By Sylvia A. Marotta-Walters, PhD
Today’s news focuses on building walls and securing borders in order to “Make America Great Again.” This begs the question: How does walling off anything lead to building greatness? An essential question for trauma psychologists becomes: What are the potentially traumatic experiences (PTE) that immigrants who cross borders without documents bring with them? In 2015, the American Psychological Association (APA) approved guidelines for education and training in trauma. Among these aspirational guidelines, known as the New Haven Competencies, are those addressing the need for culturally competent assessments and interventions. Two of the guidelines, which are cross-cutting and foundational, are presented here. These guidelines provide the framework for the complexities psychologists should keep in mind as the broader society raises questions about immigrants in the United States.
The Stereotypical Andrés
To illustrate the complexities of the assessment and treatment of Latina/o immigrants, let us hypothesize first that Andrés, an individual from El Salvador, is forced to leave his country because his life is threatened by drug cartels. He makes his way into Mexico and eventually finds himself in Brownsville, Texas. His destination is Houston, where he has friends who made the journey before him and who can help him find work. Employers in Houston are known to look the other way when hiring construction workers, as this allows the employer to successfully underbid those whose workers are legal.
The journey itself is fraught with PTEs, from the initial fear for his life, to fears of theft from the guide he has paid to help him cross, and fears of being imprisoned by Immigration and Customs Enforcement officers. Andrés proves to be resilient, finds stable (if hard) work, and makes meaning from his PTEs with the help of his support system in Houston. As a result, he may never seek out any form of psychological treatment. If Andrés does eventually seek treatment, the focus of assessment may not be the immigration-related PTEs, but could instead be about attachment injuries stemming from his early childhood having unfolded in the chaos of poverty and crime.
The Shadow Andrés.
There is, however, a large proportion of immigrants with PTEs who are not like Andrés at all. These Latina/Latino immigrants came to the United States on tourist or student visas (Pew Hispanic Center, 2006), outstaying their legal time, and melting into the shadows of life as undocumented workers. The Shadow Andrés is more common than the Stereotypical Andrés. These shadow immigrants live with a different kind of fear though they may work side by side with immigrants like Andrés. Their fear tends to increase with time; the longer such an immigrant is here, the more their social isolation might grow and contribute to overall psychological distress. This kind of fear may not meet criteria for posttraumatic stress disorder, but it does contribute to existential crises that may evolve into other forms of mental disorders.
The shadow immigrant may also choose specific areas of the country to live in for reasons of anonymity, though anonymity may result in further isolation (Documet, et al., 2015). Documet and colleagues (2015) call these communities “new growth communities” and psychologists who work in them may not have been previously exposed to Latina/o immigrants in their work settings. In fact, the southern region of the United States is the one that experienced the most growth in Latina/o populations from 1990–2000 (Marotta & Garcia, 2003), with North Carolina being one of the states with the greatest increase. The dominant population must accommodate an influx of people who are not like themselves and who choose to live in group housing, in part to replicate some of the support systems they have left behind. These group houses depart from the United States custom of one household per family, though they are culturally congruent to Latina/os.
New growth communities often do not have the infrastructure to support physical and mental health service delivery for new immigrants. Immigrants’ jobs are unlikely to provide health insurance so that access to services that are scarce to begin with is further impaired. The exposure criterion of a posttraumatic stress disorder diagnosis requires actual or threatened death or serious injury, which for the shadow immigrant may arise from a crime-infested neighborhood or from white Americans who threaten anyone who is a cultural “other” with bodily harm. Indeed, some of these threats could be coming from co-workers, thus creating daily exposure to danger. A culturally sensitive psychologist must be able to parse the individual differences that immigrants such as Andrés and his shadow counterpart bring to treatment, even though the two may share a country of origin and a similar developmental age. Clearly, assessments and interventions need to be tailored to the differences that each Latina/o presents.
From Research to Practice
Tailoring competencies to any cultural group requires translating what is known from research into practical applications. Thus, the knowledge, skills, and attitudes comprising a set of competencies must be adapted to the cultural context in which the practitioner works. This kind of tailoring is a combination of science and art. To illustrate the tailoring process in the case of immigrants like both versions of Andrés, the focus of this article shifts to the cross-cutting competencies that bridge the specific competencies outlined in the APA document. Two of these cross-cutting competencies are lifespan awareness and practitioner self-awareness.
Both Stereotypical Andrés and his shadow counterpart are adults who, though they may be of similar age at the time they present for treatment, may have significant differences in PTEs and in the developmental stages at which these were experienced. Early separations from primary caregivers sometimes are necessitated by dangerous neighborhoods, with Latina/o parents being willing to separate from their children in order to keep them safe. Stereotypical Andrés might have been sent away from his family at an early age, even before the necessity for emigration arose. His development may have been disrupted and his ability to trust could have been compromised. Conversely, Shadow Andrés may have been considered a self-sacrificing pioneer who was willing to leave his family in order to come to the United States. He leaves his country with a secure attachment. Thus, his and his family’s motivations can affect subjective appraisals of what happens to him subsequently. Shadow Andrés may have “hero” status in that he sends money home to his family and is considered successful for having found steady employment.
Developmentally, Shadow Andrés has a foundation of ego strength, which may be lacking in Stereotypical Andrés. Trauma psychologists know that early exposure to deficient environments or adverse experiences in childhood can be risk factors in the later development of psychological and even physical distress. Such an awareness of the implications of developmental trajectories on a presenting concern is a cross-cutting competency. Part of a developmentally aware assessment involves factoring in strengths that treatments can build upon as PTEs are metabolizing in treatment. Strengths- such as the capacity to trust or to be confident in one’s identity, while not traditionally considered essential to the diagnostic process, are nonetheless important to include from a culturally competent approach to assessment and intervention (Marotta, Choi, & Shaine, 2015).
The second cross-cutting competency that influences psychologists’ assessment of Latina/o immigrants is an awareness of how one’s own life experiences and implicit biases may play a role in service delivery. Implicit biases are a human characteristic to which we are all subject. Psychologists are encouraged to use stereotypes as a foundation for generating hypotheses that can aid in clinical decision-making. This is sometimes termed an etic approach, defined as an outsider looking in to a culture that is not one’s own. For example, resources such as Ethnicity and Family Therapy (McGoldrick, Giordano, & Garcia-Preto, 2005) provide information about cultural groups that clinicians can use to check whether values and beliefs ascribed to Latina/o cultures are applicable to the specific person in the office. This can help the practitioner recognize and develop particular risk and protective factors to be considered in treatment planning.
The challenge in using a purely etic approach is that implicit biases on the part of the psychologist may create an us/them mentality that impairs the development of an effective working relationship with the client. In today’s politically charged discourse about Latina/o immigrants, such implicit biases can be presumed to be even more difficult to bring to conscious awareness, as psychologists are inundated with messages about Latinos as criminals, as people unable to adapt to United States culture, or simply as “other.” This negative cognitive overload makes an etic approach especially problematic as it could widen the gap between the psychologist and her or his Latina/o client on an unconscious level.
The United States cultural value of independence may also unwittingly reinforce the difference between the self of the psychologist and the client as other (Sparks, Cunningham, & Kritikos, 2016). Brown (2009) attempts to address this gap by suggesting that in trauma-focused work, an emic approach may be more effective, wherein we as humans participate in traumatic experiences together and thus can assume a we/us stance in working with those from other cultures. Our common experience is that the majority of the population is exposed to PTEs (APA, 2015). To be consciously aware of our biases means to engage in a dialectic of self-examination and exploration of the cultural messages we absorb from our social milieu. This dialectic is an iterative process that is repeated throughout the course of assessment and treatment.
Becoming a culturally competent trauma psychologist in the middle of today’s divisive national conversations about immigration is a timely consideration for all of us. It requires all psychologists to re-focus on the foundational competence of diversity, and for those trauma psychologists who live and work in geographic centers for migrants, it is an essential exercise in professional development.
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Sylvia A. Marotta-Walters, PhD, ABPP, is a Professor of Counseling in the Graduate School of Education and Human Development (GSEHD), at the George Washington University in Washington, DC. Her research focus is on the spectrum of trauma and stress disorders, with a particular emphasis on the developmental consequences of trauma exposure and diversity issues in counseling.
Most recently, Marotta-Walters published on combat veterans and resilience, and on the psychospiritual development of individuals with a history of clergy-perpetrated sexual abuse. In 2015, she was invited to speak at a conference on terrorism in Madrid. The conference was held at the Universidad de Complutense, one of the oldest academic institutions in Spain. Marotta-Walters continues to collaborate with faculty there. Marotta-Walters is an associate editor for Psychological Trauma: Theory, Research, Practice, and Policy, and previously served on its editorial board. Additionally, she has served as an associate editor for the Journal of Counseling & Development.