Davorka Marovic-Johnson, MEd, NCC, LPC, had a long history of providing mental health services to refugee clients from around the globe before transitioning into private practice. The horrors of war and the stress of adjusting to a new country can have a lasting effect on mental health and physical health.
Davorka came to the U.S. from Yugoslavia after high school to attend the University of Tampa in 1988. When she graduated four years later, Yugoslavia was beginning to fracture as groups seceded from the country. Fighting broke out along primarily religious and ethnic lines, including The Bosnian and Kosovo wars. Today, the area where she grew up is now a small country named Montenegro and is bordered by Bosnia and Herzegovina, Serbia, Kosovo, Albania, and the Adriatic Sea.
In 1995, Davorka moved to St. Louis to pursue a graduate degree in Counseling. She interned at the War Trauma Recovery Project. Davorka’s lived experience and understanding of similarly spoken languages led her to work with an influx of Bosnian refugees to St. Louis. She was trained in Cognitive Processing Therapy, a treatment for post-traumatic stress disorder (PTSD).
In June 2002, Davorka became a licensed professional counselor. She accepted a role as Clinical Supervisor at The Center for Survivors of Torture and War Trauma in the Forest Park Southeast neighborhood led by the late Sister Jean Abbott, a woman she cherished and admired. The Center’s mental health services included instruction in art, nutrition, yoga, and tai chi. The doors were open for kids after school. Unfortunately, programmatic funding ended after a decade.
In 2016, the Center merged into its longtime collaborator Bilingual International Assistant Services (BIAS), as part of BIAS’s wraparound services. Davorka worked with BIAS for a year as clinical director, before transitioning to private practice. She says, “I was working for 17 years in a really intense environment—trauma treatment, supervising clinicians—it was a lot.” She still collaborates with BIAS, speaking highly of their care toward clients and comprehensive resources.
Today, her practice is located at 230 S. Bemiston Ave. in Clayton. She is pursuing a PhD in Education with an emphasis in Counseling at the University of Missouri-St. Louis. She provides international clinical training and workshops for various universities and community agencies. She also sits on the Washington University Institute of Clinical and Translational Sciences/Institute for Public Health Community Advisory Board.
The overwhelming needs of refugees
In the late 1990s and early 2000s, St. Louis accepted about 70,000 Bosnian refugees. Davorka says, “At the time, I was the only licensed therapist who spoke those languages.”
Davorka says the refugees had experienced major trauma, post-traumatic stress, depression, anxiety, and difficulty adjusting from their old way of life. “For most refugees, when they come to the United States, it’s overwhelming. There’s lots of loss. They lost their homes. They lost their country. They are separated from family members. Some of them witnessed horrible events.”
Davorka says refugees often have an unrealistic vision of the U.S. “They think life will be much easier, but when they come here … many of my clients were in a really rough neighborhood.” She adds that often refugees are resettled in areas that have little access to needed resources.
Davorka says there were many excellent programs during the Bosnian influx, but there were also many barriers to overcome: language comprehension, transportation, bureaucracies, and access to medical care. She says the burden is greatest on the older refugees. “Some of them came from little villages,” she says. “I have seen hundreds of Nepali clients [who have had] no education and don’t know how to write.”
Davorka says, on top of the stress they have experienced, their lifestyle changes. Many may stay in their homes. “Before the war, they had farms; they were working. They’re here and they don’t know where to go, or they don’t feel safe.”
While working with Bosnian refugees, she says she had to be conscious of being from a culture that may be on the other side of a civil war than her client. “I could be a trigger, because of my name or how I speak.” A screener was created to help the clients determine who they were comfortable seeing.
Davorka also had to be aware of how some cultures may see her as a woman and to respect differences in etiquette. Some clients were uncomfortable shaking hands or sitting with her without their wives present. She, in turn, had to educate them as to what might not be appropriate in American culture. She says having trainings with interpreters—educating about mental health while learning about a culture and customs—and debriefings were crucial to a successful experience.
Refugees are offered benefits or job opportunities in their first five years in the U.S. After that, they are required to become American citizens. The naturalization process involves submitting a 20-page Application for Naturalization; a biometrics appointment; and an exam showing basic ability to read, write, and speak English during an interview with an immigration officer.
While Davorka was with Center for Survivors, she noticed a lot of refugees were failing to gain citizenship. She says sometimes an interview with an official can bring back trauma for refugees, and others had great difficulty learning English. Some opted to return to their country for fear they would end up homeless in the US.
Davorka asked immigration lawyers what they needed to do for those with mental health disorders or learning disabilities. They explained that tests would have to be administered to prove what kind of disability the person had and how it impaired their ability to learn. The results must be submitted in a nine-page Medical Certification for Disability Exceptions form, which can only be certified by medical doctors, doctors of osteopathy, or licensed clinical psychologists.
BIAS was able to provide tutors to teach those who can learn English, but she says doctors often don’t have time to help those who have difficulty with English to complete the form. She says, “It takes me 3 hours, at least, and I’m experienced in this for 20 years.” She spends the first two hours administering cognitive tests, and then reviews medical records and writes out a report. After all that work, there is still the possibility that Immigration may not accept it.
Treating the bad influences
Davorka still sees some of the refugees she worked with before private practice, but most of her clientele were born in the U.S.
She assesses her clients in three ways: a genogram, looking at family history and patterns to identify unprocessed trauma that can be passed down to subsequent generations; an emotion-focused assessment to examine how emotions were expressed within the family and what coping skills were used; and a secure attachment assessment to see if the client had safe emotional bonds with someone or someone who comforted them. She says those who don’t have a safe person and place to express themselves, tend to isolate or develop addiction.
Davorka educates her clients about the gut-brain connection and its role in mental health. She says she sees a lot of inflammation from processed foods and chemical exposure, in her adult and young adult clients, which can lead to mental health problems. She says many of her former refugee clients have developed chronic conditions—high blood pressure, diabetes, and cancer—potentially a result of exposure to toxins at factory jobs.
Loneliness can have a major impact on physical health, Davorka says, noting that it increases the risk of premature death. “We are biologically wired for connections,” she says. “When you look at the brain and neurons, the neurons communicate—they fire together—and those who don’t, they die.” She says the majority of Americans reported being lonely, and that was before the COVID-19 pandemic.
Davorka recommends physical activity and getting outside as two ways to improve both your physical and mental health. She advises a walk in the sunshine, which produces serotonin, a chemical connected to mood and feeling better. She also tells her clients to focus on what they have control over. She says current culture is often focused on greed and fear. “Whatever neuropathways you feed, that’s what’s going to expand and become a reality.”
The U.S. plans to accept 100,000 Ukrainian refugees this year. Davorka visited Kiev last August and felt perfectly safe exploring the vibrant city. She is heartbroken watching the images of destruction in the news and reminds us to have empathy for refugees, as a terrible change in a living situation can happen anywhere.