During the months surrounding the 2016 presidential election, immigration rhetoric was criticized so that Daniel Gutierrez, a licensed professional counselor (LPC) and member of the American Counseling Association, noticed a significant increase in panic disorders in a free clinic in Charlotte, North Carolina. One therapist even told Gutierrez about a client who had panic attacks every time a political advertisement was on TV.
Four years later, Gutierrez, an assistant professor in William & Mary's advisor training program and coordinator of the search focus for the University of Clinical Mental Health Advisory Program, encounters immigrants who are afraid and no longer understand immigration process in the United States. Many are concerned about family members in the countries they have left. Some fear that visiting these family members may not be able to easily return to the United States themselves. Some are confronted with people shouting, "Go back home!" While shopping or walking down the street. Fear, guilt, and worry are constant emotions for many immigrants, notes Gutierrez, who is also the New Leaf Clinic faculty director at William & Mary in Williamsburg, Virginia.
In fact, Gutierrez says that providing counseling services to immigrants can sometimes feel like they are working in a hospital emergency room. "We're just trying to stop the bleeding for a minute, and sometimes we don't have time to look at some of the other issues," he says. "You don't even know where to start. There is so much trauma and fear."
"You have such a history of past trauma that it overshadows everything," Gutierrez continues. "They will have this experience at the border crossing or in their home country and when they arrive here it affects [experience] every relationship." Gutierrez has seen cases where a mother has trouble connecting with her partner and children because of the guilt she felt for the trauma that occurred when the family entered the United States. For this reason, consultants often have to deal with major presentation problems – trauma, anxiety, depression – before they can deal with other issues such as relationship problems, he explains.
Immigrants are also exposed to countless stress factors that affect their mental health after they have migrated to a new country. In fact, researchers have identified an immigration paradox in which newer immigrants often outperform more established immigrants in the areas of health, education, behavior, and criminal law.
This paradox shows how harmful acultural stress factors such as financial concerns, inadequate living conditions or food, cultural misunderstandings, the inability to communicate or speak a new language, lack of employment and isolation for immigrants can be. Lotes Nelson, a frequent member of the Southern New Hampshire University clinical faculty, suggests that these stressors can cause symptoms of anxiety, depression, post-traumatic stress disorder (PTSD), behavioral disorders (especially in children), or substance abuse Expenditure.
Isolation and the lack of a support system can cause immigrants to turn inward and internalize their symptoms, says Nelson, who lives in St. Augustine, Florida and provides services as an LPC and licensed clinical supervisor in North Carolina. Your immigrant customers often report that something is wrong – their hearts are racing or they feel constantly sad, for example – but they cannot say exactly what it is or why they feel that way. They also often lack people whom they trust to speak about their concerns.
One problem is that access to counseling services for immigrants is restricted. Gutierrez, author of the "Counseling for Couples and Families with Latin American Migrants in the United States" chapter in the upcoming book, "Intercultural Perspectives on Family Counseling," says that migrants are less likely to receive psychiatric services, and when they do , performance is often inferior to what the majority culture maintains. "The consultants who offer care [to immigrant populations] are overwhelmed with large numbers of cases. You are on the verge of burnout. … The stories of immigrants about traveling over are really difficult [also]”he explains.
Gutierrez also notes that the consulting profession does not have enough skilled workers who understand the cultural impact and nuances of working with immigrants.
Nelson, a certified advisor and minority graduate student on the National Board for Certified Counselors, also points out that immigrants may not voluntarily seek counseling because many are not exposed to mental health care until they arrive in the United States were. At least in the beginning, she says, they couldn't see the advice as an acceptable service or treatment. If someone is unfamiliar with the psychiatric care process or questions the validity of the therapy, they will not be able to easily share their thoughts, concerns, and fears with the counseling, explains Nelson, a member of the ACA.
Gutierrez and Nelson agree that in order to overcome some of the obstacles immigrants face in psychosocial care, counselors need to cultivate personal relationships and build trust in them. Consultants need to understand where each client comes from and how that person's transition to life in the United States went. Gutierrez also emphasizes that counselors need to partner with immigrants and the communities that serve them if they really want to make a difference.
Overcoming language barriers
Language is often an obstacle to working with immigrants, and finding bilingual counselors can be a problem, Gutierrez says. When Gutierrez lived in Orlando, Florida in 2009, he went to his own psychosocial counselor, but found only five Latin American people who spoke both Spanish and English.
Gutierrez, co-founder of the annual Latinx Mental Health Summit, also points out that native Spanish speakers sometimes use physiological terms to speak about mental illness, which leads to misdiagnosis or loss of translation. In some Latinx cultures, for example, you can say "my heart hurts" or "I have pain in my heart" to describe sadness.
Nelson has observed that immigrants suffering from anxiety often also describe their symptoms physiologically, e.g. B. abdominal pain. Some clients may believe that abdominal pain is purely physical and is not related to mental health, she emphasizes.
Consultants can overcome language barriers by working with interpreters. Due to the complexity of translating mental health terms and concepts, Nelson warns advisors that they work with qualified interpreters, not just people who accidentally speak the language. Some clients may not have certain mental health concepts or symptoms in their culture, so their language may not even have a word to describe them.
Nelson invites interpreters to ask their questions to clarify and help them find a sense of what they are translating. She also asks her to translate her words literally to the client to avoid possible misinterpretations.
Finding qualified interpreters can also be a challenge, Gutierrez emphasizes. Nelson and Gutierrez have used interpreting agencies, hospitals and university language departments to find interpreters. Once consultants find a qualified person, they need to make sure the translator treats clients' information confidentially, Gutierrez adds. He advises consultants that interpreters sign confidentiality agreements. For him, the best scenario is to work with interpreters in the auxiliary areas (e.g. case management, nursing, health education), since they already understand the importance of customer confidentiality.
When working with clients from different cultures, there is also a risk of misinterpretation of body language, Nelson notes. While nodding in US culture usually means understanding, some clients who grew up in Asian cultures may nod because they are ashamed of not fully understanding what is being communicated or do not want the therapist to do it to feel bad when they don't understand. Nelson explains.
Nelson also had customers bring their children with them to translate for them at the meeting. In this case, she explains to the customer that the conversation may go beyond the child's developmental age, even if the children may be able to translate. Therefore, she would prefer to work with a translator. However, some customers resist working with a translator and only feel secure when someone in their family unit translates their personal information. In this case Nelson respects the customer's preferences but carefully explains the possible consequences of choosing this option.
Prioritization of the family
Many immigrants place great value on the family, and this means that counselors should also make this a priority. “When a client has to choose between their child and the visibility of [a therapist]they always have priority over the family. You always have priority over children, ”says Gutierrez. "Family cohesion is therefore a stronger predictor of whether [immigrants] uses services or benefits from services than [it is with] the majority culture."
Gutierrez says that counselors can manage immigrant populations more successfully if they offer family services, provide some form of childcare, or help clients relate their own well-being to their mental health and well-being of their children.
Nelson agrees that counselors must find ways to involve the family if they are to successfully approach immigrant populations. Since childcare can be a challenge for many of these customers, she suggests that the advisors consider providing customers 'children with a separate room to paint, watch movies, or other development-friendly ones during their parents' session Can carry out activities. However, she acknowledges that this facility is not always possible, so counselors may need to find other ways to accommodate families.
Customers often come to Sara Stanizai, a licensed marriage and family therapist and owner of Prospect Therapy in Long Beach, California, because they pursue two contradicting messages: the individualistic mindset that is prevalent in the United States and the United States collectivist thinking is often emphasized in their homes. The family was so central to an adult Stanizai client that the client's mother had to speak to Stanizai before the client could work with her.
If clients discuss problems with their family and the therapist advises them to set better limits, this could counteract the mental health and well-being of clients, since being with their family is a priority for them, Stanizai says.
Instead, she works with customers to redefine the problem with their families and find common ground. Instead of focusing on why a client is in conflict with their parents, it helps the client think about the underlying motivations and values that everyone agrees on. For example, the client can agree with the parents 'desire to have more opportunities and be successful, even if the client does not fully agree with the parents' high expectations or demands to get a clear A.
Due to the stigma that often surrounds mental health in migrant communities, some clients may not feel able to speak openly to their families about counseling. Gutierrez emphasizes that this is strange for them because they have such strong family units. The inability to contact their families can prevent these clients from going to counseling because they fear that they will be "caught".
Confidentiality therefore becomes particularly important when working with immigrants whose communities may stigmatize counseling or whose experience or undocumented status could prevent them from freely sharing their stories. For example, if a person's pastor transfers the client to Nelson, she will point out, "I know that you came here because your pastor recommended counseling, but that does not mean what you are saying here Her pastor goes back. This meeting is for you and everything you say here will stay in this room. "
When working with immigrant clients, counselors should consider the general support system of the individual, which can include family, friends, religious leaders, community elders, local organizations, doctors, and other professional service providers, Nelson says. She reminds her customers that she is only part of her support system. For example, when spirituality is important to a client, she says, “It sounds like you have a lot of respect for your worship leader. I want you to keep going to them while you come for advice. You have a lot of support around you. "
"If you as a consultant [have] … have a tunnel vision – that's me and my client – working with immigrants, it will most likely not be successful," Nelson says. "If you just look at one of these resources like friends, [clients] you get a fraction of the treatment they need."
Partnership with the Community
Gutierrez learned the value of community and partnerships when he worked as a consulting professor at the University of North Carolina at Charlotte (UNCC). Mark DeHaven, a respected professor of public health sciences at the UNCC, taught Gutierrez about community work and connected him to Wendy Pascual, the former director of the Camino Community Center, a local independent clinic.
Through his partnership with Pascual, Gutierrez learned that there were 85 people on the waiting list in the clinic to take advantage of psychiatric services. He also discovered that primary care for immigrants was often a starting point for using services. The majority of the patients in the clinic had psychological problems related to depression, anxiety, stress or trauma, and these problems were often a major reason for their physiological complaints (e.g. diabetes, high blood pressure). Physical illness was often just a symptom of a mental health problem – one that remained untreated due to the lack of qualified counselors and services.
Gutierrez worked with Pascual and a team of scientists, including DeHaven, to meet this need and reduce mental inequality within the Latinx immigrant community in Charlotte. The students of the graduate counseling service of the UNCC agreed to offer counseling services for the clinic, so that the services for the immigrant population remained free of charge and were operated as part of the student counseling training.
Gutierrez notes that advisors have to partner if they want to make a difference in immigrant communities. He emphasizes the word partnership. "There is a difference between partnership and collaboration," Gutierrez says. “Working with people in a community is fine. you do your things and then you go back home But partnership [involves]… to get together with people in the community and… to take on their mission and vision. "
Partnerships enable counselors to reach migrant communities and better understand clients' cultural values. For clients who are immigrants, it's often about personal relationships and building trust, Gutierrez says. But he notes that the word Confianza in Spanish is more than just trust. "It is trust. It is a connection. It is a partnership. It is someone who invites you to break bread," he explains.
Gutierrez warns the advisors not to assume that immigrant clients will come to them. Instead, he advises counselors to work in the communities they want to serve. He also recommends participating in community events such as church or local celebrations as a first step in building these partnerships. By attending the annual Puerto Rican Festival in Charlotte, he was able to cultivate relationships with individuals and learn more about what work has already been done to help immigrant communities.
Consultants should "just follow the crowd backwards," he advises. For example, they can search for and get in touch with people who are organizing food and backpack trips or trying to register voters, because these people are already doing great work in the community.
Partnerships have also helped immigrants find Nelson, who finds that most of their customers visit them based on recommendations from religious leaders, resettlement agencies, or other customers. She also agrees that migrant families value seeing counselors in their communities, including at events, festivals, fairs, their places of worship, and so on.
Nevertheless, consultants must remember to adhere to their ethical commitments, such as protecting customer confidentiality, in such community interactions. When a customer brings Nelson a flyer for an upcoming event, they carefully weigh their ethical commitments against the customer's needs: will attending the event damage or promote their relationship with the customer? Could this in any way affect the client's treatment or client's progress?
She also has conversations with customers across borders. They discuss how the customer wants to deal with this dual relationship, and discuss scenarios about what could happen if Nelson attended the event. Will the client recognize them (and vice versa) when they see each other? How does the client want to explain their relationship with family members and friends who may be attending the event?
For Gutierrez, the religious community was the greatest asset when working with immigrant populations. In churches and other spiritual communities, immigrants can usually use their own language, connect with others like them and feel safe and heard, he explains. For this reason, Gutierrez advises counselors to work with pastors and other spiritual leaders to educate them about the benefits of professional counseling. Often that's all that practitioners have to do to increase the number of immigrants who can get advice, he says.
Gutierrez tested the power of spirituality for immigrant communities by holding identical educational counseling courses (with the same curriculum and teacher) in a clinic and in a church. While only 20-30% of immigrants completed the course in the clinic, 90% of the class stayed in the church saying that the class was closer to God and better aligned with their beliefs, Gutierrez says.
When clients value spirituality, counselors can incorporate it into their sessions and adjust interventions to incorporate spirituality (while maintaining the competencies developed by the association for spiritual, ethical, and religious counseling values), Gutierrez says. For example, counselors could ask clients how they understand a situation from their own religious or spiritual perspective, or they could discuss the use and function of meditation and prayer, if necessary, he explains.
Nelson had immigrant clients with symptoms of depression or anxiety who reported that "I am obsessed with the devil because I feel that way." Other clients told her that she was brought to church and to church in her home country would have been prayed for days or weeks for such feelings. When this happens, it relates mental health needs to medical ones, since the concept of medical health is often familiar to these clients, even if it isn't. She asks them where they were going when they were in physical pain. When they answer that they went to a doctor or healer in their village, she compares this process to looking for a psychologist to find out why they are sad or feeling emotionally, psychologically, or socially uncomfortable.
Diagnosis of the person, not the culture
"We treated culture in counseling, sometimes it's a diagnosis," Gutierrez claims. He explains that practitioners sometimes try to adapt counseling approaches to specific cultures – for example, using cognitive behavior therapy (CBT) for all Latinx clients. But this method ignores the differences between cultures, he says. CBT may work well for one Latinx client, but another Latinx client may prefer psychoanalysis.
"Good cultural accommodation or adapting cultural care begins with a good conversation about the needs of the customer and the services you provide," says Gutierrez.
“A person is still sitting on this chair. … It's less about the strategies you use than the person you work with … because it deals with multiple layers of stress, challenges and stigmas. Find out what their story is before you make any assumptions, ”he advises.
Being culturally receptive can mean adjusting the length of counseling sessions, Gutierrez notes. Although a 50-minute clinical session is standard in the U.S., shorter sessions may work better for some immigrants, he says.
Similarly, according to Nelson, it is dangerous for consultants to quickly agree on a diagnosis without knowing the overall picture of the client. On the surface, it may look as if a client with a migrant background is afraid of moving to a new country. However, counselors should take into account everything that the person has experienced before, during and after the migration, she explains. Past and persistent trauma and adverse childhood experiences can affect a person's development and potentially lead to disruptive behaviors, PTSD, depression, and anxiety, she adds.
To learn more about customer immigration experiences, Nelson often says, “Tell me what you went through physically and mentally. What was the life situation like during the migration and what is it like now? What kind of threats have you encountered? "
Customers will often refuse to answer these questions because they do not yet want to focus on the traumatic experiences they have had, Nelson says. Many customers answer according to the motto "I don't think about it. This is over now. I want to concentrate on the here and now" or "That's exactly what I had to do to come here and live a better life."
When customers discard their past experiences, Nelson respects where they are emotional and cognitive and does not urge them to tell more of their story at that moment. She admits that as a consultant, it is easy to develop an unspoken agenda with clients, and she constantly remembers that advice is about enabling clients to tell their stories when and how they need it.
Both Gutierrez and Stanizai emphasize the importance of advisors educating themselves about different cultures and of not immigrant clients being the burden of this enlightenment. While multicultural training courses can be helpful, learning from the community itself is often equally (if not more beneficial), says Stanizai. Gutierrez agrees that immersion is the best teacher and advises counselors to put themselves in environments where they are surrounded by people who are different from themselves.
Stanizai, who specializes in working with first-generation Americans / bi-culture and leads a self-help group for adult children of Tiger mothers, advises the counselors to spend time reading books and watching the media who work for and by people in their respective cultures. "Find a local news source, radio station, novels, or non-fiction books that you can educate not only about specific topics, but also about cultural values and beliefs," says Stanizai.
Cultural awareness helps counselors learn more about privileges, avoid assumptions or recognize stereotypes about groups of people, and better understand how immigration behavior affects established beliefs and mental health within established American culture that can impact customers, says Stanizai. Most immigrants will not care if advisors are familiar with all cultural customs, such as marriage contracts, but they will care if advisors have a surprised reaction – e.g. B. "What is it? It is so different! “- something they share about their culture.
Regardless of how many consultants train themselves, they can never learn about the different experiences and cultures of their clients. Gutierrez notes that counselors are sometimes afraid to speak about race and ethnicity because they fear they may make a mistake. This fear can lead to overcorrections and cause consultants not to ask important questions, he notes.
According to Gutierrez, it is okay for consultants to deal directly with a client's race or ethnicity, which is different from that of the consultant. For example, an advisor could raise the issue by saying, “My family is Latinx. My parents came here from Cuba. You are Asian. I wonder how you find getting help from someone whose background is different from yours. "
Gutierrez and Stanizai also advise consultants to take a tutorial stance when working with migrant clients by asking questions about their unique experiences. Counselors might ask, “What was it like growing up in your family? To what extent did culture play a role in your childhood? How is your family different from your best friend's family? How is it the same? ”
Gutierrez warnt, dass die Hybris der Berater auch ein Hindernis für die effektive Zusammenarbeit mit Kunden sein kann, die Einwanderer sind. Wenn Berater sich als Retter fühlen und alle Probleme des Einwanderers lösen wollen, untergräbt diese Denkweise den Fortschritt des Klienten, erklärt er.
Stanizai stimmt zu. "Für sehr gut gemeinte Therapeuten ist es einfach, ihren Klienten zu beweisen, dass sie gute Menschen sind", sagt sie. "Sie möchten sicherstellen, dass Sie [clients’ stories] nicht zu Ihrem eigenen Vorteil verarbeiten. … Das ist wirklich abstoßend und die Leute können es eine Meile entfernt spüren. “
Den Einwanderern den Weg ebnen
Berater müssen nur die Geschichte oder Reise eines Einwanderers hören, um zu erkennen, wie widerstandsfähig sie sind, stellt Gutierrez fest. "Ich gebe ihnen keine Lösungen. Sie finden sie “, sagt er. "Sie haben all diese Schwierigkeiten und Herausforderungen gemeistert, und daher steckt in ihnen diese erstaunliche Belastbarkeit."
Oft belasten der Druck und die Anforderungen des Lebens, Strategien zu entwickeln, um zur Arbeit und nach Hause zu kommen, sie, und Gutierrez sagt, er biete ihnen einfach einen sicheren Raum, in dem sie keinen haben all diesen zusätzlichen Druck zu spüren. "Normalerweise mache ich ihnen nur den Weg frei", sagt er.
Die Bereitstellung dieses Raums kann viele Formen annehmen. Ein Therapeut, von dem Gutierrez weiß, dass er Klienten oft alte Hymnen oder Volkslieder singen lässt, um ihnen zu ermöglichen, ein Stück ihrer Seele wiederzugewinnen, das sie möglicherweise während ihrer Reise verloren haben. In diesem sicheren Raum können Kunden trauern, was sie verloren haben oder was sie auf ihre eigene Weise beunruhigt, erklärt Gutierrez.
Berater könnten auch erwägen, einfach eine Tasse Kaffee mit ihren Kunden zu teilen. Gutierrez erinnert sich an einen Klienten mit Migrationshintergrund, der bereits zu Beginn seiner Beratungskarriere seinen Einfallsreichtum unter Beweis stellte und ihm beibrachte, „die Regeln zu brechen“. Der Klient brachte Gutierrez eine Tüte Kaffee als Dankeschön, aber Gutierrez erklärte, dass er die des Klienten nicht akzeptieren könne Geschenk aus ethischen Gründen. Der Kunde sagte: "Oh, also kannst du es nicht von mir nehmen?" Also öffnete der Kunde die Tasche, ging zur Kaffeemaschine und kochte zwei Tassen Kaffee. Der Kunde sagte dann: "Nun, ich werde eine Tasse trinken. Wir können es miteinander teilen. “
Dieser Moment war ein Wendepunkt für Gutierrez. Jetzt genießt er oft eine Tasse Kaffee mit Kunden, während sie in der Sitzung sprechen. Diese kleine Geste wirkt der Feindseligkeit und den Herausforderungen entgegen, mit denen Einwanderer konfrontiert sind, insbesondere in der heutigen Umgebung. Gutierrez weist darauf hin, dass es auch eine angenehme Beratungsatmosphäre schafft, die eingewanderten Klienten hilft, Frieden zu finden, und sie wissen lässt, dass "hier Platz ist für [them]."
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RELATED READING: Siehe den exklusiven Online-Artikel "Straddling two worlds", in dem die komplexe und kritische Frage der Identitätsentwicklung unter Einwanderern untersucht wird.
Schauen Sie sich auch die Fragen und Antworten von Counseling Today 2016 mit Gutierrez an.
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Lindsey Phillips ist ein mitwirkender Autor von Counseling Today und UX-Content-Stratege. Kontaktieren Sie sie unter [email protected] oder über ihre Website unter lindseynphillips.com.
Letters to the editor: [email protected]
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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.
