Using the Multiphase Model of Psychotherapy, School Counseling, Human Rights, and Social Justice to Support Haitian Immigrant Students
M. Ann Shillingford, Seungbin Oh, Amanda DiLorenzo
Natural disasters over the past few decades have necessitated mass migration of Haitian immigrants to the United States. Haitians residing in the United States have experienced significant cultural and social challenges. Recent political deportation mandates have increased the systemic challenges that Haitian students and their families are currently facing in the United States. These systemic barriers have fostered an increase in stressors affecting the mental wellness of Haitian students and their families. This article introduces school counselors to the culturally focused, multiphase model of psychotherapy, counseling, human rights, and social justice as a framework to assist Haitian students and their families.
Keywords: Haiti, immigrant, school counseling, human rights, social justice
There has been a growing trend in the counseling profession to provide culturally relevant services to all clients. In fact, most recently, Ratts, Singh, Nassar-McMillan, Butler, and McCullough (2016) proposed the Multicultural and Social Justice Counseling Competencies to support the evolving need for multiculturally competent counselors to support today’s diverse populations and their varying mental health needs. One diverse group that has caught the attention of counseling professionals is the Haitian population. A long history of political unrest, coupled with grievous damage from natural disasters over the past few decades, has snowballed the migration of Haitian families into the United States. With mass migrations come challenges with cultural identity, social and academic obstacles, and psychological impairment. This article highlights the role of school counselors as social justice advocates and introduces the multiphase model of psychotherapy, school counseling, human rights, and social justice as a framework for offering services to Haitian students and their families. The authors present literature underlining the experiences of the Haitian population both within the context of their home country and also as immigrants in the United States.
Effects of Natural Disasters on Haitian Migration
Over the past few decades, the small nation of Haiti has suffered tremendously from natural disasters. In January 2010, a major 7.1-magnitude earthquake shook the island’s core, killing close to 300,000 men, women, and children. An equal number of individuals were injured and at least 1.5 million were displaced. Among the damage and destruction were almost 4,000 schools (CNN, 2017). Six years later, Hurricane Matthew swept through the south side of the island, killing over 900 citizens and leaving severe devastation in its tracks (BBC News, 2016). A year after that, Haiti, already crippled economically by previous natural disasters, was hit by Hurricane Irma, a Category 5 storm. Cook (2017) reported that homes, bridges, and housing already weakened by previous disasters were destroyed. Not only were homes destroyed, but the country’s ability to rebuild also was diminished.
Each natural disaster in Haiti has meant a struggle for regrowth. Between 2015 and 2016, it was reported that the economic growth in Haiti was down to a staggering 2% (U.S. Department of State, 2018). Damage from natural disasters, drought conditions, governmental unrest, and a significant decrease in the country’s currency were identified as contributors to the financial stagnation (U.S. Department of State, 2018). Migration trends portrayed a parallel between decreased stability in Haiti and increased migration to the United States and other more secure territories. In fact, over the years, the United States has been the recipient of thousands of immigrants seeking security and a better future for their families. Stepick and Stepick (2002) reported that in the 20th century, the number of Haitian immigrants to the United States reached an all-time high. By 2010, there were approximately 587,000 Haitians living in the United States, and that number rose to almost 700,000 by 2015 (Migration Policy Institute, 2017). The distribution of Haitian immigrants varies from state to state, with Florida having the largest population (46%), followed by New York (25%), New Jersey (8%), Massachusetts (7%), Georgia (2%), and Maryland (2%). These numbers may continue to rise as the outlook for the island of Haiti remains bleak.
Prior to the January 2010 earthquake, Haitian migration to the United States was considered high due to unemployment, low socioeconomic stability, poverty, violence, and political instability on the island (Cone, Buxton, Lee, & Mahotiere, 2014). Presently, Haiti is considered the economically poorest country in the Western hemisphere (Coupeau, 2008; Mendelson-Forman, 2006). Haiti also has been notorious for its high number of orphans, with at least 380,000 before the earthquake and a significantly increased number of displaced and homeless children after the earthquake (Little, 2010). Concern exists for the well-being of Haiti’s survivors of natural disasters, particularly the children. According to Potocky (1996), in the past years many Haitian children and their families who fled Haiti due to hardships and entered the United States as refugees often suffered from post-traumatic stress disorder (PTSD; Potocky, 1996).
The U.S. Department of State (2018) estimated that Haiti has received nearly $5.1 billion in aid from the United States since the earthquake. Assistance offered included increasing the number of officers on the police force to increase security, increasing basic health care through development of new clinics, construction of a mega power plant to provide electricity, and support for farmers to increase crop development. Even so, Haitians continue to struggle and have sought immigration support from the United States. Reports have suggested that as many as 55,000 Haitians applied and have been granted visas to the United States since the earthquake, and as many as 500 orphaned children have been allowed travel documents for adoption by U.S. families (Zissis, 2010).
To support Haiti over the past decade, U.S. Homeland Security has offered Temporary Protected Status (TPS) to large numbers of Haitians affected by the debilitating conditions caused by natural disasters as well as political unrest. TPS is offered to individuals from foreign countries where it may be unsafe or where resources are inadequate to support the citizens. TPS may be granted to individuals who are already in the United States or those still in their native country. TPS allows recipients to remain in the United States and secure travel and employment authorization (U.S. Department of State, 2018). As such, TPS has been granted to an estimated 60,000 Haitian citizens following the destruction from the 2010 earthquake. Outside of Haitians who have entered the United States through the TPS program, it has been reported that at least 40,000 more Haitians have entered the United States seeking refuge following Hurricane Matthew (Fifield, 2016). It appears that with each natural disaster the number of Haitian immigrants in the United States has increased.
Impact of Migration on Haitian Students and Families
Migration to a new country may come with difficulties for families, particularly children. Haitian children experience multiple layers of challenges in the American educational system and society at large. To better support Haitian students, counselors need to understand the impact of these hardships on various aspects of Haitian students’ lives and needs. The following sections provide a review on the complications facing these students and their unique needs.
Research suggests that traumatic events affect the physiological, psychological, and social welfare of immigrant students (Bean, Derluyn, Eurelings-Bontekoe, Broekaert, & Spinhoven, 2006). Haitian families may experience household stress due to separation of family members between the United States and their homeland (Desrosiers & St. Fleurose, 2002). Additional stressors include cultural misunderstanding and isolation in the school setting (Chhuon, Hudley, Brenner, & Macias, 2010); differences in educational policies, pedagogical practices, and teaching styles; and overall differences in school culture and climate (Cone et al., 2014). These challenges, particularly in the school setting, may be problematic for Haitian students and parents trying to acculturate to the American system.
Haitian students experience significant social difficulties. In a study exploring stressors experienced by immigrants to the United States, Haitian parents and children reported the highest number of stressors among immigrants from the Caribbean islands (Levitt, Lane, & Levitt, 2009). In addition, it has been reported that Haitian immigrants have a 20–30% higher chance of living in poverty-stricken conditions in the United States than people who are White (Hernandez, Denton, & Mcartney 2009). Douyon, Marcelin, Jean-Gilles, and Page (2005) indicated that students in highly populated Haitian communities—such as the Miami-Dade, Florida, area—may be surviving in not only poor health conditions, but also hostile territories where education appears to be futile and a life of crime is more appealing. Those social problems may add stress to the Haitian household, which may compound existing economic problems (Chierici, 2004). Indeed, migration disrupts the familial and social networks as well as the behavioral norms and cultural values of new immigrants. It places responsibility on counselors and other educators to meet the needs of these students academically, socially, and culturally (Asner-Self & Marotta, 2005). Thus, it is imperative for schools to help provide both supportive relationships to foster resiliency and additional resources for Haitian immigrant students.
Social and Cultural Needs
Haitian students face potential cultural difficulties, such as language barriers, cultural identity, and acculturation, particularly in the school setting. Haitian students and their families may primarily speak Haitian Creole, yet few interpreters are available to assist with standardized test explanations (Kretsedemas, 2005), student code of conduct reviews, and other pertinent information that may affect students’ academic functioning. In comparison to Spanish, which is taught in American schools, Haitian Creole is spoken only within the Haitian culture (Phelps & Johnson, 2004). Although Haitian Creole is based on the French language, it has syntactical influences from West African languages. It should be noted that it is not a dialect of French, but is its own independent language (Solano-Flores & Li, 2006).
Along with sensitivity to language barriers, Haitian students may encounter challenges in developing their cultural identity. As reported by Doucet (2005), Haitian students who may be struggling between their own cultural identity and the American culture might encounter school-related problems such as suspensions, truancy, academic failure, and eventual school dropout. Cone and colleagues (2014) reported the results of a qualitative study and emphasized the difficulty in identity formation that Haitian students experience in the United States. Identity formation was influenced by three factors: differences in pedagogical approaches to teaching between Haiti and the United States; differences in disciplinary approaches between teacher groups; and pressure from peers to become Americanized. To counter the stigma associated with being and looking different, Cone and colleagues noted that Haitian students may accede to their peers and hide any indication of their Haitian heritage. Consequently, these practices may foster added stress within the family network and community at large. Struggles with cultural identity formation can cause Haitian students to feel anxiety, confusion, fear, helplessness, and homesickness (Bachay, 1998), which may ultimately lead to increased risk of PTSD.
To further compound psychological distress experienced by Haitian families living in the United States, in November 2017, U.S. President Donald Trump declared an end to TPS for Haiti and several other countries (Park, 2018). This means that at least 60,000 Haitians currently residing legally in the United States through TPS can be deported by January 2019 (Daugherty, 2018). Additionally, deportation holds on Haitian citizens activated following the 2010 earthquake are being released, increasing the number of Haitians being deported. Deportation is destructive to family units, especially children. Children are affected by the knowledge of deportation of individuals within their community, even when that individual is unrelated to them. When a family member is deported, the rest of the family, including children, may suffer from poverty, reduced access to food and health care, and limited educational opportunities (Wiley, 2013). Thus, the already fragile academic, social, and cultural experiences of some Haitian students and families currently residing in the United States might be further aggravated by political mandates and changing policies. Therefore, culturally relevant support is warranted from those who serve this population, including school counselors and other stakeholders.
School Counselors’ Role in Supporting the Haitian Students
According to the American School Counselor Association (ASCA; 2012) National Model, professional school counselors are to develop a comprehensive school counseling program that addresses the social, personal, academic, and career needs of students. Several approaches have been introduced to provide school counselors a pathway to supporting immigrant students, including parenting workshops for Jamaican parents (Morrison, Smith, Bryan, & Steele, 2016); community outreach programs on college preparation for first-generation Latinx students, families, and friends (Tello & Lonn, 2017); and a comprehensive, multilevel system of support that includes school–family–community partnerships for adolescent immigrants (Suárez-Orozco, Onaga, & de Lardemelle, 2010). A thorough search of the literature, particularly school counseling literature, yielded a dearth of information on working with Haitian students and their families. In light of the numerous challenges that this population faces, the scarcity of research support is disappointing. Therefore, the authors provide a guideline for school counselors to support their Haitian clients by using the Multiphase Model of Psychotherapy, Counseling, Human Rights, and Social Justice (MPM; Chung & Bemak, 2012). The MPM was developed by counselor educators as a culturally responsive intervention to support individuals from marginalized groups. The MPM is psychoeducational in nature and consists of “affective, behavioral, and cognitive interventions and prevention strategies that are rooted in cultural foundations and relate to social and community process and change” (Chung & Bemak, 2012, p. 2).
Multiphase Model of Psychotherapy, Counseling, Human Rights, and Social Justice (MPM)
The MPM was developed by Chung and Bemak (2012), who expertly recognized the need for a culturally sensitive approach to supporting refugees globally. Chung and Bemak indicated that an effective counselor is one who understands the importance of refugees’ historical, sociopolitical, cultural, and psychological context when dealing with displacement, loss, and trauma. The MPM was constructed as a trauma-based model that integrates humanistic trauma therapy, exposure therapy, stress inoculation approach, and cognitive behavior therapy, and is framed by the multicultural counseling competencies (Arredondo et al. 1996). According to Chung and Bemak, the MPM includes five phases: (a) mental health education; (b) group, family, and individual psychotherapy; (c) cultural empowerment; (d) indigenous healing; and (e) social justice and human rights. Each phase can be used independently of the other and can be adjusted based on the needs of the client. The following section expands on the five phases and incorporates practical interventions for school counselors.
Phase One: Mental Health Education
Mental health education focuses on defining the counseling process for the client. Haitian immigrant students might not have had exposure to counseling in the past; therefore, it is important for school counselors to thoroughly explain what counseling is about, what the expectations are, and the expected outcomes of counseling. Chung and Bemak (2012) also noted the importance of discussing the meaning of confidentiality in both the context of the U.S. counseling community and in the client’s native community. Confidentiality is an ethical consideration supported by ASCA as an obligation for school counselors (ASCA, 2014). Lazovsky (2008) remarked on the fact that laws and regulations regarding confidentiality may differ internationally, so it is important for the counselor to explain the meaning and objectives of using confidentiality as it relates to family and school. During this phase, school counselors should pay close attention to the experiences of marginalization and trauma that these students and their families may have faced and the psychological distress related to potential deportation. Mistrust of Americans may be an essential part of the Haitian family’s survival mechanism (Stepick, Stepick, & Kretsedemas, 2018); therefore, school counselors should be cautious in this phase to be culturally sensitive to the fears and anxiety that the student and family may be experiencing.
Phase Two: Group, Family, and Individual Psychotherapy
The second phase is focused on providing culturally relevant counseling techniques and strategies. To do so, the school counselor needs to understand the contextual background of the student. What have their experiences been either while in Haiti or within the United States? How has that student and the family been affected by natural disasters and sociopolitical experiences? Based on this information, the school counselor needs to decide on the most appropriate culturally relevant interventions for the student. Surveys and questionnaires are an ideal format for gathering information about the experiences of Haitian students and their families (Ekstrom, Elmore, Schafer, Trotter, & Webster, 2004). However, school counselors should be mindful of language barriers and provide surveys that have been translated in both English and Haitian Creole. Additionally, individual and group counseling sessions need to be adapted to meet the cultural needs of the Haitian student. For instance, singing, dancing, and spiritual guidance are an integral part of the Haitian culture (Marcus, 2010). School counselors should consider the collectivist cultures of the Haitian population, which may influence their decision to engage the students in small groups as opposed to individual counseling. By utilizing culturally relevant counseling approaches, school counselors might find small group expressive techniques to be beneficial for developing trust, while assessing the psychological needs of the student.
Phase Three: Cultural Empowerment
Cultural empowerment extends support for client needs beyond the counseling setting to community resources. This phase incorporates collaborating with multiple agencies. Examples of such agencies include housing services, social services, and health services. The school counselor can choose to develop a team approach with the school’s social worker and other school stakeholders and serve as the facilitator of services. The objective during this phase is to serve as an advocate and guide for the student and their family to reduce their levels of stress and anxiety as well as meet their basic needs. In fact, Chung and Bemak (2012) surmised that cultural empowerment goes beyond in-office counseling to the greater community, with helpers rallying for services and resources to meet the families’ basic needs. Finally, cultural empowerment may mean providing adequate interpretation services for students and families (Kretsedemas, 2005) so that all stakeholders fully understand each other and the processes that are at work. In fact, school counselors and educators have a civic obligation to provide interpretive services to students and parents with limited English proficiency (Office for Civil Rights, 2015).
Phase Four: Indigenous Healing
From the American viewpoint, counseling, therapy, medicine, and health care are considered important aspects of holistic healing. However, within the Haitian culture, indigenous healing has been noted as a longstanding cultural practice. It is not uncommon for individuals from the Haitian population to seek help from spiritual healers, herbal specialists, and midwives rather than more formalized Westernized therapy. In fact, many Haitians hold extreme faith in natural healing and may be hesitant to pursue counseling in the context of the United States. Furthermore, Haitian individuals often believe that illness is caused by supernatural forces (Nicolas, DeSilva, Grey, & Gonzalez-Eastep, 2006); therefore, it is not unusual for families to pursue help from family healers, spiritual healers, or folk medicine in seeking the supernatural cause of illnesses. Nicolas and colleagues (2006) noted that common beliefs may attribute illnesses to evil spirits, a poor relationship with God, or offending the Lwa, a deity associated with the voodoo religion. Although not all Haitians hold these indigenous views, there may be a general mistrust of mental health services. Counselors working with Haitian clients should be cautious to embrace culturally sensitive practices that combine Westernized practices with indigenous healing. Seeking consultation from a Haitian spiritual healer might be a first step in formulating an effective counseling approach. Nicolas and colleagues (2006) suggested seeking these healers through Haitian community centers and through communication with family members of the clients. Counselors should avoid assumptions and initiate conversations with Haitian clients to understand their beliefs and practices.
Phase Five: Social Justice and Human Rights
The final phase of the multiphase model focuses on counselors advocating for the rights of their clients. Haitian immigrants in the United States experience political discrimination. For example, recent threats of deportation and the termination of TPS protection can be discriminatory. At this phase, it is vital that counselors examine their own worldviews, community relations, and the role of politics and political policies in counseling, as well as the impact of social injustices (e.g., discrimination, oppression, racism) on the well-being of their clients (Chung & Bemak, 2012). Griffin and Steen (2011) mentioned nine steps that school counselors can employ as social justice advocates: develop cultural competence; use data to support work, particularly educational inequalities; gain allies, recognizing that the work cannot be done alone; speak up at school, at town hall meetings, and at board meetings, and write to state legislators; educate and empower parents and families; stay politically engaged and know what is happening in the current political environment; be bold and confident in beliefs; be persistent, understanding that systemic barriers may stand in the way of progress; and conduct research to demonstrate the needs for justice, equity, equality, and fairness. School counselors are inundated with multiple roles and as such may not have the time and/or resources to cover all nine steps mentioned. However, knowledge of these practical strategies may be helpful in their ethical decision making and development of a culturally sensitive, comprehensive school counseling program. Essentially, school counselors should be leading agents of change, seeking to provide culturally relevant services to their immigrant students.
Haitian children face various systemic challenges adjusting to the U.S. educational system and society. Given their unique challenges and needs, Haitian children require specialized, culturally responsive school counseling programs. To provide such programs, school counselors need practical strategies on how to provide culturally appropriate interventions that address the multiple systemic challenges to Haitian students’ well-being. However, school counselors may find it difficult to find such information given the dearth of school counseling literature concerning Haitian students. Therefore, this article provides practical guidelines using the MPM that may strengthen school counselors’ approach to providing culturally responsive services to Haitian students and their families.
Using the MPM, school counselors will be in a better position to explore the benefits of counseling with their Haitian families. The model encourages school counselors to assess the unique needs of the children and families within a cultural context. Moreover, by using this model, school counselors are encouraged to actively engage in collaborative partnerships with multiple agencies and professionals to meet the practical needs of Haitian families. Lastly, school counselors need to work beyond the structure of the office setting and integrate social justice advocacy work for systemic changes to maximize therapeutic changes for Haitian students and their families. The authors hope that this guideline will help school counselors to better understand the multiple layers of challenges for Haitian students, as well as how to provide culturally relevant support.
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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- M. Ann Shillingford is an associate professor at the University of Central Florida. Seungbin Oh, NCC, is a doctoral candidate at the University of Central Florida. Amanda DiLorenzo is a doctoral student at the University of Central Florida. Correspondence can be addressed to M. Ann Shillingford, P.O. Box 161250, Orlando, FL 32816, Dr-S@ucf.edu.