Unrelenting coverage of the children and families who’ve fled violence and poverty in their home countries—only to be met in many cases with shocking conditions in detention centers along our southern border—has made the plight of immigrants and refugees to America unavoidable. And for those who are recent or first-generation immigrants, the churning public debate about who belongs in this country can exacerbate the weighty psychological toll of immigration itself. What traumas have they experienced before crossing into the United States? How do they adjust to being here? And where can they turn for help?

Enter Rosa Maria Bramble, a clinical social worker, adjunct lecturer at the Columbia School of Social Work, and an immigrant herself. Bramble specializes in the impact of traumatic events on immigrants and refugees, providing psychosocial evaluations for immigration hearings and treating traumatized asylum seekers. She also speaks and writes about these issues and has a chapter on immigrants in the second edition of the bestseller The Dangerous Case of Donald Trump. We spoke recently about her life, work, and the vital importance of mental health services to immigrants, refugees, and asylum seekers.

Ryan Howes: How did you get interested in immigration issues?

Rosa Maria Bramble: Well, I’m an immigrant myself. I came from Venezuela when I was seven. That’s certainly shaped my way of approaching social work and my understanding of the issues immigrants face in coming here: the legal obstacles, the dynamics of families carrying so many hopes and dreams and traumas. I’ve seen how much my mother and father struggled, how they gave up so much to come here, and what they encountered once they did.

RH: What challenges did your family face?

Bramble: My mother had a successful restaurant in Caracas, but there was a lot of political turmoil at the time with the overthrow of the dictator, Marcos Pérez Jiménez. It’s similar to what’s happening there now. My father was worried the upheaval would disrupt his children getting a good education. So we all left to come here. It was very difficult for my mother. She lost so much—her restaurant, her extended family, her place in society—and she struggled with depression as a result. The language was also a problem for her. My father spoke English, but my mother didn’t.

She never really adjusted to life here and eventually decided to return to Venezuela when I was a teenager. She gave up hope that she could succeed here, especially after my brother, who suffered from mental illness, passed away. Through all these hard times, though, my parents’ focus on making sure we had a good education remained. I became a clinical social worker. Two brothers are engineers, and my sister is a nurse’s aide.

RH: What was it like for you making that transition to living in the U.S. as a seven-year-old?

Bramble: It wasn’t as traumatic for me as it was for my mother because I was so young, but I do recall what it felt like to lose my extended family and childhood friends. (Today, we’re back in touch and very close, almost like I never left.) But I think the transition of adaptation and acculturation is quite difficult, particularly when there’s not an established community to help with the process. Currently, three million Venezuelans have been displaced because of the situation in our country. But when I was a child, we really didn’t have a Venezuelan community in New York to help us, not like the way many Puerto Ricans, Dominicans, or Columbians had.

RH: How important is that familiar community to the transition?

Bramble: Actually, that’s one of the things I’m focused on. I have a private practice, but I’m also a founder of Borders of Hope, or Fronteras de Esperanza in Spanish. We aim to address the needs of the Venezuelan asylum seekers, for example, who are at such a loss when they come here. They think they can just apply for asylum and get it; that’s what they’re told. But they often end up being victims of fraud from corrupt attorneys, with nowhere else to turn for help.

What’s unique about a refugee population is that it’s a forced migration. I’ve been working with refugees for many years, and I’ve found that one of the most difficult things about their experience is that most of them didn’t want to leave. It’s different from saying, “Hey, I have this dream, and I’m going to do whatever I need to get to this country.” So that’s an added traumatic stress, and I address it with the weekly groups I facilitate for the Venezuelan community. It’s really profound: the loss of your status, of your country, which is actually one of the wealthiest in Latin America.

RH: What else do you see in your work with asylum seekers?

Bramble: Human trafficking is a big issue. Back in the ’90s, when I first started writing psychosocial evaluations to support immigration cases, we weren’t so familiar with it, but now, unfortunately, I regularly come across women who’ve been trafficked into this country.

I also worked for many years with Latino gay men who were HIV positive and seeking asylum because of institutionalized homophobia in Latin America, where they were denied access to medical care because of their sexual orientation. They all carried the trauma of growing up in a country that punished them for being who they were. Transgendered people face the same thing. A lot of these asylum seekers face premigratory trauma, the reason for leaving; transition trauma, such as crossing borders; and then postmigratory trauma, which can include adjusting to a culture where they often encounter discrimination, racism, and lack of social support.

RH: Many clinicians aren’t really aware of the role of mental health professionals in the immigration process. When you’re doing a psychosocial or a forensic evaluation for someone who’s coming into the country, what are you looking for?

Bramble: Psychologists and social workers are so important for the refugee community! After bearing witness to the stories of asylum seekers, they can attest that, in fact, something traumatic or life-threatening did occur. They can offer insight into the effects of that experience, so the judge or immigration officer can understand the psychological toll of what an individual went through. For the most part, refugees have a much higher incidence of PTSD than the general population.

When I meet clients, we go through what happened to them—or if it’s a child, it may be what they’ve witnessed—and how it’s affected their life. Then I ask them the most important question: “If the conditions in your country were different, would you have left?” That’s when people break down. “No, of course not. I’d have stayed with my family and everything I had in my home country!”

In the psychosocial evaluation, we call this a refugee displacement experience. Individuals lose their sense of integrity, dignity, identity because of a life-threatening situation. It comes with a credible fear of returning to their country and being killed. In the case of Venezuela, people are being arrested as soon as they get to the airport.

RH: So the psychosocial evaluation needs to emphasize how torn they were about leaving?

Bramble: With the evaluation, we seek to understand and assess how the individual was before and after the traumatic event, as well as what’s happening beyond that in their country. Often it’s pervasive gender-based violence. I’ve worked with many women who, just by virtue of being a woman, suffered multiple traumas, including sexual abuse, gang rape, and torture that looks very different from what men are subjected to. With the political prisoners I’ve worked with, it’s obvious how gender-based violence plays out in terms of torture. For women, the sexual violence is horrific.

RH: Is part of your work building a case for why they can’t go back because of the retraumatization?

Bramble: Exactly. Based on the evaluation, I have to establish there’s a credible fear of being killed or at the very least retraumatized that’s sustained.

RH: Could you describe what an immigration hearing is like?

Bramble: It depends. It may be in front of a judge, which means that the individual’s initial application was denied. In this country, you have a one-year deadline to formally apply for asylum from the time you request it. Many people either don’t know that or are too distressed to meet the deadline. When they apply after the deadline has passed, the immigration officer will likely deny the case, which means they end up in front of a judge.

In that hearing, the judge reviews all their information, looking for discrepancies in their story and asking probing questions. Social workers play an important role for two reasons: helping the client develop a bit of a window of tolerance so they can tell their story as calmly as possible, and helping the judge understand that memory recall when trauma is involved can really be impaired.

If I need to testify, for example, I’ll explain to the judge and government attorney how memories of traumatic events aren’t integrated, and how intimidating and dysregulating it can be for asylum seekers to recall all the details. Plus, they have to do it in front of the judge, the government attorney, their own attorney, the interpreter, and the clerk. After that, the judge decides whether to grant asylum or not.

RH: It seems like that creates a fundamental dilemma for asylum seekers. They can’t be so traumatized that they can’t tell the story, but if it doesn’t sound like they’ve been traumatized, then they could be sent back.

Bramble: Fortunately, there’s an appeal with asylum seekers, which is different from with other immigration cases. I don’t want to get political, but that’s part of what this 45th president is so focused on—the fact an asylum case can be appealed, multiple times. But we have this appeal process in place because the United States signed a treaty to that effect with over 100 other countries.

RH: Most therapists are used to hearing stories of deep emotional pain and trauma, but what you’re describing seems particularly difficult. What are the rewards of doing this kind of work?

Bramble: Seeing evidence of the horror that one person can inflict on another human being, or sometimes an entire population, can be vicariously traumatizing. But there’s also a kind of vicarious resiliency that comes with working with asylum seekers.

I’m honored and privileged to work with these individuals to help restore their dignity. In a forensic evaluation, clients typically don’t want to talk about what happened to them, but I let them know that social justice is central to the process. I tell them, “By getting your asylum approval, what happened to you is being recognized and validated by an official court of a country. That’s the beginning of your healing journey.” That’s the empowering part of the process I like to emphasize.

RH: I notice that you use EMDR treatment when working with traumatized immigrants. What other methods do you use?

Bramble: I also use approaches like Internal Family Systems to explore the part of them that needed to seek asylum and the part that’s still there in their home country. I talk to them about how the body carries the trauma, and I bring in integrated coherent breathing, helping them use the breath as a resource to reduce their symptoms, especially the hypervigilance that’s so present in asylum seekers. I use Sensorimotor therapy to help them feel physically grounded and prepare for the stress of a hearing. Of course, a little psychoeducation about trauma can be very healing as well.

RH: How can the mental health professions better serve the immigration population?

Bramble: I think therapists need to be open to a human experience that’s different from the one they know. We need to do a better job of teaching about this kind of work in social work schools, in graduate schools. We need to acknowledge the impact of globalization. More and more people are coming from different parts of the world, and we need to prepare ourselves to be effective with these clients. We need to be aware that we’re approaching trauma from a Western perspective, which may not apply to other cultures. One of the best tools for me in working with clients from all over the world is simply learning from them.

We also need to learn to be flexible in our vision of therapy. Are we willing to do that? If we can’t have nice 50-minute sessions, how can we can build a relationship with asylum seekers and people from traumatized communities? That’s an increasingly urgent challenge that the therapy professions need to face.



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Ryan Howes

Ryan Howes, Ph.D., ABPP is a Pasadena, California-based psychologist, musician, and author of the “Mental Health Journal for Men.” Learn more at ryanhowes.net.