2022 Guide to Refugee Counseling Resources
In 1980, in the aftermath of the Vietnam War, the United States Senate signed the Refugee Act of 1980. This legislation increased the annual ceiling for refugees to the United States from 17,400 to 50,000. It also updated the definition of refugee to include any person with a “well-founded fear of persecution.”
Since the Act was signed in 1980, the United States has admitted over 3 million refugees and increased refugee resources. Humans fleeing civil war, religious persecution, and genocide have traveled in droves to the United States.
With over 26 million refugees worldwide, only a fraction will require permanent relocation to another country. Even fewer will be approved to resettle each year. The United Nation’s High Commissioner for Refugees (UNHCR) facilitates the worldwide refugee resettlement process. They charge countries accepting refugees for resettlement to care for and protect those sent to them. “Since, by definition, refugees are not protected by their own governments,” UNHCR’s website states, “the international community steps in to ensure they are safe and protected.”
The Geneva Convention of 1951 granted rights to refugees under international law. The convention gives refugees the following rights (among others) in their countries of resettlement:
- Move freely
- Public Relief and Assistance
As a result of these rights, refugees are commonly provided with the assistance of social workers, counselors, and other professionals. For refugees to have a brighter future, everyone in their support network must understand where they come from, what challenges they face, and how to empower them. This guide includes the latest studies and statistics concerning refugee resources, as well as the latest information concerning refugee counseling resources. The guide concludes with a list of refugee resources and contacts.
The UNHCR defines refugees as “people who have fled war, violence, conflict or persecution and have crossed an international border to find safety in another country.” Refugees differ from internally displaced persons, who have been forced to leave their homes for safety but remain in their own countries. It also differs from asylum seekers, who have fled to another country but whose claims have not yet been determined to meet the criteria of “refugee.” Asylum seekers sometimes become refugees, though they are sometimes returned to their home countries.
Recent Refugee Crises
The 21st century has seen refugees entering the United States from every corner of the world. Three of the largest conflicts creating U.S.-bound refugees include:
Syrian Civil War
Over half of Syria’s civilian population has been displaced since the civil war erupted in 2011. According to Mercy Corps, 6.6 million have sought refugee status in other countries, while 6.7 million are internally displaced, most of them women and children.
Political Instability in Afghanistan
According to the UNHCR, 6 million people have been driven from their homes in Afghanistan by violence and poverty, and 2.7 million have sought safety in other countries. An estimated 80% of refugees from Afghanistan are women and children.
South Sudan Civil War
Out of 4 million people displaced from their homes by war and natural disasters in South Sudan, 2.2 million have sought refuge in neighboring countries. Again, the majority are women and children.
Refugee Composition & Identity
In most cases, refugees return home when it is safe to do so or are permanently established in the country to which they fled. A fraction of refugees need a new country to call home, which is called “resettling.” Refugees who are deemed most vulnerable are referred for resettlement first. According to PBS News Hour, this includes “those with acute medical needs, like someone needing heart surgery; at-risk women and girls, including single female heads of households; and victims of torture.”
Refugees in the US: Demographics
The following statistics describe the general identity of refugees:
- According to the Migration Policy Institute, 42% of forcibly displaced people are children under the age of 18.
- MPI also states that 31% of refugees resettled in the U.S. are under the age of 14.
- Medill National Security Zone states that refugees to the United States tend to be more female than male.
Refugees in the US: Language and Culture
- According to MPI, between 2011-2021, over half of all refugees resettled in the U.S. came from Myanmar, Iraq, or Bhutan.
- MPI also states that between 2010-2020, 48% of refugees to the U.S. identified as Christian, while 33% identified as Muslim.
- According to the Center for Immigration Studies, only 6% of newly arrived refugees identify as being proficient in English, and 18% state they speak basic English. Approximately 72% state they speak no English at all.
Refugees in the US: Mental and Physical Health
Newly resettled refugees have likely faced extreme emotional and physical trauma throughout their displacement. A refugee may experience more violence and suffering before arriving at a new home than most humans endure in their lifetime. Refugee counseling resources are vital for these individuals.
- According to the American Psychiatric Association, approximately 1 in 3 refugees experience high levels of depression, anxiety, or PTSD symptoms.
- A study from PLOS Medicine found that PTSD symptoms are more common in female refugees than in male refugees.
- According to the World Health Organization, after addressing initial health concerns, refugees tend to be relatively physically healthy. They do, however, have difficulties accessing healthcare systems, which can contribute to health concerns later on.
- The same study from PLOS Medicine found that refugee anxiety levels reduce over time without intervention, appearing to ease in refugees who have been resettled for longer than four years. However, depression and PTSD rates among refugees do not appear to diminish over time.
Governmental Resettlement Support
The U.S. Refugees Admissions Program facilitates the initial reception and placement of new refugee arrivals. Every refugee admitted to the United States is assigned to a local non-profit resettlement agency to assist with the transition and distribute available refugee resources. Reception and placement services last three months, though some resettlement agencies may offer extended support through independent funding.
Refugees are eligible for all entitlement programs and refugee resources from each person’s first day in the United States. Medicaid, SNAP benefits (food stamps), TANF, and SSI are all open to refugees and their families. In addition to these programs, refugees have access to:
- Refugee Cash Assistance (available for eight months post-resettlement)
- Refugee Medical Assistance (available for eight months post-resettlement)
- Matching Grants
- Refugee Social Services
Factors for Successful Integration
Professionals providing mental health services and refugee counseling resources should consider both their psychological and practical needs. A 2005 meta-analysis showed that refugees with limited economic opportunities had poorer mental health outcomes. This analysis also revealed that permanent, private housing for resettled refugees was beneficial for mental health, proving that effective interventions for well-being take place both inside and outside the therapist’s office.
Even the highest quality trauma-focused therapy isn’t sufficient for refugees to create long-term wellness. Practitioners must also help resettled clients meet practical needs such as education, language acquisition, and employment.
The Geneva Convention promises refugees the right to education, but the promise isn’t fully realized by many refugees living in displaced situations. According to the UNHCR, almost half of refugee children aren’t yet enrolled in school.
Ensuring that refugees and their children have access to (and take full advantage of) quality education increases their likelihood of thriving in their host countries. For refugees who may eventually be able to return to their home countries, education means they bring with them the possibility for lasting peace. A UNHCR education report found that regions with very low education levels have a 50 percent chance of conflict over a 21 year period.
A recent study in Social Psychological and Personality Science found a strong link between refugees’ English proficiency and their long-term well-being. Experts believe this is related to loneliness and a sense of belonging. Authors of the study noted that “refugees in the UK who were unable to speak English felt incapable of building relationships with local people and, as a consequence, experienced particularly high levels of isolation.”
A BMC Women’s Health study found that “refugee women suffered from being separated from their loved ones and felt compelled to achieve something of value in the host country. All experienced both physical and mental anguish.” A Scandinavian Journal of Psychology study found that refugees to Norway who were unemployed were much more likely to be diagnosed with mental health disorders, and their symptom severity was likely to be higher than refugees with employment.
Employment is particularly important because it is a primary determinant of socioeconomic status, which has been strongly linked to mental health in a study from the Canadian Journal of Psychiatry. According to one JAMA study, there was “a clear linear relationship between refugees’ mental health and measures of their economic opportunity, a composite construct including the right to work, access to employment, and socioeconomic status.”
Refugees’ ability to support themselves is a top concern for nations striving to resettle them. The Gender Policy Report states that there is an emphasis on putting refugees on quick paths to self-sufficiency in the U.S. However, there are some questions about whether this short runway comes at a cost—especially after a recent Social Problems study showed that refugee employment rates take a dip after they have been in the U.S. for five years. “Instead of being given the time to learn English and find jobs that match their skills and abilities,” the authors noted, “refugees are funneled into low-paying jobs that do not offer long-term sustainable employment and offer few opportunities for upward mobility.”
A Journal of Health and Social Behavior study shows that when younger immigrants become citizens, they have better health outcomes later in life.
U.S. Citizenship and Immigration Services states that refugees may apply for U.S. citizenship once they’ve been lawful permanent residents of the United States for five years. This process is called “naturalization.” The USCIS also states that refugees in the United States are eligible to apply for lawful permanent resident status (also known as “getting their green card”) after being physically present in the U.S. for one year.
The naturalization process is extensive, and refugee applicants will be required to:
- Complete a background interview
- Pass an English language exam
- Correctly answer civics questions
- Take an oath of allegiance to the United States
Counseling Interventions for Refugees
When it comes to effective interventions for the psychological well-being of resettled refugees and proactive refugee counseling resources, the research base is relatively slim. According to World Psychology, the shortage stems from the seemingly limitless number of variables (language, culture, experiences) compared with the small number of resettled refugees (less than 12,000 refugees resettled in the U.S. in 2020, according to the Center for Immigration Studies). The discrepancy makes it difficult to conduct a study that is strong enough to pass modern standards since scientific research is based on controlling variables.
The good news is there are several studies pointing to therapeutic approaches that help treat depression and PTSD in internally displaced individuals or asylum seekers. Those methods include:
According to one study of refugees in Egypt, “IPT predicted a significant decrease in symptoms of PTSD, state anger, and depression.”
The IPT model links depression with life events, including death, conflict, change, or loneliness. By exploring the depression trigger and working together to find new coping skills, clinicians can help clients regain emotional stability.
The World Health Organization offers a free training guide for providing Interpersonal Psychotherapy in a group setting. The WHO believes that group IPT should be the first-line treatment for depression.
Narrative Exposure Therapy
In a Journal of Consulting and Clinical Psychology study of refugees in an African refugee camp, 71% of individuals treated with Narrative Exposure Therapy had reduced PTSD symptoms a year after treatment.
According to the American Psychological Association, NET “has been most frequently used in community settings and with individuals who experienced trauma as a result of political, cultural, or social forces (such as refugees).” During NET, a client creates a narrative describing the story of their life, concentrating on traumatic events but including positive events as well. At the culmination of treatment, the clinician presents the client with an “autobiography.”
The practitioner manual for Narrative Exposure Therapy is available for purchase here.
Cognitive Behavioral Therapy
A meta-analysis found that trauma-focused Cognitive Behavioral Therapy (TF-CBT) was an effective treatment for PTSD in refugee children. A randomized control trial showed that culturally adapted CBT (CA-CBT) effectively treated both anxiety/depression and PTSD symptoms in Syrian refugee women in Turkey.
CBT focuses on identifying and addressing maladaptive thought patterns in order to decrease depressive symptoms. Treatment typically involves education-based sessions during which the clinician teaches the client to recognize their thoughts and address them constructively. As the American Psychological Association puts it, “through exercises in the session as well as “homework” exercises outside of sessions, patients/clients are helped to develop coping skills, whereby they can learn to change their own thinking, problematic emotions, and behavior.”
Therapists wishing to become trained in conducting Trauma-Focused Cognitive Behavioral Therapy can learn more here.
Eye Movement Desensitization and Reprocessing
A small study in a Syrian refugee camp found that just two sessions of Eye Movement Desensitization and Reprocessing significantly reduced PTSD symptoms. A few other studies showed similar positive results.
EMDR uses bilateral brain stimulation (often through eye movements) to help clients reprocess traumatic memories and reduce PTSD symptoms. EMDR has been a gold-standard treatment for PTSD in western clients; however, experts are still establishing the research for its usefulness for refugees.
Clinicians who wish to become trained in EMDR therapy can find more information here.
Therapists should adapt all therapy models to culturally-competent practices, and there are resources available to help.
Additional Resources for Refugees
Here is a list of refugee resources for both refugees and refugee counselors.
Respond Crisis Translation
Respond Crisis Translation provides language support for non-English speaking refugees working with professionals. According to their website, “We serve NGOs, human rights groups and lawyers, clinics, activist collectives, therapists, non-profits, and school networks that provide support to refugees and asylum seekers.”
USA.gov has information about federal assistance programs, including SNAP (food stamps) and Medicaid. Refugees are entitled to any benefits for which they meet eligibility criteria. They do not have to have their green card or citizenship to apply.
International Refugee Assistance Program
IRAP is a non-profit that represents refugees in need of legal support. Their mission is to “organize law students and lawyers to develop and enforce a set of legal and human rights for refugees and displaced persons.” They offer assistance in cases such as special immigrant visas, family reunifications, and private refugee sponsorship.
Switchboard is an online resource library providing information and education to those supporting refugee resettlement. This one-stop authority offers training on everything from supporting refugee mental health to navigating engagement with communities.
Cultural Orientation Resource Exchange
CORE helps refugee resettlement supporters understand refugee cultures and effectively orient them to the culture in the United States. According to their website, CORE “connects and supports refugee resettlement staff globally to deliver effective Cultural Orientation which helps refugees and Special Immigrant Visa holders achieve self-sufficiency in the United States.”
The US Citizenship and Immigration Multilingual Resource Center
The USCIS supplies information and official paperwork regarding green cards, citizenship procedures, and government processes in more than 20 different languages.
The Refugee and Immigrant Center for Education and Legal Services
The RAICES runs the Canopy Hotline, which connects refugees and their networks with local resources all around the country. Service providers can inquire by calling or texting 800-437-3071.
The Immigrant Learning Center
ILC offers free remote English classes to immigrants and refugees. According to their website, “The ILC staff determines the language needs and personal and educational goals of each student when they enroll. Students are placed into programs that best meet their individual needs, and counseling is provided to help them achieve their goals.”