Explore the challenges and strategies in counselling Syrian refugees in Canada, focusing on trauma, cultural adaptation, and mental health support.
This paper discusses the information on and experiences from Syrian refugees resettling in Canada. The purpose is to highlight relevant circumstances, cultural identities, barriers, and struggles amongst this population to provide insight future counsellors who want to or will work with this population.
The first section provides an overview of the Syrian refugee crisis and how the Canadian government responded, organized, and supported their stay. This is followed by a brief paragraph of statistics that are related to the Syrian refugee population in Canada. The second section dives into potential counselling considerations including unmet health care needs, cultural considerations including Muslim communities, and collectivism and individualism, and language considerations. The next section discusses counselling strategies and interventions like frameworks and models, cultural competence and humility skills, interpreters, and general interventions. The last section concludes with highlights and directions with future research.
Canada is one of the leading countries to intake refugees (Kuo et al., 2020). In 2015 to 2020, the Canadian government accepted just over 44, 000 Syrian refugees in over 350 communities across Canada (Government of Canada, n.d.-b). To receive Syrian refugees, the Canadian government created The Horizontal Initiative: Syrian Refugees program (Government of Canada, n.d.-a). This program ensured that the refugees were granted protection and became permanent residents and to have the opportunity to benefit from health, social, and economic systems and to integrate into Canada including receiving Canadian citizenship (Government of Canada, n.d.-b). Resettlements were processed through three different programs including the Government Assisted Refugees (GARs), Private Sponsored Refugees (PSRs), and Blended Visa Office Referred Refugee (BVORR) (Government of Canada, n.d.-a). About 55% of the Syrian refugees were assigned to GAR, 35% to PSR, and 10% to BVOR (Government of Canada, 2019-c). The GAR program assigns a destination for refugees to live that includes a government funded Service Provider Organization (SPO) to support the resettlement process and the Federal government provides one-year financial support (Government of Canada, 2019-c). The PSR program are supported by permanent residents or Canadian citizens (Government of Canada, 2019-c). They have the same responsibilities as the SPO’s for the GARs (Tuck et al. 2017). Last, the BVOR program was a blend of GAR and PSR (Government of Canada, 2019-c).
The Syrian population is 87 % Muslim, 10% Christian, and 3 %. Jewish. The Muslim population is almost three quarters Sunni Muslim, and the remaining are Alawi, Iswali, and Shia. Official languages amongst Syrians are Arabic, Kurdish, Armenian, Aramaic, and Circassian. Syrian ethnic groups are 90% Arabs, and 10% of Kurds, Armenians, and others. About 49% of the population is female and 51% is male. The age distribution among Canadian Syrian refugees is as follows: 34.2 % of children and youth between ages 0-15 years old, 14.6% youth and young adults, 47.7% adults between 25-64 years old, and 3 % of 65 years old and higher (Citizenship and Immigration Canada, 2015-b). This information an help clinicians gauge cultural identities, intersections potential issues, and concerns that the minority populations might experience.
Health Care
For integration and resettlement to be successful, mental health and well-being is pivotal for refugee communities (Pandalangat & Kanagaratnam, 2021). Tuck et al. (2019) found that over 40 % of Syrian refugee health needs were unmet within the first three years. Majority of the unmet needs were associated with GAR (Government of Canada, 2019-c). There are multiple reasons as to why Syrian refugee health needs are unmet including a perceived unmet need, systemic barriers, and language barriers. There are also unique barriers for refugees like a loss of health records. Furthermore, there may be a lack of knowledge and/or understanding from Syrians of how to use and what to expect from the healthcare system and practitioners (Tuck et al., 2019). However, practitioners could also have a lack of understanding and resources.
Mental Health
Age, gender, health service satisfaction, perceiver control, perceived (Kuo et al., 2020) perceived control and perceived lack of social support stress are factors that predict mental health like depression-level symptoms (Ahmad et al, 2021). Other variables that contribute to psychological and emotional disorders include socio-economic stressors, social and interpersonal stressors, resettlement policy stressors, daily ecological stressors, premigration factors like experiencing trauma, loss of their homes and/or loved ones, torture, rape (Ahmad et al., 2021), bombings, poverty (Ungar 2017), food and shelter insecurities, racism, anti-refugee hate, and anti-Muslim hate (Mayor, 2021) and postmigration factors like acculturation stress, receptivity from locals, accessible, knowledge of resources (Kuo et al., 2020), less social support, financial difficulties, downward social mobility, family problems, language challenges, and loss of/challenged cultural identities and practices (Ahmad et al., 2021). Post-migration stress and sleep symptoms have an impact on the relationship between mental health and trauma exposure (Lies et al., 2020). Having a sense of belonging, greater sense of agency and control have been found to be a protective factor (Kuo et al., 2020). Furthermore, Ahmad et al. (2021) found that during the initial stages of resettlement Syrian experienced depression at a lower prevalence, however, this increased overtime. Moreover, the most common mental health problem amongst refugee children (Ungar, 2017) and adults (Hadfield et al., 2017) who have experienced war and violence is post-traumatic stress disorder (PTSD).
Refugee children are a vulnerable population that show more aggression and act out at school than native-born children (Ungar, 2017). Refugee youth struggle building relationships with peers, experience racism, have sociolinguistic difficulties, are actively excluded, and often bullied, which leads to low self-esteem. Moreover, trauma can impair cognitive development, poorer academic results, anxiety disorder, attention-deficit/hyperactivity disorder, and conduct disorder. Positive experiences at school are protective factors against these negative experiences (Ungar, 2017). It has been indicated that pre-sleep arousal is crucially related to PTSD, anxiety, and depression symptoms with the refugee population. Additionally, Syrian refugee unmet health needs have been found to be correlated to lower income, unemployment, the use of the health services, disability, insubstantial housing, and families with more children (Tuck et al., 2019).
Muslim Communities
It is important for counsellors to understand the specific experiences that Muslims face as minorities in this country. Many Muslims experience racial profiling, racism, discrimination, and Muslim hate, which is influenced by negative representations on media. Additionally, it is important as a counsellor to also acknowledge feelings of hesitation towards help-seeking behaviours because mental health issues in general are seen as shameful matters that should only be discussed with family (Jisrawi & Arnold, 2018). Something else for counsellors to know how important faith is for coping, problem -solving, and social support (Kuo, 2018).
Collectivism and Individualism
Syrian refugees have collectivist orientations, which clash into Canadian individualistic values, and government thus cause strain and struggle to adapt and integrate (Ungar, 2017). Traditional family roles are challenged and forced to adapt to new employment patterns and living conditions (Kuo, 2018; Ungar et al., 2017; Iqbal et al., 2021). Women can feel encouraged and/or forced to do more, which adds stress and responsibility towards mothers and causes marital conflicts and the patriarchal authority that is valued in Muslim culture is undermined. Many males face a change in social status and responsibilities as their education and or experience is not accredited in Canada, causing them to get a lower paying job and forcing the mother to also find a paying job. The pressures of becoming independent from the government while also facing the cultural and systemic challenges can easily inflict stress and negativity.
Individualism encourages children to think more about themselves and less about their family needs and wants, which invites disrespect (Iqbal et al., 2021). These experienced feelings of discontent and dissent are suppressed to show gratitude and avoid further conflict. This process is refereed to fragile obligation. Therefore, it is likely and possible that a counsellor would hear dissatisfaction towards the Canadian individualist culture (Iqbal et al., 2021).
On a positive note, studies have found that private sponsorship tends to promote better integration for refugees (Haugen, 2019; Ungar, 2017). Haugen (2019) discovered that rural communities were PSRs openly welcomed Syrian refugees, which contributed to their ability to adapt, learn the language, feel a sense of belonging, and increase their social networks. The small communities were creative in addressing the common barriers to support the refugees. Many refugee communities decided to stay in the rural town after assistance because they felt at home. A sense of belonging acts as a protective factor (Haugen, 2019) and is associated with few emotional problems and aggressive problems for children at school (Ungar, 2017).
Free English language classes are offered and are federally funded for newcomers, like refugees, through a program called Language Instruction for Newcomers in Canada (LINC) (Citizenship and Immigration Canada, 2010). This program also offers free childcare services for no cost, and transportation services for eligible participants. This is a vital resource for Syrian refugees as 75% proclaimed to not understand English or French (Government of Canada-c, 2019). Language acquisition is associated more possibilities to employment and social networking (Jiswari & Arnold, 2018; Kuo, 2018), and is an influential factor to acculturation. Acculturation is a process of change in cultural identity due to cross-cultural interactions (Lindner et al., 2020). Berry (1997, as cited in Lindner et al., 2020) further highlighted there are four acculturating orientations including integration, assimilation, marginalization, and separation. The LINC program created an advantage for refugees to integrate in Canada (Lindner et al., 2020). Integration has been linked to positive adapted acculturative outcomes, along with assimilation, but on a lower scale (Lindner et al., 2020).
Even though services were free, some Syrian women were not able to attend due to being occupied with family duties and workload (Kuo et al., 2020). This influences the family as mothers have the most pull and responsibility for language maintenance (Lindner et al., 2020). However, many parents make a conscious and solid effort. When it does not work out for them and their children end up excelling in the language without them, which causes an acculturation gap leading to barriers and conflict within the family. It is important for many Syrian Muslim families that Arabic is used at home to uphold religious identity like reading the Qu’ran. Kurdish Syrian families are even more motivated to uphold their language and cultural beliefs as they are a minority amongst their communities (Lindner et al., 2020).
The Refugee Mental Health framework (Pandalangat & Kanagaratnam, 2021) and the Culturally Responsive and Socially Just (CRSJ) model (Collins, 2018) are both holistic. They provide guidelines of how to consider and incorporate micro, messo, and macro factors. These approaches are naturally flexible and adaptable and can be used for planning and interventions.
The Refugee Mental Health framework specifically recognizes the common experiences of political violence, trauma, distortion of family and peers, and impeding natural coping mechanisms. This is formulated into various dimensions. The community dimension subdivides into home, resettling, and “in flux”, and the system dimension subdivides into research and policy, service provision, and design, prevention and promotion, community leadership, and education and advocacy. Moreover, context, resources, and dynamic learning are considered for each person in an ongoing manner (Pandalangat & Kanagaratnam, 2021).
The CRSJ model takes an anti-oppressive stance that encourages a collaborative process with the client that encourages the counsellor to reflect on culture, social location, intersectionality, privilege and power, systemic influences, views on health and healing, and locus of control. It is a value-based practice that promotes ongoing self-awareness, cultural awareness, cultural humility, and cultural sensitivity (Collins, 2018).
Cultural competence is a traditional approach in counselling that emphasizes ongoing knowledge, skills, and behavioural changes regarding minority groups (Fischer-Borne et al., 2015; Jisrawi & Arnold, 2018). Cultural humility requires counsellors to continuously critically self-reflect, to be accountable, and to view people as unique and complex with multiple intersections that make the whole identity. It is also important when adapting this approach to aim to reduce power imbalances (Fischer-Borne, 2015). The counsellor takes a humble approach by establishing comfort for both the counsellor and client with their differences. This can be achieved the use of empathy and acceptance. It is also important to inquire about the degree of acculturation to understand their present cultural identity. Counsellors should not push for information that is not relevant to the client’s issues (Jisrawi & Arnold, 2018).
To honour both cultural competency and humility, counsellors can bring awareness and advocate regarding the health care system and accessibility barriers (Kuo et al., 2020). Furthermore, it they could create a network and collaborate with other community, social, and governmental organizations like faith-based groups (Kuo et al., 2020), and interpreters (The British Psychological Society, 2017). Counsellors can also advocate for anti-bullying interventions at schools (Ungar, 2017) and school-based trauma interventions (Mayor, 2021).
Offering an interpreter could help improve communication and prevent language and cultural barriers. It would be ideal to find a trained interpreter in mental health and cultural broking or to provide training because it is common for interpreters to have inadequate training (Wright, 2014). Building a trusting relationship with the interpreter and the client is important and tricky (The British Psychological Society, 2017). Some ethical considerations include multiple relationships between the client and interpreter and boundaries of competence. Because interpreters are a small community, it is possible the interpreter and client could share history, be formerly acquainted (APS, 2013), or share similar traumas (Huminik, 2018), which all risks compromising adequate counselling. To reduce these risks counsellors can clarify, maintain, and reinforce roles by writing and signing a contract, seek ongoing supervision (The British Psychological Society, 2017; Wright, 2014), collaborate treatment goal with the client and interpreter, and debrief with the interpreter after every session (APS, 2013; Wright, 2014). Counsellors should also expect interruptions, to lose concentration and the need to take breaks often, and slower disjointed conversations (The British Psychological Society, 2017).
Counsellors recognize the importance of spiritual beliefs and consider using faith-based interventions (Jisrawi & Arnold, 2018; Kuo, 2018). This can be done by inviting an imam into session or co-facilitating in a Mosque (Jisrawi & Arnold, 2018). These considerations and methods could ease acculturation stress (Jisrawi & Arnold, 2018). Further, it could be beneficial to support and empower Syrian refugees to maintain stability and control by helping them manage (Kuo et al., 2020). This can be done by teaching adaptive stress-management skills and coping strategies and encouraging resilience by utilizing their personal resources like religious faith. Furthermore, broaching topics or race, power, and/or privilege may be beneficial for the therapeutic relationship and help establish trust and awareness of intersecting cultural identities (King & Borden, 2018). This could ease clients and create a culturally safe space.
Another approach is to consider inquiring about sleep hygiene and unprocessed trauma. This could inspire sleep-focused interventions to reduce symptoms of PTSD, anxiety, and depression symptoms (Lies et al., 2020). To further reduce mental health symptoms, counsellors can provide resources and encourage social support (Ahmad et al., 2021; Jisrawi & Arnold, 2018) by connecting them with community social groups (Jisrawi & Arnold, 2018; Ungar, 2017).
Working with the Syrian refugee population requires counsellors to consider many factors. For example, although most Canadian Syrian refugees are young, Arab, Sunni Muslim who speak Arabic, there is diversity within this population. Further, most refugees that were assigned to GAR programs appeared to have a correlation with more unmet health needs. While PSR programs seemed to have the most promising outcome from the resettlement process. Pre-and post migration stress regarding war related experiences and acculturation factors seem to be crucial to understanding mental health problems. Language acquisition could be the major factor to overcome integration. Cultural barriers are largely due to collectivist and individualist values and beliefs clashing. However, small rural communities may be the best option for Syrian refugees to feel like home when the local communities are prepared and educated.
Counsellors should use multicultural approaches like the Refugee Mental Health framework and the CRJS model to critically consider how lived experiences and cultural identities are affected by other Canadians, systemic processes, and to collaborate with clients in making suitable goals towards healing. More research is necessary regarding the refugee experience as it is ongoing, promising interventions like faith-based interventions, school-based interventions, sleep interventions, and psychoeducation amongst locals to receive refugees.
Ahmad, F., Othman, N., Hynie, M., Bayoumi, A. M., Oda, A., and McKenzie, K. (2021). Depression-level symptoms among Syrian refugees: findings from a Canadian longitudinal study. Journal of Mental Health, 30(2), 246–254. https://doi.org/10.1080/09638237.2020.1765998
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Citizenship and Immigration Canada. (2010-a). Evaluation of the Language Instruction for Newcomers to Canada (LINC) Program. Retrieved from https://www.canada.ca/content/dam/ircc/migration/ircc/english/resources/evaluation/linc/2010/linc-eval.pdf
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Wright, C. L. (2014). Ethical issues and potential solutions surrounding the use of spoken language interpreters in psychology. Ethics and Behavior, 24(3), 215–228.https://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=pbh&AN=94856614&custid=s7439054
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