Considerations When Counseling Immigrants and Refugees

The difficulties that immigrants and refugees experience as they transition to a new location can have a tremendous impact on their well-being. Many struggle to meet their most basic needs. Barriers to care are vast: Language, finances, and transportation are only a few of the factors that can prevent them from receiving the mental health care that they need.

We spoke to Ahou V. Line, MS, NCC, RPT, CSC, CCPT-S, LPC, and Mahera Badat, who work primarily with refugees and immigrants. Both shared information they consider especially helpful for other counselors serving these populations.

Shortly after Line was born in Tehran, Iran, her family fled the country, first to Germany and then to the United States in search of the “American Dream,” she says. Line provides counseling in English and Farsi.

“This has been such an asset, because there are often Farsi-speaking clients who may speak English but find more comfort in seeking services in Farsi,” she says. “It just allows for more authenticity in communication in the counseling relationship.”

Because she moved to the United States at a young age, she understands the plight of adolescents who are immigrants, she says, adding that many of them have a disconnect with their parents because they have such different experiences growing up in two completely different cultures.

“I love working with this population for so many reasons,” she says. “One of the biggest ones is allowing these children to have a voice and validate that their experience is hard. Secondly, because of my focus on engaging parents in sessions, I have found that communication between parent and child can become much healthier when a counselor can understand the clear divide and misunderstandings between huge cultural shifts in upbringing.”

Counselors shouldn’t assume that immigrant and refugee clients know what to expect from sessions, she says, “because there are many stigmas directed toward counseling, and because help-seeking behaviors are rarer, often our clients may be coming to us against the advice or recommendation of family and loved ones. This is so helpful for us to know as counselors, because it helps direct us to be more explicit about what to expect from counseling and helps us understand their own reasons for coming.”

For counselors, cultural sensitivity is essential.

“Examine your own biases and consider things like accents,” she says. “Often, many microaggressions are related to accents. Counselors may speak louder and slower to a client with an accent without recognizing the immense courage it takes to seek counseling that is not in your first language.

“I so often have counselors call with referrals with Middle Eastern families,” she continues. “The first question I ask is, ‘Did they ask for a referral for a Middle Eastern counselor specifically?’ We get nervous about our own competence and rush to make a referral when a client hasn’t asked for one. Consider the help-seeking behaviors of immigrants and the stigma related to mental health. If it took great courage for a client to call you in the first place and then you immediately refer them out, imagine how that can impact their help-seeking behaviors in the future.”

The more counselors learn about cultures outside of media portrayals, the more they will be able to demonstrate the cultural humility that puts clients at ease, Line says.

“Learn about countries from which refugees are coming to the United States. Learn about different languages and never assume that one country speaks one language or has one religion. Consider continuing education in different populations that could benefit your clinical work.

“Never assume and always lead with curiosity,” she continues. “Celebrate differences, and don’t assume that all presenting concerns are related to your client being an immigrant or a refugee. When you can really connect to understanding what it may feel like to be in an immigrant’s shoes, you realize the immense courage it takes for some clients to seek services.”

Though her family has lived in the United States for five generations, “We are visibly ‘brown’ and Muslim,” says Mahera Badat. “Given my identity, I have encountered experiences where people ask me where I am from and sadly, even tell me to go back to my country, whatever that means. This allows me to still identify with clients. Secondly, I speak Urdu, which allows me to take clients who speak Urdu, Hindi, and Punjabi.

“Many individuals share intense and often traumatic stories of their experience, and I am there to validate, empathize, and hear them,” she continues. “Though we are expanding our services and open to all ethnic groups, most of our clients identify as Afghani, Iraqi, Arab, and Somali.”

The culture shock that immigrants and refugees experience can be overwhelming, she says.

“Immigrants and refugees do not understand American culture, typically because most of them never planned on coming to the United States.,” Badat says. “Most clients I speak to had good lives in their country of origin and for a plethora of reasons were forced, or out of desperation, required to come.”

Hearing about the mistreatment that many of her clients have endured is extremely difficult, she says.

“Many people, specifically Americans, assume immigrants and refugees are going to take their jobs, or they are coming to the United States. for benefits, etc., but the sad reality is that most of them do not want to be here,” she says. “Most are well-educated individuals—doctors, nurses, business owners—and they struggle to find equivalent jobs in the U.S.; often they do not meet educational requirements for those jobs in accordance with U.S rules, and the processes to transfer a degree are hard. Additionally, immigrants and refugees go through years of waiting on the government to supply them with basic needs such as a permit so they can legally start working.”

Badat recommends that counselors create a professional network and keep a “resource book” including information on where to refer clients for help with housing, rent, employment, legal services, and other needs. She also recommends being patient when counseling.

“It can be taxing, especially when listening to their trauma, but remember to take care of yourself first,” she says. “This population can be very unfamiliar with counseling, but be patient and allow them to have a space where they can share, be heard and validated; sometimes that is all that is needed.”

Ahou V. Line, MS, NCC, RPT, CSC, CCPT-S, LPC, received her bachelor’s degree in psychology and child development from the University of Texas at Dallas and her master’s degree in school counseling and clinical mental health from Southern Methodist University in Dallas. In May of 2023, Line will complete her doctoral degree in counselor education from The University of North Texas. 

Mahera Badat received her bachelor’s degree in psychology and Islamic studies at the University of Texas at Austin. During her undergraduate studies, she was a program tutor at Amaanah Refugee Services in Houston. Badat was a member of the 2021 NBCC Foundation Minority Fellowship Program Mental Health Counseling Master’s cohort of fellows. She is currently a master’s student in the clinical mental health counseling program at Seattle University and is a Social-Emotional Wellness Counselor at Refugee Women’s Alliance in the Center for Social-Emotional Wellbeing.