This article discusses critically the focus on stress symptoms when treating traumatized refugees. It describes common challenges that practitioners meet, when working with extreme trauma. It suggests three concepts that might help to understand the complicated dynamics of severe traumatization. These concepts deal as well with the nature of post-traumatic problems as with the way they might be treated. A clinical case is used to exemplify and discuss the concepts. Finally the article offers some thoughts on the special dynamics of the situation of refugees.