Growing recognition that the world faces a modern epidemic of torture has stimulated widespread interest amongst mental health professionals in strategies for the treatment of survivors. In this article we outline the distinctive experiences of torture survivors who present for treatment in western countries. These survivors are usually refugees who, in addition to torture, have suffered a sequence of traumatic experiences and face ongoing linguistic, occupational, financial, educational and cultural obstacles in their country of resettlement. Their multiple needs call into question whether "working through" their trauma stories in psychotherapy will on its own ensure successful psychosocial rehabilitation. Drawing on our experience at a recently established service, we propose a broader therapeutic aim.

Many immigrants to Australia are refugees, some of whom have experienced acute stress and trauma, including torture, prior to or during their escape from their home countries. In response to a growing recognition that the health care services may not be meeting the needs of these people the NSW Department of Health funded the establishment of a community-based rehabilitation service for traumatised refugees. This paper provides an overview of the recent history of the service, some of the organisational and staffing issues faced during its first year, some characteristics of the first 200 clients, principles of treatment, clinical, nosological and therapeutic issues and relationships with other agencies.

The treatment of refugee survivors of torture and trauma has attracted increasing clinical attention. The present study surveyed therapists concerning the emphasis that was placed on disclosure of previous traumatic experiences in therapy with refugees from Chile and Cambodia. Significant differences were found between the two groups with trauma story discussion being judged by therapists to be more important to treatment outcome in Chilean patients. The problem of potential therapist bias limits definitive conclusions, however we suggest that differences in cultural preparedness for psychotherapy aimed at uncovering previous traumatic experiences may be the main reason for variations in styles of therapy offered to these distinctive ethnic groups. Other possible explanations are differences in diagnostic profiles and types of previous traumatic experiences.