Clients of all backgrounds may have experienced trauma, but some circumstances make it much more likely. Clients with multiple intersecting marginalized identities require particular consideration from counselors.

Mina Attia, PhD, NCC, has studied the experiences of LGBTQ+ people who are current or former asylum seekers. His research has been published in the Journal of LGBTQ Issues in Counseling and The Counseling Psychologist.

Dr. Attia and co-author Dr. Bagmi Das recently presented on the topic of their research at the NBCC Foundation’s 2024 Bridging the Gap Symposium: Eliminating Mental Health Disparities, which was held from March 15–16. We spoke to him about how counselors can best employ a trauma-informed approach to their work with this population.

Tell us about the impetus for your research and your overall findings.

There's a big misconception on who these folks are, and there's a lot of interchange between the use of “refugee” and “asylum seeker.” These are both people who are fleeing persecution or because of fear that they will be persecuted based on race, religion, nationality, membership in a particular political opinion, or a membership in a particular social group. That is the same, but the process is what differentiates refugees and asylum seekers.

Refugees are coming into the country with an adjusted status of refugee, so they're not having to apply from the ground up. Most of the time, that is done outside of the USA. Asylum seekers, on the other hand, are coming to the USA and seek asylum once they get to a port of entry or once they’re inside the United States.

In one study, we looked at the overall experiences of trauma and adjustment of LGBTQ+ asylum seekers, and in the other, we were looking at the experiences of post-traumatic growth and resilience. After we completed the first study, we realized there was a lot of focus on the trauma, the difficulties that people go through—and that's important. But there was not much focus on what the post-traumatic growth looks like. What is the resilience that this population displays and what are the factors that go into why these folks are so resilient and make it on the other end?

Asylum seekers and LGBTQ+ individuals are both more likely than the general population to have experienced trauma. Should counselors be aware of additional concerns or complicating factors for these intersecting identities?

We know that all asylum seekers have experiences of trauma at some point, and one of the reasons why they're fleeing is typically related to an experience of trauma. In many countries, these are folks who are fleeing because same-sex activity is punishable by death. Relationships are criminalized; transgender people are brutally murdered. They’re living in this constant state of fear.

One thing that counselors can do is examine the impact of the state of trauma on adult development. Often with these individuals, it's not like an isolated incident of trauma; it’s actually this ongoing state of trauma that they're living in. So, it is important to consider how that has an impact on someone’s development.

Also looking at things from a lens of intersectionality. For example, looking at the impact of religion as well as LGBTQ+ identity, looking at socioeconomic status, looking at educational status, looking at the impact of racism on folks.

There was one participant that I spoke with from Ghana, who said that while he was extremely discriminated against back home for his queer identity, he had never experienced racism until he came to the United States. So, recognizing all these things that we're talking about, we have to view them from an intersectional lens, especially for counselors.

What challenges have you faced when trying to build trust and the feeling of safety with this population?

While a counselor may think that we want to connect these people with folks from their community, a lot of times people actually don't want to be connected to that community, because it takes them back to the same traumatic experiences that they went through. Sometimes asylum seekers who require interpretation services would actually prefer an interpreter that’s not from their same background, from their same home country. 

What we know works is connecting with affirming spaces, to connect them with folks who have similar experiences and in spaces that affirm their identities. That is really key to a healthy adjustment after migration.

Is a trauma-informed approach necessary for a counselor working with the LGBTQ+ asylum-seeker population?

Absolutely, especially because this population has many layers of trauma that they experience. They experience trauma premigration, during migration with fleeing and the journey, and then they experience trauma postmigration when they're getting resettled and going through the asylum process. With these multiple layers of trauma, for counselors to do this work correctly, they have to do it from a trauma-informed lens.

What considerations of trauma-informed care are most relevant for LGBTQ+ asylum-seekers?

One important thing is knowing resources that you can connect folks to. A lot of times, if folks are new to the country, they're trying to figure out, what are some LGBTQ plus friendly services that are around?

They need services for legal assistance. They need services for housing. They need services for mental health and physical health. So, being connected and having a list of resources of affirming services for this population will also be really important.

The asylum process actually imposes a restriction that prevents the seeker from working or earning income for 180 days. It's a very difficult position to be in while immigrating to a new place. Migrants don't necessarily have a family here anyway, but with this population, they're often ostracized from their families because of their identities. So, they're really having to start with nothing. 

Does a trauma-informed counselor need additional training or preparation to work with this population?

We don't have formal training on how to work with the LGBTQ+ asylum seeker population. But through research like this, through attending conferences that have sessions that focus on this, counselors can get additional training on working with this population—and they should. If a counselor is not competent in doing this work, they actually should avoid it. Because if you're not able to clinically work with trauma, then you could actually end up doing more harm.

Is the asylum-seeking process itself potentially traumatic?

LGBTQ+ individuals who become asylum seekers typically go through life in a very hidden way. The asylum process is very unique because they must be outed—it's an outing process for them in order to apply for asylum.

You're applying based on this one very sensitive thing that you've never talked about before. So that alone can be a very traumatizing experience, especially when you've lived in a very fearful, closeted way your whole life.

We also know that asylum seekers who are members of this community will be detained two times as long as their counterparts, and they are 97 times more likely to experience sexual victimization during detainment—97 times.

Counselors are in the forefront of providers who can support this population both through clinical services and through advocacy. Counselors can advocate for a trauma-sensitive asylum process.

We know that there are a lot of hurdles for folks, and many times the experience is not trauma-sensitive. We're dealing with folks who have experienced a lot, and with trauma, it could be easily triggered.

What are we putting in place to make sure that folks are telling their stories and feeling supported throughout the asylum process? Improving this process helps society in general because the more that we're helping folks be healthy and integrate into society, the healthier we are as a society.

Dr. Mina Attia, PhD, NCC, is an Assistant Professor of Counseling and Human Development and Co-Director of the Clinical Mental Health Counseling Program at The George Washington University in Washington, DC. His research agenda consists of two main branches. The first focuses on trauma and adjustment of immigrants, refugees, and asylum seekers. The second explores multicultural issues of ethics and professional identity development in counseling. Dr. Attia's scholarly pursuits span nationally and internationally with publications in professional peer-reviewed journals and conference presentations, trainings, and lectures.

Dr. Attia has practiced mental health counseling in various settings. His clinical experiences include psychiatric rehabilitation, outpatient private practice, university-center counseling, as well as clinical supervision of counselors-in-training.