Mental health in low- and middle-income countries, particularly in post-conflict contexts like Rwanda, remains challenged by limited access to care and entrenched cultural stigma. This case study, drawn from community-based psychosocial support sessions led by Umuhumurizamutima (trained community counselors), illustrates the therapeutic and cultural complexities of unspoken trauma through the use of the empty chair technique. In one session, a young woman’s tears were not for what she expressed but for what she “wasn’t able to say,” revealing how silence can hold a greater emotional burden than words. Situated within Rwanda’s cultural history, where silence often serves as a survival mechanism. This observation underscores that emotional expression does not always equate to healing. The discussion highlights the need for practitioners to recognize unarticulated pain, listen “between the lines,” and provide presence-centered, culturally sensitive care. Recommendations call for strengthening decentralized mental health services, expanding lay counselor training, and fostering safe, empathetic spaces where individuals can share their stories without fear. This case contributes to the literature by documenting field-based insights that are rarely captured in formal research, reinforcing the notion that healing lies not only in speaking but also in being heard.
