There is nothing like ‘the typical refugee’, since refugees are a very heterogenous group. But all refugees share the experience of being forced to leave their home country. In most refugees we find high and often maximum levels of stress and trauma associated with war, persecution, flight as well as rejections and a status loss in exile. While some refugees are remarkably resilient, we find high and sometimes endemic rates of Post-traumatic Stress Disorder and depression among refugees.

I have ever been attracted by the intersection of human rights work and psychotherapy. It was when a large number of refugees – mostly Kurdish torture survivors and victims of the war in the Balkans – fled to Germany in the late 1990s that I met Thomas Elbert and Maggie Schauer. With our different backgrounds in neuroscience and clinical psychology, we tried to develop a short term treatment that would meet the needs of the survivors and be effective for a large number of patients in need.

Like other trauma-focused approaches, NET aims to change the memory representations of the traumatic events through talking about the events and the related affects and meanings. What is unique about NET – in comparison to Prolonged Exposure and Cognitive Processing Therapy – is the lifespan approach. Instead of identifying a single index event, NET targets the full life history of the patient. Survivors of multiple trauma have experienced not one event, but a series of events throughout their life, and the processing of a traumatic event requires understanding the way a person has experienced and dealt with previous events.

The key to a successful NET is the re-construction of the life story, the contextualization of the traumatic events in time and space in a person’s autobiography. If the therapist is compassionate, respectful, truly interested and unafraid of emotions, NET allows a corrective relationship experience, counteracting previous social rejection.

Unlike some other trauma therapies, NET is not a commercialised procedure that requires specialised licensing. There are many qualified trainers worldwide, some of whom are connected with the founders through the NGO vivo.org

We were forced to try NET via telehealth, and surprised to see how well it works, as soon as you meet standard requirements of telehealth treatments. Some case-examples, feasibility studies and recommendations on how to use NET online have been published.

We have carried out NET in various unsafe settings in war-affected countries where patients were confronted with far more aversive reminders and threats than media presentations. NET has been tried with refugees without a permit to stay. Many of the Afghan refugees in our current treatment study have lost contact with their families since the Taliban have taken over the country. Ongoing stress is, unfortunately, the rule rather than the exception in the life of a war-affected person or refugee. It is evident that ongoing stress operates against treatment, since patients should learn to distinguish between a safe present and threatening past. But life forces us to compromises. If the person has some minimum stability in her or his life and basic needs are met, it may be better to do NET than to wait for a safety that will not come in near future.

Once you have started any exposure you should do everything to continue. Treatment might be temporarily interrupted by the need to protect the patient from harm or to deal with catastrophes in the patient’s life, but you should try to continue exposure once the patient is safe again. There are ways to help the patient to cope between sessions. For some patients, some form of communication between sessions might be relieving.

There is a version of NET that has been adapted for children, called KidNET. It is essentially the same procedure in a child-friendly form. It is also described in the manual.

Written Exposure is a fascinating treatment that operates with minimum therapist involvement – the therapist askes the patient to write down his or her events in a protected environment. In NET, the therapist is very active and directive in helping the patient to share his or her emotions and to reconstruct the fragmented narrations of the traumatic events. It is the therapist (or the co-therapist) who writes the life story in NET (some of our patients cannot read or write anyways). NET is also not restricted to the processing of one event, but focuses on the construction of the full autobiography, from birth to the current situation. In NET, the therapist offers to share the trauma in a (time-limited) relationship, which might counteract shame and other social emotions.

Fear of social exclusion is often a realistic and not pathological emotion among refugees, who often experience discrimination and refusal in the exile community. NET does not aim to change realistic fears. However, quite often social emotions have a biographic background, since they are related to in previous (traumatic) losses. In this way, NET can help to process grief, to accept uncertainties and to understand the personal fears related to current relationships and the environment.