APA has been closely following the recent and ongoing threats to immigrants and refugees living in the United States. These groups are “at risk of psychological harm due to factors including the stress of starting a new life away from family and culture, as well as prejudice and discrimination.” This article series takes a look at some of the ways psychologists are working to help immigrants, the communities where they live and the resources that are available to clinicians who want to help these at risk groups.
Carter, K. (2020, January 31). Helping children through the emotional toll of immigration. https://www.apa.org/members/content/immigration-emotional-toll
Chevon Matthews, MA, LCPC (MD), LGPC (MD), NCC, is aware of what's happening these days. For her, the disturbing news reports about the thousands of children being separated from their families at the borderopens in new window hits close to home because her clients, mostly children, are actually living these stories. “They don't know what is going to happen if their parents weren't born here,” she says. And the result of not knowing is often fear, depression or anxiety. Matthews is a counselor at Onyx Therapy Groupopens in new window, located in Washington, D.C., where 1 in 7 residents are immigrants and 1 in 10 children are born to at least one immigrant parent. She works with a child population, who are immigrants, and their families.
In her work, when families are torn apart because children must leave family members who remain in their country of origin, or because some family members are forced to return to their country, she sees the children go through feelings of loss. They also experience a kind of grief that's different from grieving a death in the family. “Coming to a new place, where the language spoken is not their first language, can cause them to mourn how things used to be,” she explains.
Because research reports have shown that the stress of the immigrant experience can negatively impact children's educationalopens in new window, social, emotionalopens in new window and physical development, these kids require special treatment. For example, the American Academy of Pediatrics (AAP) reports that because immigrant children are likely to have experienced trauma in their country of origin, or during their journey to the United States, they are particularly in need of trauma screening and social support. The AAP has compiled an Immigrant Child Health Toolkitopens in new window for the treatment of immigrant children's mental health symptoms. The APA's Fostering and Building Resilience in Immigrant Children (FABRIC) program helps organizations that serve the needs of immigrant children. The program trains staff to provide trauma-informed support and resilience building. It also offers individuals with the skills to manage and mitigate the stress they may encounter in working with traumatized children.
Detecting emotional symptoms
However, the effects of being a child in an immigrant family aren't always obvious. Sometimes the symptoms in Matthews' clients will seem like nothing, but she can see through that, she assures. Matthews knows when kids are hiding their emotional struggles, because they don't know that they can trust anyone outside of their own families — like when a client of hers appeared nervous and avoided eye contact, which looked like anxiety. Because Matthews also noticed that the client was very resistant to answering questions, her intuition led her to believe that maybe it wasn't anxiety, but a lack of trust. By silently observing and asking questions such as what the client liked to do, she got the client to open up to her. After that, “the client would come to the session, ready to share updates,” she says. Matthews addressed whatever issues the child was actually experiencing, instead of incorrectly treating anxiety that wasn't there.
Matthews uses non-directive play therapy as her model of choice with her immigrant clients. Her office is a play therapy room, with toys, activities, and arts and crafts. There are very few rules — just the ones to keep children from hurting themselves or others. Beyond that, “they can also do whatever they want to do. I allow them to be their true selves, with no judgment,” she says.
Providing an environment where there is no judgment is a key part of creating a safe spaceopens in new window where anyone who is feeling the effects of a horrible experience can heal. In a report, the U.S. Department of Health and Human Services (PDF, 11MB)opens in new window also states that inside a safe space, you must provide a client with choices and a sense of control. Matthews' non-directive play therapy does exactly that. Her clients guide their own therapy session. They chose what to play with and whether Matthews can play too. They can also choose to simply sit in silence or stare at the wall.
But you don't have to be a counselor or a mental health professional to create a safe space for an immigrant child who is feeling the pressures of immigration. EdWeekopens in new window has listed four ways to create a safe space for children, including the encouragement of self-expression, like Matthews does in her play-therapy sessions. Facing History and Ourselvesopens in new window, which uses historical analysis and the study of human behavior to create safe schools, also has a list of five ways to create a safe space for a childopens in new window. The list includes giving children a sense of ownership by making an agreement that creates whatever the children have envisioned an ideal environment to be; making sure that they understand that they belong in the space; giving them time to reflect; and allowing them to use their voice.
Matthews notes that even if a safe space is created, trust may still be difficult for a counselor to earn, and children may still be resistant to share things with their therapist. “It comes with their culture,” explains Matthews. “What you are encouraged to share depends on whether the clients' families tend to keep things among themselves.” Whether it is basic needs not being met, or their status of citizenship, child clients can end up conflicted about what to share in therapy. They have been told by adults they already trust not to share certain information, yet they are being encouraged by another adult to share things.
One client took about 3-5 sessions to trust Matthews, but eventually play therapy helped the client open up. Once a client starts talking, establishing what Matthews calls therapeutic rapport, the counseling process moves forward and they start to let her in. “The benefits of play therapy are that they end up trusting me and they tell me things that they might not tell anyone else,” she says.
Developing cultural competence
Equally as important as establishing trust, is cultural competence — a vital part of serving immigrant children. “Cultural competence, as a mental health professional, is having an understanding of our clients' culture, and being knowledgeable enough to help them within their cultural beliefs,” explains Matthews. “I do a lot of research and reading to make sure that I am as culturally aware and culturally competent as possible.”
The knowledge of immigrant children's culture can impact what resources are used to help them and their families. “We know that immigrant children are more likely to live in poverty, more likely to be uninsured, and they may have health problems,” says Matthews. For example, some children adjust to immigration better if their families already speak the language. Other families, coming from a culture where they didn't speak English, would need different kinds of assistance.
Knowing what types of services are needed is also important, Matthews stresses. Wraparound services, which fill in gaps in what a person may need besides therapy, are crucial. Immigrant families may need access to services through referrals, as well as to food pantries, clothing closets in churches, or assistance with health insurance. “I am just meeting one need,” she explains. “If I see what other needs there are, like GED classes, ESL classes — I am not a teacher, but I can connect them to those things.”
With play therapy, and the ability to connect her clients to the services they might need, Matthews has been able to witness improvements in her clients — both in their social skills and in their behavior.
Onyx Therapy Groupopens in new window is a minority-, veteran- and woman-owned business that is dedicated to cultivating and strengthening individuals, families, schools, organizations, and agencies through counseling and therapy, professional development, research, and consultation.
APA Immigration Coverage
APA Policy and Advocacy Efforts
- APA: Stop sharing immigrant youths' confidential psychotherapy notes with ICE
- APA Calls on Government to Ensure Immigrants and Refugees Can Access Health, Mental Health Services | Official Statement (PDF, 50KB)opens in new window
- APA CEO: Administration Decision to Penalize Immigrants Who Rely on Public Programs Will Harm Vulnerable Populations
- APA Calls for Action on Border Crisis
- APA Services Advocacy on Immigration
Recently Published Research
- Middle-School Latino Children Report More Depressive Symptoms After Family Member Arrested, Study Finds
- Psychological Research on Immigrants and Refugees
Further Reading and Resources
- Book: Mental Health Practice With Immigrant and Refugee Youth
- Podcast: On the Front Lines of the Immigration Crisis
- The Dire Consequences of Family Separation for Refugee Mental Health
- LGBTQ Asylum Seekers: How Clinicians Can Help (PDF, 534KB)opens in new window
- Div. 43 Presidential Initiative on Social Justice
- Psychologists Help Youth Who Return to Mexico Because of Deportation Threats
- Immigration and refugees topic page
