Therapy approaches to effectively support immigrant clients

People immigrate to the United States for many reasons, including work, education, family reunification, and safety. Some individuals—particularly refugees and asylum seekers—arrive after fleeing war, violence, persecution, or natural disasters. In one study on migrants from several Central American countries, 83% reported violence as a reason for fleeing their country.

Refugees and asylum seekers may face elevated psychological risk due to pre-migration trauma, dangerous migration journeys, and post-migration stressors such as legal uncertainty, discrimination, language barriers, and limited access to care. These challenges can contribute to higher rates of anxiety, depression, and post-traumatic stress.

But immigrants as a whole should not be generalized. Those who aren’t refugees may experience different versions of acculturation stress, which is the psychological impact of trying to adjust to a new environment with different language, values, and societal norms. Acculturation stress can lead to higher rates of depression, anxiety, and suicidal ideation. Clinicians should avoid assumptions based on immigration status alone and instead take an individualized approach that considers both risk factors and strengths, including resilience, family support, and cultural protective factors.

The impact of trauma on mental health presentation 

Presentations and understandings of trauma symptoms can vary widely across cultures depending on cultural narratives, belief systems, and localized idioms of distress. If a clinician were to only listen for language outlined in the DSM criteria for PTSD, for example, they may miss or interpret distress. Given that the DSM-5-TR is formed from a western-centric viewpoint, there are limitations to the scope of what it can grasp. 

Understanding localized idioms helps with accurate assessment, rapport, and culturally responsive care without abandoning diagnostic frameworks. Examples of alternative cultural idioms of distress include “qaracan” for Somali refugees, being victims of black magic for some of the Rohingya population, or the term “susto” for certain Latino individuals. These cultural conceptualizations and experiences can have overlap with DSM-based PTSD criteria, but may also go outside the lines of westernized explanations. 

Navigating cultural identity and belonging

Individuals who have immigrated may face a complex mix of challenges in regards to identity, belonging, and intergenerational conflict. It can be difficult for clients who are in a new country to retain a strong sense of self and find social belonging. 

To help with cultural integration, research from the British Journal for Social Psychology recommends helping individuals to consider dual identities, dual social groups, and the primary language of the new country. For therapists this can look like supporting clients in identifying their struggles, helping them retain their cultural identity, helping finding new relationships via technology, maintaining old relationships that are rooted in their home culture, encouraging and brainstorming ways to try and build relationships with people in their new environment, and encouraging learning more of the country’s first language if necessary. This approach supports clients in honoring both their cultural heritage and their current circumstances, integrating these into a coherent sense of self.