Main Discussion : Applied Cross-Cultural Psychology: Immigration Policies and Practice
Psychology as an applied social and behavioral science is uniquely positioned to address some of the most prevalent issues in society. One area of application is immigration. Consider this one statistic from the American Psychological Association Presidential Task Force on Immigration report,
Crossroads: The Psychology of Immigration in the New Century (2012), and the follow-up version, Working With Immigrant-Original Clients: An Update for Mental Health Professionals (2013): “… by 2020, one in three children below the age of 18 will be the child of an immigrant.”
Considering the changing views about and pressures on immigrant families and communities, psychology can advance scientific research into the immigrant experience and develop culturally appropriate services for mental health and acculturative stress. It can inform public policies and practices that encourage optimal outcomes for the individual, family, and society.
In this Discussion, you will consider ways cross-cultural psychology can inform appropriate immigration public policy and practices as an example of how principles of cross-cultural psychology apply in everyday life.
To prepare:
· Review Chapter 12 in your course text, focusing on the varied applications of cross-cultural psychology.
· Explore other related Week 6 Learning
Resources
on the topic of immigration. In particular, read the reports and review the website from the American Psychological Association.
· Consider how cross-cultural psychology can positively influence policies and practices regarding immigration. Formulate a list of strategies to recommend to your colleagues.
· Consider high-stress factors on immigrants, particularly the effects of prejudice, which impact immigrants’ mental health and specific ways that psychologists can respond.
By Day 3
Post an explanation in which you do the following:
· Analyze how cross-cultural psychology can positively influence policies and practices regarding immigration. Provide specific examples from the Week 6 Learning Resources and any additional resources you researched.
· Respond to this quote from Working With Immigrant-Original Clients: An Update for Mental Health Professionals (APA, 2013, p. 4): “The negative consequences of living with prejudice should be an issue of grave concern for psychologists.” Explain at least two of those consequences and, based on the Learning Resources, what psychologists can do in support of immigrants.
Note: Be sure to support the responses within your initial Discussion post (and in your colleague reply) with information obtained from the assigned Learning Resources, including a reference list for sources used. For information regarding how your Discussion will be evaluated, please review the grading rubric located in the Course Information area of the course.
Resources
hiraev, E. B., & Levy, D. A. (2017). Cross-cultural psychology: Critical thinking and contemporary applications (6th ed.). New York, NY: Routledge/Taylor & Francis
· Chapter 9, “Psychological Disorders” (pp. 252–284)
· Chapter 12, “Applied Cross-Cultural Psychology: Some Highlights” (pp. 346–368)
These chapters discuss cultural views on psychopathology, psychotherapy, and culture-bound syndromes, as well as various avenues in which cross-cultural psychology can be applied, including in health practices, business decisions, immigration policy, human rights, and working abroad. There is no Test for Understanding in Week 6.
Based on Crossroads: The Psychology of Immigration in the New Century
the Report of the APA Presidential Task Force on Immigration
Working With
immigrant-origin Clients
A n U p dAt e f o r M e n tA l H e A lt H p ro f e s s i o n A l s
American Psychological Association
Working With Immigrant-Origin Clients
An UpdAte for MentAl HeAltH professionAls
Based on the Report of
the APA Presidential Task Force on Immigration:
Crossroads:
The Psychology of Immigration in the New Century
APA Presidential Task Force on Immigration Members
Carola suárez-orozco, phd (Chair)
dina Birman, phd
J. Manuel Casas, phd
nadine nakamura, phd
pratyusha tummala-narra, phd
Michael Zárate, phd
APA Public Interest Directorate Staff
lauren fasig, phd, Jd (director, Children, Youth and families office)
Amani Chatman (program Coordinator, Children, Youth, and families office)
efua Andoh (Communications staff, pi executive office)
Copyright © 2013 by the American psychological Association. this material may be reproduced in whole or in part without fees or permission
provided that acknowledgment is given to the American psychological Association. this material may not be reprinted, translated, or distributed
electronically without prior permission in writing from the publisher. for permission, contact ApA, rights and permissions, 750 first street, ne,
Washington, dC 20002-4242.
http://www.apa.org/topics/immigration/report.aspx
http://www.apa.org/topics/immigration/report.aspx
1An Update for Mental Health Professionals
Working With
Immigrant-Origin Clients
An UPDATe For MenTAl HeAlTH
ProFeSSIonAlS
Based on Crossroads: The Psychology of
Immigration in the New Century the Report
of the APA Presidential Task Force on
Immigration:
E
very year since 1990, approximately one million new
immigrants have entered the United states. Accord-
ing to the U.S. Census Bureau (2011b), over 40
million U.s. residents are foreign-born—13% of the total
population. of these, approximately 18.1 million are natu-
ralized citizens, 11 million are authorized noncitizens, and
another 11 million are undocumented.
As the foreign-born population has grown, so has the
population of their children. immigrant-origin children
have become the fastest growing segment of the national
child population. thirty percent of young adults between
the ages of 18 and 34 are first- or second-generation im-
migrants, and by 2020, one in three children below the age
of 18 will be the child of an immigrant.
one in five persons residing in the United states is a first-
or second-generation immigrant; thus, immigrants and their
children have become a significant part of our national
tapestry. Because psychologists are, and increasingly will be,
serving immigrant adults and their children in a variety of
settings, including schools, community centers, clinics, and
hospitals, they need to be aware of this complex transforma-
tion in demographics and consider its implications.
Factors Fueling U.S. Immigration
searching for work, reuniting with family members, and
seeking humanitarian refuge are all reasons for immigra-
tion. the lack of documentation regulation has also con-
tributed to the growth of undocumented immigration
over the last 2 decades. reasons for seeking humanitarian
protection include wars, violence, risk of persecution, and
environmental disasters.
separated families often desire reunification, which may
take years, especially when complicated by financial hurdles
and immigration regulations. the longer the separation,
the more complicated the family reunification and the
greater the likelihood that children will report psychologi-
cal symptoms.
Demographic Profile of
the U.S. Immigrant Population
immigrants who have arrived in the United states over the
last 4 decades represent a wide range of cultures, ethnici-
ties, and races. this diversity of cultural values, beliefs, and
practices provides a challenge to the science and practice
of psychology. in addition, clinicians carry their own sets
of cultural attitudes that influence their perceptions as they
encounter those who are culturally different.
Racial and Ethnic Diversity
during the previous great wave of migration in the early
1900s, most new arrivals originated from europe. it was
only in the mid-1960s that immigrants began to contrib-
ute to the great diversification of the United states. since
1965, more than three quarters of new immigrants arriv-
ing in the United states are “of color,” with origins in Asia,
latin America, the Caribbean, and Africa. one third of the
foreign-born population in the United states comes from
Mexico, and Asians account for 28.2% of the foreign-born
(U.S. Census Bureau, 2010). But by far the largest group
of immigrants (nearly 55%) originate from latin America,
a racially and ethnically complex region consisting of
indigenous origin, White european origin, African ori-
gin, and mestizo (or mixed origin) populations. Although
Africans constitute only 3.9% of today’s immigrants, the
African-born population in the United states has increased
dramatically since 1960, from 35,555 to 1.4 million, with
most of that growth occurring in the last decade.
Many of these immigrants arrive in the United states at
the stage in their lives when they are most likely to start a
family, which further adds to ethnic and racial diversifica-
tion of the U.s. population. According to the U.S. Census
Bureau (2011a), four states with large numbers of im-
migrants have already become “majority/minority” states
(less than 50% White)—California, Hawaii, new Mexico,
and texas—with Maryland, Mississippi, Georgia, new York,
and Arizona projected to reach this designation next.
Diverse Destinations
some geographical areas, such as California, texas, new
York, florida, and illinois, continue to be popular destina-
tions for immigrants. However, other areas are also expe-
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2 Working With Immigrant-Origin Clients
riencing an increase in immigrant populations. in the past
2 decades, a growing number of states with no previous
immigrant populations have seen very high rates of new
migration. southern states have experienced the most
dramatic change in immigrant populations compared with
other states.
Educational Diversity
immigrants arrive with varied levels of education, but they
tend to be overrepresented at both the highest and lowest
ends of the educational and skills continuum. for example,
25% of all physicians, 24% of science and engineering
workers with bachelor’s degrees, and 47% of scientists with
doctorates in the United states are immigrants (portes &
rumbaut, 2006). these highly educated immigrant adults
are participating in and driving innovation, research, and
development and contributing substantively to technological
progress. But at the same time, many highly educated immi-
grants, particularly ethnic and racial minorities, experience
unemployment, underemployment, and downward mobility.
At the other end of the spectrum, some immigrant adults
have education levels far below those of the average U.s.
citizen. Certain sectors of the U.s. economy rely heav-
ily on “low-skilled” immigrants, including the agriculture,
service, and construction industries. Approximately 75% of
all hired farm workers and nearly all those involved in the
production of fresh fruits and vegetables are immigrants
(Kandel, 2008).
Language Diversity
An estimated 460 languages are currently spoken in homes
in the United states. Acquiring the language of the new
country is a critical aspect of the academic transition for
first-generation immigrant students. According to the U.S.
Department of education (2010), 20% of children speak
a second language at home. english language fluency levels
vary among non-native english speakers. While there are
concerns about the immigrant population’s inability or
unwillingness to learn english, research finds a consistent
pattern of english language assimilation within a generation.
Religious Diversity
immigrants also contribute to religious diversity. religion
is a fundamental part of life for most people throughout
the world. newly arrived immigrant adults and children
who are feeling disoriented in their new land are par-
ticularly likely to turn to their religious communities for
support.
Characteristics That Make
Immigrant Populations Resilient
immigrants demonstrate a remarkable pattern of strengths.
research suggests that immigrants today are highly mo-
tivated to learn english and do so more quickly than did
previous generations. they have very high levels of engage-
ment in the labor market, and the children of immigrants
go on to outperform their parents. Although recently ar-
rived immigrants often face many risks, including poverty,
discrimination, taxing occupations, fewer years of school-
ing, and social isolation, they do better than expected on
a wide range of psychological and behavioral outcomes
compared with their counterparts remaining in the coun-
try of origin and second-generation immigrants born in
the United states. new immigrants’ optimism, greater
family cohesion, and availability of community supports
contribute to their resiliency.
Major Mental Health
Challenges Faced
by Immigrants
The Immigration Process
the immigration process involves separation from country
of origin, family members, and familiar customs; exposure
to a new physical environment; and navigation of unfamil-
iar cultural contexts. stresses involved in the immigration
experience can cause or exacerbate mental health diffi-
culties, including anxiety, depression, posttraumatic stress
disorder (ptsd), substance abuse, suicidal ideation, and
severe mental illness.
Acculturation
Acculturation, a multidimensional process, involves
changes in many aspects of immigrants’ lives, including
language, cultural and ethnic identity, attitudes and values,
social customs and relations, gender roles, types of food and
music preferred, and media use. immigrants may feel pres-
sure to assimilate to the U.s. mainstream culture.
Acculturation may occur in stages, with immigrants
learning the new language first, followed by behavioral
participation in the culture. While some settings, such as
workplaces or schools, are predominantly culturally Ameri-
can, others, such as an immigrant’s ethnic neighborhood
and home environment, may be predominantly of the
heritage culture. from this perspective, acculturation to
both cultures provides access to different kinds of resources
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3An Update for Mental Health Professionals
that are useful in different settings and is linked, it is hoped,
to positive mental health outcomes.
Psychological acculturation refers to the dynamic pro-
cess that begins when immigrants enter the new country
and begin to adapt to its culture.
Behavioral acculturation refers to the extent of immi-
grants’ participation in their culture of origin and/or new
culture. While adopting American ways, immigrant adults
may continue to participate in their heritage culture and have
friendships with others from the same country with whom
they can share interests and values, consume ethnic foods, and
read and view native-language print and electronic media.
Intergenerational conflicts are common in immigrant
households, reflective of an acculturation gap between
parents and children. immigrant children behaviorally
adapt to the U.s. culture quickly. Adolescents in particular
are exposed to American culture through movies, music,
television, and many other electronic outlets. As immigrant
parents and children increasingly live in different cultural
worlds, conflicts result, including verbal arguments between
parents and children regarding friendships, dating, marriage,
gender roles, and career choices.
Because immigrant parents are immersed primarily in one
cultural context and their children in another, they often
know little of their children’s lives outside the home. for
immigrant children, it can be difficult to live with the
expectations and demands of one culture in the home and
another at school. Children may not turn to their parents
with problems and concerns, believing their parents do
not know the culture and its institutions well enough to
provide them with good advice or assistance.
in some cases, second-generation children and adolescents
may experience role reversal when they are in a position
to translate for their parents from their native language to
english or to help their parents and/or grandparents navi-
gate mainstream culture. older adult immigrants are often
the most vulnerable to mental health problems, with the
exception of victims of warfare and torture.
Acculturative conflicts are often at the root of what
brings immigrant families into treatment. even im-
migrants who have lived in the United states for a long
time and appear to have adopted the American lifestyle may
continue to maintain strong identification with, and hold
the values of, their culture of origin. psychological services,
which should include settings and programs designed to
assist immigrants with adapting to their new country, must
value the need to learn the ways of the new culture and the
need to maintain a connection with the old.
Acculturation-based presenting problems include:
• Changes in gender roles
• intergenerational conflicts
• family conflict and loss of communication
• role reversal
• negotiation of identity and loyalty to culture of origin
and new culture
• loneliness and isolation
the process of integrating the social and cultural values,
ideas, beliefs, and behavioral patterns of the culture of ori-
gin with those of the new culture can lead to acculturative
stress if they conflict.
Employment Problems
employment problems may impact immigrants’ mental
health as well. loss of occupational status can lead to feelings
of frustration, uselessness, and anger. employment difficul-
ties have been associated with depression and anxiety and
are among the risk factors for perpetrating intimate partner
violence. Meaningful employment can help the immigrant
adjustment process by decreasing feelings of isolation; con-
tributing to the building of new social networks; and provid-
ing opportunities for new friendships, cultural learning, and
development of english-language skills.
Traumatic Experiences
traumatic experiences place immigrants at risk for mental
health problems, including depression and anxiety disorders,
and particularly ptsd. such experiences can occur at vari-
ous stages in the immigration process and may include sub-
standard living conditions, unemployment, low self-esteem,
poor physical health, community violence, and lack of social
support. Any of these traumatic events can affect the ways in
which immigrants adjust to their new cultural context.
Undocumented immigrant children and youth are fre-
quently subject to particularly traumatic experiences,
including racial profiling, ongoing discrimination, expo-
sure to gangs, immigration raids, the arbitrary checking of
family members’ documentation status, forcible removal
or separation from their families, placement in detention
camps or in child welfare, and deportation.
4 Working With Immigrant-Origin Clients
trauma-based presenting problems include:
• Migratory trauma, including pre-migration, migration,
postmigration, and deportation
• interpersonal violence
• depression, anxiety, ptsd
• Compromised identification with country of origin
and adopted country
• interpersonal difficulties
• feelings of persecution and distrust of authorities and
institutions
Discrimination and Racism
discrimination and racism, both overt and subtle, have im-
portant implications for immigrants’ sense of well-being and
belonging. immigrants, especially those of color, are often the
targets of discrimination or at least the victims of aggression.
Whether overt or subtle, the negative impact of discrimina-
tion on the psychological well-being of an individual is the
same. specifically, experiences of racial/ethnic discrimination
have been associated with mental health problems, includ-
ing stress, depression, anxiety,
substance abuse, and thoughts
of suicide. distrust in the sys-
tem affects immigrants’ ability
to seek care for mental health
challenges.
immigrants who are racially
distinct from the majority are at greater risk for expe-
riencing discrimination than those who are not. Many
immigrants from Asia, latin America, the Caribbean, and
Africa encounter racial discrimination for the first time in
the United states. profiling contributes to a social atmo-
sphere that produces fear and anxiety for those immigrants,
especially those of color, who might possibly live in fear of
being spotted and deported. stereotypes mask the unique
psychological experiences and concerns of different im-
migrant communities. the negative consequences of living
with prejudice should be an issue of grave concern for
psychologists.
discrimination-based presenting problems include:
• discrimination (overt and aversive)
• overt and subtle or aversive forms of racism with
detrimental effects
• effects of profiling
• A sence of fear, anxiety, and a compromised sense of
safety
• racial identity issues
• feelings of being a “second class” person
• lack of a sense of belonging (e.g., perpetual foreigner
stereotype)
• decreased use of mental health services
Barriers to Mental
Health Services
While an increasing number of immigrants are seeking
mental health services, most immigrants underutilize these
services. these barriers can be broadly grouped into the
following categories: social-cultural, contextual-structural,
and clinical-procedural.
Social-Cultural Barriers
social-cultural barriers include differences in symptom
expression and attributions and conflicting views about
the causes of, and ways of
coping with, mental health
problems. some immigrants
may view self-help as the best
means of dealing with mental
health problems or may not
understand how psychological
problems can be treated from a Western perspective. others
may prefer alternate sources of help rooted in their cultural
origin (e.g., priests or imams).
Another social-cultural barrier is the stigma some cultures
associate with mental health problems. some cultures that
maintain strong family ties see individuals with mental
health problems as bringing shame to the family, destroy-
ing the family reputation, exposing a family weakness, or as
retribution for family wrongs.
Contextual-Structural Barriers
Contextual-structural barriers include lack of access to ap-
propriate and culturally sensitive mental health services in
immigrant languages, lack of access to interpreters, short-
age of racial/ethnic minority mental health workers and/or
persons trained to work with racial/ethnic minority per-
sons and culturally diverse elders, and lack of knowledge of
The negative consequences of living
with prejudice should be an issue of
grave concern for psychologists.
5An Update for Mental Health Professionals
available and existing mental health services and resources
(e.g., transportation and child care) for accessing services.
the racial and political contexts of the adopted country
affect immigrant adults’ and children’s (both authorized
and unauthorized) sense of safety and belonging and their
ability to trust that systems of care will help them when
they are facing mental health challenges.
Unauthorized immigrants face additional challenges related
to documentation status (e.g., ineligibility for services
provided by the county or state, fear of identification as
undocumented, and deportation). those who live a mi-
grant existence typically do not seek help, either due to
fears related to unauthorized status or to frequent moves
in search of work. immigrants in rural areas may face
additional barriers, including lack of access to culturally
competent services and service providers.
Clinical-Procedural Barriers
Clinical-procedural barriers include lack of culturally
sensitive and relevant services,
clinician bias, and commu-
nication problems related
to language differences and
cultural nuances. for example,
a clinician might downplay
the role of religion and spiri-
tuality in the client’s life and
overemphasize autonomy and
independence as therapeu-
tic goals, failing to take into
account the client’s cultural
values. the clinician may
misdiagnose presenting problems and fail to assess the ap-
propriateness of tests and assessment strategies.
Prevalence of Barriers
While contextual-structural and clinical-procedural barri-
ers can be found across varied regions of the United states,
they are becoming ever more prevalent and/or more no-
ticeable in small towns and rural communities of the south
and Midwest, where a growing number of immigrants
from Mexico, Central America, and south America are set-
tling in search of low-skilled labor opportunities.
Treatment Considerations for
Mental Health Providers
Assessment and Diagnosis
the role of sociocultural context must be recognized in
order to provide ethical and appropriate standards of care,
diagnosis, and treatment. those in favor of cultural assimi-
lation believe that the best approach is for immigrants (and
other minority groups) to blend rapidly into the dominant
culture. they contend that adopting the norms and rules of
the dominant culture will eliminate ethnic differences and
thus drastically reduced prejudice.
Conversely, those holding a multicultural ideology be-
lieve that all cultural groups should have the opportunity
to retain their basic cultural norms, values, traditions, and
language within a greater cultural framework. those who
advocate for multiculturalism believe that prejudice is
reduced and self-esteem enhanced through an apprecia-
tion of group differences. According to this perspective, the
country benefits from the presence of diverse groups that
bring a broad array of skills.
for example, diverse language
skills are necessary for many
jobs in the business and ser-
vice sectors.
findings from research on
common group identity and
group distinctiveness imply
that assimilation and multi-
culturalism may mean differ-
ent things to different groups,
depending on their structural
position in society. Within an assimilated world, the major-
ity group is preserved and the status quo remains intact. At
the same time, when minority groups espouse multicultur-
alism, the underlying message is that they do not want to
change but rather preserve their cultural traditions. A solu-
tion to this impasse may involve combining both perspec-
tives and articulating ideologies in which immigrants may
preserve their cultural distinctiveness while simultaneously
developing a shared American identity with those born in
the United states.
for culturally competent treatment, clinicians must under-
stand immigrants’ experiences as encompassing an effort
to fit between cultural frameworks. immigrants bring with
them cultural values, beliefs, and attitudes that may fit well
or may clash with those in the United states. Clinicians
must consider the interaction of person and environment
A solution to this impasse may
involve combining both perspectives
and articulating ideologies in which
immigrants may preserve their cultural
distinctiveness while simultaneously
developing a shared American identity
with those born in the United States.
6 Working With Immigrant-Origin Clients
and related intersections of social identities (e.g., gender,
race, ethnicity, age, sexual orientation, social class, disabil-
ity/ability, and immigration status) in addressing mental
health needs in immigrant communities.
Cultural context shapes the ways in which clients con-
ceptualize and express psychological distress and resil-
ience, cope with distress, and seek help. the significance
of culture is relevant not only to the client but also to the
mental health professionals who provide help and the care
system in which it is provided. in the end, the solution
may involve preserving cultural distinctiveness while also
developing a shared identity with those born in the United
states.
one difficulty in the assessment of immigrants is the lack
of valid and culturally appropriate diagnostic tools that
recognize cultural differences in the expression of and
coping with psychological distress. this presents a signifi-
cant challenge to clinicians who rely on established testing
and assessment strategies and
instruments. Clinicians must
critically examine resources
developed in a Western mid-
dle-class context before ap-
plying them to non-Western,
non-middle-class participants.
Appropriate multicultural as-
sessment requires that clini-
cians arrive at an accurate, sound, and comprehensive
description of the client’s psychological presentation by
gathering data on historical, familial, economic, social, and
community issues. this knowledge is critical in choosing
appropriate tests and in interpreting the results.
Clinician bias, the tendency to universally apply euro-
centric models of illness without taking a patient’s culture
into consideration, can contribute to overdiagnosis and a
lack of attention to resilience. Clinicians can benefit by us-
ing multiple sources of evidence when assessing immigrant
clients and identifying culture-specific expressions of well-
being and distress.
it is important that clinicians examine their own bi-
ases and expectations that may affect the testing process.
they should also consult with colleagues and supervisors
who may be more familiar with the client’s sociocultural
context, the specific diagnostic tests being considered, and
culture-bound syndromes and who may be able to provide
support throughout the assessment process. Bicultural and
bilingual researchers are perhaps best able to establish a
rapport and trust within immigrant communities and gain
entry into populations that might otherwise be difficult to
access.
Clinicians’ self-assessment should include the extent to
which their socialization informs their evaluation of the
racial and cultural data of the client. Clinicians are encour-
aged to recognize that they may hold attitudes and beliefs
that can detrimentally influence their perceptions of and
interactions with individuals who are ethnically and ra-
cially different from themselves.
Clinicians should understand the implications of psycho-
logical testing and diagnosis. they should not only consider
the fairness and utility of diagnostic tests in the context of
language, educational background, and cultural norms but
also recognize that many immigrant clients are concerned
about diagnostic labels due to cultural stigma and/or im-
migration status.
While assessments usu-
ally occur in the context
of educational and clinical
settings, practitioners may
also assess clients in judicial/
legal settings, including family
courts, immigration courts,
and criminal courts. Clini-
cians may be called on to
make critical decisions that
significantly affect the lives of immigrants and their fami-
lies—deportation or asylum, family unification or separa-
tion, incarceration or freedom.
issues in assessment include:
• lack of standardized translations of instruments
• lack of appropriate normative standards, norm refer-
enced groups, and studies on reliability of test scores
with different immigrant groups
• problems with timed tests in educational, clinical, and
forensic settings
• research suggesting that poor, immigrant, and ra-
cial/ethnic minority children are disproportionately
placed in low-ability groups early in their education
(Blanchett, Brantlinger, & Shealey, 2005)
• failure to take culture into consideration can lead to
misdiagnosis (e.g., overpathologizing)
Bicultural and bilingual researchers are
perhaps best able to establish a rapport
and trust within immigrant communities
and gain entry into populations that
might otherwise be difficult to access.
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7An Update for Mental Health Professionals
issues in diagnosis include:
• the present diagnostic system (Diagnostic and Statistical
Manual of Mental Disorders) favors Western, eurocentric
conceptualizations of mental illness
• diagnosis does not typically include clients’ cultural
explanation of illness and health
• Complications with diagnosis occur when assessment
is not conducted in native or first language or with the
use of translators
• failure of clinician to assess resilience
• issues do not reflect the experiences of cultural adjust-
ment and acculturative stress
Best Practices in Assessment
and Diagnosis
to cultivate best practices in assessing and diagnosing im-
migrant clients, clinicians should:
• examine the extent of cultural and linguistic differ-
ences between the clients and the dominant culture
(e.g., WisC-iii spanish and the WisC-iV spanish;
ortiz, 2008).
• Consider using revised culturally sensitive versions of
classic measures (e.g., tell Me a story [teMAs]; Con-
stantino, Malgady, & rogler, 1988), which is a revision
of the thematic Apperception test.
• recognize the dynamic nature of culture and incor-
porate cultural variables as central to all phases of the
assessment process (Yeh & Kwan, 2010).
• Use more comprehensive assessment approaches—for
example: the Multicultural Assessment procedure
(ridley, li, & Hill, 1998) and the Multicultural
Assessment-intervention process (dana, 2005).
• incorporate culturally sensitive assessment interviews,
collecting information on acculturation, language,
religious practices, racism and prejudice, and cultural
values as part of the assessment process.
• Use a contextual approach that attends to clients’
explanatory models and to clinicians’ assumptions and
biases.
• recognize the conditions and circumstances under
which assessment and diagnosis take place and the
implications of testing and diagnosis on client’s present
and future.
• Assess the possibility of culture-bound syndromes.
• recognize that disorders can lie on a continuum.
• Work in collaboration with translators and interpreters.
• Work in collaboration with families and community
members when appropriate.
• Consult with colleagues.
Principles Clinicians Should
Apply in Providing Effective
Mental Health Services to
Immigrants
to increase the accessibility and efficacy of services, clini-
cians and practitioners should adhere to the following
guiding principles:
• Use an ecological perspective.
• integrate evidence-based practice with practice-based
evidence.
• provide culturally competent treatment.
• partner with community-based organizations.
• incorporate social justice principles in providing service.
Ecological Framework
An ecological framework proposes that the human expe-
rience is a result of reciprocal interactions between indi-
viduals and their environments, varying as a function of
the individual, his or her contexts and culture, and time.
ecological approaches acknowledge that behavior does not
occur in a vacuum but is affected by the larger culture and
society, as well as the local community and its institutions.
thus, the social climate and receiving environment into
which immigrants arrive help shape their experience in
and adaptation to America.
each immigrant has his or her own set of characteristics
that, in interaction with the environment, may place him
or her in varying positions of resilience or vulnerability.
this information should be gathered and used to inform
interventions, including effects of migration (before, dur-
ing, and after), legal/documentation status, acculturation,
risk and resilience, cultural and religious beliefs, age of mi-
http://psycnet.apa.org/doi/10.1177/0011000098266001
8 Working With Immigrant-Origin Clients
gration/developmental stage, race, ethnicity, gender, social
class, sexual orientation, disability/ability, experiences of
racism and discrimination, language and educational barri-
ers, and access to services and resources. this information
is often critical to developing a complex understanding of
the individual’s experiences of distress.
Evidence-Based Practice and Practice-Based Evidence
to maximize effectiveness, clinicians should select inter-
ventions that are rooted in evidence-based practice (eBp)
and practice-based evidence (pBe). the eBp approach
stresses learning from research about intervention programs
and components that have been found to be effective with
other samples and applying this knowledge to the needs of
the particular clients being served. evidence-based practice
approaches psychological treatment with the assumption
that individual characteristics and sociocultural context
both play important roles in assessment and intervention.
the pBe approach seeks to understand “practice as usual”
and gather evidence on its effectiveness. it is particularly
important to understand what is meant by practice as usual
because when eBts are implemented, they are integrated
into existing practice settings. practice-based evidence
involves learning from the wisdom of clinicians who have
provided direct clinical services to immigrant communities,
in particular noting how they have modified traditional ap-
proaches to treatment in their work with immigrant clients
and its effectiveness.
Culturally Competent Treatment
Cultural competency should be an inherent principle that
underscores all work performed by psychologists. As de-
fined here, culturally competent mental health care pro-
vides services in ways that are “acceptable, engaging, and
effective with multicultural populations” (Birman et al.,
2005, p. 12). Clinicians should assess the capacity of pro-
grams to provide services in ways that are acceptable and
effective with multicultural populations. Cultural compe-
tence involves three broad dimensions: therapists’ cultural
knowledge, therapists’ attitudes and beliefs toward cultur-
ally different clients and self-understanding, and therapists’
skills and use of culturally appropriate interventions. Cul-
tural competence in practice includes attending to actual
treatment practices and promoting access to services, such
as interpreters and legal assistance. in addition, in recent
years scholars from different theoretical orientations (e.g.,
cognitive–behavioral, psychodynamic, family systems, hu-
manistic, and integrative) have increasingly addressed issues
of diversity and cultural competence.
APA’s Multicultural Guidelines (APA, 2002) provide
six major principles of culturally competent psychological
practice, research, education and training, and organiza-
tional change:
Guideline 1: psychologists are encouraged to recognize
that, as cultural beings, they may hold attitudes and beliefs
that can detrimentally influence their perceptions of and
interactions with individuals who are ethnically, racially,
culturally or nationally different from themselves.
Guideline 2: psychologists are encouraged to recognize
the importance of multicultural sensitivity/responsiveness,
knowledge, and understanding about ethnically, racially,
culturally, or nationally different individuals.
Guideline 3: As educators, psychologists are encouraged
to employ the constructs of multiculturalism and diversity
in psychological education.
Guideline 4: Culturally sensitive psychological researchers
are encouraged to recognize the importance of conducting
culture-centered and ethical psychological research among
persons from ethnic, linguistic, and racial minority back-
grounds.
Guideline 5: psychologists strive to apply culturally ap-
propriate skills in clinical and other applied psychological
practices.
Guideline 6: psychologists are encouraged to use orga-
nizational change processes to support culturally informed
organizational (policy) development and practice.
Cultural competence involves the use of appropriate
cultural knowledge, positive attitudes toward culturally dif-
ferent clients, self-understanding, and the use of culturally
appropriate interventions. theorists of different orienta-
tions (e.g., psychodynamic, cognitive–behavioral, humanis-
tic) in recent years have called for the integration of issues
of sociocultural context into conceptualization and inter-
vention.
research on culturally adapted interventions indicates that
interventions in clients’ native languages are more effec-
tive than those conducted in english, culturally adapted
interventions are more effective than those not targeted
to specific cultural groups, and ethnic matching in the
therapeutic dyad is likely to improve client retention and
therapeutic outcomes. As such, it is particularly important
to understand “practice as usual” because when eBts are
implemented, they are integrated into existing practice set-
tings. With increasing pressure to implement eBts, provid-
ers who have been serving immigrant communities for
http://www.nctsnet.org/nctsn_assets/pdfs/materials_for_applicants/MH_Interventions_for_Refugee_Children
http://www.apa.org/pi/oema/resources/policy/multicultural-guidelines.aspx
9An Update for Mental Health Professionals
many years are faced with integrating their existing prac-
tices with intervention approaches developed for popula-
tions different from the ones they serve.
When immigrants do require clinical treatment, a resilience
and coping perspective is important to incorporate into
the treatment process. some immigrants may draw strength
from family structures that U.s. therapists may judge nega-
tively or misunderstand. it is important to note that what
may be considered a strength in one cultural context may
be considered deviant or undesirable in another. Cultur-
ally competent treatment requires an understanding of the
complex interplay of pathology and resilience for immi-
grant clients.
Culturally competent psychological practice with immi-
grant-origin clients takes into account:
• pre-migration factors
• Migration experience
• reception in the new environment and trauma
• language/communication
• symptom expression, which can be culturally mediated
• Changes in gender roles and intergenerational issues
• economic stress and marginalization
• resilience
• intersectionality/multiplicity of identity
Comprehensive Community-Based Services
the establishment of comprehensive community-based
services that provide mental health, social, legal, and educa-
tional assistance and are located in settings where the target
immigrant population is likely to be found (e.g., schools,
churches, and community centers) is critical. there is evi-
dence that when these varied services are provided togeth-
er, there is an increase in the use of mental health services.
An alternative to clinic-based services, community-based
mental health services address the larger context of immi-
grants’ lives.
educational settings, including public and parochial schools
and community colleges, have been identified as particularly
effective sites from which to provide diverse mental health
services to immigrant children and their families. stigma
surrounding mental health services can be reduced when
such services are provided as an educationally connected
intervention in a safe, familiar setting, and schools have natu-
ral access to families who may be reluctant to seek mental
health services for their children in more traditional settings.
Social Justice Perspective
the social justice perspective in psychological treatment is
rooted in the belief that all people have a right to equitable
treatment, a fair allocation of societal resources, and a share
in decision making. All relevant personnel within the legal
system should be trained to work with immigrants in gen-
eral and those with mental disabilities in particular.
Clinicians can work toward making society a better place
for all by challenging systematic inequalities. to successfully
follow a social justice approach, clinicians must make use of
the ecological framework to interpret all of the contribut-
ing factors associated with immigrants’ mental health status.
therapeutic interventions should then be designed to help
individuals take steps to change themselves and to change
the conditions contributing to the problems they face.
Conclusion
psychologists are, and increasingly will be, serving im-
migrant adults and their children in a variety of settings,
including schools, community centers, clinics, and hospitals.
they should thus be aware of this complex demographic
transformation and consider its implications as citizens,
practitioners, researchers, and faculty.
Clinicians have a unique and important contribution to
make to the immigration discussion in several domains.
specifically, the field must advance scientific research to
understand, ensure, and maintain positive outcomes for
immigrant-origin adults, children, and adolescents; pro-
mote the delivery of culturally and linguistically appropri-
ate services among psychologists, educators, and commu-
nity service providers; and educate and train psychologists
and others who work with immigrants in understanding
the broad range of migration, acculturative, and family
stressors that can affect the mental and behavioral health of
immigrant families.
By 2010, nearly 23% of U.s. children (16 million under the
age of 18) had immigrant parents. Well over three quarters
of these children are U.s. citizens, and these predominantly
latino and Asian families are driving the diversification of
the United states. the successful incorporation of chil-
dren of immigrants into the educational system is one of
the most important and fundamental challenges today. in a
knowledge-intensive economy, how they fare education-
10 Working With Immigrant-Origin Clients
ally will play a critical role in their future and—given their
high numbers—in the kind of society we will become.
Meeting the needs of immigrant-origin students, however,
has not been a national priority. this population is largely
overlooked and underserved, and more attention must be
focused on their educational needs by supporting activities
that underscore the importance of providing fair access to
educational opportunities for immigrant-origin children
and adolescents.
As the immigrant population continues to grow, more
psychological research is needed to understand the com-
plexities of the immigrant experience across the life span
and immigrants’ reciprocal interactions with their environ-
ments. At the very least, appropriate assessment instruments
and qualified psychologists should be used in settings
where there is a high density of a particular language and
culture represented (e.g., spanish-speaking clinicians in
areas where many students or clients speak spanish as a
first language). When this is not possible and an assessment
is done through an interpreter, extreme caution must be
taken in making diagnoses. psychologists should be mind-
ful of making high-stakes decisions about individuals’ lives
based on what might be considered speculative assessment
strategies with immigrant populations. More clinical train-
ing is needed to enable psychologists to provide cultur-
ally competent services to these populations and to better
understand how to support and promote resilience.
Clinicians and researchers must consider the critical role of
social, cultural, economic, and political contexts in the ex-
perience of immigration, acculturation, and psychological
well-being. Clinicians would benefit from using knowledge
from multiple sources of evidence in their approaches to
assessment and treatment with immigrant clients. evidence
from empirical studies and from practice that is adapted to
suit the mental health needs of specific groups should be
used to guide the development of innovative clinical prac-
tices in clinics and community settings. L
11An Update for Mental Health Professionals
Relevant APA Resolutions
and Reports
American psychological Association. (1998). Resolution on immigrant chil-
dren, youth, and families. retrieved from http://www.apa.org/about/
policy/immigrants.aspx
American psychological Association. (2001). Resolution on racial/ethnic
profiling and other racial/ethnic disparities in law and security enforcement
activities. retrieved from http://www.apa.org/about/policy/racial-
profiling.aspx
American psychological Association. (2002). APA guidelines on multicultural
education, training, research, practice, and organizational change for psycholo-
gists. retrieved from http://www.apa.org/pi/oema/resources/policy/
multicultural-guidelines.aspx
American psychological Association. (2005). Policy statement on evidence-
based practice in psychology. retrieved from http://www.apa.org/prac-
tice/resources/evidence/evidence-based-statement
American psychological Association. (2006). Resolution on prejudice, stereo-
types, and discrimination. retrieved from http://www.apa.org/about/
policy/prejudice
American psychological Association. (2010). Resilience and recovery after war:
Refugee children and families in the United States. retrieved from http://
www.apa.org/pi/about/newsletter/2011/02/refugee.aspx
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http://www.apa.org/topics/immigration/report.aspx
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a better America: Preventing discrimination and promoting diversity. Washing-
ton, dC: American psychological Association. retrieved from http://
www.apa.org/pubs/info/reports/promoting-diversity.aspx
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AMERICAN
PSYCHOLOGICAL
ASSOCIATION
PUBLIC INTEREST DIRECTORATE
750 First Street, NE
Washington, DC 20002–4242
202-336-6056
www.apa.org/pi
http://www.apa.org/about/policy/immigrants.aspx
http://www.apa.org/about/policy/immigrants.aspx
http://www.apa.org/about/policy/racial-profiling.aspx
http://www.apa.org/about/policy/racial-profiling.aspx
http://www.apa.org/practice/resources/evidence/evidence-based-statement
http://www.apa.org/practice/resources/evidence/evidence-based-statement
http://www.apa.org/about/policy/prejudice
http://www.apa.org/about/policy/prejudice
http://www.nctsnet.org/nctsn_assets/pdfs/materials_for_ applicants/MH_Interventions_for_Refugee_Children
http://www.nctsnet.org/nctsn_assets/pdfs/materials_for_ applicants/MH_Interventions_for_Refugee_Children
http://psycnet.apa.org/doi/10.1177/07419325050260020101
http://www.ers.usda.gov/publications/err-economic-research-report/err60.aspx
http://psycnet.apa.org/doi/10.1177/0011000098266001
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http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_11_1YR_DP02&prodType=table
