd (Host) · 1:09:02
Thank you for listening to this episode. I hope you enjoyed my conversation Nouria. If her story and insights resonated with you, please share this episode with a friend, leave us a review, or add stars in the rating of the show. And don't forget to follow us. It really helps this community grow. In 2 weeks, I will be interviewing Rugare Gomo, who's an immigrant from Zimbabwe who shares how he's reclaimed his identity. Identity, his authentic self as a Black gay man in Australia. His story is really interesting, so stay tuned. I was your host, Emma Bellamy, and I cannot wait to bring you on another journey from there to here.
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