Shadin Atiyeh
This study explored the challenges and strategies employed by counselor educators in training students to work effectively with refugee populations. Utilizing a qualitative descriptive analysis, a qualitative open-ended survey was conducted with 11 counselor educators and a focus group meeting with four counselor educators from various CACREP-accredited master’s programs across the United States. The analysis revealed several barriers to effective training, including the perceived limited relevance of the topic, time constraints within courses, and the complexity of addressing refugee issues. Participants emphasized the pressing need for comprehensive curricula that integrate refugee concerns and enhance multicultural competence. Findings suggest that diverse teaching strategies, such as case studies and experiential learning, are essential for preparing students to meet the unique mental health needs of refugees. This study underscores the importance of equipping future counselors with the skills and knowledge required to support this underserved population effectively and to advocate for the integration of refugee topics across counseling courses to promote social justice.
Keywords: refugees, barriers, multicultural competence, curricula, counselor educators
According to the American Counseling Association (ACA; 2014) Code of Ethics, counselors must gain multicultural competence to work with diverse populations and to advocate for equitable access to mental health care among underserved populations. Refugee populations represent a diverse group who face barriers to accessing mental health care in many societies (Satinsky et al., 2019). The UN Refugee Agency (formerly the United Nations High Commissioner for Refugees; 2025) defined a refugee as a person who flees their home country because of persecution based on race, religion, nationality, political opinion, or membership in a social group. The number of forcibly displaced people globally was 123.2 million people at the end of 2024, including 42.7 million refugees (The UN Refugee Agency, 2025). Despite the growing global need for counseling services among refugees, counselor training programs often do not include orientation to refugee issues in their counseling courses. The Council for the Accreditation of Counseling and Related Educational Programs (CACREP; 2023) addresses migration in its standards within the definitions of cultural identity, diversity, and marginalized populations. However, the topic of migration is included explicitly within the standards when relevant to the impact of migration on family functioning for the marriage, couple, and family counseling specialization (CACREP, 2023). Counselors are currently facing a global humanitarian call to support refugee populations (Snow et al., 2021). The goal of this study was to explore approaches to counselor education that teach counseling students about refugee concerns and the barriers counselor educators face in training counseling students to develop this competence. The findings offer diverse strategies to facilitate multicultural competence among counseling students and illuminate the barriers to access, which the profession must address in order to respond to the current mental health crisis among the growing number of refugees globally.
Refugee Resettlement in the United States
The United States has admitted more than 3.1 million refugees since the passage of the Refugee Act in 1980 (U.S. Department of State, 2018). To address the unprecedented global refugee crisis, the United States raised its admissions ceiling to 125,000 for fiscal years 2023 and 2024. In the fiscal year 2023, the United States also launched a private sponsorship pathway for refugee arrivals called Welcome Corps. This allowed groups of citizens to sponsor and resettle refugees in their communities. The United States also established a pathway for migration to those fleeing the Ukrainian and Afghan crises and allowed eligibility for refugee services for those individuals in addition to a streamlined application process for Cubans, Haitians, Nicaraguans, and Venezuelans to seek refuge. These actions yielded more opportunities for migrants to seek refuge and more communities across the country welcoming refugees outside of the traditional refugee resettlement structure. Traditionally, refugees are resettled in 48 states, with Washington, California, Texas, Ohio, and New York being the top resettlement areas (U.S. Department of State, 2018). The top 10 native languages that refugees living in the United States speak include Arabic, Nepali, Somali, Karen, Spanish, Swahili, Chaldean, Burmese, Armenian, and Farsi (U.S. Department of State, 2018). In fiscal year 2024, 100,034 refugees were admitted, with the top five countries of origin being the Democratic Republic of Congo, Afghanistan, Venezuela, Syria, and Burma. Although this was a record number for the traditional refugee resettlement program in the 21st century, it did fall short of the 125,000 ceiling set by the federal administration (Refugee Council USA, 2024). In January 2025, the federal administration closed both the traditional pathway for refugee resettlement and the parole application processes, as well as removing legal status for previously approved groups (Church World Service, 2025).
Mental Health Needs
Refugees are ethnically diverse and have varied experiences and backgrounds; however, they all share an increased risk for trauma-related distress and underuse of services (Bemak & Chung, 2021). One distinction between refugees and other migrants is that while immigrants tend to arrive in the United States healthier than the native-born population and then develop illnesses over time, refugees tend to enter the country less healthy than the native-born population (Pampati et al., 2018). Refugees have higher prevalence rates of post-traumatic stress disorder and depressive disorders (Bartholomew et al., 2021), and compared to other immigrants, refugees have the additional difficulties of pre-migratory traumatic experiences, grief, and loss of self-determination (Rometsch et al., 2020). Immigrants who choose to migrate and prepare for that transition face barriers such as culture shock and acculturation difficulties. However, refugees flee for their safety, without a choice and often without time to prepare, often leaving behind valuables and important documents. This loss of self-determination compounds in migration, as host countries often do not offer refugees the right to work, establish a lawful presence, or study. Much of the current literature related to the resettlement of refugees focuses on traumatic experiences before migration and leaves out the stressors involved after resettlement to a third country (Interiano-Shiverdecker et al., 2020). However, the daily stressors post-migration can be more distressing than war-related trauma and necessitate a social justice perspective to counseling (Kondili et al., 2022). These daily stressors may include acclimating to a new culture, language, and socioeconomic status, as well as navigating new social systems to access public benefits and health care. The focus of refugee services toward self-sufficiency as quickly as possible contrasts the policy of referring the most vulnerable refugees to resettlement, and the refugees’ years of experience having to depend on others for survival. Discrimination and prejudice are risks to overall well-being, affecting self-esteem, belonging, and self-determination (Interiano-Shiverdecker et al., 2020). The need for counseling services among refugee populations, particularly in resettlement to the United States, is well established.
Barriers to Counseling for Refugee Populations
Despite the need, refugees face various barriers to access for counseling services. Regardless of cultural background, refugees commonly experience barriers related to transportation, language, loss of social networks, financial difficulties, and limited access to resources (Tribe et al., 2019). Cultural barriers to seeking mental health counseling include shame about sharing personal or family concerns with those outside the family, a need to maintain a positive reputation within the community, and disbelief that talking about an issue could make it better (Hosseini et al., 2023). Refugees, who often have experienced oppression that breeds mistrust of people in power, may have concerns related to privacy and safety in counseling (Duden & Martins-Borges, 2021). With varying educational levels and interrupted education due to conflict, refugees may also lack knowledge about the availability and utility of counseling services (Duden & Martins-Borges, 2021).
Systemic issues also play a role, such as a misalignment between the mental health care system’s offerings and the specific needs of refugee communities (Bartholomew et al., 2021). Individualized Western conceptualizations of mental illness and its treatment are limited in being able to address the mental health needs of refugee groups (Bartholomew et al., 2021). Psychosocial distress presents itself with somatic symptoms such as headaches, backaches, and stomach pains among refugee groups, complicating identification and treatment of psychosocial disorders (O’Brien & Charura, 2023). Effective support requires a holistic and culturally sensitive approach that addresses not only specific psychiatric conditions but also the practical, social, and cultural contexts of their lives (Salami et al., 2019). In summary, refugees face a complex web of interconnected barriers to accessing mental health care. These include practical issues like cost and language, cultural factors such as stigma and differing illness beliefs, and systemic problems where the services offered do not match clients’ perceived needs. Overcoming these barriers requires a multifaceted approach that includes providing practical support, fostering cultural humility among clinicians, and adapting therapeutic models to be more responsive to the unique circumstances of refugee populations.
Multicultural Competence in Counseling Refugees
Ratts et al. (2016) created a multicultural counseling model that includes attitudes and beliefs, knowledge, skills, and action across the domains of interventions, relationships, client worldviews, and counselor self-awareness. Ratts et al. (2016) approached multicultural competence with an awareness of the need to include a broader concept of diversity, intersectionality of identities, and the role of counselors as social justice advocates. Cultural competence requires flexibility in accepting individual conceptualizations and needs rather than knowledge of a set of generalized facts about a cultural group (Cabell et al., 2024). To work with refugees effectively, counselors must have a range of skills, including navigating boundaries, advocating, responding to trauma, facilitating acculturation, and working with interpreters (Atiyeh & Gray, 2022). Training and preparation of counselors in their master’s-level courses are key to laying the foundation for multicultural competence development to work with refugee clients. This training also extends toward multicultural competence with other populations (Atiyeh & Gray, 2022). Although it is understood that counselors need to be culturally competent social justice advocates, knowing how to support trainees in learning and demonstrating those skills in real-world contexts is less understood (Kuo et al.,2020). Professional development training on specific cultures is important to further develop multicultural competence beyond master’s-level training (Cabell et al., 2024). Much of the training provided in master’s counseling programs relies on a traditional model of counseling utilizing Western-based theories, and promoting refugee mental health requires incorporating a collaborative and social justice approach (Kondili et al., 2022). Counseling programs may be deficient in preparing counselors who are knowledgeable about their clients’ worldviews (Damra & Qa’aymeh, 2024). The intersection of the high need for counseling services, the systemic barriers preventing effective and culturally responsive counseling, and the limited competence among counselors poses a serious health equity issue that the profession must address.
Method
The purpose of the study was to explore the ways that counselor educators address refugee concerns in counseling courses in order to highlight barriers and resources for counselor education. The research question was: What are the experiences of counselor educators who address refugee concerns in master’s-level counseling courses? I conducted a qualitative descriptive analysis study utilizing an open-ended qualitative online survey and a focus group session. This approach is appropriate when exploring participants’ experiences and perceptions from a naturalistic orientation (Sandelowski, 2010). As the current literature demonstrates a need for competent mental health counseling for refugee populations, further investigation into the barriers that counselor educators experience in training students to work with this population and how they navigate these barriers is important. Qualitative description offers a starting point to explore how counselor educators incorporate refugee concerns in the classroom at the master’s level. The survey included questions related to which courses cover refugee concerns, what strategies they use, what barriers they face in doing so, and the training they have had related to refugee concerns. The study design followed a descriptive content analysis with the intent of describing how counselor educators may be teaching students in the classroom how to work with refugee clients, the resources they utilize, and the challenges they face in doing so. This qualitative approach can be useful in identifying and sharing data in a way that is relevant to a specific audience (Sandelowski, 2000).
Study Design
I shared an online survey with open-ended questions utilizing Qualtrics on listservs and social media groups for counselor educators. These outlets for recruitment were appropriate to seek out counselor educators who self-identified as incorporating refugee concerns into their master’s-level counseling courses. After an initial analysis of the survey data, I posted a focus group meeting opportunity on the same listservs. In the focus group meeting, initial themes were shared, and participants were asked to react to and expand on the results. The transcript for the focus group meeting was coded using in-vivo coding. Individual codes were grouped into categories and those were grouped under major themes.
Participants
Participant inclusion criteria included counselor educators who teach master’s-level counseling courses and address refugee concerns in those courses. I recruited participants online through emails to a listserv of counselor educators and social media groups of counselor educators. These included CESNET and social media groups for the NBCC Foundation Minority Fellowship Program recipients and alumni. An invitation to participate in the focus group meeting was sent to the same groups. Eleven participants completed the open-ended survey and four counselor educators participated in the focus group meeting. Demographic data were not collected as part of the survey or focus group questions in order to preserve anonymity, as the community of counselor educators with experience incorporating refugee topics in their courses may be quite small, and demographic data may reduce their openness to provide in-depth responses.
Procedure
This study received ethical approval from the host institution’s IRB. The emailed recruitment message included a research information sheet explaining the research and participation expectations. It also included a link to complete the survey using Qualtrics. There were no planned follow-up procedures after the survey. Eleven participants completed the open-ended survey, which included the following questions:
- In what classes and during which topic areas do you include refugee concerns in your counseling courses?
- What activities or resources do you use to teach counseling students about refugee concerns?
- What barriers or challenges do you face when teaching counseling students about refugee concerns?
- How have you received training or education regarding refugee concerns, if any?
These questions were developed to respond to the research question of: What are the experiences of counselor educators who address refugee concerns in master’s-level counseling courses? The questions were also framed to lead to practical resources and techniques for counselor educators to utilize within their courses. I grouped responses to these questions into descriptive categories. I submitted and obtained approval for an amendment to the initial IRB approval to obtain focus group data to expand on emerging themes from the survey. I emailed a recruitment message with an edited research information sheet detailing focus group procedures and an invitation to a virtual meeting on Microsoft Teams, which four participants attended. Participants had the choice to be off-camera during the meeting. The meeting was recorded for transcription, and the recording was deleted after the transcription was created. I presented these to the focus group participants for elaboration and description of the emerging themes. I shared the initial results from the survey data and asked participants to share what stood out to them about these findings. I also asked the focus group participants the same questions from the survey. The focus group meeting was semi-structured with an in-depth discussion following the participants’ responses to allow for a deeper discussion of the research question that the open-ended questionnaire could not offer (Bengtsson, 2016). The transcript of the focus group meeting was analyzed and coded in vivo. Those codes were grouped into categories and then organized into themes.
Data Analysis
I downloaded Qualtrics responses in an Excel spreadsheet and reviewed them several times following a content analysis approach (Sandelowski, 2000). I then read through the data two times before conducting in-vivo coding. A code was written next to the relevant data on the Excel spreadsheet. Similar codes were then grouped together in Microsoft Word. While staying close to the data, it was organized into categories (Prasad, 2019). I organized the data into categories so that the description could lead to meaningful implications to which the focus group participants could react. After the focus group, the meeting was transcribed automatically using Microsoft Teams and analyzed separately from the survey data. This analysis included the same process of reading through the transcript twice initially, then a round of initial in-vivo coding within an Excel spreadsheet, then grouping similar codes into a table on Microsoft Word, and finally grouping those categories into larger themes.
Researcher Positionality and Reflexivity
A key element of rigor in qualitative research is researcher reflexivity (Olmos-Vega et al., 2023). While inherent biases, subjectivities, and power imbalance inevitably inform data analysis and influence the research process, sharing the positionalities of the researcher is an important first step in trustworthiness (Olmos-Vega et al., 2023). Olmos-Vega et al. (2023) defined reflexivity as a dynamic and collaborative process that involves self-critique and context evaluation by first making positionality explicit. I am an assistant professor in the counselor education department at a public urban university offering CACREP-accredited master’s-level programs in clinical mental health, school counseling, and clinical rehabilitation counseling. I also have over 10 years of experience providing counseling and employment services with refugee populations and supervising such programming. I approach my clinical and academic work from a constructivist and existential perspective in which knowledge and experiences are co-constructed through meaning-making and perspective-taking. I have not personally experienced migration, forced or otherwise, but have grown up around immigrant communities as the child of an immigrant. I conducted this study to bring attention to the need for counseling services for refugee communities and the struggles faced and strategies employed by educators when training counseling students to do so. This is the perspective with which I approached study design and data interpretation. I also developed reflexivity throughout the process by checking initial interpretations from survey data with the focus group participants and connecting themes with the quotes from the data.
Results
The initial survey results are outlined in Table 1. Focus group participants discussed their reactions to these responses and expanded on them in their own answers to the same questions. The analysis of the transcript yielded 89 codes that were grouped into 11 categories and three themes.
Table 1
Survey Results
| Courses | Strategies | Barriers | Training for Educators |
| Diversity | Guest Speakers | Lack of student interest | Conferences |
| Ethics | Videos | Not relevant | Articles |
| Family | Articles | Limited time | Lived experience |
| Trauma | Poems | Not covered in textbooks | Consultation |
| Group | Case Studies | Political reasons | Workshops |
| Career | Student Presentations | Too complex | None |
| School | Textbook | ||
| Internship | |||
| Advocacy |
Description of Courses
The survey results indicated that refugee concerns may be addressed in courses throughout the master’s program, not just in a singular course focused on multicultural diversity. These courses included an introductory course on diversity topics in addition to ethical practice, family counseling, treating trauma, groupwork, career counseling, school counseling, clinical courses, and a course on advocacy strategies. This is in line with guidance within the counseling literature on facilitating multicultural competence across the curriculum. Multicultural competence is too complex and important to be limited to only one class. Doing so may allow students to grasp some of the complexity involved in working with refugees and develop their counseling skills to work with intersectional identities. However, focus group participants were struck by the lack of standardization to how counselor educators address refugee concerns in their courses, highlighting the variability in responses to which courses include the topic. This variability also comes up in the ways that counselor educators approach training students to work with refugee clients.
Description of Strategies
Counselor educators also broach the topic in various ways: allowing students to bring it up, inviting a guest speaker, or having a discussion led by the educator. Participants shared that it comes up in courses because students bring up the topic through their papers, presentations, or case presentations, if they happen to be working with a refugee client. Participants might bring refugee concerns into the classroom as they discuss current news stories or events.
The content presented by counselor educators included peer-reviewed articles, student presentations, case studies, and textbooks. Participants also utilize creative approaches that highlight the lived experiences of refugees, such as poetry or film. Guest speakers share their own clinical experiences working with refugees in the field. Focus group participants shared specific examples, such as incorporating case studies in various classes. One focus group participant described a paper assignment given to students in which they needed to analyze an ethical issue relevant to a population facing racism or oppression; some students selected a concern facing refugees. Another participant led an internship experience at a local shelter for migrants and trained students to work specifically with this population through experiential training and weekly supervision. Although this participant described requiring students to have a traditional counseling experience before participating in this internship and the importance of having balance in skills for both conventional in-office counseling and nontraditional counseling conducted in shelters, they stated, “It can be very, very difficult to get them to understand that counseling does not have to happen in an office in 50 minutes.” This participant identified that in practice, “These are not the skills that they are taught in the classes . . . there’s a lot of retraining . . . unteaching and untraining can be a barrier and a challenge.” This discussion of strategies utilizing experiential learning quickly turned into a discussion of challenges and barriers in attempting to fit work with refugee clients into the current paradigm of training counselors, which often relies on Western theories of counseling. Another participant in the focus group reflected on how difficult it was to adapt to working with refugee clients after graduating from a master’s program, even while sharing a language and cultural background with clients. They stated, “When I graduated as a master’s student, I went into an agency to work with refugees, and at first, just implementing everything we learned was sometimes damaging.” Allowing for supportive opportunities to practice throughout the master’s curriculum allows students to have safe opportunities to practice before graduation. One participant offered that they “do a lot of shadowing” throughout their practicum experience. Another participant agreed: “I think that that’s where that immersion experience is going to be critical, and immersion doesn’t have to be going to a refugee camp. It could be through different means.”
Description of Barriers
Participants also identified challenges they may face while trying to educate counseling students in the classroom on how to work with refugee clients. These challenges included a perception of the lack of relevance of refugee concerns, limited opportunities to teach students how to work with refugee clients, and the complexity involved in refugee concerns. Some of the quotes from participants illuminated the challenges in teaching counseling students to work with refugees. The direct quotes that support these themes are listed in Table 2.
Table 2
Challenges to Incorporating Refugee Concerns
| Theme | Quotes |
| Lack of Relevance | “Some students don’t seem interested or think that they don’t want to work with that population.”
“Students don’t see the need to learn about it.” “I think opportunities to work with refugees are limited in our area and so it isn’t a ‘pressing’ concern. Doesn’t mean it isn’t important, but we focus on the concerns that our students will likely face in their service provision at higher rates.” |
| Limited Opportunity | “Large amount of topics in learning objectives to cover over a semester.”
“I don’t have a lot of time dedicated to the topic.” “It doesn’t appear in many of the counseling texts as an area to address.” |
| Complexity
|
“Many students lack knowledge about the refugee experience and [have a] misunderstanding of the difference between refugees and immigrants.”
“Students think it’s too hard.” “My state doesn’t want educators discussing ‘diversity’ topics.” “Their previous political beliefs can be an obstacle.” “Addressing this topic as it relates to intersectional identity, and culturally responsive treatment knowledge and resources.” |
Focus group participants elaborated on these themes. The second point from the survey results that stood out to them, after noticing the variability with which counselor educators were discussing refugees, was the sense that competence to work with refugee clients was not important or relevant to students. They made sense of this as being from a place of experiencing the privilege of not having to be aware of the level of forced displacement in the world. One focus group participant highlighted that this ignorance has consequences: “The privilege of not needing to be competent is harmful to communities.” Participants also explored this lack of interest and/or relevance further, stating: “It takes work to gain the competence, and if it’s not something that is of interest, folks are not seeking it out.” The underutilization of mental health services for refugees is further exacerbated by the lack of culturally competent counselors. This lack of interest may also be fueled by stereotypes about the population. Focus group participants shared their perceptions that “a lot of people are afraid of getting into it because of whether it’s like the competence piece or fear of vicarious traumatization or . . . I guess just like lack of interest” and “working with refugees, there is this . . . view of this population as broken. So there is a fear that either I’m going to do harm or not be helpful enough.” Another potential source for this ambivalence is also economic. Focus group participants discussed that there “isn’t a lot of money in it” when referring to working with refugee clients and that it is often grant-funded work in community agencies. They all discussed how counseling students are often entering the profession seeking to work in private practice, providing services reimbursed by medical insurance rather than counseling work in community settings.
Counselor educators are also affected by the limited time, resources, and applicability of current counseling theories to be able to incorporate the complexity needed when addressing refugee concerns in counseling courses. Focus group participants shared that counselor educators themselves “lack the competence to talk about this population” or “don’t feel comfortable enough as educators.” The textbooks used in counseling courses also do not provide enough information on the topic to help guide the discussion in class. One participant mentioned, and others reiterated it multiple times during the focus group, that “we don’t have more than a chapter.” Educators then must seek out additional resources or adapt existing approaches, with one participant sharing that “our counseling theories are not really applying to this population, so we have to spend a lot of time either adapting them or unlearning them.”
Despite these barriers, focus group participants shared multiple reasons why counselor educators and counselors need to persist in developing competence. They all highlighted the scenarios in which counselors may encounter issues related to forced migration or clients from refugee backgrounds. Participants shared that “every border university should have really solid training and education for this population,” and “if you don’t work with refugees, you might have a client that has a family member or friend from that background,” and “in the school setting, like children have to go to school, and so they’re finding themselves being faced with working with refugees.” Participants also shared that they learned a tremendous amount from their refugee clients, deepening their own skills and ability to adapt: “Learning experience for me is like you learn from them probably more than they learn from you,” and “you have to really be flexible to learn from them as much as they’re learning from you to be able to be helpful.” Participants also shared how rewarding the work has been and how they have seen students benefit from “the joy and the reward of working with this population.” Another participant shared that “once they’ve experienced this work, they just love it. There is so much joy in it.”
Description of Training Opportunities
Participants also shared opportunities they had to learn about refugee concerns as educators. These included conferences, reading journal articles, attending workshops, work experiences, and personal lived experiences. Participants shared specific workshops that were useful, such as the Trauma Systems Therapy for Refugees training, Global Mental Health training from Johns Hopkins University, and consultation with local refugee resettlement agencies. These may be a starting place for counselor educators who want to gain training before integrating refugee concerns into their courses. The study findings included several resources available to counselor educators, such as case studies and experiential learning opportunities.
Incorporating refugee concerns throughout master’s-level counseling courses may be useful in facilitating multicultural competence among counselors to work with refugees and other diverse populations. The concern about whether teaching counselors to work with refugees is relevant is striking, given the high need for mental health services among this population and the limited access to those services. Given this need for mental health services and the ethical mandate for counselors to work toward access to mental health care for underserved groups, counselor educators can and must do more to overcome the challenges and complexity involved in facilitating multicultural competence among counseling students.
Discussion
The purpose of the study was to explore the ways that counselor educators address refugee concerns in counseling courses to highlight barriers and resources for counselor education. The research question was: What are the experiences of counselor educators who address refugee concerns in master’s-level counseling courses? Counselor educators who do so incorporate refugee concerns throughout the curriculum using various methods while navigating challenges of complexity, limited time and resources, and potential disinterest. The study results demonstrate the importance of incorporating refugee representation throughout the curriculum at the master’s level. The results suggest various approaches, building on current literature that advocates for opportunities to engage in service learning or immersive experiences. In the following sections, I share resources from the extant literature. These experiential opportunities build students’ abilities to be flexible in “unlearning” traditional theories and serving diverse populations. The diversity of approaches reflects an opportunity for flexibility and creativity in classrooms as well as a threat to the standardized inclusion of multicultural competence to work with refugees across counseling. Part of the variability in how counselor educators are incorporating refugee concerns in their classes stems from the lack of intentionality with which it is addressed. For example, educators often wait for students to bring it up themselves rather than purposefully incorporating refugee concerns in the classroom. CACREP may more intentionally address forced migration and its effect on mental health to offer a framework for its inclusion in master’s-level courses and textbooks. A thorough list of competencies for working with refugee clients and ways of assessing and building these competencies could inform educational approaches. The challenges faced by counselor educators suggest future areas of advocacy needed for our profession to meet the counseling needs of refugee populations.
The Multicultural and Social Justice Counseling Competencies offered a framework advocating for counselors to understand the social context of their clients, intentionally broach concerns related to power and privilege, and advocate for systemic change (Ratts et al., 2016). For counselors to be prepared to utilize this framework with refugee clients, they must have basic knowledge of the sociopolitical context globally, an ability to confront their own biases and attitudes toward refugees, as well as skills to broach topics of power and privilege with refugee clients and to advocate for equitable access to counseling services. This study provides findings and resources counselor educators may utilize in their educational spaces, facilitating this competence for master’s-level counseling students.
Resources for Counselor Educators
Participants discussed various methods such as utilizing film and literature, experiential learning, and case studies. They shared the importance of intentionally exposing students to migrant stories and experiences at the master’s level. Existing literature provides a few examples of assignments and useful resources. These might be adapted to different courses across the curriculum.
Incorporating literature and film in counseling courses may facilitate self-awareness and empathy. These also allow for experiential learning before the clinical courses. The United Nations (2022) published an article listing recent films on refugee stories that included Flee, Simple as Water, Encanto, Captains of Za’atari, and Three Songs for Benazir. The Penguin Book of Migration Literature presents a diverse collection of fiction and poetry from migrant perspectives throughout history. Houseknecht and Swank (2019) recommended asking students to search “interview with a refugee” on YouTube and identify a video that is at least 10 minutes long and write a reaction paper as if the interviewee was their client.
Experiential learning can encourage students to actively experiment and then bring back their learning and reflection into the classroom (Houseknecht & Swank, 2019). Service learning components within courses improved multicultural and social justice knowledge and skills (Midgett & Doumas, 2016). A cultural immersion and social action project may be useful in developing multicultural competence and social justice advocacy competence (Pechak et al., 2020). Service learning early in the program, while students are developing their conceptualizations of the counseling profession, may be more beneficial for students to gain social justice and multicultural competence skills (Midgett & Doumas, 2016). Students need applied experiences within the community to develop these skills (Midgett & Doumas, 2016). Houseknecht and Swank (2019) described a role-play activity to simulate counseling with an interpreter where the students who act as counselors and clients write their responses and the student acting as an interpreter reads them.
Participants shared the use of case studies, suggesting that those who have experience with refugees may build them from their experience. Case studies can provide an opportunity for students to conceptually apply skills such as diagnosis, treatment planning, case management, career counseling, and ethical decision-making. Snow et al. (2021) recommended the website iamanimmigrant.com as a source of immigrant stories. Kondili et al. (2022) presented two case studies that incorporate a community and advocacy approach. Case studies can be presented in various courses that allow for intersectional identities where immigration status is one factor that interacts with other aspects of the client’s social identities, the counselor’s social identities, and the overall context. Snow et al. (2021) also presented a useful case study and guide for counselor educators on ways to incorporate refugee concerns throughout various counseling courses.
Study Limitations
The current study contributes to a deeper understanding of how counselor educators may attempt to incorporate refugee concerns and the challenges they face. However, it has some limitations. One main limitation was the lack of any demographic data on participants, which limits the information on context, such as the location in which the participants are teaching and their professional experience in the field. An online survey design was chosen because it may allow for more candid responses through anonymity and privacy (Blease et al., 2023). It also allowed participants to complete the study on their own time at their convenience, and it ensured complete anonymity. However, it did not allow further probes to gain further description or meaning behind the survey statements. The focus group partially filled that gap. The number of participants across both data collection methods was low, potentially because of the low number of counselor educators who incorporate refugee concerns into their courses.
Future Research
The leaders of the counseling profession need to make it more likely that refugee clients can find counselors who can understand refugee experiences, promote mental health literacy among refugee communities, demonstrate respect, and assess clients’ understanding of mental health (Snow et al., 2021). Counselor educators have a responsibility to train counselors to become advocates with a social justice orientation (Clark et al., 2022). Further research can support counselor educators as they endeavor to train counselors and advocates addressing the refugee crisis. Theories of mental illnesses and their treatment that are indigenous to the populations served need to be identified and utilized within counseling. The need to continuously adapt Western models poses an accessibility barrier for non-Western groups. Building on the limitations of this study, future qualitative studies may further investigate the rewards and challenges related to incorporating refugee concerns into counseling classrooms. Quantitative studies could identify the effects of training counselors to work with refugees on students’ overall competence and the accessibility of counseling services to refugee populations and other underserved groups. The impact of the political environment devaluing and silencing equity approaches in education poses new barriers. This was a point that survey participants made but focus group participants did not discuss. This may be because they were not experiencing that barrier at the time. Research should explore how counselor educators navigate these challenges and their threats to our professional values. As demographic data was not collected for this study, further research could explore the connection between professional identity and context and their approaches to educating counselors on working with refugee clients.
Conclusion
Advocating for social justice and positive social change is an aspect of ethical professional identity for counselors and counselor educators (ACA, 2014). Increasing the competence of counseling professionals would make counseling more accessible to refugees, currently an underserved group. Professional counselors risk losing perspective on the societal and group dynamics of wellness when they provide mental health services in individualized settings. However, a commitment to equity, justice, and beneficence is a part of counselors’ professional ethics and identity (ACA, 2014). As health professionals, counselors must advocate for conditions that promote wellness within communities. Therefore, developing advocacy skills and a commitment to social justice is crucial to establishing cultural competence and ethical practice with refugee clients. With the rising numbers of refugees globally, there is a greater need for counselors who are trained and competent to counsel refugee populations; it may become more likely that counselors will encounter refugee clients in their careers. Counselors may need to grow their knowledge base, skills, and awareness related to refugee issues. Counselor preparation programs and supervisors play an important role in facilitating that competence. Further training and research in this area will support the multicultural and social justice competence of counselors to meet the growing need globally and in the United States.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest
or funding contributions for the development
of this manuscript.
References
American Counseling Association. (2014). ACA code of ethics. https://bit.ly/acacodeofethics
Atiyeh, S., & Gray, G. (2022). Counsellors’ competency to counsel refugees: A constructivist grounded theory study. Counselling and Psychotherapy Research, 22(1), 32–42. https://doi.org/10.1002/capr.12477
Bartholomew, T. T., Gundel, B. E., Kang, E., Joy, E. E., Maldonado-Aguiñiga, S., Robbins, K. A., & Li, H. (2021). Integrating cultural beliefs about illness in counseling with refugees: A phenomenological study. Journal of Cross-Cultural Psychology, 52(8–9), 705–725. https://doi.org/10.1177/00220221211038374
Bemak, F., & Chung, R. C.-Y. (2021). Contemporary refugees: Issues, challenges, and a culturally responsive intervention model for effective practice. The Counseling Psychologist, 49(2), 305–324. https://doi.org/10.1177/0011000020972182
Bengtsson, M. (2016). How to plan and perform a qualitative study using content analysis. NursingPlus Open, 2, 8–14. https://doi.org/10.1016/j.npls.2016.01.001
Blease, C., Torous, J., Dong, Z., Davidge, G., DesRoches, C., Kharko, A., Turner, A., Jones, R., Hägglund, M., & McMillan, B. (2023). Patient online record access in English primary care: Qualitative survey study of general practitioners’ views. Journal of Medical Internet Research, 25, e43496. https://doi.org/10.2196/43496
Cabell, A., Burgess, D., Brown, E., & Medina, C. (2024). Counseling trainees’ experiences working with Afghan refugees: Building cultural humility. Counselor Education and Supervision, 63(1), 41–57. https://doi.org/10.1002/ceas.12290
Church World Service. (2025). Daily state of play: Trump’s indefinite refugee ban and funding halt. https://cwsglobal.org/blog/daily-state-of-play-trumps-indefinite-refugee-ban-and-funding-halt
Clark, M., Moe, J., Chan, C. D., Best, M. D., & Mallow, L. M. (2022). Social justice outcomes and professional counseling: An 11-year content analysis. Journal of Counseling & Development, 100(3), 284–295. https://doi.org/10.1002/jcad.12427
Council for the Accreditation of Counseling and Related Educational Programs. (2023). 2024 CACREP standards. https://www.cacrep.org/for-programs/2024-cacrep-standards
Damra, J. K., & Qa’aymeh, S. (2024). Exploring the supervisory needs of school counselors in refugee school settings. International Journal for the Advancement of Counselling, 46, 703–720. https://doi.org/10.1007/s10447-024-09568-x
Duden, G. S., & Martins-Borges, L. (2021). Psychotherapy with refugees—Supportive and hindering elements. Psychotherapy Research, 31(3), 402–417. https://doi.org/10.1080/10503307.2020.1820596
Hosseini, Z., Syed, H., Raza, Z., Mansouri, M., Magan, I. M., & Awaad, R. (2023). A systematic review of evidence-based interventions for Afghan refugee mental health: A cultural adaptation analysis. Journal of Cross-Cultural Psychology, 55(1), 25–46. https://doi.org/10.1177/00220221231213884
Houseknecht, A., & Swank, J. (2019). Preparing counselors to work with refugees: Integration of experiential activities. Journal of Creativity in Mental Health, 14(1), 127–136. https://doi.org/10.1080/15401383.2019.1566039
Interiano-Shiverdecker, C. G., Kondili, E., & Parikh-Foxx, S. (2020). Refugees and the system: Social and cultural capital during U.S. resettlement. International Journal for the Advancement of Counselling, 42, 48–64. https://doi.org/10.1007/s10447-019-09383-9
Kondili, E., Interiano-Shiverdecker, C., & Hahn, C. (2022). Counseling and social justice advocacy interventions with refugees: Two case studies. Journal of Multicultural Counseling and Development, 50(4), 219–229. https://doi.org/10.1002/jmcd.12270
Kuo, B. C. H., Soucie, K., & Huang, S. (2020). Developing clinical trainees’ multicultural counseling competencies through working with refugees in a multicultural psychotherapy practicum: A mixed-methods investigation. International Journal for the Advancement of Counselling, 42, 249–268. https://doi.org/10.1007/s10447-019-09392-8
Midgett, A., & Doumas, D. M. (2016). Evaluation of service-learning-infused courses with refugee families. Journal of Multicultural Counseling and Development, 44(2), 118–134. https://doi.org/10.1002/jmcd.12041
O’Brien, C. V., & Charura, D. (2023). Refugees, asylum seekers, and practitioners’ perspectives of embodied trauma: A comprehensive scoping review. Psychological Trauma: Theory, Research, Practice, and Policy, 15(7), 1115–1127. https://doi.org/10.1037/tra0001342
Olmos-Vega, F. M., Stalmeijer, R. E., Varpio, L., & Kahlke, R. (2023). A practical guide to reflexivity in qualitative research: AMEE Guide No. 149. Medical Teacher, 45(3), 241–251. https://doi.org/10.1080/0142159X.2022.2057287
Pampati, S., Alattar, Z., Cordoba, E., Tariq, M., & Mendes de Leon, C. (2018). Mental health outcomes among Arab refugees, immigrants, and U.S.-born Arab Americans in southeast Michigan: A cross-sectional study. BMC Psychiatry, 18, Article 379. https://doi.org/10.1186/s12888-018-1948-8
Pechak, C., Howe, V., Padilla, M., & Frietze, G. A. (2020). Preparing students to serve a refugee population through a health-focused interprofessional education experience. Journal of Allied Health, 49(3), 131–138. https://www.proquest.com/scholarly-journals/preparing-students-serve-refugee-population/docview/2441573255/se-2
Prasad, B. D. (2019). Qualitative content analysis: Why is it still a path less taken? Forum: Qualitative Social Research, 20(3), 36. https://www.qualitative-research.net/index.php/fqs/article/view/3392/4502
Ratts, M. J., Singh, A. A., Nassar-McMillan, S., Butler, S. K., & McCullough, J. R. (2016). Multicultural and social justice counseling competencies: Guidelines for the counseling profession. Journal of Multicultural Counseling and Development, 44, 28–48. https://doi.org/10.1002/jmcd.12035
Refugee Council USA. (2024). 2024 fiscal year: US refugee admissions. https://rcusa.org/wp-content/uploads/2024/10/FY24-Refugee-Arrivals-Report.pdf
Rometsch, C., Denkinger, J. K., Engelhardt, M., Windthorst, P., Graf, J., Nikendei, C., Zipfel, S., & Junne, F. (2020). Care providers’ views on burden of psychosomatic symptoms of IS-traumatized female refugees participating in a humanitarian admission program in Germany: A qualitative analysis. PLoS ONE, 15(10), e0239969. https://doi.org/10.1371/journal.pone.0239969
Salami, B., Salma, J., & Hegadoren, K. (2019). Access and utilization of mental health services for immigrants and refugees: Perspectives of immigrant service providers. International Journal of Mental Health Nursing, 28(1), 152–161. https://doi.org/10.1111/inm.12512
Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing & Health, 23(4), 334–340. https://doi.org/fvxrh4
Sandelowski, M. (2010). What’s in a name? Qualitative description revisited. Research in Nursing & Health, 33(1), 77–84. https://doi.org/10.1002/nur.20362
Satinsky, E., Fuhr, D. C., Woodward, A., Sondorp, E., & Roberts, B. (2019). Mental health care utilisation and access among refugees and asylum seekers in Europe: A systematic review. Health Policy, 123(9), 851–863. https://doi.org/10.1016/J.HEALTHPOL.2019.02.007
Snow, K. C., Harrichand, J. J. S., & Mwendwa, J. M. (2021). Advocacy and social justice approaches with immigrants and refugees in counsellor education. Canadian Journal of Counselling and Psychotherapy, 55(1), 7–27. https://doi.org/10.47634/cjcp.v55i1.68482
Tribe, R. H., Sendt, K., & Tracy, D. K. (2019). A systematic review of psychosocial interventions for adult refugees and asylum seekers. Journal of Mental Health, 28(6), 662–676. https://doi.org/10.1080/09638237.2017.1322182
The UN Refugee Agency. (2025). Figures at a glance. https://www.unhcr.org/about-unhcr/overview/figures-glance
USA for the UN Refugee Agency. (2022). Oscars 2022: Five powerful movies about the refugee crisis. https://www.unrefugees.org/news/oscars-2022-five-powerful-movies-about-the-refugee-crisis
U.S. Department of State. (2018). Admissions & arrivals. http://www.wrapsnet.org/admissions- and-arrivals
Shadin Atiyeh, PhD, NCC, ACS, LPC, CCC, CRC, is an assistant professor at Wayne State University and was a 2017 Doctoral Fellow in Mental Health Counseling with the NBCCF Minority Fellowship Program. Correspondence may be addressed to Shadin Atiyeh, 5425 Gullen Mall, Detroit, MI 48202, shadin.atiyeh@wayne.edu.
