Counseling refugees: examining mental health professionals’ learning experiences and recommendations for effective training

Refugees experience a variety of complex mental health, trauma, and wellness concerns (Bhugra & Gupta, 2011; Kirmeyer et al., 2011) and often do not have access to mental health services. The underutilization of mental health services by refugees and the limited availability of culturally appropriate care highlights the mental health disparity that exists for this culturally and linguistically diverse population (Gong-Guy, Cravens, & Patterson, 1991; Kirmayer et al., 2011; Vasilevska, Madan, & Simich, 2010). One significant barrier to access is the limited availability of mental health professionals adequately trained to provide culturally competent services (Bartolomei et al., 2016; Gozdiak, 2004; Posselt et al., 2017). While there is significant literature on refugee populations and mental health, there is a scarcity of research on how to effectively work with this population. Furthermore, although mental health training programs emphasize cultural competence and multicultural training, there is evidence that mental health professionals are not adequately prepared to effectively provide services to refugees (Khawaja & Stein, 2016; Posselt et al., 2017; Robinson, 2013; Schweitzer et al., 2015). This may be influenced by the lack of focus on refugee populations in formal training and education (Pietrese, et al., 2009; Priester et al., 2008). Considering the limited knowledge about the training and educational learning experiences that prepare counselors to effectively work with refugee populations (Engstrom, Roth, & Hollis, 2010; Khawaja & Stein, 2016; Lee & Khawaja, 2014), a foundational qualitative study was proposed to explore the experiences of preparation, learning, and training of mental health professionals who have provided counseling to refugees, and better understand how they learned to serve this population. Interpretative Phenomenological Analysis (IPA) was utilized to explore the preparation, training, and learning experiences of counselors who work with refugees, including both formal training (i.e., graduate preparation) and informal learning (i.e., learning from experience). Furthermore, this study aimed to gather recommendations from mental health professionals based on their own experiences as to what is needed in mental health curricula to better prepare mental health professionals to work with refugees. Nine superordinate themes emerged from the data analysis process: Personal Identity, Values and Worldview; Language Barriers and Use of Interpreters; Ethics and Boundaries; Barriers, Access and Systems; Knowledge; Working with Trauma; Role of a Counselor; Developing Confidence; and Learning Strategies. Ultimately, this knowledge will serve to inform education, training, and preparation to work with a population with an immense need for access to culturally competent counseling services. The theoretical framework that guided this study is the Cultural Competence and Confidence Model (CCC), defined as “a conceptual model that depicts the multidimensional components of the teaching-learning process of cultural competency that could serve as a valuable cognitive map to guide educators, researchers, and learners” (Jeffreys, 2010, p. 45). Implications for practice, education and training, and research are offered based on the results of this study