Born and raised in Barranquilla, Colombia, Carolina Coronado never thought she’d leave her native country.
But one day in the mid-2000s she received a phone call from a Colombian guerrilla group — part of a rebellious anti-government movement — threatening her family.
“We moved immediately from Barranquilla,” Coronado said. “I left everything behind. Dog, car, house.”
Her son Nicola Villegas, who was 13 years old at the time, described the day the family immigrated to the United States as “chaos.”
Villegas, his sister Natalia Munive, who was then 6 years old, and Coronado made the trip. The family couldn’t afford to check bags on the plane, so they carried all the luggage they were allowed and ran through the airport to catch their flight.
“I didn’t have anything when I came here,” said Villegas, now 26, who studies education for fourth through eighth graders at the Community College of Philadelphia. “I didn’t even have a book on the plane from Colombia. All my childhood [was] practically gone.”
With help from a Colombian government agency, Coronado and her children relocated to Bogotá. She started the refugee application process to relocate her family to the U.S., but said it was complicated and lengthy. Midway-through, a friend in Philadelphia offered to help move the three to the U.S.
From Colombia, Coronado sent her savings to her helper, who used it to rent Coronado a house in Northeast Philadelphia and buy her a cheap car.
After boarding their plane in Bogotá, Colombia’s capital, Coronado’s family flew to Panama and then Houston before arriving in Philadelphia. The trio almost missed their Panama connection and then did miss their flight in Houston due to a lengthy immigration process.
Coronado and her children didn’t speak English at the time, and they met with an immigration officer at the Houston airport for an interview — without a translator present. The immigration officer asked what the three were doing in Houston and why they wanted to enter the U.S.
“I don’t know how I understood what they said, but I remember there was a lot of people … that had been with us and they had [helped],” Coronado said. “I think maybe the situation forced me to read the body language.”
ADJUSTING TO NEW SURROUNDINGS
Coronado, Villegas and Munive navigated many difficulties during their first years in the U.S. Villegas started at Grover Washington Middle School while Munive entered first grade at Laura H. Carnell School.
Villegas (pictured below) said the first school year was “ridiculous,” and he felt the impact of cultural differences when other kids picked on him because he didn’t speak English.
One day at school, Villegas broke down when a boy punched him in the face during lunchtime. Unfamiliar with the language and cultural customs, Villegas didn’t know how to react or ask the kid why he did it.
“I had never talked to him, I didn’t know English, I didn’t know anything,” Villegas said. “I was so frustrated with not being able to know how to express myself that I just left and walked to the bathroom and splashed water on my face.”
For Munive, the problems she experienced were mainly identity issues stemming from looking Caucasian, but only speaking Spanish, she said. As she grew up, Munive’s experiences made her aware of the different races living in Philadelphia.
“What is a Hispanic?” said Munive, 19, who studies social work at La Salle University. “What is a white? How does that carry itself in Philadelphia? How do you approach someone else who is maybe white and Hispanic?”
The immigration and cultural assimilation processes impacted both Munive’s and Villegas’ mental health. Munive said she began developing anxiety at a young age, while Villegas experienced depression.
“The first two years was the biggest shock,” Villegas said. “I had no friends. You’re vulnerable. You’re not used to anything that’s happening.”
The first time Munive experienced anxiety was in first grade. A group of friends at her school went around pulling each other’s pants down as a joke.
“That was normal for them, and they did it for me and … they just killed me,” Munive said. “It was that difference of social constructs.”
After the incident, Munive (pictured below) began crying everyday. She said the newness of the culture and her surroundings made everything feel much worse.
“The smallest thing would happen and I felt it a lot deeper,” Munive said. “Every single time that I wasn’t around someone that I knew, I would immediately be deeply freaking out.”
She started a habit of making a best friend and keeping that person around at all times for support as a coping mechanism.
Munive still experiences anxiety, especially in unfamiliar environments. She tries to avoid going to new places alone.
“I get anxiety when I’m not babied,” Munive said. “But that’s the experience of putting a little girl who came from … higher-middle-class Colombia to basically poverty in Philadelphia.”
Like her children, Coronado said the immigration experience impacted her mental health. When she left the airport after first arriving in Philadelphia, she broke down in tears.
“[I was] crying because the part of the world that I come from is completely different,” Coronado said. “You start to feel anxious because you are not ready for what you’re seeing, facing … but it happens.”
In Colombia, Coronado had been practicing psychology for 11 years. But when she arrived in Philadelphia, she was still waiting for the World Education Services to assess her credentials. WES is a nonprofit organization that evaluates how international students’ and professionals’ credentials transfer to the U.S.
Coronado said the process was long and complicated, and she had to start working at a factory to support her kids.
A professional all her life, it was the first time Coronado had done factory work. She would try to make herself feel better about the work by telling herself she was being paid to not use her brain, or she’d view it as a workout.
“You try to comfort the situation that you are living to something more positive,” Coronado said. “Trying to put a costume to the reality that you’re living, so you don’t feel like the reality is so hard.”
STARTING FROM ZERO
Coronado drew on her psychology background to remind herself the situation was only temporary. Still, Villegas remembers Coronado often coming home from work in tears.
Eventually, WES processed Coronado’s transcript and let her work as a psychotherapist in the U.S.
Despite her work experience and six-year psychology degree, Coronado (pictured below) said she was demoted in the transfer process. She couldn’t resume practicing as a psychologist, which involves making diagnoses, administering mental health tests and prescribing medicine, so she started working as a counselor at Hispanic Community Counseling Services in Kensington.
Coronado said the demotion is frustrating. With 27 years of experience, she often knows a client’s diagnosis, but co-workers won’t listen to her because she isn’t a licensed U.S. psychologist.
“When you’re an immigrant, you have to know that you have to start from zero,” Coronado said. “You have to admit it that no matter who you were in your country, now you’re here and no one. You start to rebuild your life again.”
She added the immigration process is especially mentally challenging when coming from a professional background.
“When you are living in higher status and you’re a professional and you came here and you don’t speak the language, you don’t know the system, ” Coronado said. “You don’t know no one. You say, ‘Oh my god, what was the mistake that I made? Why am I here? Why, why God?’”
Coronado, who has worked at HCCS for 10 years, is pursuing a master’s degree in family therapy. She works with many immigrant and refugee clients with similar immigration experiences to her family’s.
The feeling of having to start over when immigrating to the U.S. often results in depression or anxiety as part of a mental condition called adjustment disorder, Coronado said.
Adjustment disorder is a temporary mental condition causing bouts of depression and anxiety that results from a dramatic life change and usually subsides after a few years.
“You start to create a new life in a space that you don’t know anything at all,” Coronado said. “You don’t know the language, making the situation worse. You feel afraid that you don’t have the legal status, and that makes the condition worse because you are scared that maybe the police or someone will put you out or people will reject you because you look different.”
AFFORDABLE COUNSELING SERVICES
For immigrants to Philadelphia, resources within the city exist to address their mental health concerns arising from the transition.
“If you haven’t dealt with the incredible stress that you experienced before you came here and the incredible stress of relocating in a completely different culture without all your [support] systems, it’s like there’s this missing component,” said Gwen Soffer (pictured below), the wellness specialist at the Nationalities Service Center. “It’s like skipping over this huge thing that could impact someone throughout their life.”
The Nationalities Service Center addresses immigrant and refugee mental health needs. NSC is a nonprofit organization providing a range of services to immigrants and refugees to aid assimilation.
“Imagine you have your life and then you essentially lose all of your support systems,” said Soffer. “You are in a brand-new culture with a language [that] in many cases [immigrants] don’t speak yet, different customs, everything different.
Council for Relationships, a nonprofit therapy organization that provides affordable counseling services, collaborates with the NSC to provide therapy to immigrants and refugees. Thomas Jefferson University graduate students working at CFR conduct counseling sessions at NSC, in an environment already familiar to the clients.
The students receive counseling hours required for graduation, while immigrants and refugees receive free counseling services. Each counseling session includes free language translation services in languages like French, Spanish, Portuguese, Burmese and Arabic.
The CFR-NSC partnership began in spring 2017 as part of CFR’s Community Partnership Initiative, a program that strives to increase vulnerable populations’ access to counseling by bringing therapy to locations convenient for them.
The collaboration addresses common barriers to immigrants and refugees receiving clinical mental health care, like high cost, finding child-care or accessing transportation. The program aims to come into the environment where someone already is instead of asking clients to come to a new, unfamiliar place.
“Given what you’ve been through, either as a refugee who’s fleeing or as someone who’s trying to acculturate to a new country, there’s a lot of emotional and psychological challenges,” said Tracey Tanenbaum, a Council for Relationships staff therapist and the Community Partnership Initiative clinical specialist. “There are therapists who are right there who can help you with that.”
Many NSC clients also experienced trauma in their home countries from social and political events that caused them to immigrate. In the process, many were separated from their families.
“Either their [family] unit was too large or … they were in different parts of the country and spread out,” said Christine Wamble (pictured below), who provides therapy in the collaboration. “Just knowing about their family’s safety, knowing about their conditions is really worrisome.”
There are many reasons why someone new to the country would need assistance.
“Our clients come for case management, they come for English classes, they come for all different things and this is just one more component, so they’re familiar with being here,” Soffer said.
NSC clients have case managers, which helps the therapists provide continued care. Case managers might forewarn therapists of potential missed appointments for clients without phones or computers, and therapists can sometimes work with a case manager to connect a client with services discussed in a counseling session.
“[It’s] that health care system having all of the components where people are able to work together physically, mentally, emotionally,” Wamble said. “I think that benefits everybody.”
ACCOMMODATING DIFFERENT CULTURES
For clients receiving therapy in lesser-known languages, the CFR-NSC program relies on over-the-phone translators from across the country.
“A couple of my clients don’t get to speak their native language because it’s a very unique language to this part of the world,” said Wamble, who has provided therapy at NSC to clients from Mexico, South Korea, Jordan and several African nations. “Sometimes having someone on the phone who can speak their language is therapeutic in itself.”
The collaboration uses the Refugee Health Screener-15, a 15-question tool that evaluates refugees’ emotional and psychological wellness by asking clients questions about how they are feeling and handling changes in their lives.
RHS-15 includes a “distress thermometer” that lets clients fill in the thermometer to indicate their stress level in the previous two weeks. The visual component gives therapists an immediate indicator of how a person is feeling, which is important for clients from cultural backgrounds who might deal with stress and emotional wellness differently.
From June 2017 to June 2018, NSC referred 45 clients from 19 different countries to on-site CFR therapists. The clients, from countries like Haiti, Brazil, Iraq, Guinea, Syria, Nigeria and Pakistan, received a total of 152 hours of free therapy.
One of the challenges of the partnership is figuring out how to provide clinical care for clients from diverse backgrounds. Some cultures carry more stigma around mental health and therapy than others, which often depends on if a culture is individualistic or collectivistic, Soffer said.
In an individualistic culture, emphasis is placed on an individual, while emphasis is placed on a family or community unit in a collectivistic culture. Soffer said while seeing a therapist is somewhat normalized in the U.S., it’s not something everyone is used to.
“[An immigrant] might deal with those things not with a therapist, but with a community member or a religious figure,” she added. “[They] would maybe handle it a different way than in the U.S.”
To address cultural differences, CFR therapists tailor their therapeutic approaches to match a client’s needs. Therapists will familiarize themselves with a client’s home country however they can, Wamble said. This includes researching a client’s country before a therapy session — learning where it’s located, what the agriculture is like and the political climate.
“[It’s] putting anything in the tank that is helpful and building that idea where this person may or may not have come from and using that as a place to ask questions or [ask them] to give anecdotes about their experience,” Wamble said.
Developing this cultural competence allows the therapists in the collaboration to develop their skills, too.
“It’s such a great lesson for [the therapists] as they move out into their careers to understand that you’re a therapist to an individual, not the theory that you learned,” Soffer said.
She added the program is important because even though many social services exist for immigrants and refugees, their mental health is often overlooked.
“Any time you can tell your story in a way where it stops controlling you, you’re in a better position to deal with your life and your relationships,” Tanenbaum (pictured above) said.
For Wamble, the most satisfying part of working with her NSC clients is their inspiring sense of positive resiliency, hopefulness and gratitude — something she said is unique to this demographic.
“There’s this ability to balance such challenging experiences with this undying level of hope, not just in their life, but in humanity,” Wamble added. “[They have] this idea that people really are good. … It’s inspiring.”