MFTs and the Lingering Problem of Child Separation at the Border

“When you lose everything, including your family and your sense of self, it is critical that you have therapeutic help,” says Damir Utržan, PhD, an AAMFT Professional member holding the Clinical Fellow and Approved Supervisor designations, and manager of mental health services and adjunct assistant professor at the Hazelden Betty Ford Foundation.

It is challenging, however, to identify those in need, connect them with the right professionals, and get them to participate in therapy and have a successful outcome, Utržan and other professionals working with these clients say.

Utržan and his family faced challenges with immigration policy before seeking asylum in the U.S., and he has worked on and written about the issues related to immigrants and refugees. He says it is important to understand that they have distinct individual histories, issues, and needs.

“It is critical to approach work with this population with curiosity and humility,” says Laura Ganci, PhD, a marriage and family therapist who now serves as director of research and planning for Children’s Services Council of Broward County, working with immigrants from many countries.

“Even being a Latina, I had to learn the nuances of the people who I was working with. The differences in culture and in their often-traumatic experience requires a willingness to discard assumptions and explore with them patiently. Even professionals trained to be objective and to subdue their biases may need to go one step beyond to avoid another layer of assumptions about immigrants or persons from another culture.”

She believes that the cultural, political, and personal issues of these clients—especially children separated at the border who have suffered trauma there—create a unique challenge, but that their problems are often even more nuanced than is sometimes assumed. 

The issue and results

The United States began to restrict immigration in the late 1800s, but continued to accept immigrants from many countries. It continued to have one of the most open immigration policies in the world, taking pride in welcoming others with laws that made immigration relatively easy and gestures and symbols that promoted it, such as the Statue of Liberty. In the early 1900s, a wave of immigration after the world wars prompted more restriction, and in the following two decades, concern about the southern border began to grow, although those entering were often welcomed into the workforce to fill low-paying, challenging jobs. 

Presidents addressed the issue in various ways, and Donald Trump made immigration the centerpiece of his campaign, calling for a border wall, expulsion of any illegal immigrants and a Muslim ban—along with strict policies about those arrested at the border. Trump’s policies were blamed for more than 3,000 children being separated from their families at the border, although Trump and his supporters say similar policies were in place and resulted in such separations during the Obama administration.

Since that time, the work of a task force set up by President Biden by early June 2021 had resulted in fewer than 40 of the families being reunited, though the administration has vowed to keep working on the problem.

While children who have undergone difficult circumstances during immigration are likely to have suffered emotionally, those who have been detained, and especially those separated from their parents, have particularly challenging layers of trauma, according to Ernestine Briggs-King, PhD, director of the data and evaluation program at the UCLA-Duke University National Center for Child Traumatic Stress and an associate professor in the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine.

“Some youth may have lost their connections to their primary caregivers by embarking on this journey, while others may have encountered the violent death of loved ones or others traveling with them,” she says. “Some may have had to take care of themselves or younger siblings, or may have experienced or witnessed violence, abuse or other atrocities. They may have been in places that were crowded, without sanitation, or simply without food and running water for prolonged periods.”

She says those experiences and the probable lack of support or treatment are likely to result in “a complex presentation of PTSD symptoms.”  

Beyond that, says Ganci, they face the stigma connected with being an immigrant, a problem worsened by the heated political discussions about their status, which they often become acutely aware of and respond to emotionally. 

A careful, thoughtful and holistic assessment therefore is critical, she says, more thorough than might be typical.

First steps

She and others say that while the trauma for a variety of reasons may be difficult to talk about, some cultures or families don’t look favorably at therapy or understand its role. Language itself may be an issue.

Jason Platt, PhD, an AAMFT Professional member holding the Clinical Fellow and Approved Supervisor designations, lecturer at the University of Nebraska-Lincoln, and a bilingual therapist based in Mexico City, says the training of therapists often does not prepare them to comprehend the complex problems of clients from another culture and country who have also suffered dramatic immigration related trauma. Children separated from family just add to the trauma. 

He says U.S. therapists may “conflate immigrant background and cultural backgrounds as being the same.” He also does not believe that training programs for therapists prepare them for work in a “globalized and interconnected world.” 

When you lose everything, including your family and your sense of self, it is critical that you have therapeutic help.

We also often don’t teach enough about relevant sociocultural histories of other nations, and so when we treat individuals and families from other national contexts, therapists are likely limited in their ability to be effective.

“It is difficult for us to see how very U.S.-oriented our approaches are, and we rarely teach healing practices that developed in other parts of the world. We also often don’t teach enough about relevant sociocultural histories of other nations, and so when we treat individuals and families from other national contexts, therapists are likely limited in their ability to be effective.” 

Ganci agrees. “[Training] programs do tend to provide a very general overview of cultural awareness and cultural differences, typically through one required diversity course. However, the models are largely Eurocentric,” she says. “Simply having a diversity course about ‘cultural competence’ is not enough because we are still being taught from one lens about things like what is healthy or typical, how we view relationships, how we change, and even the production of knowledge or research. A general awareness of cultural differences doesn’t require students to really deconstruct the models and examine if those approaches align with certain values of other cultures.”

She says a single diversity course adds a “shiny layer” but doesn’t help if underlying assumptions exist or students are not asked to dissect models and approaches and reflect on how they come from a specific ideology.

She also says more self-reflection is needed, asking students to consider their own belief system, their own privileges, biases, assumptions and how their lens may filter another person’s experience. 

Awareness of other cultural customs is important. For example, she notes that sometimes in Latin cultures there is a certain type of spiritualism—even concern about curses, or what is called “mal de ojo,” which translates to “evil eye.” Not understanding beliefs such as that, rooted in the culture—or at least having been prepared to learn about them—makes therapists less effective, missing an opportunity to make inroads or perhaps offending a client by not acknowledging their significance.

Beyond that, Latinx people have different ideas about what are the most valuable human character traits, or about authority, or about how we interact socially—which can create subtle barriers and make them wary of therapeutic sessions, generally.

Even the differing immigration status of family members can have a dramatic effect on relationships and emotional health, Utržan says, but is not something therapists may immediately consider.

As the 2016 presidential campaign rolled on, unaccompanied minors poured across the Mexican border, most arriving from Central America; in particular Guatemala, Honduras, and El Salvador.  

Treatment strategies

For treatment, Utržan has advocated for a “wholistic approach” that considers the many factors affecting these clients, starting with an assessment that “takes into account people’s cultural values, beliefs, and attitudes” and “contextual factors such as the sociopolitical climate.”

“MFTs often broker interdisciplinary collaboration between physicians, attorneys, and social workers. Research suggests that an integrative approach is the most appropriate when working with refugees and immigrants,” he says. “MFTs are in a unique position to help refugees and immigrants overcome insurmountable obstacles. They are trained to not only embrace complexity but also instability and uncertainty.” 

Briggs-King says she believes trauma-informed strategies are valuable because they “recognize the need for attention to linguistic, cultural, developmental issues in addition to the need for physical and emotional safety.” 

“There are a range of treatments and promising practices that have been used with this population to meet their diverse needs. Everything from group, family, and individual cognitive behavioral treatments to the inclusion of expressive arts and mindfulness.”

Ganci believes narrative therapy may also be helpful because she has found that she makes progress with understanding these clients and helping them when they are telling and examining stories about their lives. It may be particularly effective with children who have undergone difficult circumstances.

Utržan agrees. “Narrative exposure therapy draws from other behavioral models and assists people in re-constructing their narrative or story to achieve a coherent identity. He also recommends cognitive behavioral therapy to help people identify and correct biased thinking that contributes to maladaptive behaviors and structural family therapy.” 

“With a strong social justice component, SFT views structure and boundaries as critical components of functioning. It empowers couples and families to restructure their thoughts, behaviors, and interactions” he notes.

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