Susan Burke, Psy.D, is a 2019 graduate of the PsyD Program in Clinical Psychology at Antioch University, Seattle.

Dissertation Committee

Jude Bergkcamp, Psy.D., Committee Chair

Cynthia de las Fuentes, Ph.D., Committee Member

Greg McLawsen, J.D., Committee Member

Document Type


Publication Date



Psychological evaluations are frequently used in extreme hardship immigration cases in the United States. These evaluations are complex; they are inherently ambiguous, and they require extensive training and specialized knowledge. General guidance for mental health professionals is available from professional organizations, the federal government, and articles in the legal and mental health literature. However, there is a lack of detailed guidance, best practices, training, and supervision so many evaluators learn on their own. Unfortunately, this has resulted in assessment processes and evaluation reports that vary widely in terms of professionalism and quality which negatively impacts the vulnerable families seeking these services.

The purpose of this exploratory study is to identify current practices of immigration attorneys and mental health professionals engaged in producing psychological evaluations for extreme hardship cases. This study utilized classic grounded theory (Glaser & Holton, 2004) to analyze interviews of thirteen study participants and redacted psychological evaluations. Credibility was identified as the core variable for this study; it accounted for the greatest variance of behavior between the participants. In conceptualizing why participants sought credibility, the Grounded Theory of striving for credibility in the face of ambiguity arose. This theory captures how struggles for human rights often evoke moral and ethical dilemmas regarding fairness and justice, which are integral values to the legal and mental health professions. However, the ambiguity and lack of external feedback inherent in extreme hardship evaluations necessitates the need for evaluators to create their own processes, rely on internal standards of excellence, and thus develop a sense of meaning for doing the work. Participants who were passionate about this work appeared to have successfully completed a meaning-making process (Park, 2010) and when positive meaning was not established, participants spoke of fatigue, burnout, poor work quality, and ultimately leaving this area of specialization. Recommendations include clarifying clinician qualifications, training, supervision, mentoring, and criteria to evaluate the quality of reports.

This dissertation is available in open access at AURA, and Ohio Link ETD Center,


Susan Burke, Psy.D., 2019

ORCID Scholar ID # 0000-0002-0858-4114

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