In our Westernized culture, we are prone to upholding a dominant approach to managing our relationships that involves boundary setting. Thus, our therapy practices and culture often emphasize setting boundaries as a key element of developing and maintaining “healthy” relationships. The United States mostly engages in an individualistic culture, which can promote and help to sustain boundaries to protect and even nurture a relationship with the self. 

But what about cultures in which the family is at the center and boundaries are often blurred? What is deemed “healthy” in such cultures — and who defines this? These are called collectivist cultures. In collectivist cultures, family members identify closely with one another and often make decisions for the family as a whole rather than for the self. Sacrifice, honor and loyalty are some of the core values of such families and cultures. For example, saying no to the family or setting limits on simple family events or dinners may be perceived as selfish and rude. 

Imagine Maryam, a married mom of two, fatigued from her workweek and yet being asked to host the weekly family dinner. This gathering includes grandparents, uncles, cousins and, of course, mom, dad and siblings. Maryam rushes to the store, then home to cook a very involved rice and stew dish. The family arrives early, adding anxiety to her already-exhausted mental state. 

Later in the week, Maryam attends her therapy session. Her therapist suggests setting limits and saying no to hosting these events in the future or proposing that her sister, Fara, hosts the next time. Maryam agrees, but she struggles because this would mean making a decision for herself and based solely on her own needs. Although this may be considered “healthy” by the dominant culture, it is causing Maryam more stress and, now, added guilt. Maryam may not even feel comfortable sharing these new thoughts with her therapist due to her culture of origin’s boundary for respecting authority (she may potentially view the therapist as the expert and authority). 

Workable boundaries

What do we do, as mental health providers, in the case of Maryam? 

First, we can validate and normalize her emotions. Next, we may pose questions to allow her to further express herself and ponder potential resolutions. In talking with her, we may at some point realize that she is stressed but at the same time happy to see and host her family. There may be no need for behavioral change here; rather, expressing emotions in a safe place and feeling heard by the counselor may be enough for Maryam. Potentially, she may need support identifying her emotions to further express them too. 

If Maryam continues to share concerns about her fatigue level, it may be supportive to suggest what I call a “workable boundary,” with consideration given to her culture and her values. This workable boundary could simply be adjusting the time that everyone comes over so that Maryam has some time to rest first upon arriving home. 

A workable boundary is flexible. It is not rigid like typical boundaries may be perceived or promoted to be. It is similar to a compromise and works to respect the client’s culture of origin and needs. The flexibility may prioritize the client’s culture and empower the client to choose what is workable. 

Straying away from the stringency of a black-and-white approach to boundary setting can be more inclusive. The less we guilt individuals into self-care and self-prioritization, the more we can become aware of their needs, wants, values and cultures. Some individuals in collectivist cultures gain energy, pride, strength and honor when the family is well and happy. 

Prioritizing client boundaries

The connectivity of emotions, identity and well-being in a collectivist family and culture of origin is complex, requiring respect for exceptional and unique boundaries. Roles and authority may serve a special function in the collectivist family experience. 

For example, in my own personal collectivist family experience, as well as in working as a counselor with college and high school students with collectivist cultural backgrounds, I learned that even the majors we chose for our college experiences originated in our family values and expectations. We honored our families by choosing to become accountants, doctors and engineers, among other professions. We struggled and wanted to quit. Yet many of us continued on this path to a field mostly chosen for us by the influence of our collectivist cultures and families. 

Experts on setting boundaries may advise students who are feeling stressed to follow their own career paths, which would encourage straying from the family norm. Here is an opportunity for us to remember our counselor ethics and to prioritize client values over our own and even over those of the dominant culture here in the United States. We can work to be culturally humble and learn to navigate and negotiate values as clients desire to apply them in their own lives. 

The goal of the client seeking counseling at the university counseling center may simply be to feel humbly supported through their time of feeling stuck or yearning to change majors. Their desire may purely be to not feel alone. What seems simple may be forgotten because we are often inundated by the dominant cultural norm of pursuing our own dreams and goals first. While students and clients may report feeling pressure, they may also report feeling pride in their struggles and motivated in their pursuit of this family dream, especially if they are from collectivist, immigrant backgrounds. 

Likewise, choosing whom to marry may be a family-based decision in collectivist cultures. Boundaries may be perceived as vague. Those outside of these families and cultures may view these family roles and relationships as examples of unhealthy enmeshment. Nevertheless, in some cultures, honoring the family will continue to be the foremost concern when making such a major decision. After all, a romantic partner is commonly considered a new member of the family. Thus, the decision requires the approval of the family in these cultures. 

Providing counseling to an individual who is navigating such circumstances and decisions may require offering further values assessment to support the decision-making process. If family is the client’s No. 1 value, this could support the client’s decision to involve the family in choosing a life partner. Setting boundaries prematurely based on individualistic cultural norms may prevent family members from playing their traditional roles in the individual’s life. 

What may be challenging to understand in the dominant culture — including the high value placed on duty, honor and authority — is part of the traditional fabric in some collectivist cultures. Often, we assume that it is harmful for others to choose our life partners. However, in many cultures, this is viewed as the practice of respecting authority and feeling honored to receive this input and potential blessing. Some clients feel excited to enter these life partner journeys with the support and input of their parents and families. Other clients may not, and that is OK too. The purpose of viewing boundary setting from a wider, more culturally inclusive lens is to stop making assumptions about what is “healthy” for all clients and desired by all clients and to stop promoting only the dominant culture’s perspective of boundaries. 

A nonassumptive approach can lead to greater appreciation of the client’s worldview, needs and ability to reach decisions with the support of the therapist. Open-minded, nondominant cultural perspectives can further encourage this process. Taking such steps can also lead to less guilt, potential shame and frustration on the part of clients who experience the world as bicultural (i.e., negotiating and identifying with two cultures). 

It is often more convenient to go along with the dominant culture’s expectations. Likewise, there is frequently less judgment when choosing the dominant culture’s norms. However, this can be harmful for individuals who appreciate and potentially want to choose collectivist cultural values and norms in some life areas. The pressure many may feel in such situations can be overwhelming. For example: wanting to live at home beyond the age of 18, wanting to date someone chosen by one’s parents, wanting to name one’s child with a chosen family name. 

These are just a few examples of the many decisions children and adults who are bicultural may face (and prefer to make) that others can regard as boundary “blurring.” The therapy setting can provide an open, safe space for clients to explore and arrive at decisions that are best for them, taking all cultures involved into consideration rather than focusing only on the expectations of the dominant culture. Counselors can set aside the boundary-setting trend that might seem liberating on the surface but that may in fact be confusing for some individuals from these cultural backgrounds. By diminishing the idea that inflexible boundary setting is the “healthy” option when it comes to managing interpersonal relationships and life decisions, the lifestyles and complexities that many culturally diverse individuals and families experience and prefer can be included and explored.

Sumala Chidchoi/Shutterstock.com

Culturally inclusive practices

I am a bicultural, immigrant American therapist and individual who has experienced and navigated, both personally and in session, the guilt that can arise from the boundary-setting expectations of the dominant culture. In choosing my life partner, I practiced strict boundary setting with family members in my collectivist culture. In choosing to go to graduate school to earn a doctorate, the boundaries were workable, blurred and, at times, enmeshed with my family’s dreams and goals. 

I have supported many diverse clients in navigating different areas of life, including grieving differently than their family, by using workable boundaries that include both their cultural and individual needs. The following steps can support more culturally inclusive practices for navigating boundary setting in collectivist cultures. 

>> Develop and pose questions or prompts that reduce the potential for “dominant culture speak,” such as “your needs” and even the word “boundary.” Instead, consider adding to your language the phrases “cultural considerations” and “family needs tied to your needs and wants.” For example, a possible question to explore with the client is, “I hear that’s hard for you. What are some ways you can meet your family needs that perhaps seem to influence your needs, especially with the weekly family dinners?” 

>> Explore the topic of guilt with clients. How does guilt affect them interpersonally and emotionally? Does it apply in their identity, role and cultures? How, if it all, does guilt come up when considering boundaries with family members, partners or friends? 

>> Investigate what the word “boundary” means to the client. Does it have a meaning? Is it culturally relevant for them or is it a new concept? How would they like to incorporate it into their wellness journey, if at all? 

>> Offer psychoeducation on boundary-setting practices for potential emotional wellness while acknowledging cultural implications. Then ask for feedback and reactions. What does the client think of this concept? Do they agree or disagree? Why? Would they like to explore these practices in their life? 

>> Finally, individualize boundary-setting practices to respect the client’s culture, needs and wants. Assess what these practices are and introduce concepts such as workable boundaries or more innovative ways that may work for the client in an inclusive style. Implement a feedback model in therapy to assess the client’s satisfaction level with such strategies.

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Shabnam Brady holds a doctorate in counseling psychology. She is a therapist, professor, author and founder of Therapy for Immigrants (@therapyforimmigrants), an Instagram community whose aim is to raise awareness and expand inclusivity practices in mental health for immigrant communities. Contact her at drbradytherapy@gmail.com.

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, visit ct.counseling.org/feedback.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Immigrants to the United States have one goal in common: to attain the American dream. For many, this dream means leading a life with fewer struggles than they experienced in their countries of origin. Africa is the second-largest continent in the world, stretching from Senegal to Somali (west to east) and Tunisia to South Africa (north to south). It has 54 countries and a population of approximately 1.3 billion people. There are about 3,000 African tribes, each of which speaks its own language or dialect.

The most widely spoken languages in Africa include English, Arabic, Swahili, French, Portuguese, Akan, Hausa, Zulu, Amharic and Oromo. It can be easy for counselors in the United States to assume that one Black client is like the other Black client, when in fact one might have been born and brought up in the U.S. and the other might be a first-generation immigrant from Africa. Such an assumption would be disadvantageous to clients from Africa because their varied and diverse experiences would be ignored. If these experiences contribute to the client’s presenting problem and yet are disregarded or overlooked by the counselor, then treatment of the presenting problem would be challenging or even elusive. 

It is important for counselors to take stock of the unique challenges that afflict immigrants from Africa and could complicate their lives in the United States. Mental health counselors are encouraged to pay special attention when working with this population to address the presenting mental health problems and other issues unique to these clients that, if left unaddressed, could have a negative impact on their well-being.

Culture shock

Relocating from Africa to the United States is likely to be a culture shock for the immigrant client. In fact, many immigrants from Africa experience culture shock even before they travel to their new country. 

The process of securing a visa to travel to the U.S. is a daunting experience that takes months — and sometimes years — to complete. Applicants physically go to the U.S. Embassy offices in their countries or regions to attend interviews and complete official paperwork related to their travel. At these offices, they are likely to see armed white police officers in full gear, complete with duty belts, guns, sunglasses and other items dangling from the belts. Applicants may feel intimidated by the sight of these officers, having previously been accustomed to seeing Black police officers carrying gear that is less threatening. 

The interview determining potential receipt of a travel visa can go either way, and applicants are aware that if they are denied, they will not necessarily learn why they were not issued visas. Issuance of a visa is the prerogative of the immigration office. There is no provision for explanations in cases of denial, although candidates can submit new applications for consideration in the future. 

Once African immigrants actually travel to the U.S., they are likely to experience culture shock in multiple ways. Depending on such factors as their previous experience with international travel, their country of origin and the port of entry to the U.S., new immigrants may be shocked by the size of the cities, highways, forests, rivers and lakes, and the sheer amount of food that gets served on a plate. They also observe that cars generally carry fewer occupants than they are used to and that there are more people driving up and down the streets than people walking or using public transportation. Immigrants from Africa also quickly realize that they are a minority race in the United States — a stark contrast to their majority status in their country of origin.

Another cultural experience that may be shocking for the new immigrant from Africa is the sole use of English to communicate. Code-switching, which is common among people who are bilingual, is not possible when English is the only language in use. Other things they learn or observe include the high cost of living, differences in dressing, the prevalence of low-context interpersonal interactions, driving on the right side of the road, a love for sports that are unique to Americans, people who are homeless, panhandlers on the streets, and the menace of opioids, to name but a few. 

The COVID-19 pandemic has introduced another complication to the cultural experiences of immigrants from Africa. In line with their social nature, these individuals support one another whenever a member falls sick by visiting and helping with child care, cooking and other household chores. COVID-19 safety guidelines do not allow people to congregate, especially around someone diagnosed with the disease. While the COVID-19 pandemic was peaking, it was common for people to be buried in communal graves. From an African context, it is uncommon for a person to die and for the bereaved family to be unable to complete all the rituals associated with funerals. It may take time for immigrants from Africa to come to terms with these tragic experiences.

Past and present trauma

Depending on their country of origin, some immigrants from Africa may have preexisting posttraumatic stress disorder or other disorders that have gone untreated from such events as war, physical abuse, sexual abuse, accidents, displacement, political violence, intertribal clashes or terrorism. There is ongoing instability in such countries as Somalia, South Sudan, Chad, Ethiopia, the Democratic Republic of Congo, Libya and the Central African Republic, with many casualties every year. In Nigeria, there is ongoing violence instigated by the terrorist organization Boko Haram. 

Survivors of these instabilities may end up immigrating to the U.S. as refugees or enter the country under another status. Their traumatic experiences in their countries of origin, compounded by new traumatic experiences in the new country to which they have immigrated, can be challenging to treat. Many of these individuals may be unaware that they even have a treatable condition. 

Loneliness

Research points to the seriousness of loneliness to one’s mental health. People immigrating to the U.S. may suffer prolonged periods of loneliness before they form meaningful relationships within their host communities. Loneliness can be compounded by cases of rejection, discrimination, isolation, stereotyping, microaggression and so on in their new communities.

They are often unable to communicate on a regular basis with family members back in their country of origin because communication by mail can take a long time and international phone calls are expensive. Loneliness, coupled with other problems, can lead to depression or degenerate to suicidal ideation for this population. 

Language

Only a small minority of immigrants from Africa report English to be their first language. Most of them have learned other languages before English. Student immigrants from non-English-speaking countries encounter fewer problems because they are usually enrolled in English classes during the first semester of their respective programs. Others who were fluent in English in their country of origin are often surprised at how different American English is from other English dialects and accents. 

Fluency in language is important for self-expression and self-esteem. Immigrants who struggle with the English language might have a harder time adjusting to their new life in the U.S. Another disappointment they typically experience is inability to code-switch — i.e., switch from one language to another — like they were used to doing before their relocation. This is because most of the members of the majority culture with whom they now interact speak only in English. 

New identities

Immigrants from Africa are faced with changing their identities in multiple ways upon arrival in the U.S. For example, in their country of origin, there may have been certain activities and roles such as child care, cooking, driving, mowing the lawn, financial management and so on that were classified by gender. In the U.S., these responsibilities are more commonly shared between men and women. 

If African immigrants were wealthy back in their home country, they likely had employed the services of a live-in houseworker to help with such chores as child care, cleaning, laundry and cooking. These chores must now be shared between the couple irrespective of their gender. Assignment of these responsibilities is often a major source of discord among couples who have emigrated from Africa. That is because in many cultures in Africa, it is the responsibility of the woman to cook, clean, do laundry and take care of the children, irrespective of her other daily roles and responsibilities. Once the couple has immigrated to the U.S., it is often difficult for their families back in their country of origin to understand this new setup of shared responsibility. Families in the country of origin will often comment that the immigrants have lost their cultural identity.

Loss

Immigrants from Africa experience multiple losses as they settle in their new country. Examples of losses include identity, wealth, social status, family bonds, language, cultural traditions, freedom, innocence, traditional food, life goals, favorable climate and familiarity. Depending on the impact of these and other losses, immigrants from Africa may need mental health help to cope. 

It has been particularly challenging for African immigrants during the COVID-19 pandemic to deal with the resultant losses. They are used to living a social life in which they congregate for no apparent reason. During the pandemic, they have largely lost this aspect of their culture because of restrictions on in-person socializing. Likewise, when fellow community members are hospitalized, they cannot be visited. When people die from COVID-19, there is added pain due to restrictions on viewing the deceased or completing traditional funeral rites. Additionally, at the height of the pandemic, people who died from COVID-19 were buried in mass graves, while others were cremated. These are not common practices among many cultures from Africa.

Family relationships

There is a common tradition in Africa alluding to the fact that it takes a village to raise a child. Extended family members, relatives and neighbors are all expected to be involved in the well-being and development of growing children. Immigrant couples do not typically have the luxury of the village caring for their children in the U.S., whose dominant culture is individualistic rather than collectivistic. If these parents are busy at work, college or with other commitments, they take their children to day care for a fee because they are no longer surrounded by close family members or friends who would have cared for their children. This can become a major source of family relationship problems for immigrants from Africa, particularly when these fathers must change their traditional attitudes and beliefs to share responsibility for child care. 

Parenting is another source of strained relationships among African immigrant families. This is in part because the village is now absent, and the couple is left to care for their children with little outside help. In addition, parenting styles in the U.S. are different from parenting styles in Africa. African parents’ cultural practice of disciplining a child may be construed as child physical abuse in the U.S., potentially landing these parents in trouble with the law.

In Africa, the cost of raising a child is low in comparison with the U.S. For this reason, immigrant couples may decide to have fewer children or not have children at all. There are also differences between the first generation and second generation of immigrants from Africa. Second-generation children have greater exposure to the mainstream majority culture and are more likely to be influenced by it. Attempts by the parents to teach the second generation the value of maintaining their culture is often met with resistance, and this can strain family relationships.    

The American dream

The common belief among aspiring immigrants from Africa is that the American dream is easily attainable. Some interpret the dream to be good education, wealth, good health, affordable health insurance and stable income. 

While some immigrants do attain the American dream, others struggle. For the latter, the lack of attainment may become a source of self-pity, shame and guilt, particularly because their family back in their country of origin may not understand that not everyone in the U.S. is wealthy. Some begin to question why they immigrated and may consider immigrating back to their countries of origin. Problems could then arise if communication within the family is not effective.

Racism

The Black Lives Matter movement has unearthed social ills that have plagued the United States for many years. As a marginalized population, immigrants from Africa may be the targets and victims of discrimination, racism, bigotry, hatred, microaggression and other social ills often propagated by institutions that are supposed to protect them. 

Now that these ills have been widely exposed, there is a possibility that they will become added sources of anxiety and associated mental health issues. Questions may arise for these immigrants regarding how safe it is to continue living in a country where they are openly not wanted. Family and friends in their country of origin may begin to have similar questions and feelings and urge them to return home.

Education

When immigrants from Africa enter the U.S. on an F-1 student visa, they are expected to maintain their student status and follow the strict guidelines from the U.S. Citizenship and Immigration Services until they complete their studies. Some of the stipulations include maintaining full-time student status by taking the required number of courses per semester and maintaining passing grades. They are not allowed to seek employment without authorization. Such authorization, when granted, permits them to work for 20 hours per week on campus. 

The cost of higher education for international students is high. Many students are not able to afford tuition to complete their studies and may end up dropping out of school. When that happens, they lose their student visa status and begin the cat-and-mouse game of evading U.S. Immigration and Customs Enforcement for violating their immigration status. 

Students who complete their studies are granted the opportunity to apply for a change of status to become U.S. permanent residents, especially if they have completed graduate studies in high-demand programs such as software engineering, nursing, medicine, computer science and so on. The process takes time, but it is the safer route that most students follow to ensure their continued stay in the country and their eventual attainment of the American dream. Before that happens, they live in constant fear of being deported.

Acculturation

Over time, continued interaction between immigrants from Africa and the majority population in the U.S. results in acculturation. Immigrants pick and choose aspects of the majority culture to adopt and aspects of their respective cultures to retain. In a symbiotic and ideal relationship, the majority culture picks aspects of the immigrant population to adopt as well. It is important that counselors working with immigrant clients from Africa encourage them to maintain aspects of their culture that are meaningful to them, lest they lose their identity completely.

Another source of family conflict may happen when children abandon some of their family’s cultural aspects in favor of aspects of the majority culture. This occurs during the preteen and adolescent years when they are developing their identities, often influenced by the majority culture. It becomes a problem if their parents are not in favor of the adopted tenets of the majority culture. 

Drug and alcohol use

Alcohol in most African contexts is used to serve social and traditional purposes. With the mainly communal lifestyles, people look out for one another to avert misuse in a “brother’s keeper” sort of way. But these close relationships are largely or completely absent in African immigrants’ new country of residence. Here, they do not have close friends or family members to keep an eye out for them or with whom they can share their problems. 

Without education and awareness of mental health counseling, some immigrants from Africa turn to self-medication with alcohol, drugs or both. Addiction is now a serious problem afflicting African immigrants, and it is good practice to assess for drug and alcohol use, even if this is not the presenting issue brought to counseling. Left unchecked, drug and alcohol dependence could easily degenerate into a generational problem that afflicts current and future generations.

Treatment guidance

Professional counselors should consider the following items when working with clients who are
African immigrants.

> Assessment: Effective treatment begins with a thorough assessment. In addition to the issues brought to counseling, it is important for mental health counselors to assess for other issues that are not so obvious. For immigrant clients from Africa, counseling may still be a new concept. They might not be comfortable sharing their problems with strangers. Hence the need for counselors to select assessment instruments and procedures that are less intrusive. 

> Rapport: Research points to the significance of developing therapeutic rapport with clients early in the counseling process. It is also necessary to maintain this relationship throughout the counseling process. It will likely require additional effort to build and maintain a trusting relationship when working with immigrant clients from Africa because counseling may be a new concept for them. In addition, it may be necessary to educate these clients on what mental health counseling is all about and their roles and responsibilities in the counseling process. 

> Cultural sensitivity: Mental health counselors are cultural beings, and they bring their culture to the counseling relationship. It is vital for counselors to be constantly aware of their culture, including the biases, beliefs and stereotypes that they hold about immigrant clients from Africa. It is also imperative that counselors refrain from imposing their culture on these clients. 

It is beneficial for counselors to learn about the unique culture of their immigrant clients from Africa by setting time aside for cultural immersion and attending ethnicity-specific cultural activities from time to time. They will then use ethnicity-specific and evidence-based interventions to work with these clients. 

> Self-care and wellness: Mental health counseling can drain our emotions and energy. Therefore, mental health counselors should engage in a self-care regimen, maintaining regular self-care activities and schedules, to reenergize. Likewise, it may be helpful to educate our clients who are immigrants from Africa on how to engage in self-care and identify wellness strategies for their improved mental health and enhanced overall health.

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Stephen Kiuri Gitonga is an assistant professor in the clinical mental health counseling program at Lock Haven University in Pennsylvania. He is a licensed clinical mental health counselor licensed to practice in Idaho, Kentucky, Utah and Pennsylvania. Contact him at skg200@lockhaven.edu.

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, visit ct.counseling.org/feedback.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.