While the need for psychotherapeutic services for refugees is well documented, little is known about the acceptability and validity of these approaches, especially from refugee and staff perspectives. Qualitative studies of user experience provide critical insight into the utility of current service approaches, and is both clinically and ethically indicated. Therefore, a systematic review of client and provider experiences of psychotherapeutic services is presented (11 studies), combining thematic synthesis and meta-ethnographic approaches. Key concepts to achieving acceptable care were: mutual understanding, addressing complex needs, discussing trauma and cultural competence. Each concept was enabled, or hindered, by a set of related themes. Results found that while practical assistance and advocacy are important to refugee clients, these aspects of care should remain rooted in therapeutic processes of mutual understanding, narrative continuity and self-empowerment through self-efficacy. Further, more ethically rigorous research is still needed in this critical area.