Be a Bridge

Therapists who work with recent immigrants write about how best to help them

by Dr. Teresa Celada-Dalton, Dr. Veronica Chavez, and Dr. Patrick Heppell

What Your Immigrant Client Might Have Been Through

While every immigrant’s story is unique, there are some hardships many people faced in their home countries. Those could include war or gang violence, extreme poverty, abuse by a family member, systemic discrimination, political chaos, torture, rape, persecution, or genocide.

Then, on their journeys, they may have experienced long and dangerous days. Threats, uncertainties, hunger, thirst, no shelter. Being raped or witnessing a loved one being raped. Being robbed and abandoned by a coyote (human smuggler).

While crossing the border is a sort of victory, it is not necessarily the end of troubles. Once in the U.S., some immigrants are placed in a shelter or detention camp for an undetermined period of time. They must adapt to a new language, culture, and traditions. They may face racism and xenophobia. They may fear ICE raids and be arbitrarily stopped and asked for papers. They are likely worried about loved ones both here and in their home country. They probably have poor access to medical, mental health, legal, and financial supports.

Psychological Impacts on Teenage Immigrants

The process of adjusting to a new home and culture can be very stressful and can lead to feelings of depression, anxiety, and risky behaviors. Uniting or reuniting with families is not always simple, especially if children haven’t seen their parents or other family members since they were young. Many children and teenagers are brought to the U.S. only to find siblings they had never met. They must adjust to parenting practices they’re not familiar with. All those pressures put families at risk of psychological tension and child welfare involvement.

Racial and ethnic discrimination lowers migrant teens’ self-esteem. Teens describe to us the stress of having to serve as the family translator for non-English speaking parents. Migrant teens tell their therapists they’re struggling with changes in gender roles; conflicts with parents who haven’t learned English or American culture; feeling responsible for helping their parents with translation and other adjustments; figuring out their identity across their own split loyalties to the culture back home and here; loneliness and isolation.

Trauma-based “presenting problems” (the things immigrant teens are feeling and doing that lead them to therapy) include anxiety; fear; depression; PTSD; substance use; suicidality; and interpersonal difficulties, including violence.

Some of the positive things immigrants leave behind are friends, family, extended support systems, traditions such as celebrations or foods, and language. These things can be a big part of an identity, and leaving them behind can leave people with a profound sense of loss. On the other hand, that cultural identity could give a person a sense of pride and help them handle discrimination.

How the decision to immigrate was made also affects the person’s sense of agency. If the person made the decision and prepared for the process, they might feel proud and empowered. Leaving home could also cause hopelessness and disempowerment if the person was forced to leave their country abruptly without preparation, which is often the case with children.

Cultural factors can keep immigrants from seeking mental health services (“I got this…I made it across the border, I can handle a little bit of racism now…” or “My family can support me through these hard times” or “No doctor [especially one from a different country/ethnicity/race/socioeconomic class] can help me.”) But if a mental health provider can talk knowledgeably and sensitively about what an immigrant has been through and is going through, that might keep them in therapy ““Maybe this social worker kind of gets me and my issues.)”

How Can a Good (and Culturally Competent) Therapist Help

Here are some tips for working well with recent immigrants:

  • Respect their resiliency. (“How did you get here? How do you continue to strive and hope?”)
  • Let them know that the psychological and physical reactions they are having are “normal” in the context of their experiences.
  • Use the therapeutic relationship as a way to help the client feel respected and accepted and to have more trust in professionals and systems.
  • Educate yourself about the culture of your client. Show genuine interest in where they come from.
  • Ask and listen. This might be the first time an immigrant client has shared their reason for fleeing their country and/or their immigration journey without being judged or feeling doubt and shame.
  • Connect your client to appropriate services (medical care, legal care, and other supports). Remind them of the importance of school and, if possible, parental involvement. Link them with community-based groups that support newcomers with similar experiences. Be an advocate. Provide information to help them navigate the school system.
  • If they need it for asylum or other legal status, document and present to the court the psychological impact of the trauma that they experienced.
  • Provide realistic hope for the individual and for immigrants as a whole. For example, provide successful stories of other immigrants who were helped by therapy and who are now productive and accepted residents in their community.

For more information on the psychological aspects of immigration, check out the American Psychological Association’s report Crossroads: The Psychology of Immigration in the New Century.

Dr. Celada-Dalton is a  psychologist with a specialty in trauma at the Community Mental Health Center of Children’s Hospital Los Angeles. She lectures on the mental health of immigrant Latinx families and works with shelters in Tijuana and organizations in Los Angeles directly assisting refugees from Central America.

Dr. Chavez is Professor of Clinical Pediatrics  at University of Southern California and a clinical supervisor for Project Heal Trauma Program. She also coordinates a program that helps Latinx families and gives workshops on Latinx and mental health, immigration, and culturally sensitive treatment approaches.

Dr. Heppell is a clinical assistant professor of Child and Adolescent Psychiatry at the New York University School of Medicine. He currently serves as the Clinical Director for the Bellevue Hospital–ACS Mental Health Team at the Administration for  Children’s Services Children’s Center.

Leaving home could also cause hopelessness and disempowerment if the person was forced to leave their country abruptly without preparation, which is often the case with children.
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