Which therapists who treat immigrants heard

Erica Lubliner is a psychiatrist at the University of California, Los Angeles, directed a clinic that provides mental health services to Latinos. She provides care for a wide range of patients: first to fourth generation immigrants, including undocumented immigrants, as well as undergraduate and graduate students at UCLA, many of whom are the first to their families in college. She usually meets patients in the bright offices on the Westwood campus, with paintings of Mexican artists hanging on the walls, and children’s books are easily accessible. But, afterward ice Raid She moved on a date online, starting last month. She told me that Lubliner’s patients were safe in the clinic, “but even getting here can be scary.”

She’s heard of it ice Agents began to park outside some local hospitals. Many of her patients took buses or walked to appoint, and they were worried that they might be arrested on the way. “It is not wise for them to leave home, because ice “Agents have been hovering and patrolling the community. Many of her patients have increased doses of anti-anxiety medications, or started taking them for the first time. Some young patients have experienced intense separation anxiety while in school, fearing that they will return home and their parents will disappear. Many adults will ask friends and family to buy grocery stores for their children, or to leave the children.

back ice Lubliner arrested people at work and felt her patients’ pain. “ice Workers on the truck were chasing the gardener. She told me that their identities had cut their identities somehow. They feel they don’t need it. They feel targeted. “Some of her vulnerable patients participated in protests against the raids, but others struggled in the adventure. “They felt indulgent for those who didn’t participate, they felt helpless, they felt fearful, but they also felt important because silence was not the answer. ”

Lubliner is one of several psychiatrists and psychologists I have recently worked with immigrant patients for many years. They are familiar with the psychological harm caused by law enforcement crackdowns and anti-immigrant rhetoric in the past. But, as Dana Rusch, a psychologist at the University of Chicago, Illinois and director of the Immigration Mental Health Program, told me: “It’s different from people during the first Trump administration. It’s different from other immigration enforcement periods, even before the Trump administration. Her younger patients asked her why people hate immigrants so much, or they and their families. Rusch said she had a hard time answering these questions. (Her typical response is to talk about oppression in an age-appropriate way.)

Lubliner also saw the increase in emotional losses to her patients by this latest raid. In the first Trump administration, she was using child and adolescent psychiatry as a fellowship and witnessed a lot of fear. “Some kids are worried – there are some avoiding schools … people are afraid to go to doctor dates,” she told me. “But now people are stuck at home. It’s completely different. Now, kids are talking to their parents about B and Plan C if they are deported. One of her patients is so scared to go out that she won’t throw away the trash, so she has a neighbor who helps her. “People are being rushed to the streets and their families don’t know where to be taken.” ” “A level of horror that I’ve never seen before. ”

For many of these patients, their fears are reminiscent of the trauma of the past: their journey to the United States, and settlements. Those with memories of life in Latin America have reported experiences of extreme poverty, abuse or discrimination by family members because they are indigenous. Many people who recall their journey to the north remember suffering extreme violence: murder, physical and sexual assault, kidnapping, blackmail and forced labor. “They were forced to work in exchange for food and shelter, or were told they had to work for a while to get the next stop on the route,” Rusch told me. “This is true for unaccompanied minors, but it’s also true for families traveling together.”

Then they arrive in the country where the threat of deportation hangs on them. Many children encounter difficulties in school, and many adults are underemployed. Food may be scarce. They heard Trump administration officials say that all are criminals, many of them violent.

Rush told me that when patients sit in her office, they can sometimes realize that they are safe, at least compared to earlier moments. But their experiences bother them. It’s hard for them to trust people. “These are very normal reactions to your experience,” she told them. They have to be on guard as they try to walk from Central America to Mexico. Now they feel the same way, she said: “In a country they don’t know, people speak a language they don’t know, and where their status is unstable.”

Rusch’s patients have a condition she diagnosed with trauma and depression, but she wants to help them understand the source of anxiety. “My patient said, ‘Oh, it’s hard for me to notice. I can’t start and stop the task. I’m not a motivated person.” I like, “No, that’s trauma, that’s anxiety, that’s frustration,” she said. “I always tell them that this is a normal response to a particular situation. If I were to assess someone’s suicide, I asked, ‘Do you want you to fall asleep without waking up?’ This is one of the first questions.” She also noted that the standard approach used to assess the risk of suicide may be less effective for patients who deal with this kind of trauma: “Even the concept of how we assess risk is far superior in some ways because they, for example, ‘Yes, I’ve been through three years because I’ve been through three years.” Transparent

Rusch said many of her patients do not want to resolve their trauma. Instead, they want to talk about “they have the ability to be able to do in their daily lives”: how to get job authorization, acquire skills for a specific trade, learn English, be prepared to answer questions from immigration lawyers, or make money to send relatives home, which may make some people feel good and may feel good if their family members have been neglected or abused.

This makes a lot of sense for Rusch. “If you don’t have food, shelter and safety, it’s hard to talk about the higher-order safety of mental health,” she told me. “It’s not to say that one is less important, but it’s hard to jump from one floor to the next without a staircase.” So, cognitive behavioral therapy or CBT is one of the preferred methods of treating anxiety in immigrants and their families. The method is designed to help patients differentiate between real and imagined fears and can help patients learn to reframe when they imagine their own fears. This is more about problem solving than psychoanalysis.

But the fear of immigration is as real as ever. The family is being separated. Immigrants with legal status are being deported. Citizens are illegally detained. As Lubliner said to me: “At this point, it’s just Latinos a risk factor.” Therapists still use CBT to treat patients, but patients like Lubliner and Rusch See See See need to be modified for fear and anxiety.

One of Lubliner’s patients is a woman whose husband is ensuring legal status. However, when he attended the Immigration Court for mandatory inspections, he was detained and deported. They have three children and she takes care of them herself. She has been unable to fall asleep and has started taking anti-anxiety medications. Lubliner also began providing psychiatric care for her children, whose teachers were worried about their behavior at school and their inability to concentrate. Lubliner told me that this kind of case management goes far beyond conventional treatment courses and is now common. Jenny Zhen-Duan, an assistant professor at Harvard Medical School and a psychologist at Massachusetts General Hospital, said she also conducted “more case management than usual” for immigrant patients, extending her care to “connecting patients with legal services, mutual assistance, information about their rights.”

The therapists I spoke to said they encourage patients to face fear directly and work with them to come up with a plan to achieve the worst. How will they respond if they are detained or deported? If the child is separated from his parents, who can contact him? Where will family members try to meet again? These conversations can be difficult, but they can also help patients get a sense of agency that has at least some things they can control. “I backed off when I needed it, and I always realized that as a representative of the medical field, I was patching up the breach of trust in the hands of the healthcare system,” Lublina said.

Lubliner also tries to help her patients by sharing space with others. She hosted a group meeting called La Plática where Spanish-speaking people can discuss their experiences with each other. Because their stories are usually similar, they tell each other things like “Yes, what you say is very real, your fear, your anger, it works.”

In these meetings, Lubliner tries to “focus on practical things like how to get yourself out of combat or flight mode because when we emphasize, we can’t think – constantly reflect.” Participants meditate. They breathe together, which is not natural for many of her patients, because for them, it is like idleness. She encourages prayer to be a form of mindfulness, and sometimes they just sigh together, which she describes as a collective complaint.