Children are more vulnerable than adults but have greater adaptive potential. They need thinking about in the context of their families and communities even if separated from them. Effects of adversity vary according to the developmental stage at which they occur, and subsequent development can also be compromised. Key developmental stages are considered, attending to what harms can be sustained, and what may be protective.

Post-migration factors affecting outcome are also reviewed, including poor housing, poverty, bullying, racism, isolation, and prolonged uncertainty.

Intervention requires building a relationship and a network of support, and possibly sequential episodes of care with incremental and ‘portable’ gains: meeting basic needs first by attending to accommodation, safety, links with schools and language skills. Age-appropriate explanations are essential.Some specific interventions are reviewed.

The chapter concludes by revisiting the need for support and protection, and understanding developmental needs and family dynamics.This can promote healthy development and reduce intergenerational transmission of trauma.

Work with people seeking asylum brings unfamiliar experiences, challenges, rewards, and dilemmas. Resonances for the therapist and sharing the client’s pain and hopelessness can be distressing. Power, powerlessness and privilege are common themes. Facing the limits of our own compassion, and of what it is possible to do, can be hard. How can we ‘do differently’ and what new skills are needed? The work can be isolating, and exhaustion, burn out, vicarious traumatisation and other existential reactions can arise.Clinicians face many dilemmas, such as over boundaries, neutrality and self-disclosure, overt political action, and how to deal with different perspectives in the same organisation. What helps clinicians do well is a focus on reflection, and accessing supervision and other reflective spaces, such as Balint groups or solidarity teams. Pitfalls of not attending to our own responses are highlighted, as is the need to protect reflective spaces. Remote meetings make access easier for both training and peer support. Meetings in non-clinical settings with people who have sought asylum can also be enlightening.

The authors outline areas that need special attention. The purpose of the appointment should be explained, and the practicalities of attendance addressed. The attitude/approach of the clinician is discussed in relation to creating a sense of safety and trust. Individuals may fear authority and may have had experiences they find difficult to disclose.

Confidentiality, safety and anxieties about the assessment are reviewed, as people may have little prior knowledge of the system and have had bad past experiences. Acknowledgement and discussion are crucial. More detailed discussion of working with interpreters follows, as this is an often-neglected area. Pros and cons of ‘remote working’ are reviewed.

Some specific aspects of assessment areconsidered: difficulties in disclosure and how to explore issues such as torture, sexual violence, domestic abuse, moral injury, and rape.

People seeking asylum may be isolated with few resources.Strengths should be emphasised, and sources of support identified, and contact facilitated. Feedback and checking understanding are helpful, and often fosters trust.Scrupulous record keeping is emphasised.