The number of displaced persons today is the highest since World War II. Flight has become increasingly dangerous and refugees are now in poorer health conditions. Severe traumatization happens in their home-countries but atrocities under flight is increasing, including torture, trafficking and death. It has become increasingly difficult to reach Western countries and those who come now meet difficult conditions with poor living conditions and growing xenophobia. There are unmet treatment needs in the refugee population and lack of early preventive measures. Many severely traumatized will also need qualified psychotherapy. This article presents a psychoanalytic view on traumatization and describes specific features of psychoanalytic therapy with severely traumatized refugees. A case example is presented to illustrate how the analyst inevitably becomes involved in traumatization related mental scenarios and how this involvement may provoke countertransference enactment. It is demonstrated how this may be solved in the therapeutic process and facilitate integration of traumatic experiences and loss.