Ten Psychotherapeutic Considerations to Assist Young Undocumented Latinx

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TEN PSYCHOTHERAPEUTIC CONSIDERATIONS TO
ASSIST YOUNG UNDOCUMENTED LATINX
MARTIN J. LA ROCHE, PH.D. 1, 4
ALICE S. LOWY, M.A. 2
CARLOS E. RIVERA, M.S. 3
Currently there are over 11 million undocumented Latinx
in the U.S., with more than 9 million living in mixed-
status families, in which at least one family member is
undocumented (Taylor, Lopez, Passel & Motel, 2011;
U.S. Census Bureau, 2013). Undocumented Latinx face a
myriad of severe stressors that range from inappropriate
medical services to the risk for deportation. Furthermore,
approximately 800,000 undocumented youth who were
previously protected under the Deferred Action for
Childhood Arrivals (DACA) program are likely to face
similar threats, as well as 300,000 more that were eligible
for DACA benefits (Krogstad, 2017). Despite the large
number of undocumented Latinx and the significant
mental health stressors they face (Garcini et al, 2016)
many clinicians are ill-prepared to address these issues.
The main aim of this paper is to outline ten
psychotherapeutic considerations that can assist mental
health clinicians effectively treat young undocumented
Latinx. Although these ten psychotherapeutic
recommendations may also be useful with non-Latinx
immigrant communities, we specifically focus on young
Latinxs because much of our experience is with this group
in particular.
1. CLINICIANS CANNOT BE NEUTRAL IN THE
FACE OF INJUSTICE
As soon as clients start narrating their experiences of
injustice with the immigration system, it is helpful for
clinicians to validate them. In sharp contrast to many
traditional psychotherapy models, in which the therapist’s
political views are not articulated, it is helpful that these
beliefs be shared with clients. This not only legitimizes
clients’ concerns, but also allows them to feel safe and
examine these issues further. It is often difficult for clients
to trust their therapists if the relationship does not rest on
these common beliefs. Thus, clinicians who share similar
political views may be more effective with undocumented
clients.
2. CLINICIANS CAN INQUIRE ABOUT FAMILY
MEMBERS’ IMMIGRATION STATUS
If families do not share their immigration status,
clinicians can inquire about it but only after reassuring
them that what is said will remain confidential. Many
families have had negative experiences with different
American institutions and may not readily disclose their
immigration status because of past experiences.
Consequently, clinicians need to be informed on how
clients’ immigration status will be protected (e.g.,
information will not be documented in the medical chart)
and accurately convey this information to them.
Furthermore, before asking about immigration status, it is
helpful to normalize families’ experiences of mistrust and
share examples of how psychotherapy has been more
effective when this information is disclosed. By inquiring
about immigration status, the message is conveyed that
this is not only a significant issue that can be discussed
within the session, but also that it is not insurmountable.
However, it is also imperative to underscore that families
can refuse to answer any questions. Otherwise, clinicians
may replicate the oppressive power dynamics that many
undocumented immigrants have repeatedly experienced in
the United States. As families begin to realize that they
1. Boston Children’s Hospital at the Martha Eliot and
Harvard Medical School
2. Northeastern University
3. Suffolk University
4. Address correspondence and reprint requests to:
49 Hancock Street, Suite 104, Cambridge MA 02139
E-mail: Martin.Laroche@Childrens.Harvard.edu
Authors’ Note:
The authors would like to acknowledge the contribution of
Andrew Richards, Psy.D., Elise Gottesman, LICSW, Daniela
Sanchez, LCSW, Olivia Carrick, M.D., Nelson Brill, Esq.,
Kathrine Papplinger, LICSW, Apolinar Quezada, and Luz
Garcini, Ph.D.

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LA ROCHE, LOWY, & RIVERA
can decide what to address in session, they may start to
feel empowered.
3. CLINICIANS MUST HELP FAMILIES TO
ESTABLISH SAFETY PLANS
It is important that families with undocumented
members and children develop and rehearse safety plans
in the event of detainment or deportation. Safety plans
should, for example, include appointed guardianship for
the children, which may also help them feel less fearful of
the process. In addition, clinicians can refer families to
recently developed toolkits, such as Defending DACA: A
Toolkit for DREAMERs (Chavez-Dueñas & Adames,
2017) to address additional concerns. Although rehearsing
safety plans can initially increase anxiety levels in many
family members it may ultimately help families gain an
enhanced sense of control. Furthermore, the way in which
they respond to confrontations may have a significant
effect on the outcome. Frequent rehearsals of the safety
plan can allow families to remain calm in dealing with
provocations from officials. By collaborating with
families on their safety plans, clinicians are reinforcing
the families’ sense of power over the situation and
helping clients use these plans as coping strategies when
they begin to feel more anxious or concerned about the
future.
4. CLINICIANS MUST LEARN ABOUT THE
FAMILY AND ITS STRENGTHS
Before intervening with the family, it is vital that
clinicians learn about the family and its dynamics. In
contrast to the traditional White American nuclear family,
the Latinx family often extends to individuals who are not
blood relatives (e.g., compadres, neighbors), who can
become central in developing safety plans. It is possible,
for example, that a Latinx family would rather leave their
children with a compadre instead of an aunt or uncle.
Relatedly, clinicians should explore levels of family
communication and conflict rather than assuming that the
family will provide emotional support. Unfortunately, the
enduring socioeconomic conditions associated with being
undocumented (e.g., lack of economic opportunities,
limited health care access, workplace exploitation) are
frequently correlated with distress and additional negative
mental health outcomes (Garcini et al, 2016), which could
hinder the possibility of supportive immigration
discussions within the family. Although the high levels of
family distress may make it more difficult for youth to
receive support from family members, these high stress
levels also underscore the need to include the family in
the treatment process.
5. CLINICIANS SHOULD HELP FAMILIES
MANAGE FEARS AND PSYCHOLOGICAL
SYMPTOMS
Collective anxiety is growing within the Latinx
community as reports on raids and deportations increase
(e.g., Gomez, 2017) and as alarming executive orders are
signed (e.g., rescinding DACA or pardoning Joe Arpaio)
(Rhodan, 2017). These fears combined with ongoing
socioeconomic limitations and experiences of
discrimination can retrigger symptoms of post-traumatic
stress, particularly among undocumented immigrants who
have often experienced traumas in their birth countries or
through their journey to the United States (Rasmussen,
Rosenfeld, Reeves, & Keller, 2007). For example,
Amnesty International (2013) estimated that 60% of
women and girls are raped or experience sexual violence
during their journey crossing the border. Similarly,
LGBTQ youth are often bullied more frequently than
other adolescents (Crothers et al, 2017), and the worry of
being deported to countries in which they could be
mistreated even more severely can generate much fear
and anxiety.
It is imperative that clinicians help families
understand how their emotional responses to current
events are affecting them. Establishing links between
adverse events and psychological symptoms helps
families understand, validate, and gradually manage their
distress rather than blaming themselves for these
difficulties (La Roche, 2013; Martin-Baró, 1994).
Understanding that their distress is aggravated by unjust
immigration conditions gradually allows families to feel
more in control. Just as psychoeducation is helpful in the
psychotherapeutic session, it is also important that factual
immigration information be discussed in the session. If
clinicians are not knowledgeable about this information,
they should refer families to someone who is. Families
can also use recently developed apps that monitor if a raid
is in process in real time/place (e.g., Migrawatch). As
information is presented to families, some of their fears
may start to dispel. Similarly, many Latinx are prone to
express anxiety and depression through somatic
symptoms (Falicov, 2014), and it is beneficial to provide
them with psychoeducation about how their symptoms are
exacerbated by immigration stress. It is also helpful to
teach them coping strategies (e.g., relaxation techniques,
diaphragmatic breathing, prayers, mindfulness) to manage
symptoms more effectively. Psychotherapy strategies are
more effective if they are congruent with the families’
beliefs and coping strategies (La Roche, 2013). Some
clients, for example, may prefer praying rather than
visualization techniques.

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6. FAMILIES AND CLINICIANS NEED TO
QUESTION IMMIGRATION POLICIES
It is important that families and clinicians
examine and question the sociopolitical meaning of
current immigration policies. Clinicians can help families
question why immigration policies are currently being
enforced more strongly, why undocumented immigrants
are being portrayed as “others,” or why prominent public
figures are depicting undocumented Latinx as rapists,
criminals, and burdens to the American economy. These
dehumanizing messages can diminish feelings of ethnic
pride, agency, and hopefulness (Adames & Chavez-
Dueñas, 2017) which can be particularly damaging for
children and adolescents’ emotional development.
However, as families deconstruct the meaning of
immigration policies, they may realize that there is
nothing “bad” with them and that, instead, there is
something wrong with current American immigration
policies. As children and their families question the
existing immigration discourse, they can start inoculating
themselves from dehumanizing messages.
7. CLINICIANS SHOULD HELP FAMILIES
IDENTIFY ADDITIONAL SOURCES OF SUPPORT
Weekly psychotherapy may be insufficient to
help families cope with ongoing and severe immigration
stressors. Families may feel isolated as well as fearful of
discussing their immigration status with others. Children
and adolescents may be especially confused about their
family’s situation, and informal social support groups
(e.g., religious or school groups) can provide them with
additional and timely aid. LGBTQ support groups for
undocumented youth may be particularly useful for
adolescents whose concerns may not be acknowledged in
other settings. In addition, support groups can be enriched
by inviting professionals (e.g., attorneys, social workers,
or psychologists) to provide education around policies
and legal representation.
8. CLINICIANS MUST BECOME INFORMED OF
POLICIES AND PROCEDURES
Mental health providers need to know their
institutions’ policies towards the assistance and treatment
of undocumented families. These policies have important
treatment implications, such as who can access mental
health services, how undocumented families are billed,
confidentiality issues, or even what services are available
for them. If the provider’s institution has not developed a
policy for undocumented immigrants, providers should
encourage the development of such policies. Consistent
with APA guidelines (2012), psychologists should
advocate for the well-being of all clients, documented or
not, within their workplace.
9. CLINICIANS MUST PRACTICE SELF-CARE
AND ADVOCACY TO BE EFFECTIVE
Working with undocumented immigrants may be
emotionally fulfilling as families start to bloom under the
right conditions; however, it can also be distressing. Many
clinicians experience painful emotional responses as they
repeatedly hear stories of injustice that also need to be
processed in supervision and consultation. Given these
stressors, the need for providers to engage in self-care
activities and not to overextend themselves cannot be
emphasized enough. To avoid burn-out, it is also
encouraged to work within multidisciplinary and
multiethnic teams that include psychologists, social
workers, attorneys, and physicians that have access to
different types of information, experiences, and skills.
Similarly, these teams can be a source of emotional
support for providers. Through these teams, clinicians can
organize training seminars to educate and support co-
workers or colleagues, as well as provide general
consultation regarding challenging cases. In addition, it is
useful for clinicians to exercise their rights as citizens and
condemn deportation policies through political marches,
rallies, calling elected officials, or through our
publications. It is important that mental health providers
and researchers have an active role in informing the
public of the benefits of sharing cultures and learning
from differences.
10. FAMILIES AND CLINICIANS CAN START
TRANSFORMING THE SOCIOPOLITICAL
CONTEXT THROUGH CULTURALLY
INFORMED DIALOGUES AND
PSYCHOTHERAPY
An enhanced understanding of social injustices
(e.g., unjust immigration policies, racial profiling, etc.) is
a first step to empower communities to struggle against
them (Freire, 1970; La Roche, 2013; Martin-Baró, 1994).
Consistent with this idea, we are finding that as people
discuss and identify these injustices in psychotherapy,
they can effectively organize themselves and respond to
them. In fact, we are finding that many undocumented
families are starting to assist others and share information,
which not only buffers them against negative mental
health outcomes and strengthens their support network,
but also empowers them to advocate for their needs.
Furthermore, we should not only focus on assisting
undocumented Latinx immigrants, but all. As we discuss
the current sociopolitical context within the
psychotherapy session, we are creating a space for clients

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and families to start questioning and challenging it within
their communities.
CONCLUDING REMARKS
Diversity has opened and broadened our economic,
intellectual, and personal possibilities. Unfortunately,
during many periods of our country’s history immigrants
have not been welcomed and have been criminalized and
traumatized (e.g., deporting or separating them from their
families). A rise of tribal narrow views is not only
harmful for undocumented immigrants, but also questions
our moral ground and can limit our growth as a country. It
is critical to counter these toxic narratives and policies by
acknowledging the needs of all people, resisting racist
policies and empowering communities to struggle for
justice. It is also important to note that many Latinx are
striving despite much adversity, which is a testament to
our strength and resilience. Our hope is that as we truly
hear each other, going beyond racism, heterosexism, and
socioeconomic injustices, we will reclaim the humanity of
all individuals, irrespective of race, gender orientation or
immigration status.
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