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The Experience of Mental Health Clinicians Working with Undocumented Immigrants from Latin America in California: Post 2016 Election Landscape

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The Experience of Mental Health Clinicians Working with Undocumented Immigrants from Latin America in California: Post 2016 Election Landscape The Experience of Mental Health Clinicians Working with Undocumented Immigrants from Latin America in California: Post 2016 Election Landscape Marina Marcus Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy under the Executive Committee of the Graduate School of Arts and Sciences COLUMBIA UNIVERSITY 2021 © 2021 Marina Marcus All Rights Reserved Abstract The Experience of Mental Health Clinicians Working with Undocumented Immigrants from Latin America in California: Post 2016 Election Landscape Marina Marcus The 2016 presidential election and restrictive immigration policies implemented under the Trump administration created a climate of heightened tension and uncertainty for undocumented immigrants from Latin America. There is a gap in the psychological literature regarding the mental health of undocumented immigrants from Latin America residing in the U.S., the largest number of which reside in California, and few studies have examined the experiences of mental health clinicians conducting therapy with undocumented immigrants, particularly keeping in mind the impact of national policy agendas that fuel anti-immigrant sentiment. Following Consensual Qualitative Research (CQR) methodology, this study gathered first-person narratives from 15 mental health professionals who work with undocumented immigrants from Latin American in California, with a focus on the effect of change in political leadership following the 2016 U.S. presidential election. Nine domains emerged from the analysis. Mental health clinicians reported that the 2016 election had a significant impact on their work, including client’s distress and the clinician’s own emotional response to the political climate. Themes in therapy following the election, challenges to conducting therapy with undocumented clients, and the risk and protective factors that were reported to have the greatest influence on client mental health are discussed. Clinical implications and recommendations for the provision of mental health services to undocumented immigrants from Latin America are offered, including a separate set of recommendations for supporting mental health clinicians who provide mental health services to undocumented immigrants from Latin America. Table of Contents List of Tables……………………………………………………………………………..iv Acknowledgments…………………………………………………………………...….....v Dedication……..…………………………………………………………...……….........vii Chapter 1: Introduction………………………………………………….……….……......1 1.1 The Present Study……………………………………………………..………4 Chapter 2: Literature Review………………………………..………………………….....6 2.1 Legislation Addressing Undocumented Immigration to the United States.…..6 2.2 Immigration from Latin America to the United States……………………....19 2.3 The Experience of Clinicians Providing Care to Undocumented Immigrants…………………………………………………………..……….38 2.4 Current Recommendations for Clinicians Serving Undocumented Communities……………………………………………………………..…..42 Chapter 3: Method……………………………………………………………………….44 3.1 Rationale for Consensual Qualitative Research Design…………………..…44 3.2 Research Participants…………………………………………………. …….46 3.3 Instruments……...............................................................................................50 3.4 Procedure………………………………………………………………..…...51 3.5 Research Team………………………………………………….……….…...55 3.6 Researcher Worldview……………………………………….…………..…..57 3.7 Data Analysis……………………………………………………..………….59 Chapter 4: Results………………………………………………………………………..64 4.1 Typical Case Narrative……………………………………………………....67 4.2 Domain 1: Impact of Election on Psychotherapy……………………….…...68 i 4.3 Domain 2: Themes in Clinical Work………………………………………...70 4.4 Domain 3: Client Mental Health: Risk Factors………………………………75 4.5 Domain 4: Client Mental Health: Protective Factors……………………...…78 4.6 Domain 5: Perceived Limitations, Challenges, and Obstacles Working with UIs………………………………………..…………………………..…80 4.7 Domain 6: Clinician Response to Working with UI Clients…………………84 4.8 Domain 7: Clinician Response to Political Climate/Election…………..……87 4.9 Domain 8: Non-UI Community Reactions Following Elections…………….89 4.10 Domain 9: Therapy Strategies for UI Clients………………………………90 Chapter 5: Discussion……………………………………………………………………94 5.1 Question 1: In light of the 2016 presidential elections and the resulting changes to immigration policy, how do proposed immigration laws and policies affect the work of mental health practitioners, if at all?.....................95 5.2 Question 2: What are the major challenges faced by mental health practitioners who directly provide services to undocumented immigrants from Latin America in California?..................................................................97 5.3 Question 3: What are the issues and themes present in post-election treatment?.......................................................................................................100 5.4 Question 4: How do practitioners perceive the psychosocial resources available to undocumented immigrants in their area?...................................103 5.5 Question 5: How do clinicians talk about the risk and protective factors they see among their undocumented immigrant clients who may be impacted by the current changes immigration policy?..................................104 5.6 Question 6: How have practitioners experienced their own ability to provide care following the election?..............................................................108 5.7 Question 7: What is the impact of undocumented immigrants' distress on the wellbeing of clinicians?......................................................................110 5.8 Limitations…………………………..…………………………………..….112 5.9 Clinical Implications……………………………………………………..…115 ii 5.10 Recommendations for Providing Mental Health Services to Undocumented Immigrants from Latin America……………………….…119 5.11 Recommendations for Supporting Mental health Clinicians Who Provide Services to Undocumented Immigrants from Latin America….…126 5.12 Future Directions...………………………………….……….........………130 References………………………………………………………………………………133 Appendix A: Semi-structured interview protocol………………………………………152 Appendix B: Demographic questionnaire…………………………………………...….155 Appendix C: Recruitment Email Message………………………………………...……158 Appendix D: Description of Research/Participants’ Rights……………………………159 Appendix E: Informed consent……………………………………………..…………..160 iii List of Tables Table 1. Participant Demographics………………………………………………………48 Table 2. Cross-Analysis: Clinician Perceptions of Working with Undocumented Immigrants from Latin America in California…………………………………...………65 iv Acknowledgments I must start by thanking my family for their encouragement and belief in me. My maternal family and I came to the U.S. as refugees when I was a young child, and their courage, determination and love allowed me to follow my passions and build a life and career I feel proud of. My mother has been a steady source of support and a model of “having it all” – a fulfilling family life alongside a thriving career. My father is the most intellectually curious person I know and was the spark that lit the fire for my love of travel and appreciation of culture. My brothers have been wonderful lifelong companions and have never missed an opportunity to express curiosity and support for my work. I’m so grateful to my extended family and the Ezroj clan for their unwavering love and support. A huge thanks to Lena Verdeli, whose warm mentorship and passion for addressing mental health resource inequity has been a guiding light throughout my doctoral training. She has valued and championed my personal goals just as much as my professional aspirations, and supported my move across the country mid-program in order to join my partner and start a family. Lena, you encourage your students to dream big and approach problems with critical thought and practical solutions. I’ll be forever grateful for your willingness to take a chance on me eight years ago, and for nurturing my interests and growth during my time at Teachers College. I am deeply inspired by my Global Mental Health Lab family and am grateful for the camaraderie and support we continue to share. Thanks to Arielle Jean-Pierre and Jen Kao, whose wisdom, grace, and humor enriched each day, and continue to inspire me. I am beyond grateful for the motivation and accountability you both provided through our v daily virtual dissertation writing sessions. Seeing your focused faces as you wrote from your corners of the country kept me going as I pushed through mental blocks in my own. Thanks to Srishti Sardana, Jen Kao, Heather Cobb, Ceren Sonmez, and Jann Gumbiner for their invaluable feedback on dissertation drafts. Thanks to Srishti Sardana, Talia Barach, and Fred Pasquarella for helping me assemble an all-star research team, and to Yakov Barton and Amanda Gooding for their assistance with the recruitment process. I am grateful to Kim Baranowski for conducting the fine research that inspired my own dissertation, and for her generosity of spirit and insight as a member of my committee at each step of the process. Thank you to Sonali Rajan, Mike Wessells, and Barry Farber for the time, energy, and feedback they volunteered as members of my committee. I am forever indebted to my research team members, Ryan Sabillo, Jennifer Alcalde, and Shreya Aragula. Our qualitative analysis lasted two years, and you never wavered. I am grateful for your kindness as our work coincided with my pregnancy and post-partum period, and for your grace through the video
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