“I Feel Like a Bird in a Cage”: A Case Study of War-Related Trauma and Social Determinants in Mental Health of a Syrian Refugee

Abstract

This thesis presented a qualitative case study exploring the cumulative impact of war trauma and adverse social determinants on the mental health of a displaced individual in Lebanon, with a focus on both client and therapist experience. The study centered on "MZ," a 37-year-old Syrian refugee whose life was shaped by early exposure to war, ongoing financial hardship, systemic marginalization, and repeated experiences of social humiliation. Through reflexive thematic analysis of therapy session transcripts, clinical notes, and the reflective journal of the Clinical Psychologist in Training (CPT), the study examined how these intersecting factors contributed to MZ’s chronic psychological distress, and how he engaged with culturally sensitive, trauma-informed CBT. The analysis also explored the therapist’s dual positionality and emotional responses within the therapeutic relationship, particularly in the context of shared trauma. The findings highlighted the psychological effects of continuous traumatic stress, the role of structural oppression in shaping trauma responses, and the importance of cultural humility, therapist reflexivity, and contextual attunement in clinical practice with displaced populations.