Medical Examiner

“Fast-Food Therapy” at the Border

Mental health professionals volunteering focus on small things that might help: small comforts, aromatherapy, and validating experiences.

A teddy bear
Getty Images Plus

In Matamoros, Mexico, families waiting to cross the border depend on volunteers for food.* They sleep in tents and bathe in the river—at least they did until, at one point this summer, guards started standing by to ensure no one tried to swim across. It is in these conditions, after traveling for weeks or even months to get here, that immigrant hopefuls prepare for their credible fear interviews and court dates, where they will make the case that they qualify for asylum in the United States. There’s little information on what the next steps will look like for them—whether they’ll be let in or sent home, whether the process will include time in detention centers, even whether, if everything goes smoothly, life in the U.S. will play out as they hope it could. The rules and ethics (to the extent they exist) that govern the whole process seem to change without notice. It is “extremely destabilizing,” says Mira Levine, a trauma counselor who works with children in Virginia. “There is a really high need to help people manage stress.”

Levine is one of a too-small handful of mental health workers who have visited towns on either side of the border to volunteer. She tagged along with a lawyer on a trip to Matamoros in July. There, she was introduced to people gathered on the plaza as part of a collection of volunteers offering other services: Here is a doctor, here is a lawyer, here is someone who can help you with your anxiety. There was no private space to have formal counseling sessions, but formal counseling wouldn’t serve much of a purpose anyway: Before you can process trauma, you have to be done experiencing it.

Shawn Gewirtz, another psychologist who went to Tijuana for a few days in December, spent some of his time there doing short sessions, with mixed results.* In one case, Gewirtz met with a man who had been sexually assaulted; Gewirtz worked with him to help process his fear and anger from the event. In another case, though, a man was afraid of violence from the people he was on the run from. Gewirtz concluded there wasn’t much he could do there—it made a lot of sense that he was anxious. Doing much counseling in the midst of trauma can be nearly impossible because telling someone that everything will be OK, when that’s potentially a lie, can end up causing more psychological damage.

Sometimes lending professional input can help in other ways. In another case, Gewirtz met a little girl who had left her home country with her mom after their home burned down (a lawyer representing her asked for a clinical evaluation). Gewirtz determined she had separation anxiety. If the girl were in his practice, he’d spend a few months working with her, deconstructing why she felt unsafe away from her parents, and working toward making her feel more safe without them. But here, again, those fears were warranted. The main thing Gewirtz could do was write up a note giving her a clinical diagnosis, explaining that her separation anxiety would mean being on her own in a detention center, which is horrific for any child, would be “even more horrific” for her. He hoped his diagnosis would help her have a better shot of staying with her family.

When Levine went to volunteer, she knew she wasn’t going to be able to really offer counseling or extended treatment to these people, no matter how intense their need, no matter how necessary treatment would be at some point. Instead, she came bearing small gifts: stress balls, rocks in small bags (the stones are the trauma, the bags hold the trauma for you), cards with illustrations to practice deep breathing (a flower on one side, a candle on the other, and aromatherapy inhalers the size of lipstick tubes in lemon, lime, mint, and rose). When Levine took those out, she was quickly surrounded by a crowd.

Aromatherapy has become so synonymous with expensive massages and essential oil multilevel marketing schemes that it’s easy to overlook the most basic use of a strong scent: It can calm the sensory system, explains Levine. It’s something to snap your focus back to the moment. Stress causes cortisol levels in the body to rise: This is helpful in a fight-or-flight situation, but it’s incredibly damaging to experience for weeks or months on end. Which is why, in the time she was there, Levine sought any way to help bring down prospective immigrants’ cortisol levels so the long-term damage would be even just a little more limited and people would be able to more cogently make their case for asylum. “Anything that helps people to be able to answer those questions articulately is going to serve them,” says Levine. Having even small tools could offer great relief.

Like Levine, Gewirtz also offered small calming exercises, which he refers to as “fast-food therapy.” He walked down the line as people waited for legal help and, since he doesn’t speak Spanish, would try to communicate breathing exercises with help from Google Translate or even just his hands. He would exaggeratedly push his stomach out while inhaling from his nose, then dramatically push all the air out through his mouth. He also led people through progressive muscle relaxation: Tensing your toes, your calves, your butt, your shoulders sends a signal to the brain that you’re in danger; releasing it all sends a message to the brain that you’re OK, a way to practice letting go of fear.

Across the border in McAllen, Texas, a group of volunteers from San Francisco called Bay Area Border Relief, including psychologists and master’s students, has made a handful of trips to a shelter where people who are leaving detention centers will stay before heading to their final destinations in the U.S. The first thing that Daniela Dominguez, a psychologist at the University of San Francisco, and her colleagues do is greet them in Spanish: “Welcome, we appreciate that you’re all here,” Dominguez translates. The warm greeting is meant to counter the treatment they’ve received so far, including what one parent told USF social worker Belinda Hernandez-Arriaga she heard from an ICE agent: “You’re in our house now, you’re going to do what we say.’ ” Here, volunteers offer the kids a choice of a stuffed animal. On their last trip, the options were: a character from Sesame Street, a teddy bear, or a unicorn (the most popular). The kids grab them, hug them, use them to self-soothe, hang onto them as the walk with their parents around the shelter. The animals are fluffy, soft, and colorful. They offer a point of connection between volunteers and the kids, establishing them as people who are there to support them and help bring them down from confusion. ”Kids would ask, ‘Are we also going to be separated from our parents here?’ ” says David Martinez, also a psychologist at USF, who has made a few trips to McAllen.

With the adults, the volunteers affirm how bad their experiences have been. “I really apologize for the treatment that you’ve received,” Dominguez will say. “I’d like to talk to you about what comes next.” She goes through the next steps of how they’re getting to where they’re going to establish a home in the country. If they’re flying and they’ve never flown before, she’ll talk them through what airports and planes are like. She’ll let them tell her about what they’ve gone through to get to McAllen—if they want to. “We are mindful of pushing them again to tell a story that they’ve been telling again and again,” she noted. Still, many people want to open up just to have someone to talk to. She just tries to affirm their experiences and how they are feeling. Sometimes, she is able to just be there as they melt down from being overwhelmed. “A big part of this work is telling them that you believe them,” she says. “ And then we start talking about ‘What do you like to do for yourself, or what are things you’ve done in the past?’ ” says Martinez. “A lot of time, people haven’t had the luxury to think about that.”

Even in these shelters, it’s still far too soon to do a traditional therapy session. Instead, Dominguez makes connection her goal. “With kiddos, because they’ve been in confined spaces, we move around,” she says. Movement helps ground them in the moment. Her team also brings coloring supplies. “I ask them very simple questions to build rapport,” says Dominguez—about their hobbies, their favorite superheroes. ”We talk about drawing the home where they’re going. We say, ‘Who’s waiting there for you?’ ” When “they see into the future, they go from something traumatic to what makes them hopeful,” she says. Dominguez, who is from Mexico, speaks to them in Spanish because it helps them feel at home. (They’re in critical demand for more mental health practitioners, she says, but especially bilingual ones.)

As she hangs out with the kids, Dominguez subtly screens them for any larger potential issues. If kids have trouble engaging in play or other noticeable behavioral issues, she’ll talk to their parents. “I give them a heads up that I can see that the child is struggling, that I can see that the child has withdrawn,” she explains. At this stage, mental health is mostly about stabilizing and preparing the parents with information.

She tries to look out for physical problems too, because even though she’s not a physician, there’s typically not one around. “We have been in situations outside our areas of competence,” she says, recalling a time that she cared for a child who had chicken pox—well, probably. “I don’t even know if it was chicken pox,” says Dominguez. Another time, she and other volunteers had to take a dehydrated baby to the hospital. “Sometimes when I’m at the migrant shelter, I feel very lost,” says Dominguez. “There are very few of us. We’re dealing with a lot.”

The volunteers try to remind each other to take breaks to eat. They debrief after hearing a story that’s particularly difficult to process. They remind each other that “there’s a reason why you are feeling stressed or overwhelmed,” Dominguez says. “This is unlike anything we have ever seen before.”

Correction, Sept. 23, 2019: In an earlier version of this piece, Matamoros was misspelled. Shawn Gewirtz’s last name was also misspelled.