Clinical Therapist, Daniela Ruiz-Cedeño, ASW, and Clinical Supervisor, Steven Frausto, LCSW, sat down with The Guidance Center’s Communications Manager, Geneses Davis, to discuss immigrants and mental health. Steven and Daniela work with clients who have migrated to the United States. This topic is also a personal one for them, as Daniela immigrated to the United States with her family when she was six years old, and Steven’s parents immigrated to the United States.

How can migrating to another country impact someone’s life and well-being?

Steven: Sometimes families have to suddenly pick up their belongings and leave home and everything they’ve known. Other times individuals have the opportunity to plan their travel. However, migrating, whether planned or abrupt, can greatly impact individuals. Leaving home and going to a new and unknown place is not easy. We’ve seen clients who come from Mexico, El Salvador, Guatemala and other countries. Many of these clients witnessed violence, had family members targeted or threatened and faced significant challenges. For these families, leaving, while difficult, is the only way they see things getting better.

Daniela: Individuals can also experience hardships that impact their mental health while on a migration journey. Sometimes, our clients are exposed to trauma while traveling and have challenges finding food, water and places to rest.

As a therapist, is it important to understand where your clients come from geographically? Why?

Daniela: It is very important to understand where our clients come from geographically. This is necessary because we research where they’ve lived to learn what’s happened in those places and what they may have been exposed to. Additionally, if our clients still have family or friends in areas that are unsafe, we have to be aware of the stressors that can still be impactful.

Steven: When we know where our clients come from geographically, we are able to better understand what their lives were like before migrating. Additionally, we are able to learn about their culture, their language, dialects and past experiences.

Individuals who migrate may have experienced trauma and great hardships before, while or after relocating. How might this impact their experiences and mental health?

Before Migrating:

Daniela: Clients can have generational trauma before migrating. This is trauma that has been passed down from parents, grandparents or other family members. We see clients that have experienced traumatic incidents, but so did their parents and grandparents. Often times this ongoing exposure to trauma becomes normalized within the family before the family relocates.

Steven: Unpacking generational trauma or the trauma our clients experienced before migrating sometimes evolves into teaching moments for the entire family. In these situations, we explain that it is concerning for children to experience things such as anxiety, difficulty sleeping or constant stomachaches even if it is typical for the child or family.

While Migrating/During Journey:

Steven: Migration journeys can be full of unknowns and are often difficult. My parents walked through deserts, stayed with strangers and were constantly on high-alert for danger. My mother was six or seven months pregnant when she migrated and didn’t have access to care. We hear stories like this all time, and know these experiences can have lasting impacts. For example, clients can have ongoing nightmares about their travels or develop fears of things that remind them of the journey.

Daniela: These journeys are unpredictable. Individuals can find themselves having to sleep in cars or in dangerous areas. They can also have constant fears and worries that they will be hurt or abducted by strangers. These stressors can negatively affect their mental health and stability.

After Relocating:

Daniela: Often, immigrants relocate to a new place with the expectation that their experiences are supposed to be great. However, as it happened with my family, after migrating your socio-economic status can drop significantly and you can go from living in a large home to sharing a small space with strangers. A lot of things change and sometimes those adjustments are not easy to handle. When flying to this country, my family could only bring our essentials. As a six year old, not being able to bring my toys or new backpack was awful. Additionally, the language barriers immigrants experience have affects. Language barriers create challenges when an individual tries to meet new people, attend school and settle into the new environment.

Steven: Individuals can be perfectly healthy before migrating. However, after experiencing hardships in the new location, they can, for the first time, become unwell. This can be scary. As the expectation that the new experience or the new environment would be better, gets challenged.

Mental health stigmas, taboos and even treatment practices do not look the same everywhere. How does this affect individuals who do or do not seek mental health treatment when migrating?

Steven: Typically, mental health taboos and stigmas make clients think of therapy as something that is only for crazy people. I had two or three clients who migrated and received mental health services before relocating. In these situations, I found the clients were open to receiving services in the United States because they were exposed to the benefits of therapy. For all of our clients, we have to get to know what their understanding of mental health services is and then help them understand it better.

Daniela: Sometimes we see families that do not understand mental health services and express doubt that someone in their family might need therapy. During these moments, we have to be open to understanding where their beliefs come from and help the families learn about mental health.

What is homesickness? When does homesickness become concerning?

Daniela/Steven: Homesickness is the act of missing a place or elements of a place where one once lived. Homesickness becomes concerning when individuals who have relocated are not able to function in their new environment. Examples of not functioning are refusing to go to school, having trouble sleeping, changes in eating or appetite and not wanting to interact.

Steven: Homesickness can be persistent or can be suddenly triggered by many things, including smells, words or foods.

Daniela: When I first came to the United States and started school, lunch was challenging for me. We see this with our clients who have migrated as well. In my experience, the food was not comforting and having to eat it made me sad and miss the food I had known all my life.

How can mental health treatment help immigrants who struggle with mental illness?

Steven: Mental health treatment can help immigrants who struggle with mental illness because it can help normalize their experiences and validate their feelings, emotions and struggles. One of the things I find when working with clients who haven’t been exposed to mental health treatment is that they didn’t know it’s okay to be sad, angry or feel anxious. Therapy is the first place they feel comfortable talking about their emotions and experiences.

Daniela: Sometimes clients express they miss where they’re from or feel unhappy, but feel like they can’t share this with others. This is because they feel as though they should only feel grateful because they made it to the new country. However, there can be mixed feelings, people can be sad, have feelings of loss after migrating and still be grateful. It’s okay to feel all these things and mental health treatment can help individuals sort through these experiences.

Why is this discussion important?

Steven: Too often, migrating to a new country is not a family’s first choice. Poverty, violence, inadequate access to jobs, food and healthcare are big reasons people set out on those difficult journeys. We need to have more empathy for one another and learn more about the experiences of others.

Daniela Ruiz-Cedeño, ASW, is a bilingual clinical therapist at The Guidance Center, San Pedro Office where she walks along side children and their families on their journey to a more balanced and hopeful life. She enjoys working closely with children and their families struggling with mental health difficulties and trauma. Daniela helps families develop insight and tools to better utilize their strengths and engage with one another as they come together to support each other and conquer challenges.


Steven Frausto, LCSW, is a clinical supervisor at The Guidance Center, San Pedro Office. Steven joins other clinicians to help provide children and families with the support needed to overcome mental health challenges. Steven enjoys working to foster growth in fellow clinicians and families by utilizing humor and providing genuine support and accountability. Steven is passionate about empowering clinicians and families to utilize tools resources, and strengths to ensure positive change and healthier, happier lives.