Strengthening mental health interventions for refugee families

Rashmi Gangamma
Rashmi Gangamma, Ph.D., L.M.F.T.

Like others in the mental health profession, Rashmi Gangamma continues to ask herself, “How can we as family therapists promote social justice in our clinical work, in the therapy room?”

One critical area of need is improved training models and intervention methods to better serve the needs of resettled refugees, according to Gangamma, associate professor of marriage and family therapy in Falk College at Syracuse University. “Refugees are often uprooted as a direct consequence of injustice, are further marginalized and under-served as they re-build their lives in a foreign country. For instance, research suggests that post-migration factors such as language barriers, loss of status and community, social support, and racial discrimination exacerbates difficulties of resettlement.”

But there is limited research on how therapists can work with refugees. In her research, Gangamma has focused on family experiences in the resettlement process of refugees from different countries. “Each refugee group is different.” She hopes her research will fill the knowledge gap so therapists can be better equipped to meet the needs of resettled refugees.

“Bottom line for me is that there is a greater need for us to understand refugees’ experiences and to build culturally sensitive and responsive mental health interventions,” she says. “Specifically, for working with resettled refugees, mental health treatment must include the socio-political-cultural contexts of marginalization. For example, resettling in the United States may mean a shift in refugees’ social locations. They may suddenly find themselves in a minority due to their religion and ethnicity, and also in a lower socio-economic class. These changes in their social locations then play a role in how social and family relationships are navigated.”

Findings from these earlier studies pointed to a need for family therapists to expand existing theoretical frameworks that guide interventions. “Refugees occupy a unique transnational space—that is, they have lived in multiple countries, currently have families spread across multiple countries, and as a result are exposed to larger processes of oppression and marginalization across countries. This can influence how refugees experience their own identities, which can affect health and well-being.” This is articulated in a recent article co-authored with Daran Shipman, clinical supervisor in the Department of Marriage and Family Therapy, published in the Journal of Marital and Family Therapy.

In addition to limited therapist training on these unique issues in working with refugees, language barriers can also present challenges in therapy settings. Interpreters who work with therapists are typically only trained on ethics and mental health terminology or for working in medical settings. However, advanced interpretation skills are necessary for therapy interventions to be most effective, particularly in sessions involving unpacking trauma experiences or when working in group therapy settings. Through funding from Central New York Community Foundation, Gangamma recently led a collaboration between the Department of Marriage and Family Therapy and community agencies in Syracuse and Utica in developing an interpreter-practitioner training module for people who work with resettled refugees. The overall aim of the module was to initiate collaborative relationships between spoken language interpreters and psychotherapists to ensure culturally responsive delivery of therapy services. Feedback received from workshop participants indicated an urgent need to conduct more of these collaborative initiatives.

Students contribute to the vibrant research community in Falk College through involvement in student- and faculty-led research projects, including Gangamma’s interpreter-practitioner training project. Giselle Ortiz G’19, alumna of the dual master’s degree program in social work and marriage and family therapy, was involved in planning the training modules as a student after taking Gangamma’s Migration and Mental Health course. Marriage and family therapy Ph.D. candidate Shaelise Tor is currently involved in the training modules. “The one word that continues to stand out to me is community. This training built community at multiple levels,” says Tor. “As a multidisciplinary team to create this training, we each brought our own areas of knowledge and experience. By consulting with different key informants, we were able to design the training with multiple disciplines in mind and with a deep respect for each person’s role. We understood early on that the therapist-interpreter collaboration represented a unique team. The workshop was an excellent opportunity to bring together community members with numerous agencies represented. There was a shared sense of purpose to better serve the refugee communities here in Syracuse. Many participants shed light on how much they wish they had this training before they entered into their roles and many voiced the need for continued training in this area.”

Gangamma believes research in refugee mental health is critical to help inform public policy, services, and programs. “One of my recent studies showed that family relationships play a central role in making meaning of suffering, and moving towards rebuilding lives. This can helpful to remember in practice and has clear implications for policy as many refugees are currently not resettled with their families,” she explains. She was recently part of a Research to Policy initiative where researchers travelled to Washington DC to meet congressional staffers and provided research-informed perspectives on impact of current policies on refugee and immigrant family well-being.

Together with fellow faculty members in Falk College, Gangamma explores these topics using an interdisciplinary approach. Gangamma recently worked with Ambika Krishnakumar in the Department of Human Development and Family Science to explore concepts of ethnic loyalty and identities in resettled refugees from the Middle East. Now, she works with Laura-Anne Minkoff-Zern in the Department of Nutrition and Food Studies and Bhavneet Walia in the Department of Public Health to examine the relationship between home and community gardening, mental health, and socio-economic well-being, with particular focus on food security, in resettled refugee populations.

Through research and practice, Gangamma hopes to better equip mental health professionals to serve the unique needs of resettled refugees, inform public policies, and ultimately fill the gap in mental health services for resettled refugees.

Faculty research in the Department of Marriage and Family Therapy span other critical topics, such as trauma-informed practice, mental health training and service delivery for veterans and military families, and supporting transgender youth and their families in therapy, among many others, and is supported by the Falk Research Center.