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AAPCSW Response to the Office of Refugee Resettlement and Confidentiality Violation

Position Statement

Released March 1, 2020

The American Association for Psychoanalysis in Clinical Social Work (AAPCSW) is outraged to learn (Washington Post, February 16, 2020) that the federal Office of Refugee Resettlement (ORR) has been sharing confidential therapy notes of unaccompanied migrant children and youth seeking asylum with Immigration and Customs Enforcement (ICE). These actions have grave consequences for their asylum status. The Post's report focuses on the devastating story of a traumatized 17-year old as an example of what is happening to countless others whose confidential information has been weaponized against them in court proceedings. Dating back to 2018 as part of the Administration's strategy to expedite deportations through information sharing, this initiative was reinforced by Congressional approval of a formal Memorandum of Agreement between ORR and ICE. The Memorandum included the additional requirement to inform children arriving at shelters that certain self-disclosures in their mandated therapy sessions could affect their release and that therapists must promptly report any shared information related to gangs and drug involvements to ICE.

Given that patient-therapist confidentiality is the foundation upon which mental health care is built, and its privileged communications should be sacrosanct, AAPCSW has profound concerns about the impact of these inhumane and unethical policies on refugee children and youth. The fundamental betrayal of trust involved in sharing confidential information has a lasting impact on these already traumatized individuals. Ample research and our own daily clinical work support the assertion that violent and abusive experiences like the horrors that these minors have endured even before arriving at our borders, prime the nervous system towards a tendency to self-protective behavior and difficulties trusting people and the environment (Porges, 2006). Thus, it is not hard to comprehend the depth of psychological harm done to these children who after gathering courage to trust their therapists by sharing their stories, then must witness that information being used against them in court hearings! This double-traumatization has the effect of sustained cumulative traumas, impacting these children’s current lives and their long-term health and well-being.

Safe-guarding the confidentiality of communication and providing a safe and trusting therapeutic environment are at the core of our professional ethics. While we appreciate the challenges faced by law enforcement officers who must make decisions quickly and responsibly, we are concerned that refugee children who are in a state of massive psychic crisis are not capable of processing the meaning of what they are told about information sharing. The current ORR policies regarding information sharing with ICE is unacceptable and must stop!

In response to these ongoing violations of the well-established privileged confidentiality of patient-therapist communications, we adhere to our advocacy tenet that “silence is not an option.” In partnership with other mental health organizations, we call on Congress to revoke this damaging policy and replace it with one that safeguards our national security and the psychological well-being of vulnerable children and youths arriving at our borders. And, we call on the Administration to honor the traditions and value systems of our country in their treatment of refugees.

References

  • Akhtar, S. (1999). Immigration and identity: turmoil, treatment, and transformation. Northvale New Jersey: Jason Aronson, Inc.
  • Beltsiou, J. (Ed.) (2016). Immigration in psychoanalysis: locating ourselves. New York: Routledge.
  • Porges, S. W. (2011). Polyvagal theory: neurological foundations of emotions, attachment, communication and self-regulation. New York: W.W. Norton and Company.
  • Stern, D. B. (2010). Partners in thought: working with unformulated experience, dissociation, and enactment. New York: Routledge.
  • Webb, N. B. (Ed.) (2006). Working with traumatized youth in child welfare. New York: Guilford Press.