Considering the psychological needs of immigrants

On September 16, the Fordham University Center for Ethics Education and Center for Religion and Culture hosted a conference to discuss whether we have a moral obligation to immigrants. Entitled “A Crisis of Conscience: What Do We Owe Immigrant Youth and Families?” the conference featured former U.S. Senator and 50^th Secretary of the Interior Ken Salazar, former immigration judge Sarah Burr, and Gabriel Salguero, President of the National Latino Evangelical Coalition. David Ushery, journalist and host of NBC’s “The Debrief” moderated the event.

Ken Salazar characterized the present moment in United States history as one of many “times of shame” on the basis of how we as a country treat immigrants—especially so-called “undocumented alien children” (UACs). He described how 12 million people are “living in the shadows of society” and stated that immigration reform represents a “national moral imperative” and the “number one civil rights and humanitarian issue” of our time, albeit an issue that has been difficult to comprehensively and satisfactorily address at the national level.

Analogously, psychology has had its own times of shame: the discipline has historical connections to eugenics and racism (Guthrie, 2008), militarism (Miller, 2005), and, more recently, torture (Soldz, 2008), that are perhaps not as well-publicized as one might prefer. Fortunately, initiatives over the interceding decades have brought the discipline—at least at the level of its professional Ethics Code (American Psychological Association [APA], 2002)—into line with values that might begin to remediate these historical shames.

The Ethics Code combines aspirational General Principles with specific, binding Standards to ensure the welfare and protection of individuals that psychologists serve. The ‘Crisis in Conscience’ conference highlights three potential barriers to meeting the needs of immigrants, and in particular UACs, while abiding by and respecting every General Principle and Standard of the Ethics Code.

First, the sheer complexity of immigrant psychological needs taxes the capacity of psychologists to receive adequate training so as to ensure equal quality of care (per Principle D, Justice, which states that psychologists ought to aspire toward equal access to and benefit from psychology for all people). As Mr. Salazar, Judge Burr, and Reverend Salguero each emphasized, immigration proceedings often split up families, thereby potentially exacerbating socioeconomic woes and disrupting developmental milestones.

The intersection of identities among immigrant families requires psychologists providing services to consider potential biases and training limitations across a wide range of possible issues—likely involving race, ethnicity, culture generally, geography, social class, language, legal status (requiring forensic knowledge), acculturation, education, family status and structure, and possibly gender, religion, and more.

Because the factors mentioned above interact with one another, with the local context of the individual, and with the particular details of the individual case, superb sensitivity to context and a high degree of training is needed. Perhaps few psychologists would even qualify to comply at an ideal level with APA standards of competence in these circumstances; if so, the field ought to provide more extensive and prospective training to adapt to the changing cultural climate.

Standard 2.03 of the APA Ethics Code states that “psychologists undertake ongoing efforts to develop and maintain their competence.” This standard helps ensure that psychologists keep abreast of changes in the discipline so that they can meet the needs of the populations they serve. The pace of culture change may, however, tax the ability of individual psychologists to maintain competence, and the field as a whole may need to develop provision strategies to assist psychologists in keeping professionally abreast of the sociopolitical context. Alternatively, analogous to transdiagnostic approaches to treatment, perhaps it would be possible to develop flexible approaches to multicultural competence that would partially redeem the challenges posed by swift cultural changes.

In any case, UACs are quite vulnerable and the potential exists for lasting psychological harm due to separation from families and other stresses. Thus, although a psychologist may not be entirely confident in her competence, access to some services may be better than no access at all. One general principle of the Ethics Code, Fidelity and Responsibility, stresses adherence to scientific and professional obligations, yet the principle of Justice stresses equal access to and benefit from psychology. Balancing access to care against concerns about competence puts these two principles into tension.

Second and related, beyond the training issues mentioned above, one might question the extent to which psychological training responds to and remediates the “historical amnesia” that Rev. Salguero identified as afflicting many Americans. APA practice guidelines encourage psychologists to learn about historical injustices such as “slavery, Asian concentration camps, the American Indian holocaust, and the colonization of the major Latino groups” (APA, 2003, p. 385). The journalist Juan Gonzalez wrote in Harvest of Empire: A History of Latinos in America, “If Latin America had not been pillaged by the U.S. capital since its independence, millions of desperate workers would not now be coming here in such numbers to reclaim a share of that wealth.”

Similarly, the conference speakers described how UACs end up on American soil in large part due to violent conditions in their homelands that have been conditioned by failed United States policies in South and Central America. Knowledge about these conditions and policies may bear upon treatment and service provision. Particularly because psychology has historically neglected historical, social, and political determinants of behavior (Bronstein & Quina, 1988), historical and cultural education efforts in psychology should receive greater emphasis and ought to occur within an interdisciplinary frame that is currently absent from training standards.

Third, Rev. Salguero noted that faith leaders “do not establish laws but do advocate for justice.” Similarly, although psychologists in the aggregate do not have the expertise, access, or political position to work directly toward legal change, perhaps psychologists can (and, indeed, ought to) advocate for justice. Because the APA Ethics Code is a professional code, however, the aspirational principle of Justice (Principle D) does not extend far beyond the confines of the consulting room, although some practice guidelines do. Principle D states that “psychologists recognize that fairness and justice entitle all persons to access to and benefit from…psychology and to equal quality” in psychological services; however, no guidance or encouragement is provided on what individual psychologists ought to do to ensure equal access.

Confining principles of justice to (individual) professional practice seems insufficient from the perspective of societal change. Judge Burr described how minors in immigration proceedings might obtain legal representation in New York City thanks to pro bono work by law schools and services provided by advocacy groups; the rest of the country, however, generally lacks access to such resources. As Judge Burr suggested, anything short of expanding due process provisions to encompass civil immigration proceedings is unlikely to remediate systemic injustice. Just so, psychologist may provide pro bono or low-fee services to increase access, and may train so as to minimize biases and ensure equal quality in care for those that they see. Without structural changes in immigration policy, education, health care (i.e., universal access thereto alongside mental health parity), labor laws, and the criminal justice system, however, such attempts can only alleviate and not remediate systemic injustice.

Moreover, the distinction between the personal and the professional may itself come into question. Just as the feminist movement emphasized that the personal is political (Hanisch, 1970), if Mr. Salazar is correct that immigration represents the focal civil rights issue of our time, any stance taken by a psychologist might necessarily be political and eo ipso personal. Although the following suggestion may reside upon a slippery slope, perhaps the APA might encourage political advocacy and activism as an aspirational goal so as to empower psychologists to try to change society so that it is easier to achieve our other aspirational principles.

In any event, psychologists will surely face serious dilemmas in working with UACs. To take but one example, it is not clear what would constitute informed consent/assent given a UAC from a third-world country who has been separated from his or her guardians. Further, as Rev. Salguero emphasized, what is just may not be in harmony with what is legal. Presumably, many psychological services—particularly forensic—will fall under the purview of governmental funding and oversight.

Inept or immoral policies may lead to human rights violations, and psychologists must be careful that providing services for UACs does not inadvertently expose them to further harm. The balance between Principle A (Beneficence and Nonmaleficence) versus Principle E (Respect for People’s Rights and Dignity) must come under constant and careful evaluation with respect to UACs, lest the APA repeat the mistakes made with respect to military torture.

References

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060-1073.

American Psychological Association. (2003). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. American Psychologist, 58(5), 377-402.

Bronstein, P. A., & Quina, K. E. (1988). Teaching a psychology of people: Resources for gender and sociocultural awareness. Washington, D.C.: American Psychological Association. doi: 10.1037/10066-000

Guthrie, R. V. (2004). Even the rat was white: A historical view of psychology. Upper Saddle River, NJ: Pearson Education.

Hanisch, C. (1970). The personal is political. In S. Firestone & A. Koedt (Eds.), Notes from the second year: Women’s liberation: Major writings of the radical feminists. New York, NY: Radical Feminism.

Miller, R. B. (2005). Suffering in psychology: The demoralization of psychotherapeutic practice. Journal of Psychotherapy Integration, 15(3), 299-336. doi: 10.1037/1053-0479.15.3.299

Soldz, S. (2008). Healers or interrogators: Psychology and the United States torture regime. Psychoanalytic Dialogues, 18(5), 592-613.

Written By Fordham University Center for Ethics Education
By: Charles M. Olbert
Charles Olbert, M.A. is a third-year Clinical Psychology doctoral student at Fordham University. For more information on his work, visit www.charlesolbert.com.

Considering the psychological needs of immigrants was originally published @ Ethics and Society and has been syndicated with permission.