S Anandavalli, John J. S. Harrichand, Stacey Diane Arañez Litam
Amidst the global health crisis of COVID-19, international students’ safety and well-being is threatened by community- and policy-level animus. In addition to adjusting to a foreign culture, a series of draconian policies and communal hate crimes during the pandemic have placed international students in an especially vulnerable position. In this context, professional counselors must be well prepared to support this community. The authors describe the current sociopolitical events that have adversely impacted international students in the United States. Next, challenges to international students’ mental health are identified to aid counselors’ understanding of this community’s needs. Finally, recommendations grounded in critical feminist and bioecological approaches are offered to facilitate counselors’ clinical and advocacy work with international students.
Keywords: COVID-19, international students, critical feminist, bioecological, advocacy
COVID-19–related fears have resulted in social and political responses characterized by racial discrimination and xenophobia toward marginalized groups (Devakumar et al., 2020; Litam, 2020; Litam & Hipolito-Delgado, in press), including international students (Anandavalli, 2020; Zhai & Du, 2020). Rates of misleading media portrayals and xenophobic rhetoric substantially increased after President Trump referred to COVID-19 as the “Chinese virus” on March 16, 2020, and have steadily risen across social media platforms (Lyu et al., 2020). Exposure to COVID-19–related racial discrimination has deleterious effects on the mental health and life satisfaction of racial minorities (Litam, 2020; Litam & Oh, in press; Wen et al., 2020), including international students residing in the United States (Zhai & Du, 2020). The extant body of literature has clearly established lower levels of help seeking, barriers to counseling, and increased rates of mental health distress among international students compared to their domestic counterparts (Auerbach et al., 2018; Clough et al., 2018; Sawir et al., 2008; Zhai & Du, 2020). These existing challenges and psychosocial stressors may uniquely combine with current sociopolitical messages and policies to further exacerbate the unique developmental and cultural stressors encountered by international students. Thus, counselors working in various roles (e.g., college counselors, private practitioners) are called to develop a deeper understanding of the ways in which international students are negatively affected by xenophobic policies following COVID-19 and to employ culturally sensitive strategies grounded in systems approaches.
Although all counselors working with international students must consider the impact of larger systemic issues on international students’ mental health, college counselors might be in a unique position to support this population because of their close proximity. Counselors must consider how the combined effects of sociopolitical influences, systemic inequity, intersectionality, and COVID-19–related experiences of xenophobia uniquely contribute to the mental health disparities of international students in a post-pandemic reality. It is vital that counselors consider the impact of social and political structures, as Anandavalli (2020) found that contextual and systemic influences (e.g., elections, travel bans, anti-immigrant sentiment) have a profound impact on international students’ mental health. Unfortunately, despite repeated calls to action, counselors may be unprepared to support international students in the United States (e.g., Kim et al., 2019). Even years after Yoon and Portman’s (2004) critique, accredited counseling programs continue to offer little to no training to students to work effectively with international students. Perhaps as a result of years of limited training and research on international students’ mental health experiences, counselors continue to have inadequate cultural competence when working with international students. In a recent study, Liu et al. (2020) noted that although Korean and Chinese international students in their study had a cautiously optimistic attitude toward their college counselors, a third of them felt hurt and disappointed by their college counselors’ cultural incompetence and reported incidents of counselors’ cultural ignorance and stereotyping. With limited attention to social justice and equity issues, counselors can further traumatize and alienate some international students (Jones et al., 2017).
Within the counseling literature, even the few studies that explored the mental health of international students from a relational and systemic perspective (e.g., Lértora & Croffie, 2020; Page et al., 2019) have failed to adopt a critical lens and examine the impact and accountability of larger social institutions on the community’s well-being. At present, a review on PsycINFO, Google Scholar, and SocINDEX using the search terms international student mental health, international students counseling bioecological model, and international students multicultural critical race theory yielded no counseling literature that addressed strategies to support the mental health of international students in the United States from a critical perspective. Thus, the following article contributes to the extant body of literature on the topic by (a) describing the ways in which current sociopolitical events and policies send denigrating messages that devalue international students, (b) outlining the mental health challenges of international students, and (c) offering specific suggestions for counselors working with this vulnerable population through a critical feminist and bioecological lens.
Sociopolitical Policies Affecting International Students
According to the Institute of International Education (IIE; 2019), as the most popular study abroad destination, the United States hosts more than 1 million international (foreign-born) students. However, in the context of the racialized COVID-19 pandemic, Chirikov and Soria (2020) found that as many as 17% of the surveyed international students have experienced xenophobic actions that threaten their safety and presence. Further, they found these rates were higher among students from East Asian and Southeast Asian countries such as Japan, China, and Vietnam (22%–30%), given increasing Sinophobia (anti-Chinese sentiment) in the country. In addition to pursuing higher education, each year thousands of international students seek post-education professional experiences to receive practical training through an H-1B visa. An H-1B visa authorizes international students and professionals to work in the United States because of their experience in specialty occupations of distinguished merit and ability (U.S. Department of Labor, n.d.). On June 22, 2020, H-1B visa holders were notified that effective June 24, 2020, the U.S. embassy would not be issuing new H-1B visa stamps; additionally, the ruling dictated that without a valid H-1B visa stamp, individuals could not enter the United States until December 31, 2020 (The White House, 2020). This xenophobic proclamation left thousands of international professionals stranded and placed them at risk of losing their employment. The announcement to ban H-1B visa holders devalued international students and professionals in the United States and reminded international students of their fragile futures and conditional status.
The most recent incident in the upsurge of xenophobic sociopolitical messages negatively affecting international students was introduced by the U.S. Immigration and Customs Enforcement (ICE) on July 6, 2020. A few weeks prior to the fall 2020 semester, international students were informed that they would be deported to their home countries if they were enrolled in fully online programs (ICE, 2020). International students became tasked with an impossible decision to either prioritize their health or their education. Unlike domestic students, who could safely attend programs online, the proclamation required international students to attend in-person classes to remain in the country (ICE, 2020). Although the proclamation was later amended to allow international students to attend online courses without deportation (ICE, 2020), the disparaging messages toward international students could not be overlooked. The presence of a discriminatory order that forced international students to choose between their safety and educational training is reflective of larger anti-immigration sentiments that push many students toward an emotional breakdown (Garcini et al., 2020).
Mental Health Challenges for International Students
Although international students contributed about $45 billion to the U.S. economy and to the development of 450,000 new jobs in the United States in 2018–19 (National Association of Foreign Student Advisers [NAFSA], 2020), worldviews that position international students as harbingers of innovation, intellectual diversity, economic success, and a necessity for sustaining higher education institutions are uncommon within American society (Williams & Johnson, 2011). Sadly, experiences of hate crimes are so frequent that many international students perceive them as normal consequences of being an international person in the United States (Lee & Rice, 2007; Pottie-Sherman, 2018). According to George Mwangi et al. (2019), for many international students, universities are far from being spaces of inclusivity and openness. Often, they were described as sites of oppression and “Americanization.” Interviews with international students from Africa indicated that due to their intersecting identities as racial and cultural minorities, participants in the study endured constant messages and actions undermining their culture and knowledge. In fact, persistent incidents of prejudice and discrimination made the participants feel “crazy” (George Mwangi et al., 2019). Chronic exposure to xenophobia, discrimination, and anti-immigrant sentiments has been documented to have profound impacts on international students’ psychological well-being (Houshmand et al., 2014; Ong et al., 2013). As a result of multiple factors, including xenophobia, international students suffer from severe psychological symptoms. One example is a recent study by Dovchin (2020), who found that parochial attitudes toward non-native English speakers and embedded linguistic racism had “serious ‘psychological damages’” (p. 815) on the international students’ mental health. Notably, the impact of “ethnic accent bullying” (p. 815) on her international student participants included development of social anxiety symptoms and suicidal ideation. Given that many of the instances of linguistic racism were found within classrooms, it is imperative that college counselors consider the pervasive influence of systemic inequities on international students’ mental health.
Critical Feminist Perspectives
Critical feminist paradigms acknowledge the powerful role of systemic influences and focus on change at structural levels. These paradigms challenge larger social structures (e.g., national and institutional policies) and promote the pursuit of social justice through clinical practice and inquiry (Moradi & Grzanka, 2017; Mosley et al., 2020). Thus, critical feminist paradigms are grounded in the philosophy that current social landscapes are inequitable and therefore unjust (Bonilla-Silva, 2013). Specifically, the critical feminist theory of intersectionality describes how systems of oppression and the social constructions of race, socioeconomic class, gender, and other identities interact in ways that influence one’s social positioning (Crenshaw, 1989). Given many international students’ intersecting identities as linguistic, racial, and ethnic minorities, counselors must consider how their unique combination of marginalized and privileged identities contribute to their social position and worldview as outlined in the Multicultural and Social Justice Counseling Competencies (MSJCC; Ratts et al., 2015). Consistent with the focus on addressing the pervasive role of sociopolitical systemic influences, the analysis and recommendations offered in this article are grounded in the critical feminist paradigm.
Bioecological Systems Theory
Oppression and change occur across multiple levels of human interactions, and each level may require varied strategies for advocacy on the part of the counselor (Ratts et al., 2015). These interactions range from everyday occurrences in one’s immediate surroundings (e.g., classrooms) to international policies (e.g., travel bans). To address the powerful influence of multiple systems on the mental health of international students, a critical feminist paradigm was applied to Bronfenbrenner’s (1979) bioecological systems theory. The bioecological systems theory outlines how systems and environment interact with an individual in ways that impact their overall well-being. According to the model (Bronfenbrenner, 1994), individuals experience a bidirectional relationship (directly and indirectly) as a result of interacting with environmental systems where the impact of the relationship is dependent on the amount of interaction taking place. The bioecological theory is represented by five concentric circles that expand to represent multiple levels of permeable systems that affect one’s development (Bronfenbrenner, 1994). The systems within Bronfenbrenner’s model include: (a) microsystem, the immediate environment (e.g., family, school, peer group, neighborhood); (b), mesosytem, connections within the immediate environment, such as college campus and roommates; (c) exosystem, external environmental settings that only indirectly affect development, such as religious institutions outside of one’s faith; (d) macrosystem, which refers to one’s larger cultural context; and (e) chronosystem, encompassing patterns and transitions over the course of time and development (Bronfenbrenner, 1994).
Although the bioecological model represents a relatively robust theory, the model is not without its limitations. Christensen (2016) noted that the theory fails to account for the effects of globalization and technological developments that affect various parts of the world differently. These disparities can be addressed by combining the bioecological model with the critical feminist paradigm, which challenges institutions and structures that cut across national boundaries. Both models combine to create a unique framework that may guide concrete recommendations for counselors actively seeking to support and advocate for international students.
Implications for Counseling International Students
As the extant counseling literature on international students suffers from a limited emphasis on a critical feminist and bioecological lens, the current manuscript offers a systemic framework for counseling international students. We invite college counselors to adopt a critical feminist and systems perspective to hold larger systems accountable for their harmful role in international students’ mental health concerns (e.g., a university’s unwillingness to engage in culturally responsive and linguistically inclusive teaching strategies; Archer, 2007). The following counseling recommendations were developed from the authors’ direct experiences through counseling international students, and through a review of relevant literature. Although these recommendations may apply to all counselors irrespective of their settings, some may be specific to a particular role (e.g., college counselor).
The microsystem level includes the bidirectional relationships between the international student and the people with whom they regularly interact (Bronfenbrenner, 1979). College counselors and community counselors working with this population can support international students at the microsystem level by asking them to identify and deeply explore “safe” and “unsafe” relationships that exist within their college/university campus, neighborhood, and relevant religious group. Next, counselors can empower international students by framing their concerns as part of a larger systemic issue to minimize self-blame (i.e., seeing themselves as the cause of their challenges; Sue & Sue, 1990). Here, the focus is placed on empowering international students to engage in self-advocacy within the systems they occupy (Haskins & Singh, 2015). The reframe may also aid in enhancing the international student’s critical consciousness (Ratts, 2017; Ratts & Greenleaf, 2017) and help them shift their perspectives from self-blame to acknowledging the role(s) of external oppressive forces (e.g., racism, xenophobia, Sinophobia; Manzano et al., 2017). Indeed, engaging in the internalization of problems in response to stressors is prevalent among many international cultures (Wong et al., 2013).
Interventions at this level might involve the use of microinterventions (Sue et al., 2019) to empower international students. Sue et al. (2019) defined microinterventions as deeds and interactions that communicate affirmation and validation to targets of microaggressions. These interventions have the potential to enhance the psychological well-being and self-efficacy of the target and disarm the effects of microaggressions by challenging the perpetrator. Counselors can provide psychoeducation on microinterventions, using caution and clinical judgment to avoid further harm to the student. It is imperative that counselors recognize and educate the international student that it could be dangerous to employ microinterventions without understanding the specificities of the context. Sue et al. noted that the minoritized individual (target) employing microinterventions must be intentional about picking their battles, as endless responses to each encountered incident of microaggression can be damaging to the target’s well-being. The target should be aware of the context of the microaggression and modify their response as the situation requires. Given that racism and oppression permeate classroom spaces, college counselors can also provide opportunities for practicing microinterventions through role plays (Litam, 2020). One microintervention is making the “invisible” visible by responding to instances of racial discrimination on campus, making the offending party (e.g., domestic students, staff) aware of their offensive actions or words, and/or compelling them to consider their impact (Sue et al., 2019). Counselors may further guide international students in educating the offender (Sue et al., 2019). Litam (2020) noted that although it is of critical importance to avoid placing the onus of responsibility on minoritized individuals (e.g., international students) to educate and/or confront their offenders, when they do engage in thoughtful responses the opportunity to educate can result in positive changes and healthier relationships.
Finally, counselors can support international students to incorporate mindfulness and self-compassion as culturally sensitive tools to address the xenophobic experiences of COVID-19–related racial discrimination (Litam, 2020). Compassion meditation may help international students release their feelings of anger and intentionally cultivate experiences of self-compassion and positive regard toward self and others. Self-compassion may be cultivated by encouraging international students to attend to their immediate needs by remaining present and non-judgmental (Germer & Neff, 2015). Grounded in the Buddhist concept of loving-kindness, international students may be trained to pay attention to their somatic experiences with a non-judgmental curiosity. For instance, as these students confront chronic racism, they may benefit from opportunities to be kind to themselves. Counselors may also guide them to engage in mindful breathing to ground themselves in the face of chronic stress (Germer & Neff, 2015).
Additionally, empowering international students to cultivate a strong sense of ethnic identity may also represent an important strategy at this level. Extant research continues to identify the role of ethnic identity as a protective factor for experiences of racial discrimination (Carter et al., 2019; Chae & Foley, 2010; Choi et al., 2016; Tran & Sangalang, 2016), including experiences of COVID-19–related racial discrimination (Litam & Oh, in press).
Counselors working with international students at the mesosystem level may continue to strengthen the interventions at the microsystem level while exploring mental health stressors that may arise through interactions between the student and their peers and/or members of the college/university campus community. Counselors who interact with various social groups uniquely position themselves in ways that establish new relationships, building support with spiritual and religious leaders (Sue et al., 2019) and mid- and senior-level administrators who are then able to directly or indirectly support international students on and off campus (Mac et al., 2019).
Leveraging their network within the university system, college counselors can explore how faculty members, administrators, and staff may improve their cultural humility and competence by collaborating with them in efforts to support international students within the campus (Hook et al., 2013). For instance, faculty members and staff could be invited to on-campus ethnic interest groups, cultural festivals, or language clubs on a regular basis to immerse themselves in their students’ cultural practices. Additionally, many international students on campus occupy shared housing. College counselors can teach international students’ roommates, peers, and resident advisors to detect signs of distress and isolation. This can potentially help student leaders and other residents better support international students and promote wellness in the student body more broadly. Engaging the community in culturally relevant strategies for promoting the mental health of international students and recognizing their distress may help college counselors in early detection of distress for this community.
The exosystem level examines social settings that indirectly impact the student but in which the student has no direct impacts (e.g., local politics, medical and social services; Bronfenbrenner, 1979). Interventions at the exosystem level might examine how educational training grounded in Eurocentrism may further marginalize international students and negatively impact their academic standing and their overall mental health and well-being (George Mwangi et al., 2019; Ploner & Nada, 2020). Counselors working with international students at the exosystem level must shift their perspectives from interpersonal interventions toward a greater examination of systemic influences. Counselors may utilize the MSJCC (Ratts et al., 2015) to consider the intersecting ways in which the privileged and oppressed identities of international students uniquely influence their mental health experiences. A detailed description of how counselors can apply the MSJCC to counseling international students can be found in Kim et al. (2019).
College counselors working at the exosystem level must play an active role in advocating on behalf of international students by working to dismantle White supremacy in college/university counseling settings (Ratts, 2017) and academic settings (Haskins & Singh, 2015). Furthermore, counselors working at the exosystem level are called to advocate for inclusive spaces and educational curricula that incorporate diversity of thought and pedagogical practices that cater to all student groups. Other examples of exosystem-level advocacy include involvement with academic units, institutions, organizations such as NAFSA and the American College Personnel Association, and communities that indirectly impact international students (Manzano et al., 2017). Trainings for educators and staff at colleges/universities about the importance of dismantling systemic racism and facilitating anti-oppressive pedagogy may also be provided (Berlak, 2004).
Furthermore, community counselors working with this population may collaborate with various social groups (e.g., host families) to develop antiracist approaches that address internalized racism and White supremacy (Kendi, 2019; Singh, 2019). These collaborations may also aid in facilitating the help-seeking behavior of international students and countering the embedded stigma against seeking mental health support (Liu et al., 2020).
The macrosystem-level focus is on cultural norms, values, and laws that influence the international student without being directly influenced by the student (Bronfenbrenner, 1979). At this level, college counselors may collaborate with other health specialists (e.g., community mental health counselors, social workers, medical doctors) and explore how current U.S. political structures impact the mental health and well-being of international students. These alliances can help students as counselors engage in advocacy initiatives and tackle public policy on behalf of the student (Chan et al., 2019). For example, college counselors can engage in advocacy efforts similar to those that encouraged college and university administrators to oppose the ICE policy by President Trump that targeted international students.
In addition to seeking change to public policies that discriminate against international students, college counselors working at the macrosystem level can also advocate for equitable practices within college and university systems and promote an educational climate that celebrates international students on campuses. Forming alliances with stakeholders (e.g., administrators, legislators, legislative staff) who directly and indirectly impact cultural norms and values in society could also be a helpful strategy for counselors supporting international students at the macrosystem level (Mac et al., 2019). Similarly, community counselors can offer cultural sensitivity training programs to members of local government agencies (e.g., credit unions, DMV). Knowledge of how visa regulations and cultural norms operate can help state and national organizations better serve this population. Finally, platforms such as the National Association for College Admission Counseling and The Chronicle of Higher Education may offer unique spaces for collaboration among counselors, educators, and allies to advocate for this community.
The chronosystem encompasses all other societal systems that directly and indirectly impact the international student over time (e.g., federal employment policies; Bronfenbrenner, 1979). Interventions at the chronosystem level could address how the transition from an international student to worker in the United States (e.g., H-1B visa–holding professional) impacts how they are perceived by American society. For example, counselors can design programs that identify and address the needs of international students based on past and current sociopolitical events (e.g., 9/11 attacks, COVID-19 pandemic). Furthermore, college counselors may consider how these sociopolitical events might lead to disparaging attitudes toward international students and actively work to facilitate workshops, webinars, or trainings that identify and dispel harmful notions. Both college and community counselors must critically consider how systems continue to evolve over time (Chan et al., 2019). Therefore, they need to be actively attuned to the needs of international students, stay abreast of the current events that affect them, and actively participate in professional advocacy efforts across various systemic levels (e.g., institutional, state, national) to continue supporting this vulnerable community.
Using the search terms listed earlier, we completed an extensive review of the counseling literature. A paucity of empirical research exists in the counseling profession on international students’ mental health needs and experiences from a critical and systemic perspective. Empirical data can help counselors discern which types of interventions are most effective for international students within the counseling setting across various systems. In this article, we highlight that because of racial, linguistic, gender, and other differences within the international student community, an intersectional approach to inquiry is necessary. For instance, the experiences of a White, German, male international student will be vastly different from the experiences of a Black, Ghanaian, female student. Thus, inquiry on the experiences of this community must be positioned in the intersectionality framework (Crenshaw, 1989). Limited access to critical scholarship on the mental health experiences of international students within the counseling setting puts counselors at risk for retraumatizing their minoritized clients (Jones et al., 2017) through potential use of microaggressions and stereotypes, as shared by participants in the study by Liu et al. (2020). Thus, a tutorial stance grounded in cultural humility (Hook et al., 2013) and openness may be needed to build a safe and meaningful therapeutic relationship (Gonzalez et al., 2020). Future inquiries may help practitioners develop training modules and culturally responsive resources to improve their counseling skills and advocacy work with international students.
This article outlines a critical feminist and bioecological systems approach to supporting international students who are at higher risk for mental health distress because of xenophobic policies, racial discrimination, and systemic barriers. Discriminatory attitudes and behaviors toward international students have heightened during the current COVID-19 pandemic. Amidst this burgeoning crisis, counselors practicing in all settings are called to consider how each of these factors uniquely contribute to the mental health and overall well-being of this vulnerable population. Future research is needed to establish specific interventions that are most effective in mitigating the effects of pandemic-related stressors on the mental health of international students. Counselors are called to engage in advocacy efforts that dismantle systems of oppression at various levels, including within the community, in university/college settings, and in state and federal policies.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
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S Anandavalli, PhD, NCC, LPC-I, is an assistant professor at Southern Oregon University. John J. S. Harrichand, PhD, NCC, CCMHC, ACS, LPC, LMHC, is an assistant professor at State University of New York at Brockport. Stacey Diane Arañez Litam, PhD, NCC, CCMHC, LPCC, is an assistant professor at Cleveland State University. Correspondence may be addressed to S Anandavalli, Clinical Mental Health Counseling, Southern Oregon University, 1250 Siskiyou Blvd, Ashland, OR 97520, email@example.com.