1. CHAPTER 21 COUNSELING IMMIGRANTS & REFUGEES

2. Statistics on Immigrants and Refugees
Over 33 million immigrants live in the United States (12% of the population).
Thirty-two percent of immigrants are naturalized citizens (foreign nationals who have become citizens of the United States.
Over half of the immigrant population originates from Latin America, and many more are from Southeast Asia.
About one third have not completed high school, but the percentage of immigrants with bachelors degrees or advanced degrees is slightly higher compared to the United States population at large.
About 36% of immigrants are legally admitted as permanent residents or have temporary work visas.
Individuals who have permission to work hold a green card.

3. Statistics on Immigrants and Refugees
There are 11.2 million undocumented immigrants in the United States.
Immigrants have received a mixed reception from the government and the public.
Many groups have tried to prevent immigrants from entering the United States and have worked to curtail rights (e.g., voting rights).

4. Statistics on Immigrants and Refugees
Refugees are individuals who flee their country of origin in order to escape persecution due to race, religion, nationality, political opinion, or membership in a particular social group.
Asylees are individuals who meet the criteria for refugee status and who are physically present in the United States or at a point of entry when granted permission to reside in the United States.
In 2010, 73,293 refugees were admitted to the United States.
Most refugees come from Asia, the Middle East, Haiti, and African countries.

5. Historical and Sociopolitical Factors
Until 1952, only White persons were allowed to become naturalized citizens.
With the Immigration Act of 1965, people from any nation were allowed to become naturalized citizens.
In 2006, the Ohio legislature passed a law that attempted to exclude immigrant rights, but it was overturned.
Many states (e.g., Arizona) are attempting to pass laws that prohibit social and other services to undocumented immigrants.
Immigrants attitudes become negative when economic conditions result in a loss of jobs or limited housing.

6. Prejudice and Discrimination
Terrorist attacks have had a negative impact on people who appear foreign.
There has been a dramatic decline in admission of refugees.
The 9/11 attacks increased feelings of nationalism throughout the United States.
The 9/11 attacks also sparked the “English only” movement.
Because of discriminatory practices, there is a decreased usage of health care resources.
Immigrants fear being deported.
Societal and governmental reactions to immigrants are influenced by social conditions.

7. Cultural and Acculturation Conflicts
Many may experience culture shock and feel isolated, lonely, and depressed.
It is also difficult for immigrants to navigate educational, social, and governmental systems.

8. Gender Issues and Domestic Violence
Male immigrants often face the loss of power and status and may develop a sense of powerlessness.
Male immigrants may be unemployed or underemployed.
Women often find it easier to gain employment, and as a result the balance of power might shift, which can lead to domestic violence.
Many women are taught to deny their own needs for the good of the family.
Fear of reporting abuse is exacerbated by economic dependence or fear of retaliation.

9. Effects of Past Persecution, Torture, or Trauma
Many refugees suffer from post-traumatic stress disorder or elevated rates of mood/anxiety disorders and exhibit dissociation, intrusive thoughts, and hypervigilance.
Central American refugees in one study showed high levels of mistrust toward service providers.
Parents often worry about their children's adaptation to the American way of life.

10. Safety Issues and Coping with Loss
For refugees coming from politically unstable situations, issues of safety may be salient.
They may be reluctant to share information for fear of being disbelieved.
Refugees may feel guilty about family members left behind and may go through a bereavement process.
It is important to identify perceptions about what has been lost.

11. Barriers to Seeking Treatment
Communication due to language difficulties
Lack of knowledge of mainstream service delivery
Cultural factors
Lack of resources

12. Implications for Clinical Practice
Consider the belief systems, values, and healing practices of all immigrants.
Offer services within communities.
Have indigenous healers on staff.
Stay current on local, state, and federal immigration laws.
Know that immigrants face multiple stressors.
In assessment and diagnosis, take into account environmental factors.
Do not assume the client has an intimate understanding of mental health services.
Use skilled and knowledgeable interpreters.

13. Implications for Clinical Practice
Be aware that the client might have day-to-day stressors such as limited resources, a need for permanent shelter, lack of employment, or frustrating interactions with agencies. Allow time to understand and provide support related to these immediate needs, or help the client locate resources related to specific needs.
Be knowledgeable and conversant with the refugee groups you work with, their pre-migration traumas, and psychological strategies used to cope with stress.
Understand symptom manifestations likely to indicate post-traumatic stress, and other mental disorders that may arise from experiences of war, imprisonment, persecution, rape, and torture.

14. Implications for Clinical Practice
Allow time for clients to share their backgrounds, their pre-migration stories, and changes in their lives since immigrating.
Inquire about clients beliefs regarding the causes of their difficulties, listening for sociopolitical, cultural, religious, or spiritual interpretations.
Carefully explain the therapeutic approach that will be used, why that approach was selected, and how it will help the client make desired changes.