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Staff Therapist Tracey Tanenbaum featured in Princeton University Migration Reporting: Supporting the Mental Health of Afghan Migrants Requires Cultural Humility, Deliberate Pacing, and Willingness to Listen

October 28, 2021 | The Refugee Health Technical Assistance Center identifies three stages for the refugee experience: preflight, flight, and resettlement. Each stage can incur mental health conditions in refugee populations, with common diagnoses including PTSD, depression, and major anxiety. As Afghan evacuees rapidly move through these stages, supporting their mental health is crucial.

According to professionals working to promote refugee mental health and wellness, being mindful of cultural differences, actively listening to and prioritizing evacuees’ voices, as well as not being too quick to act, is exceptionally important in delivering the best care to these populations.

“Because there’s a lot of trauma, try to provide what’s called ‘trauma-informed care,’” said Tracey Tanenbaum, a staff therapist at Council for Relationships in Philadelphia. “And when you provide trauma-informed care, the idea is that the client, not the therapist, is the expert in their own experience . . . They are in charge of telling their stories.”

Council for Relationships is a non-profit therapy provider, and Tanenbaum is a liaison for a partnership the Council has formed with Nationalities Services Center (NSC), a resettlement agency also in Philadelphia. The goal of the partnership is to provide mental health counseling to refugees in the Philadelphia area after they have been resettled.

While Tanenbaum has not worked directly with refugees, from her professional experience, as well as from the training she’s undergone for the partnership with NSC, she said she believes that Afghans are dealing with multiple forms of trauma, and what therapists working with traumatized patients try to do is listen and support them.

“It’s really important to help people identify the strengths that they have, one of those strengths being their own culture, and their family,” Tanenbaum continued.

Dr. Jeff Winer, a clinical psychologist and researcher at the Trauma and Community Resilience Center at Boston Children’s Hospital, also emphasized the importance of listening before taking action, especially as Afghan migrants are in the acute resettlement phase, which involves initial arrival and outreach from government programs.

“I think a misstep is being eager to intervene as opposed to be eager to listen,” Winer said. “And I think that can create this kind of overly top-down, patriarchal, colonizing kind of thing of like, ‘Oh, we’re going to tell you, here’s the thing, here’s the intervention. I’m a psychologist; let me teach you the thing.’ Usually it’s not effective.”

Winer recognizes that because a lot is happening at once right now, there can be eagerness to set things in motion, but stressed the importance of elevating cultural experts.

“I’m a white man. I never lived in Afghanistan, and I don’t speak the language,” Winer continued. “The value that I’m going to add, part of that is connecting and advocating and integrating people who have that cultural knowledge and cultural expertise.”

Winer is involved with the National Child Traumatic Stress Network (NCTSN), an organization that aims to improve treatment for traumatized children. NCTSN has published information on understanding refugee trauma, and it foregrounds the importance of cultural awareness, providing guidance on how to approach treating refugee children, including a recommendation to, “Identify how to access linguistic support and cultural resources (e.g., interpreters).”

Gwen Soffer, manager of wellness services at NSC, stressed the importance of having interpreters available when counseling refugees. Soffer described how language barriers can lead to ineffective therapy if clients cannot fully express themselves or access parts of their memory completely.

“There are many agencies that don’t [provide interpretation services], mainly because it’s very expensive,” Soffer said. “We get it, we’re a nonprofit. It’s expensive. But if you’re going to work with these communities, it’s absolutely necessary to have the interpretation. Ideally you would have a therapist that is bilingual in that language.”

In her role, Soffer manages NSC’s wellness liaisons, which are community members that NSC trains to connect NSC and the community. NSC is training two people to be liaisons for the Afghan arrivals. She emphasized that the expectation for these liaisons is not providing therapy or counseling, but rather being able to identify potential mental health and wellness concerns within their community that they can then alert to NSC.

Soffer went on to say that while it is common for new arrivals to experience stress, trauma, and anxiety, NSC does not immediately address these concerns, unless a migrant is showing signs of acute distress. Instead they wait until the migrants have their basic needs met and have been contacted by the wellness liaisons. In this way, she and Winer have emphasized taking an unhurried, deliberate approach and prioritizing the needs of Afghan people, and refugees overall, rather than assuming that American mental health professionals know how to best provide assistance.

The professionals also shared how even framing helping refugees’ struggles as “mental health concerns” may not be the best course of action.

“We have to understand what it means for different cultures to seek mental health treatment,” Tanenbaum said. “We, as therapists in America, need to be very mindful of how other people view it and try to destigmatize it as much as possible.”

The NCTSN informational echoes this idea, highlighting the importance of considering the language mental healthcare providers use when interacting with clients. Assuming that mental health is even an immediate concern for arrivals is also something to be wary of.

“I like to always point out that, even though our clients. . .have experienced a lot of trauma, not everybody comes with a mental health concern,” Gwen shared. “We definitely see with our clients a lot of resilience and strength.”

As Afghan migrants are still in the early stages of resettlement, the current focus is building their livelihoods in America, including securing them housing, food, medical care, education, and employment. Over time, as they settle into their new homes, programming will be implemented to ensure the transition is as seamless as possible, a lot of it related to culture and identity. For example, despite the fact that children tend to adapt to foreign cultures better than adults, they still often face racism and xenophobia in school, so NSC is working with Philadelphia schools to address this issue.

Winer discussed a strategy used to aid children experiencing acculturation gap distress called “bridging, bonding, linking,” in which immigrant students are connected with students of similar cultural and ethnic backgrounds, then across cultural and ethnic backgrounds, and then between social hierarchies with people in positions of relative power. He connected the strategy back to identity and belongingness and their importance in terms of psychosocial wellness.

“If you think about it in terms of both individual and community resilience,” Winer said, “the more that we can do that, the more that we can help facilitate collaborative belongingness and try to help folks connect in these understandably incredibly challenging experiences.”

Read the full article from The McGraw Center for Teaching and Learning at Princeton University

Tracey Tanenbaum, M.Ed, LMFT is a Community Partnerships Initiative Clinical Specialist and a Staff Therapist at our Center City and University City Offices. She currently sees clients via online therapy. To set up an appointment, you can reach her at ttanenbaum@councilforrelationships.org or 215-382-6680 ext. 7083.