Over the past few years, we’ve noticed an influx of people coming for therapy or evaluations that have undergone recent immigration experiences. Most are recent refugees forced to flee their homes, lives and loved ones due to overt persecution. Some have chosen to come to the States in order to work towards an improvement in life quality. There are significant challenges that many of these people face, and our being sensitive to these challenges can help foster a more supportive, transformational relationship during such a critical time in their lives. These sensitivities can be shared by therapists, evaluators, attorneys, medical professionals, and others looking to assist recent immigrants. What follows are ways in which I prepare for meeting with immigrant clients in order to best serve them. We generally see a lot of clients looking for an evaluation that supports their asylum or residence status, the most common example being someone who has come to the states seeking asylum due to persecution in their home country. An evaluation of their trauma symptoms and diagnosis, and resultantly the anticipated effects should they be denied asylum, can be of great benefit to the court in understanding the complexities of the case.

Probably the most important factor in working with this population is to strive towards what I call “cultural humility,” or the sense that this person’s heritage informs their experience (and experience of me) in a way that I can’t really understand without hearing from them. This involves acknowledging that their experiences of our society and our interactions are grounded in assumptions that I likely don’t fully grasp. My intention then is to humbly acknowledge this lack of understanding, and attempt to get a sense of these assumptions through them. My hope is to be informed enough about their culture prior to the first meeting to ask the proper questions of them to get an understanding of what it might be like for them to sit with me. By exploring their assumptions about helping relationships, gender roles, vulnerability, etc., I’m more able to accurately assess where they are. This also allows me to see them as an individual rather than a stereotyped personification of their culture of origin.

Another salient issue, especially with recent refugees or those who have witnessed heinous traumas, is the effect the trauma can have in their telling of their story. Many people have come into my office too flooded with emotion to share the violence they’ve witnessed, instead deferring to loved ones or translators. My approach in these cases is to ground them in the present moment, either by having them explore their environment (i.e., “find me 3 blue things in this room”) or their breath. The best breathing technique I’ve found is the 3-6-9 breathing space in which I ask them to slowly count to 18 while inhaling for the first 3 counts, holding the air in their lungs for a count of 6, and using the final 9 counts to slowly exhale. This regulates the nervous system while giving them something to gently focus on (the counting).

I also like to encourage clients to maintain as much contact as is possible with their country of origin. There can be a tendency to want to create an artificial boundary between life here and the one they left behind as processing both the feelings of leaving behind a home country as well as thinking about cultivating a life here can be overwhelming. However, I often encourage people to maintain their network of support, even if those people are across an ocean.

Finally, I do my best to find resources for people. They may need help in finding a translator, food, a therapist who speaks their native language, transportation, etc. Helping people discover the resources potentially available to them will help them feel empowered in a situation in which they generally have very little power.

An immigration experience, especially one precipitated by persecution or trauma, is a jarring, life- and identity-altering experience. Being in a helping relationship with someone in such a critical and sensitive life period can be a powerful experience. To do so requires sensitivity, humility, and a heightened empathy towards the specific situation of the individual. This ideally fosters an environment in which I can readily and quickly provide information which will be helpful to the court.


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