Welcoming Borders

By Candace Y.A. Montague

November 2024

Imagine being uprooted from your home and forced to flee your country. Your family is scattered for safety reasons. Some follow you, but others land elsewhere. Those times when you would laugh and create meals together or just reach out for a hug are now replaced with electronic barriers such as mobile devices and computer screens. It’s a barrier that may not be broken for a very long time. How does a person reconcile with such a tremendous change and adjust to a new life they didn’t ask for?

It’s a scenario that Dania Fakhro, PhD, a native of Syria, understands from both the angle of a counselor and a refugee. In 2003, the Iraq War sent thousands of people into Syria seeking refuge. Fakhro , then 21, volunteered at Iraqi and Palestinian refugee camps helping people find homes and resources. She learned a lot during those days.

“I was working in the camps and hearing their stories, which made me become more involved with this community. This is where my curiosity started related to this community and how they can accept what happened,” she says.

Then in 2011, political unrest began in Syria. This time it was Fakhro, her husband and relatives who needed to flee to safety. “The shift that happened in my country when the war started is when things really got so chaotic,” she explains. “I became a refugee myself. I had to find a country for myself because it was so difficult to survive there. It’s like I didn’t have access to my country anymore.”

Fakhro has been separated from her extended family since 2011. Some of them fled to Europe while others remained in Syria. Due to her pending asylum/refugee status in the U.S., she is not allowed to leave the country as it would jeopardize her case. She has since made a life for herself in the U.S. She earned her doctorate in counselor education and supervision from the University of Central Florida and is now an assistant professor at the University of North Carolina at Charlotte specializing in complex trauma and refugee mental health.

Fakhro tells her story through the eyes of an adult who can process political unrest and violence. But imagine making a seismic transition like this as a child or adolescent. Refugee and asylum-seeking children experience profound trauma and often don’t have ways to reconcile what they have been through. And finding culturally sensitive and comprehensive mental health care in a new country can be challenging. However, there are ways to break through the cultural barriers and provide effective counseling to children and adolescents.

How Children and Teens Cope

By the end of 2023, a record 47.2 million children around the globe lived in forced displacement, according to UNICEF. Most were fleeing conflict and violence. At the U.S.-Mexico border, in fiscal year 2023, 118,938 unaccompanied children were in the care of the U.S. Office of Refugee Resettlement. Most were seeking asylum — poverty, gang violence, political corruption and the residuum of catastrophic weather events have caused many families to make desperate decisions to get their children to safety.

Although adults often understand the risks and rewards of getting to a different country, children do not. Instead, children are left with questions and fear, Fakhro says. Even adolescents, who may have a better sense of what is happening, are often not ready to process it all.

“Adults understand things differently,” she says. “They are developmentally capable of understanding what war is: We lost someone; this is what happens. While for children, they can’t make sense of what happened to them. They cannot process the trauma they have witnessed. They might see some of their family members disappearing and never returning. So, they have unanswered questions.”

Rosalind Ghafar Rogers, PhD, LMHC, is a clinical behavioral health subject matter expert with the U.S. Committee for Refugees and Immigrants’ Refugee Health Services in Arlington, Virginia. Rogers’ mother is Afghan and her father is American. She has lived overseas during select portions of her childhood. Her stint in Bangladesh, from fifth grade to ninth grade, made a positive impression on her.

Rogers said living overseas contributed to the development of key characteristics that align with a career as a mental health professional: empathy, compassion, a strong sense of justice and a desire to help people. “Living overseas and being half Afghan had the greatest impact on my decision to focus my professional work on the most vulnerable populations — those affected by war, conflict and displacement.”

After earning her doctorate in international psychology in 2021, Rogers began doing consultation work and developing and managing mental health and psychosocial programming for unaccompanied Afghan youth at three shelters in Michigan. She was also recentlyfeatured as one of the co-presenters for ACA’s course on working with newly arrived Afghans (see bit.ly/AfghanRefugeesCourse).

Rogers offers more insight into the difference between how children and adolescents process forced displacement: “With children, you may see regressive behaviors. So, let’s say a child who has been toilet trained may regress to bed wetting again or sucking his thumb. You may also see the kids being much more needy in terms of refusing to be separated from their caregiver for any amount of time. So, they constantly want to be right next to their parents. That’s very, very common.”

She continues, “With adolescents, it’ll be more like rule breaking. Also, internalized behaviors start showing up more because they can process their emotions more compared to children, and they have a greater kind of cognitive awareness.” Teens may engage in self-harm, such as cutting, or isolate themselves because they don’t feel any sense of belonging to a peer group. Or, they may become part of a peer group that gets into more trouble, she says.

Post-Resettlement Stressors

There is always a large adjustment period whenever anyone emigrates to a new environment. Resources that were once plentiful and accessible are now limited. Cultural norms may shift, and the community where immigrants land may not be aware or accommodating.

Schools can often have a big impact on refugee children and adolescents. In many cases, they can be the first and only chance for children to interact with a counselor. Therefore, having culturally competent mental health professionals in schools is critical to success.

Dawnette Cigrand, PhD, LSC, is department chair and professor of counseling education at Winona State University in Minnesota. She is also a co-author for the 2024 ACA book Counseling with Immigrants, Refugees, and Their Families from Social Justice Perspectives.

Cigrand’s journey in working with immigrant populations began when she was a counselor in an elementary school in rural Iowa in 2002. There, she worked with a young Hispanic boy who was new to the school. “He was in third grade and couldn’t speak any English,” Cigrand recalls. “After a couple of weeks, I could just tell he was really struggling emotionally, and so I started bringing him into my office. I didn’t speak Spanish, so we just started doing some drawings and trying to work through what was going on for him.”

Cigrand reached out to the Red Cross, which provided a translator to accompany Cigrand on a home visit to speak to the mother. “We talked about what concerns she had and obviously just the change from life in Mexico. It was kind of a culture shock [for them],” she says.

Cigrand now works in Minnesota with refugees and immigrants. The state has a large population of Hmong (95,000) and Somali (86,000) immigrants. Cigrand trains school counselors on how to help children and adolescents, many of whom are second- and third-generation residents. Their families often came to Minnesota for job opportunities.

Children experience trauma and stressors when their families are forced to flee or are trying to find a new home. But the stressors don’t subside after they reach their destination. “One misconception of immigrants and refugees is that when they arrive in the U.S., they are now fine, or at least safe. This is not the case,” Cigrand says. “Instead, we know they face trauma in all phases of their migration journey: during pre-migration, the migration journey and post-migration. Many Americans do not realize trauma continues to happen here in this country, and we are part of the problem.”

Research shows that the effects of pre-migration trauma can manifest as depression, post-traumatic stress syndrome and anxiety once a person has made it to their destination. This can be exasperated by encountering discrimination, unemployment, legal issues and resettlement stress.

Rogers says even food can present a barrier that isolates refugees. “A lot of the kids that I worked with at the shelters were being served food that wasn’t tasty to them. The youth complained about not being served rice or bread — both key staples of Afghan food — and not being familiar with or liking the Western dishes they were served,” she explains.

Even more so, cultural norms and requirements aren’t always met. For example, halal meat is extremely important to Muslims, but it may be challenging for Muslim refugees to find it. “We had to work with the shelters on making sure that they were providing halal meat,” Rogers says. Her group also helped shelters plan culturally appropriate meals.

Mental Adjustments to a New Life

Chanel S. Rodriguez, PhD, has extensive background knowledge in how to help immigrants and refugees adjust to their new life in the U.S. The daughter of a Cuban mother and Iranian father, Rodriguez grew up in Orlando, Florida, surrounded by people who had lived experience with forced displacement. Both of her parents came to or remained in the U.S. due to revolutions in their native countries.

The mental aerobics of adjusting to a new life can be simultaneously exhilarating and exhausting. Rodriguez got into professional counseling after an internship at Georgia State University during her graduate program led her to work with asylum seekers from Central and South America.

“I worked predominantly with children, adolescents and their families,” she says. “That’s when I really got into a lot of trauma work.”

Processing pre- and post-migration trauma is no easy feat. Rodriguez, now an assistant professor of counseling at Marymount University in Arlington, Virginia, explains some of the stressors that can be felt by children seeking asylum — a process that can take up to two years: “Asylum seekers have to be in the U.S. to start the asylum process. Most of them will tell you they just had to up and leave immediately because of safety. They have to get multiple, extensive background checks. They’re given temporary benefits, like health insurance and food assistance. They are expected to pay the U.S. government back for every single family member that had their transportation paid for. Imagine the stress.”

(For more on the stressors refugees face and assessment strategies, see the ACA practice brief “Counseling Newcomers and Refugees: Children and Adolescents” at bit.ly/RefugeePracticeBrief.)

Rodriguez says pre-migration trauma is often a precursor to mental health issues for refugee youth in the U.S. “When we talk about trauma, it comes from a white-centered ideology of one situation, maybe two.” It doesn’t acknowledge the “complexity of the trauma and the chronic trauma that many folks of color experience,” she says.

Adolescents may feel an additional layer of stress, as they often serve as the translator for their parents. Rodriguez strongly advises against using a child as a translator during counseling sessions. “These kids are parentified when they’re the translators of the language and cultural brokers of their parents,” she says. “As a bilingual therapist, I always push for bilingual therapy. …Don’t ask the bilingual client to do something we do not ask monolingual clients to do.”

How to Reach Children and Adolescents

Counselors and psychologists agree that play therapy can be one of the most effective ways to reach reluctant children. It provides the child with some autonomy over the session while giving the therapist a glimpse into their thoughts and feelings. Play therapy activities can include things such as role play, costume play, puppet play, sand tray activities or board games.

Rogers suggests using art to break through with adolescents. “We did a group on creating a mask and using that analogy in sessions: So, this is the mask that I wear when I’m at the shelter. This is the mask I wear when I leave the shelter and I’m in public. This is the mask I wear when I’m with my family,” she explains.

“Clients create these different masks, and then they describe them and the differences between them. You really begin to see some of the issues that they’re struggling with that maybe they can’t verbalize.”

Fakhro often involves the whole family in therapy.

“Most often, the refugees come from collective cultures, which means you have to involve the family as a whole,” she says.

She also suggests counselors focus on the child’s strengths instead of their issues. “If the child is curious, we can use the curiosity to help the child go through some of these issues,” she says.

Refugee children and adolescents experience profound challenges when immigrating to a new country. It takes culturally sensitive mental health care providers to help them process their trauma and build up their trust and confidence again. Providing an empathetic environment and respecting their journey are just some of the ways mental health professionals can support their healing.