Therapy for immigrants, children of immigrants and acculturation stress in Washington State
Your parents gave up a country so you could have this. And you do have it: the degree, the job, the life that was the point of the sacrifice. What you feel, more often than you'd admit, is a low-grade guilt with no clear object. Nothing you achieve makes it go away.
You send money home. You translate the paperwork. You're the emergency contact and the one who handles the insurance call. Nobody asked if you wanted the job, and there's no way to put it down that doesn't feel like betrayal.
I'm Dania Uritskiy, LICSW, and I'm the daughter of immigrants from El Salvador. A large share of the people I see are immigrants or their grown children. I work in English or Spanish, in my Edmonds office or online anywhere in Washington.
What adult children of immigrants carry
The details change by family and country. Certain patterns don't.
Guilt about success. For the chances you got and your cousins didn't, for being comfortable in a way your parents never were, and sometimes for not even wanting the exact thing they sacrificed for. Saying you're tired of being the one who made it can sound ungrateful, so most people don't say it.
Obligation with no ceiling. Money with no upper limit, and being on call indefinitely. Running your own decisions through what your family would think of them, down to where you live and if you're even allowed to be tired.
The eldest daughter, the responsible son. You were parentified early: translating at nine and helping raise your siblings. Now it's hard to need anything from anyone, because needing was never on the table. That overlaps a lot with people-pleasing and boundaries.
Being the first at everything. First at university, first in a professional job, with nobody to ask how any of it works and a private shame about not already knowing. Add the second job nobody counts, adjusting your name and accent and register all day, which I wrote about in code-switching as a survival strategy. If work is where it hurts most, therapy for professionals is a good place to start.
Parentification, and the child who translated
Parentification means a child taking on jobs that belong to an adult in the family. Some of it is practical: paperwork, the bank, the landlord, getting younger siblings to school. When a child interprets between their parents and English-speaking offices, it has its own name, language brokering. Many of the people I see did it in grade school, sometimes translating news about their own family that no child should be the first to hear.
The emotional kind usually weighs more. Being a parent's confidant, the one who calmed the fights, the kid who kept their own needs small so nobody else would fall apart. Pitching in isn't harmful in itself, and plenty of people are proud of what they helped make possible. What I look at is how much, for how long, whether it fit your age, and whether anyone noticed what it cost. It isn't a diagnosis. In adults it tends to show up as stepping in before anyone asks, and finding it strange to be taken care of.
Acculturation stress, briefly
Acculturation stress is the strain of adapting to a new culture while keeping some of the old one. Children of immigrants often feel it hardest, because they adapt faster than their parents and become the family's guide to a country the adults are still learning. By adulthood your feelings may come easier in English while your mother's live in Spanish, so the conversations that matter most get the hardest to have.
The DSM-5-TR, the manual clinicians use for diagnosis, lists "acculturation difficulty" among circumstances that can be a focus of clinical attention. It isn't classified as a mental disorder. A lot of people find that a relief. Struggling to live between two cultures doesn't mean something is wrong with you.
Why "just set boundaries with your family" doesn't fit
That advice was written for a family structure that may not be yours. It treats obligation as an error to correct, when for many of my clients it's a value they hold on purpose.
So we get precise. We sort out which parts you choose and would choose again, which parts run on autopilot because they were assigned to you at eleven, and which parts are costing you something you can't keep paying: your sleep, your health, your marriage, your own kids' childhood.
Then we change the ones you want to change, in sizes that don't blow anything up. Usually the hardest skill is tolerating a family member's disappointment without rushing in to fix it. Most of the other changes depend on that one.
My position, plainly: interdependence is a legitimate way to organize a life, and the goal here is a real say in your obligations rather than independence from your family. If a therapist ever frames this as your family versus yourself, I'd look for a different therapist.
The anger underneath the guilt
This part tends to surprise people.
There's often real anger under the guilt. At your parents, and at being made responsible for adults while you were still a child. Being angry at people who sacrificed for you can feel unbearable, so the anger gets converted into guilt, which is easier to carry and does more damage over time. Saying it out loud to someone who won't argue you out of it changes something.
Five years with first-generation college students
For about five years, first as an intern and then as staff, I was a therapist at Baltimore City Community College. Many of the students there were working full time, raising kids, or both. A lot of them were the first in their family to go to college, and many were immigrants or the children of immigrants.
They rarely came in saying "my family." They came in saying they were behind. Missed classes and no sleep. The textbook word for it would have been time management. Usually it was something else: a role at home that didn't shrink because school had started. A younger brother still needed a ride. A parent still needed someone to come along to the appointment and translate. The paycheck still went partly to the household.
What struck me was how many of them couldn't tell anyone at home that it was hard. They were supposed to be the success story. Admitting they were struggling felt like it would take something from parents who had given up so much.
I also ran support groups there. The most useful moment in a group was often just someone saying it first, out loud, and watching other people recognize themselves. I think about that often in private practice, where most people arrive convinced they're the only one who feels ungrateful.
Plenty of the professionals who find me now grew up in that same role, and they're still in it.
Intergenerational trauma, and what got handed down
Intergenerational trauma is pain from what an earlier generation lived through, such as war, displacement, violence or poverty, passed down through a family and shaping how the next generation feels, copes and parents. It isn't a diagnosis, and it mostly travels through ordinary family life.
Something I often say early on: the parent who can't stand to hear you say no is usually not controlling for the fun of it. Often they're carrying something nobody processed. A war. A migration that went badly. A childhood of real scarcity, or a loss nobody in the family has ever named.
What reaches you is the strategy that got them through it. Vigilance. Catastrophic thinking about money. An intolerance of separation. A rule that family business never leaves the house. What gets passed down is usually the adaptation the story required, more than the story itself. More in inter-generational trauma: the pain we inherit.
This matters in practice. You're up against a survival rule, and survival rules don't yield to good arguments. That's why the calm conversation you rehearsed keeps failing. If your mother can only hear a boundary as abandonment, her being upset isn't proof you did it wrong. The better question is whether you can stay in the relationship while she's upset.
Many people are relieved to hear they can hold two facts at once. What happened to you was harmful, and the person who did it was also on the receiving end of something. Most of the guilt lives in the belief that one fact cancels the other.
There's more on migration grief, identity and belonging on my multicultural counseling page.
Questions I hear from first-generation adults and their parents
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It depends on who's counting. On the census and in most research, first generation means people born in another country, and second generation means their children born here. But many US-born children of immigrants call themselves first-generation, meaning the first generation raised in this country. In college, first-generation means the first in your family to earn a degree.
None of these is wrong. I use whatever word you use for yourself.
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Because you go as a visitor to a place you were raised to call home. Relatives tease your accent, and you may feel more American there than you ever do here. Then you fly back and feel relieved, and guilty about the relief.
It's a kind of grief, even if you never lived there. I wrote more about it in assimilation, belonging and the grief of leaving home behind.
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Very. Often the oldest did the translating and lived under the strictest rules. By the time the youngest came along, the parents had more money or less energy to fight, and the rules loosened.
You can love your siblings and still be angry that they got a childhood you didn't. Often the anger points past them toward your parents. A sibling is just a safer person to be angry at.
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Then we start by separating what they wanted for you from the job itself. Usually what they wanted was safety and a kind of respect they didn't get here. Sometimes you can honor that and still choose a different path. Sometimes you can't, and the work is learning to make the choice anyway without waiting for their blessing.
Feeling guilty about it doesn't mean you're choosing wrong.
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With the expectation nobody has said out loud. Who they'll live with, and whether one of them wants to go back to die in their own country. Many families never talk about it until a fall or a diagnosis forces the question.
In therapy we look at what you want to give, what your marriage and your own kids can absorb, and how to have the conversation with your parents and siblings before the crisis instead of during it.
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This happens a lot, because of papers, money, distance or timing. You may have watched the funeral on a phone. Then you went back to work, where nobody knew the person and the bereavement policy didn't stretch to a flight you couldn't take anyway.
Grief without the usual rituals tends to stay unfinished. We give it the time it didn't get. Some people end up making a ritual of their own here, and that can help more than they expect.
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Many people have never added up the total. Start there, over a year, including the emergencies. Then look at what it's competing with: your retirement, and the conversation you keep avoiding with your partner.
There's no right number. But a number you chose on purpose feels different from one that grows every time someone calls, and it's much easier to defend when your family pushes back.
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No. It often surfaces in midlife. Your parents start needing you in new ways, or your own child reaches the age you were when you started translating at the bank, and something you filed away comes back. That's a good time to look at it.
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Sí. Casi todo lo que escribí aquí habla de los hijos, pero también atiendo a personas que llegaron ya de adultas. El duelo por la gente que dejaste, empezar de cero en un trabajo que no tiene nada que ver con lo que estudiaste allá, ver a tus hijos crecer en otro idioma. Todo eso se puede trabajar en español. Te cuento más en la página de terapia en español.
What happens next
You pick a time for us to meet directly on my calendar. Fifteen minutes, free, video or phone. You don't have to have the words ready or fill out long forms, I understand the first step can be difficult.
We meet virtually and talk about what's going on. I'll tell you honestly whether I'm the right fit, and if I'm not, I'll point you toward someone in my network who is.
If it feels right, we schedule your first full session, usually within a week. I see clients at my office in Edmonds on the waterfront, or virtually across Washington State.
