Exploring Immigrant and Sexual Minority Mental Health Exploring Immigrant and Sexual Minority Mental Health provides mental health practitioners with up-to-date theory, cutting-edge research, and therapeutic strategies to assist them in their work with multicultural clients By focusing on the immigrant psyche, this volume hones in on appropriate counseling interventions and effective, culturally specific psychotherapeutic practices by introducing the use of Diversity and Identity Formation Therapy (DIFT), a theoretical concept designed for immigrant and sexual minority identity formation This work can be used in interdisciplinary settings and is applicable for those working in a number of mental health d isciplines including counseling, social work, therapy, and more Pavna K Sodhi, EdD, is a psychotherapist, researcher, and educator in Ottawa, Ontario, Canada Her research merges mental health issues with concepts surrounding identity formation Her work on immigrant issues, ethnic identity formation, sexual minorities, and multicultural mental health concerns has been featured in both national and international scholarly journals and books She is fluent in English, French, and Punjabi This page intentionally left blank Exploring Immigrant and Sexual Minority Mental Health Reconsidering Multiculturalism Pavna K Sodhi First published 2017 by Routledge 711 Third Avenue, New York, NY 10017 and by Routledge Park Square, Milton Park, Abingdon, Oxon, OX14 4RN Routledge is an imprint of the Taylor & Francis Group, an Informa business © 2017 Taylor & Francis The right of Pavna K Sodhi to be identified as author of this work has been asserted by her in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988 All rights reserved No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe Library of Congress Cataloging in Publication Data Names: Sodhi, Pavna K., author Title: Exploring immigrant and sexual minority mental health: reconsidering multiculturalism / Pavna K Sodhi, Ed.D Description: New York, NY: Routledge, 2017 Includes bibliographical references and index Identifiers: LCCN 2016045309| ISBN 9780415841863 (hbk: alk paper) | ISBN 9780415841870 (pbk: alk paper) | ISBN 9780203760345 (ebk) Subjects: LCSH: Cultural psychiatry | Ethnopsychology | Immigrants–Mental health | Sexual minorities–Mental health Classification: LCC RC455.4.E8 S636 2017 DDC 362.2089–dc23 LC record available at https://lccn.loc.gov/2016045309 ISBN: 978-0-415-84186-3 (hbk) ISBN: 978-0-415-84187-0 (pbk) ISBN: 978-0-203-76034-5 (ebk) Typeset in Sabon by Deanta Global Publishing Services, Chennai, India To my daughters, Nadya and Ameya, who have taught me the importance of enjoying every moment I love you both with all my heart To Mom and Dad, who continue to demonstrate healthy family attachment, resiliency, and perseverance in their ways of being Thank you for all the unconditional love and support over the years This page intentionally left blank Contents List of Illustrations ix Foreword by Peter Gamlin x Acknowledgments xiii Introduction to Exploring Immigrant and Sexual Minority Mental Health xiv Part Migration Patterns and Diasporic Experiences Introduction Pre-Migration Visions, Reasons for Immigration, and Post-Migration Obstacles and Challenges The Family Context 20 Employment Barriers and Financial Stability 46 Mental Health Concerns 59 Part II Identity Development and Models 81 83 Introduction Ethnic Identity Formation 87 Sexual Identity Development 108 Intersection of Ethnic Identity Formation and Sexual Identity Development 119 viii Contents Part III Emerging Trends in Multicultural Psychotherapy 125 Introduction 127 Cultural Competencies and Clinical Logistics 130 Multi-Theoretical Perspective Applicable to Immigrant and Sexual Minority Populations 140 10 Diversity and Identity Formation Framework 157 11 Future Directions and Concluding Thoughts 176 Index 185 List of Illustrations Figures 4.1 Mental Health Resiliency Model 73 4.2 Interventions to Assist New Immigrants in North America 74 5.1 Immigrant Adult Identity Formation Spectrum 103 7.1 Intersection of Identity Synthesis, Entering a LGB Community, and Integration Stage 121 7.2 Multiple Minority Identity Development Framework 122 10.1 Psychotherapeutic Framework for Multicultural Clientele 158 10.2 Ethnic Identity Formation and Sexual Identity Development in Multicultural Populations 159 11.1 Recommendations and Future Directions for Multicultural Populations 181 Tables 10.1 Case Conceptualizations of the Singh Family 10.2 Application of the DIFT Framework to the Singh Family 162 165 Chapter 11 Future Directions and Concluding Thoughts When we are no longer able to change a situation, we are challenged to change ourselves (Viktor Frankl, 2006) Congruent with Viktor Frankl’s sentiments noted above, inner motivation and initiative are necessary in establishing change in people’s perception of themselves and how they interact in certain circumstances For clinicians working with multicultural populations, change toward remedying a problem can occur during the therapeutic session; however, it appears that including external motivational factors (e.g., societal, familial, and community) brings a more collaborative outlook toward change within the client’s life The objectives of this book, as outlined in the main Introduction, were essentially to explore the various components of the immigrant mindset, and from there to determine counseling techniques that would be applicable for multicultural clients Yet the main purpose of this book, after distinguishing these counseling interventions, was to provide clinicians with frameworks, case conceptualizations, and a multi-family member case study based on the Diversity and Identity Formation Therapy (DIFT) perspective This approach would render a more holistic view toward working with multicultural populations, again applying theory into practice and practice into theory There was added motivation for writing this book, particularly around the importance of learning about mental health and cultural and sexual diversity through a positive lens and recognizing that this exposure needs to commence at an early age During my eldest daughter Nadya’s schooling, particularly Grade 3, I was shocked to hear that she learned about the lesbian, gay, bisexual, transgendered, and queer (LGBTQ) community by means of a mandated public school anti-bullying program (Accepting Schools Act, 2012) The year prior, the city councilor’s son died by suicide as a result of anti-gay bullying in his high school; hence, the initiative Future Directions and Concluding Thoughts 177 for this act It was an unfortunate yet familiar story that made provincial newspaper headlines From there, instead of informing the students of the various sexual preferences, they chose to teach this topic through an important yet negative context I questioned how this “lesson plan” could have been conducted differently Perhaps the teachers could have taught the students about the LGBTQ community first in health class In the past, I have openly discussed with Nadya the various family dynamics current in today’s society but was waiting until she was 10 years old to share positive attributes of the LGBTQ population with her After she disclosed how she learned about the LGBTQ community, I sincerely regretted not discussing this topic with her earlier, especially as she was genuinely curious about whether same-sex individuals could be in relationships When this occurred, I had to re-teach her that anyone could be bullied or discriminated against (sometimes based on nothing)—it is not solely centered around their sexual orientation She was receptive to my comments, and we certainly continue to have insightful conversations about the LGBTQ community, transgender students enrolled in her school, and, most recently, LGBTQ refugees Exposure to diversity does not end with casual or situational conversations about multiculturalism or sexual minorities; it needs to be consistent and evolving at home, in schools, and within communities, nurtured and endorsed by individuals who are authentically interested in the cause and have training in cultural sensitivity issues (Gamlin et al., 2001) Throughout the dissemination of my research, recommendations and future directions have been repeatedly suggested (Sodhi, 2003, 2009) As noted, there has been a remarkable amount of service fragmentation, lack of interest and enthusiasm, and inconsistent government support regarding culturally sensitive resources and training The remainder of this section is divided into three thematic concepts (i.e., training, cultural competence, and interventions), demonstrating how collaborative and mutual learning and awareness could, potentially, take place Training One of the most current themes to augment cultural competence with the mental health community involves consistent training, professional development, and continuing education Interest and training regarding the complexity of working with culturally diverse clients need to be consistent and current Training topics include, but are not limited to, how psychosocial aspects, acculturation, identity formation, and the immigration process impact the family dynamics; multicultural counselor training programs/ certificates (e.g., college, undergraduate, and graduate level); cross-cultural training in health professions (e.g., psychology, medicine, social work, nursing) to enhance knowledge, skills, and awareness and ameliorate cultural 178 Trends in Multicultural Psychotherapy misunderstandings; and the impact of discrimination on the immigrant mindset (Arthur & Stewart, 2001; Rothe, Pumariega, & Sabagh, 2011) Goodman, Liang, Helms, Latta, Sparks, and Weintraub (2004) noted: that an effective multicultural-social justice training intervention should allow psychology and counseling students to expand their learning across three levels: (a) the macro level: government, policy, and social norms; (b) the meso level: community and organization; and (c) the micro level: individual (cited in Kuo & Arcuri, 2014: 1044) Graduate-level training on multicultural therapy skills could be offered in experiential practicum settings by working directly with ethnically, racially, and sexually diverse clients (e.g., immigrants, LGBTQ populations, international students) (Ahmed et al., 2011) Concerning the intersection of ethnic and sexual identity, both individualistic and collectivistic and systemic characteristics need to be considered Clinicians require cultural sensitivity training to gain a clearer understanding of how these variables play into one’s identity formation and how to learn how to navigate their amalgamated identity Supports should be available on campus for these individuals to access (Gervacio, 2015; Kassan & Nakamura, 2013) As well, ongoing dynamic psycho-education and compulsory courses in culturally sensitive topics (e.g., multicultural counseling, immigrant mental health, sexual diversity) could be offered at the post-secondary level (Alderson, 2004, 2013; Cheshire, 2013) By offering courses that incorporate content pertaining to immigrants or sexual minorities, clinicians will become more trained, informed, and competent to work with multicultural individuals Alternatively, positive space training (learning how to create safe spaces for sexual minorities in school, work, and organizational milieus) would be equally effective to lessen heterosexism and increase competence when working with this dynamic population (Ryan, 2003) Cultural Competence Becoming culturally competent goes beyond formal training; clinicians should continue to be transparent, trustworthy, congruent, compassionate, and empathic Clinicians who educate their clients on the variety of mental health issues, treatment options, and ethnically diverse mental health facilities and spend adequate time cultivating a therapeutic rapport can significantly contribute to the continuity of care component (Donnelly et al., 2011; Sadavoy, Meier, & Ong , 2004) Bhui and Morgan (2007) state that cultural competence in the mental health professions should: Future Directions and Concluding Thoughts 179 recognise that an individual may be quite different from other members of the same racial and ethnic group … not to overgeneralize, each individual is unique; consider how racial and ethnic differences between themselves and the patient might affect psychotherapy; these include: differences in conceptualisation of mental health and illness, differences in conceptualisation of the self in relation to family and community and differences in communication styles; acknowledge that power, privilege, and racism might affect interaction with patients; keep learning about issues of race and ethnicity, and become a “mini- ethnographer” with patients and the public (p 192) However, microaggressions are still very prevalent within the mental health profession and, particularly, between the clinician and client (Ahmed et al., 2011; Sue, 2010) By increasing public awareness and promoting more inclusive work environments, individuals can become more familiar with diversity and learn about the importance of mitigating racism and different forms of discrimination present in our society Comparable to developing cultural competence skills, it would be advantageous for clinicians to become more accustomed to LGBTQ counseling material and themes, community resources, LGBTQ college and university support groups, and relevant websites such as Affirm: Psychologists Affirming their Lesbian, Gay, Bisexual and Transgender Family, http:// www.stonybrook.edu/commcms/affirm/index.html, or the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling, http://www algbtic.org/l-g-b-t-resources.html (Datti, 2009) By accumulating this knowledge, clinicians will be better equipped to guide their LGBTQ clients through the various stages of sexual identity development (Degges-White, Rice, & Myers, 2000) Ali and Barden (2015) contend that it is the counselors’ role to familiarize their clients with the “cyclical nature” in the coming out process, in that it may not be linear; “it is important for counselors to assist in exploring beyond a one-time culminating event” (p 510) The counselor and client would work together for the client to achieve the awareness phase of the coming out process More research could be conducted to investigate why the coming out process occurs in a non-linear manner for multicultural populations, instead of completing the stages in a sequential fashion (DeggesWhite, Rice, & Myers, 2000) Interventions From the literature, there is a lack of accessible multilingual and multicultural mental health resources and interpreters (Donnelly et al., 2011; Sadavoy, Meier, & Ong, 2004) This often creates a barrier for multicultural individuals 180 Trends in Multicultural Psychotherapy to seek treatment, as bringing a family member can make it challenging to disclose the etiology and symptoms of their mental health issue Psychosocial interventions such as family counseling, ethnic community, societal, and familial endorsed programs have been recognized to improve an individual’s mental health By providing individualized personalized treatment options, instead of overgeneralizing the cultural front, clients may become resilient and self-aware and contribute to the social capital of the community (Leu, Walton, & Takeuchi, 2011; MacDonnell et al., 2012; Rothe, Pumariega, & Sabagh, 2011) Less informal and intimidating settings (e.g., community centers) may appear more inviting for immigrants to seek therapeutic help, instead of health centers (Sohtorik & McWilliams, 2011) What may be most beneficial for this population is to build more holistic multi-disciplinary culturally and racially diverse mental health centers, where multiple languages are spoken and Eastern and Western practices are supported Services could include medically trained individuals, psychotherapy, physiotherapy, massage therapy, naturopathy, life coaching, meditation, yoga, and reiki (Owen et al., 2011) These culture-centered counseling and psychotherapy facilities could eventually be built in the urban areas nationwide or around the globe (Roland, 2005) Arevalo, Tucker, and Falcon (2015) have suggested alternative methods of alleviating mental health issues They proposed socializing with community members, though recreational or leisure activities endorsed by the community, to reduce mental health symptoms Ethnic community centers exist where there is programming ranging from support groups; weekly religious activities; acknowledgment of annual cultural holidays and celebrations; monthly meetings and get-togethers for senior immigrant men and women; psycho-educational seminars, workshops, and courses regarding aging, mental health, yoga, and tai chi; and volunteered services/expertise by community members of all ages where members can congregate and subsequently reduce their symptoms of depression and loneliness (Sodhi, 2008, 2015) A support group setting can be to be a significant outlet for the LGBTQ community, particularly to share narratives, learn about LGBTQ resources, and develop friendships in order to navigate sexual identity stages and to help reduce mood-related symptoms (Rhodes et al., 2013) Resources for the LGBTQ population could include the maintenance of online forums, newsgroups, web diaries, and blogs to overcome heterosexism or homophobia Parents and supportive friends can become more involved with the Parents, Family, and Friends of Lesbians and Gays (PFLAG) National Organization in terms of increasing awareness about sexual minority issues Resources in the form of websites, support groups, and multilingual written documents (i.e., brochures) as well as ethnic community centers where individuals can congregate need to be maintained and validated There are Future Directions and Concluding Thoughts 181 advantages to all of these services, for those who prefer in-person contact and support versus those who prefer less overwhelming online resources The result should provide individuals with the opportunity to heal and become more resilient and comfortable in their host culture (Donnelly et al., 2011; Ruiz-Casares et al., 2015) Recommendations to improve this circumstance such as training, cultural competence, and interventions continue to be made; however, if we were to conceptualize this concern on a larger psychological and universal level, what would it look like? Training Cultural Competence Interventions ZPD/Neuroplasticity Figure 11.1 Recommendations and Future Directions for Multicultural Populations Vygotsky (1978) conveyed that, “language and culture are the frameworks through which humans experience, communicate, and understand reality” (p 39) Elaborating on this concept, Wexler (2010) stated: language—spoken and written—facilitates the influence of the humanmade and extended social environment on the development of children, and the latter is itself clearly a product of cultural evolution and it seems increasingly probable that the former is in large part as well (p 15) Keeping this in mind, how we better communicate or expose individuals to diversity? Referring to the zone of proximal development (ZPD), where social interactions, construction, and co-construction of concepts, meaning making, scaffolding, and personal development occur, it only makes sense that individuals would benefit from a collaborative environment to effectively learn about multiculturalism and its necessity in our diverse society (Vygotsky, 1978) By learning from others and accumulating knowledge, individuals will be able to move in their ZPD with the guidance of culturally sensitive mental health professionals Using a neuroplasticity platform, individuals will be able to remodel and transform their brain to modify, process, and integrate these concepts into their culturally accepting mindset (Doidge, 2007, 2015; Kays, Hurley, & Taber, 2012) 182 Trends in Multicultural Psychotherapy The purpose of this book entailed providing clinicians with current counseling and therapeutic techniques specifically for multicultural individuals to become psychologically resilient in their host country It will take a couple more decades for all members of society to appreciate every color of the rainbow; however, with continuous positive dialogue and supported implementation of current interventions, the multicultural population entity will be woven within the fabric of our diverse and colorful continent References Accepting Schools Act (2012) Bill 13 Retrieved on April 30, 2016 from https:// www.ontario.ca/laws/statute/S12005 Ahmed, S., Wilson, K B., Henriksen, R C., & Jones, J W (2011) What does it mean to be a culturally-competent counselor? 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the Canadian Psychological Association conference, Ottawa, Ontario, June 4−6, 2015 Sohtorik, Y & McWilliams, N (2011) Hugging, drinking tea, and listening: Mental health needs of Turkish immigrants Journal of Multicultural Counseling and Development, 39, 66–77 Sue, D W (2010) Microaggressions and marginality: Manifestations, dynamics, and impact Hoboken, NJ: John Wiley & Sons Inc Vygotsky L S (1978) Mind in Society: The Development of Higher Psychological Processes Cambridge, MA: Harvard University Press Wexler, B E (2010) Neuroplasticity, cultural evolution and cultural difference World Cultural Psychiatry Research Review, 11–22 Index acculturation process 66–7 Adair, C 69 “affirmative action” 13, 54 Ahmed, S 55 Ainsworth, M D S 142 Albanese, P 60 Alegría, M 72 Ali, S 109, 179 Amatea, E S 160 Arevalo, S P 180 autoethnography narrative inquiry 144 Barden, S 109, 179 Beck, Aaron 148 Beiser, M 59–60 Berry, J W 88, 99, 121 Beynon, J 39 Bhui, K 178 bicultural identity formation 91 Bollywood movies 34 Botterff, J L 24 Bowlby, J 141, 142 Briones, E 47, 102 Brooks-Harris, J E 140 Bruner, J 143 Buddha 83, 147 Buddhist psychology 140, 146–8 Buzan, Tony 74 “cached-heterosexual privilege” 115 career potential 55, 63 Cass, V 108, 110, 121 Chinese dialect 34 citizenship, obtaining 47 Citizenship and Immigration Canada 74 Clinton, M 69 cognitive behavioral therapy 140, 148–51 color-blindness 133 coming out process: “cyclical nature” in 179; psychotherapeutic themes involving 128 ‘compartmentalization’ 92 CORE values 31, 75 cultural competencies and clinical logistics 130–6; building culturally sensitive rapport 132–6; clinical barriers 131–2; color-blindness 133; cultural empathy 130; language 132; myth 132; racial microaggressions 133 “cultural identity” 83 culture shock 65–6 Cummins, J 95 Dalai Lama 127 Dallos, R 144 Das, A K 27, 52 D’Augelli, A R 108, 111, 119, 121 Daya, R 132 Delgado-Romero, E 134 Diagnostic and Statistical Manual for mental health disorders (DSM)-5 64 discrimination: in the labor market 51–54; post-migration 12–17; workplace 54 Diversity and Identity Formation Therapy (DIFT) 157–74, 176; application of DIFT framework (Singh family) 165; Buddhist psychology perspective 169; case conceptualizations (Singh family) 162; “clinging” 167; cognitive behavioral perspective 169; counseling outcomes 173–4; family case study 160–74; Immigrant Adult Identity Formation Spectrum103; 186 Index LGBTQ lifestyle and coming out process 164; multicultural populations 158; narrative therapy 168; PFLAG groups 174; problem identification 163; thematic groupings 163; theoretical perspective 157; transference issue 166; validation, lack of 168; worldviews 157; zone of proximal development 170 Doidge, N xv-xvi, 94, 141 dominant culture perceptions: ethnic identity formation 101; sexual identity development 115–16 Donnelly, T T 69, 131 Dosanjh, J S 30 Dreby, J 24 dual identity development 120 Dudley, R 160 Eliason, M J 115 Ellis, A 148, 160 “emotional balance” 142 empathy (cultural) 130 employment barriers and financial stability 46–55; “Affirmative Action Programs” 54; career potential 55; citizenship, obtaining 47; decision to immigrate 46; discrimination in the labor market 51–4; language barriers 47–9; language proficiency, employment opportunities and 48; occupational downgrading 49–50; recognition of prior learning and reclaiming professional identity 54–5; workplace discrimination 54 English as a Second Language (ESL) 47 “enmeshment” 28 Este, D 69 Esterson, A 60 ethnic identity formation 66, 87–103; adolescents 90; bicultural identity formation 91; code-switching practices 93; community membership 98–100; ‘compartmentalization’ 92; components of ethnicity 88; cultural identity 87; dominant culture perceptions 101; ethnic selfidentification, need for 94; familial influences 97–8; hyphenated identity formation 94; identity, dimensions of 89; Immigrant Adult Identity Formation 102–3; individualistic and collectivistic ideologies 101–3; metaphor 96; situational ethnicity 93; societization 95; Vygotskian dimension to identity formation 95–6; zone of proximal development 95, 103; see also sexual identity development, intersection of ethnic identity formation and Ewashen, C 69 Falcon 180 Falicov, C J family context 20–43; academic and professional expectations 35–40; communication 31; CORE values 31; cultural preservation, intergenerational communication, and language transmission 30–3; elderly parents 25; “enmeshment” 28; family dynamics 23–30; firstgeneration women 22; gender roles 20–3; “generational dissonance” 42; generation gap 42; grandparents 25; in-laws 27, 29; intergenerational conflict 41–3; interpersonal relationships 40–1; language transmission 33–5; ‘modified extended family’ 30; secondgeneration woman 23 Fassinger, R E 108 financial stability see employment barriers and financial stability Foner, N 24 Four Noble Truths 147 Frankl, Viktor 176 Fromm, Erich 141 future directions 176–82; cultural competence 178–9; ethnic community centers 180; interventions 179–82; psychosocial interventions 180; training 177–8; zone of proximal development 181 Garza-Guerrero, A 65 “generational dissonance” 42 generation gap 42 Georgiades, K 59 Ghuman, P A S 30, 39 Goffman, Erving 70 Goodman, L A 178 Goodwill, A M 60 Grewal, S 24 Index 187 Halbertal, T H 83 Hays, P A 149 Helms, J E 178 Henriksen, R C 55 Hilton, B A 24 Holzman, L 95 homophobia 108 Hoskins, M 133 Hwang, J J 69 identity formation framework see Diversity and Identity Formation Therapy “Identity vs Identity confusion” 84 Immigrant Adult Identity Formation Spectrum 103 immigration, reasons for 7–9 in-laws 27, 29 “intercultural space” “intersectionalities of influence” 72 Ivey, A E 132, 145 Ivey, M B 132 izzat 71 Jackson, J S 72 Jasso, G 12 Johnson, S M 142 Jones, J W 55 Kagotho, N 68 Kakar, S 27–8 Kelly, A 39 Kemp, S 27, 52 Kim, U 99 Kinsey, Alfred 108, 110 Klein, F 108 Klosko, J S 150 Koren, I 83 Kuyken, W 160 Kwak, K 33 Kwan, K K 89 Kyu, H H 59 Labor Market Index 38 Laing, R D 60 language: barriers 47–9; client and counselor 133; cultural differences 132; as multicultural issue 132; proficiency, employment opportunities and Language Instruction for Newcomers to Canada (LINC) 47 Latta, R E 178 Laungani, P 90 lesbian, gay, bisexual, transgendered, and queer (LGBTQ): populations, mental health issues of 61; stigma associated with being 145 Li, H Z 133 Liang, B 178 life traps 150 Lingle, D W 130 Literacy Information and Communication Systems (LINCS) 74 “mainstreaming” 61 Martin, C E 108 McShane, K 60 McWilliams, N 59 Meichenbaum, Donald 148 mental health concerns 59–75; children of immigrants 64; CORE values 75; culture shock 65–6; definition of mental health 59; ethnic identity formation and acculturation process 66–7; gender differences 67–8; generational concerns 68–70; immigrant mental health conditions 64–5; “intersectionalities of influence” 72; izzat 71; “mainstreaming” 61; mind maps 74–5; “mystification” 60; postmigration 63; post-traumatic stress disorder 65; pre-migration risk factors 62; resiliency 72–4; seniors 68; social conditions 70; stigma 70–1; stressors and barriers to accessing mental health services 71–2; triggers for mental health challenges 68 mental health disorders 149 Merali, N 133 Meyer, I H 61 Mikulas, W L 147 mindfulness 147 mind maps 74–5 “modified extended family” 30 Montgomery, M J 47, 102 Moodley, R 143 Morales, E 120 Morgan, N 178 multiple minority identity 121–2 multi-theoretical perspective 140–52; autoethnography narrative inquiry 144; Buddhist psychology 140, 188 Index 146–8; cognitive behavioral therapy 140, 148–51; deconstruction 144; “emotional balance” 142; Four Noble Truths 147; LGBTQ, stigma associated with being 145; LGBTQ lifestyle and coming out process 164; life traps 150; mindfulness 147; movements of psychotherapy 140; multicultural counseling and therapy 140, 145–6; narrative therapy 140, 143–5; psychoanalytic therapy 140–2; re-construction process 145; scaffolding 143; sexual minority populations, counseling approaches for 151–2; “unconditional positive regard” 148 “mystification” 60 narrative therapy 140, 143–5 naturalization Newman, F 95 Nowakowski, M 60 occupational downgrading 49–50 Ogbu, J 7–8 O’Hanlon, B 144 O’Mahony, J M 131 Padesky, C A 160 Pannu, R 89 Parents, Family, and Friends of Lesbians and Gays (PFLAG) 174, 180 Patterson, B 59 Peavy, R V 133 Pedersen, P B 145 “personal identity” 83 Phinney, J S 87, 95 Phukon, G 88 Pomeroy, W B 108 post-migration discrimination 12–17 post-migration obstacles and challenges 9–12 post-traumatic stress disorder (PTSD) 65 pre-migration visions and reasons for immigration 7–9 psychoanalytic therapy 140–2 Ream, G L 113 Ridley, C 130 Rotheram, M 87 Rumbaut, R 62 Salas-Wright, C P 68 Savin-Williams, R C 108, 113 scaffolding 143 Schope, R 115 Schwartz, S J 47, 102 Schwitzer, A M 160 Segal, U A 24 Settlement.org 74 sexual identity development 108–16; “cached-heterosexual privilege” 115; community membership 115; dominant culture perceptions 115–16; familial influences 113–15; homophobia 108; homosexuality 108; “life span” model (D’Augelli) 111–12; sexual identity model (Cass) 110–11 sexual identity development, intersection of ethnic identity formation and 119–22; bisexual versus gay/lesbian 120; conflicts in allegiances 121; denial of conflicts 120; description 121–2; dual identity development 120; establishing priorities in allegiance 121; identity integration 119; integrating various communities 121; multiple minority identity 121–2; psychosocial factors 119 Shaikh, S 39 Shelton, K 134 Simek-Morgan, L 132 situational ethnicity 93 “social identity” 83 societization 95 Sodowsky, G R 89 Sohtorik, Y 59 Sparks, E 178 Stewart, J B 51 Stewart, S 130 Sue, D 146 Sue, D W 84, 146 Tajfel, H 83 Takeuchi, D T 72 Tate, K A 160 Thompson, M 99 Toohey, K 39 transference 141, 164 Troiden, R R 108 Tucker, K L 180 “unconditional positive regard” 148 uprooting Index 189 “upward social mobility” 49 US Citizenship and Immigration Services 73–4 validation 144; lack of 168; workplace 55 Vaughn, M G 68 Verkuyten, M 120 Vetere, A 144 Vontress, C E 131 Vygotskian dimension to identity formation 95–6 Vygotsky L S xv, 3, Weintraub, S R 178 Welcome to USA 73 Wexler, B E xv Williams, D R 72 Wilson, K B 55 workplace discrimination 54 World Health Organization, definition of mental health 59 Young, J E 150 zone of proximal development (ZPD) 95, 103, 170, 181 This page intentionally left blank .. .Exploring Immigrant and Sexual Minority Mental Health Exploring Immigrant and Sexual Minority Mental Health provides ? ?mental health practitioners with up-to-date... national and international scholarly journals and books She is fluent in English, French, and Punjabi This page intentionally left blank Exploring Immigrant and Sexual Minority Mental Health Reconsidering. .. labor market; and recognition of prior learning and reclaiming professional identity Chapter examines immigrant and sexual minority mental health concerns that communicate pre- and post-migration