This paper considers two pertinent strands in the contemporary immigrant mental health literature: 1) the distinction made between stressors that are endemic to most immigrant experiences vs. those migration stressors that precipitate trauma per se; and 2) clinical guidelines that continue to refine the assessment of immigrants' presenting mental health problems, given the provision of services in institutions that are foreign to both the language and idioms of distress of the populations being served. Case vignettes highlight the research findings and practice recommendations.