This is a section of our The Asylum Process: Interdisciplinary Responses to Multifaceted Challenges full day training on August 16, 2023.
In this session we look at how forensic evaluation and supporting documentation can support asylum seekers through the very complex asylum processes.
Dr. Katherine McKenzie discusses the historical and legal background of asylum, the criteria for gaining asylum, performing medical evaluations of asylum seekers, forms of torture and persecution and common related scars, and teaching asylum medicine.
Dr. Hawthorne Smith discusses his role as a treating clinician supporting the needs of his asylum-seeking clients and how the goal of producing the most detailed, comprehensive, and insightful report possible is part of that. He looks at types of psychological documentation, clinical assessments, evaluation priorities and techniques, and notes on testifying on behalf of clients in asylum court.
Questions responded to in chat, not during the training:
Question: Thank you so much, Dr. Smith, for emphasizing that the client is the “expert” that is guiding us—that goes so far to show respect and honor the trust they’re giving us with their trauma history.
Answer from Hawthorne Smith: It is wonderful when the things that are true are also the things that are effective. We can never be the “expert” in the room more so than the person with the lived experience.
Question: The library metaphor is so helpful to use when testifying about memory and possible inconsistencies. I’ve seen “lightbulbs” go on in terms of judges’ faces when they can visualize what’s going on with traumatic memory.
Answer from Hawthorne Smith: I will usually make some self-deprecating remarks about how it simplifies things for me – so it does not appear that I am “dumbing things down” for the adjudicators. I find that it’s much better to talk with someone in a parallel fashion than in a hierarchical manner.
Question: When preparing a psychological report do you address the probability of malingering directly?
Answer from Hawthorne Smith: Yes. I usually put it in the context of observed data and how the person has followed “peaks and valleys” that are in line with external stressors or their overall trajectory in treatment. It’s especially important when someone has made progress in treatment and is not always presenting as “in crisis.” we can be confident in saying that they do not appear to be exaggerating, malingering or “faking bad” for a specified secondary benefit.
Question: What do you advise when working with patients/clients who are completely “shut down” when it comes to discussing their trauma histories?
Answer from Hawthorne Smith: I didn’t get to expound on this area. first, to normalize and not make them feel like our response is punitive. Sometimes reiterating how their engagement makes it easier for us to do the most thorough job on their behalf as possible. It is also important to document that this is observable behavior. some clients may become better able to engage over time, but may shut down again when in front of the judge. Having observed data from previous times that this has occurred may help to normalize their responses in court (or at least place them in a normative context).
Question: Can an asylum evaluator (PCP) also be considered an expert on domestic violence in immigration court if they have treated DV survivors extensively and has published on the medical treatment of DV survivors?
Answer from Hawthorne Smith: I would pose this question to the attorney on the case to see if it is helpful/appropriate to engage in both endeavors on the same case. It could clarify or it might muddy the waters. I think this might be a case by case sort of determination, based on the details.
Question: I thought it was interesting that we have to present ourselves as professionals/experts in the courtroom and not advocates. As a social worker, I also serve as an advocate, so I was wondering what would happen if a social worker conducts the forensic eval and has to go to court and testify. Where do we draw the line and how do we go about it in court?
Answer from Katherine Mackenzie: As long as you are able to convey that you conducted the FME and gathered evidence objectively i think the court would respect that
Question: Considering the complexity of the asylum legal process, do you have recommendations for how non-legal providers can possibly address asylum seeker clients’ sense of ambiguity about the asylum process in general, while still avoiding providing ‘legal advice’?
Answer from Hawthorne Smith: Even with its complexity and increasingly un-systematic functioning, the asylum process is still one of the best ways for persecuted individuals to attain a firm status in the US. It’s like a “necessary evil” in a situation where there are not many better alternatives.
Asylum Seekers in a Time of Record Forced Global Displacement: The Role of the Clinician
Katherine C. McKenzie, MD
- Istanbul Protocol https://www.ohchr.org/sites/default/files/documents/publications/2022-06-29/Istanbul-Protocol_Rev2_EN.pdf
- Scruggs et al. A qualitative study of legal perspectives on medical affidavits in the asylum process. JFLM.44:72-8 https://pubmed.ncbi.nlm.nih.gov/27639654/
- Lustig SL, Kureshi S, Delucchi KL, Iacopino V, Morse SC. Asylum grant rates following medical evaluations of maltreatment among political asylum applicants in the United States. J Immigr Minor Health. 2008 https://pubmed.ncbi.nlm.nih.gov/17492260/
- Fact Sheet No. 241: Female Genital Mutilation. World Health Organization. 2000 (2023) https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation