Counseling and Family Therapy with Latino Populations

Strategies that Work

Robert L. Smith, R. Esteban Montilla, Robert L. Smith, R. Esteban Montilla

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781135426071
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

For the Latino population, the family bond is powerful and enduring. Family serves as the primary source of support, care, guidance, and healing; all difficulties that arise for an individual are surmounted together. Therefore, a practitioner working with a Latino client must gain the trust and respect of the family in order to carry out treatment efficiently. He or she must essentially become a part of that family to encourage members to share their issues without the concern of breaching the confidence of the family.

Counseling and Family Therapy with Latino Populations helps the therapist to join the Latino family in order to identify and explore the difficulties that threaten their welfare. With this fundamental principle as the basis, the book's editors and contributors write chapters that focus on work with children and adolescents, group counseling and substance abuse counseling. They incorporate specific case studies, methods, and strategies for intervention and provide insight into the cultural relevance behind each example. This book is a necessary resource for therapists working with Latino clients who wish to offer effective techniques while continuing to value the integrity of family tradition.

---

PART I

---

An Overview

---

CHAPTER 1

---

Counseling and Therapy With Latino Families

ROBERT L. SMITH, NADIA BAKIR, AND R. ESTEBAN MONTILLA

INTRODUCTION

The Latino population has grown from 12 million in 1980 to 39.2 million or 13.5% of the total population (U.S. Census Bureau, 2003). Therefore, the need for competent multicultural counselors and family therapists is very much in evidence. An overview of what is known from current literature when counseling Latinos is included in this chapter. Within this chapter, several writers (Corey, 2005; Gladding, 2002; Ivey D’Andrea, Ivey & Simek-Morgan, 2002) suggest that certain counselor characteristics are necessary for effective counseling and therapy, including those professionals working with Latino families. The relevance of these characteristics when counseling Latino families is discussed. As a major theme in Part I of this text, the authors agree with D’Andrea and Daniels (2005), Fukuyama (1990), and McFadden (1999), who support the notion of a transcultural universality. This suggests that certain factors, conditions, and therapist characteristics are important regardless of culture. Preferred family therapist characteristics as identified by four Latino families conclude this chapter.

OVERVIEW: COUNSELING AND FAMILY THERAPY WITH LATINOS, INCLUDING THE VALUES OF MULTICULTURAL COMPETENCY

Multicultural competence, its relevance, and need for it in the field of mental health were recognized in the mid-1960s. However a definition of competence was not developed until Division 17 (Counseling Psychology) of the American Psychological Association (APA) put forth a catalytic position paper in 1981 (Atkinson, Bui, & Mori, 2001). Developed by the Education and Training Committee of Division 17, this manuscript identified 11 multicultural competencies considered essential for counselors working with ethnic/racial minority clients.

Multicultural counseling competencies have largely focused on three areas: (1) awareness of the counselor’s worldview and how he or she is the product of cultural conditioning; (2) knowledge of the worldviews of culturally diverse clients; and (3) the skills required for working with a culturally diverse clientele (Corvin & Wiggins, 1989; D’Andrea, Daniels, & Heck, 1992; Holcomb-McCoy & Myers, 1999). Many assumed that counselors and family therapists who were competent in these three areas possessed the characteristics and strategies necessary for effectively working with culturally different clients (Holcomb-McCoy & Myers, 1999; Ponterotto, Rieger, Barrett, & Sparks, 1994; Sabnani, Ponterotto, & Borodovsky, 1991). Perhaps this assumption is simplistic because related research has yielded mixed results.

Underutilization of mental health services by Mexican Americans has been documented (Atkinson, Casas, & Abreu, 1992) despite this population’s often being in more stress than European Americans. Atkinson et al. (1992) offered three explanations for this scenario:

• Mexican Americans prefer ethnically similar counselors, which the field currently lacks (García & Zea, 1997).
• Mainstream counseling and psychotherapy values held by White therapists conflict with those of many Mexican Americans.
• Mexican Americans believe counselors and family therapists will not provide them with culturally sensitive treatment.

These three issues are discussed next.

Preference for ethnically similar Counselors

Research on the effects of ethnic similarity between counselors and clients has produced mixed results. Many multicultural researchers and scholars believe that matching counselor—client characteristics by ethnicity is favorable (Malgady & Constantino, 1998; Ponce & Atkinson, 1989; Sanchez & Atkinson, 1983; Santiago-Rivera, Arredondo & Gallardo-Cooper, 2002). Yet, such counselor—client matching may prove to be difficult considering the diversity within the Latino population, including race, language preference, culture, and country of origin (Santiago-Rivera et al., 2002). Moreover, the proportion of Latino professionals in mental health agencies in the United States is less than the proportion of Latinos in the general population. A review of rosters of professional organizations conducted in 1971 revealed that less than 2% of APA members had Latino surnames (Ruiz, 1971). More recently, Hess and Street (1991) found that Hispanics were among the most underrepresented minorities in counselor education programs, consisting of 3.4% of the student body and 2.1% of the faculty. Although these figures are outdated, similar percentages are believed to exist today.

The current research on preference of counselor ethnicity and counselor—client match must be interpreted with caution because many use a form of stimulus that does not adequately resemble counselor—client interaction in the natural environment (Hess & Street, 1991). Generalization of these studies to the Latino population is limited for several reasons. First, studies that used college students as subjects are not reflective of the larger and more diverse Latino population, which may differ on a range of factors including age, education, language, life experience, and coping skills (Kouyoumdjian, Zamboanga, & Hansen, 2003). Second, studies tend to rely on methods such as self-report surveys and interviews and to use the findings to evaluate outcome variables.

It is concluded that some Latino clients prefer to work with a Latino counselor, but others may not. Empirical evidence has suggested not only that ethnic matching of client and counselor has no influence on clients’ perceptions of counselor credibility, but also that it is not always preferred by ethnically diverse clients (Kouyoumdjian et al., 2003). Atkinson and Lowe (1995) found that many ethnoculturally diverse individuals report a preference for counselors with similar attitudes and values over those of a similar ethnicity. Sue’s (1988) review of research findings on psychotherapeutic services revealed that treatment of ethnoculturally diverse clients from culturally similar and dissimilar therapists resulted in similar outcomes.

Inherent values of latinos Conflicting With Those of White Therapists

To explain the underutilization of mental health services by Latinos, Kouyoumdjian et al. (2003) believe that Latino perceptions of mental health providers play a role. Many Latinos may feel that non-Latino therapists may not sensitively attend to their psychosocial needs. In addition, Latinos who do seek therapy may receive treatment that does not adequately address their specific needs (Ibrahim & Arredondo, 1986). As illustrated by Casas, Pavelski, Furlong, and Zanglis (2001), an unfortunate truth in the field is that traditional training of mental health professionals has been based largely on European American, middle-class culture. When this framework is applied to clients who are not European American and/or are not of middle-class status, problems arise.

Despite a lack of clinical support on the efficacy of cross-cultural counseling and family therapy practice, it is nevertheless safe to believe that multiculturally sensitive practitioners need to provide services in a manner congruent with the culture of the client. Religion and spirituality, for example, are central issues in the lives of most Latinos (Falicov, 1998; Santiago-Rivera et al., 2002). Despite their importance, these issues are often ignored in psychology (Koss-Chioino & Vargas, 1999).

Social bonds in the Latino culture should never be minimized. Latinos generally value relationships over the individuation from parents and family that is characteristic of the dominant culture (Gloria & Rodriguez, 2000). Mainstream psychological theory emphasizes individuation from family as a healthy counseling goal; however, failing to acknowledge the particular importance of family may actually lead a Latino client towards resistance or even premature termination of therapy (Gloria & Rodriguez, 2000). Understanding the values and influences of family and spirituality for Latinos is therefore central to the effectiveness of therapy.

Failure to Provide Culturally Responsive Treatment

Demographic studies of Latinos have demonstrated a susceptibility to mental health problems. They are often younger, less educated, and more likely located within the lower end of the socioeconomic spectrum. Their minority status alone causes them to encounter different experiences from those of their White counterparts, which include factors such as intolerance, discrimination, and socioeconomic challenges (Gloria & Rodriguez, 2000). Atkinson and Lowe (1995) suggest that culturally responsive helpers should acknowledge a client’s ethnicity and culture and recognize the way in which this client’s problem fits into a context of culture. Atkinson et al. (1992) have shown that Mexican American clients rate culturally responsive helpers as more credible and culturally competent than unresponsive helpers, regardless of the clients’ levels of acculturation.

The literature often clusters Latinos into a general category when in fact this population is heterogeneous in nature. Numerous differences exist among Latinos, including age, gender, social class, sexual orientation, country of origin, level of acculturation, and more. Even Latinos who have certain characteristics in common differ in their individual life experiences. Several studies have attempted to link Latinos to a particular counseling style (Kouyoumdjian et al., 2003; Santiago-Rivera et al., 2002) or inferred that a counselor of the same ethnicity would best suit this population (Malgady & Constantino, 1998; Ponce & Atkinson, 1989; Sanchez & Atkinson, 1983; Santiago-Rivera et al.). However, it is important to remember that preference of a therapeutic approach or ethnicity has yet to be linked solidly to counseling outcome (Ponce & Atkinson, 1989).

KNOWING ONESELF

The rapidly changing technological society and multicultural movement amplify the need to understand the role that values play as expressed by the therapist and client (Axelson, 1999). Most multicultural theorists emphasize the importance of counselors and family therapists possessing cultural self-awareness and adhere to the expression “counselor, know thyself” (Fuertes & Gretchen, 2001; Santiago-Rivera et al., 2002; Sue, Arredondo, & McDavis, 1992). Family therapists must recognize their worldviews, how they are affected by their cultural surroundings, and how this may influence their therapy with ethnic minorities. The therapist’s self-awareness can be achieved through self-exploration efforts such as experiential and didactic exercises, supervision, consultation, and therapy (Constantine & Ladany, 2001).

Most family therapists have only the best intentions when working with ethnoculturally diverse clients. Nonetheless, as Falicov (1998) asserts, “By emphasizing adaptation to normative structures of their own ecological niches in the dominant culture, therapists may come to believe that they’re favoring the objective truth rather than personal cultural biases, and may unwittingly commit a form of cultural imperialism.”

The truth is that some therapists are prejudiced against certain ethnically diverse clients (Wampold, Casas, & Atkinson, 1981). Although many practitioners may not consciously feel this way, they should nevertheless examine the way in which their cultural beliefs may affect their perceptions of Latinos and the therapeutic practices that they implement with Latino clients (Kouyoumdjian et al., 2003). Therapists who hold negative views of their clients have been shown to impede counseling progress by unintentionally using words and displaying behaviors that reflect these negative perceptions (Kouyoumdjian et al.). Some professionals may subtly discriminate against clients who do not conform to expected cultural stereotypes (Falicov, 1998). Also, for mental health professionals who have not sufficiently learned their own culture, the differences encountered in another culture can quickly become frustrating rather than understandable differences to which they can adjust (Vace, DeVaney, & Wittmer, 1995).

Therapists have two cultures: one is personal and the other professional. The experiences in both cultures have an impact on the thoughts, feelings, and behaviors of the therapist (Axelson, 1999). The combination of one’s cultural values and theoretical orientation creates a counseling worldview that influences how one observes, evaluates, defines, and approaches client issues (Sanchez, 2001). Recognition of this enables the helping professional to be authentic, which is a necessary trait for competent therapy (Vace et al., 1995).

The field of counseling psychology has generally encouraged counselors to focus on assisting clients in developing new insights and strategies to help them overcome disabling states of depression, insecurity, phobia, dysfunctional interpersonal styles, etc. (D’Andrea et al., 2001). Although such treatment strategies may be helpful in assisting individuals of some ethnic or racial groups, they may conflict with culturally constructed meanings of coping ingrained in the values and traditions of clients from other cultural backgrounds (D’Andrea, 2000). Because within-group diversity exists among Latinos, certain interventions may be more successful with some clients than with others.

THE IMPORTANCE OF DEVELOPING A WORKING RELATIONSHIP

No single counseling or therapy model has yet been proven to have successful outcomes with all Latinos. Falicov (1998), a Latina therapist, states that no Latino way of doing therapy exists. She refutes the notion that only Latinos can adequately counsel other Latinos. Falicov and numerous others report that core conditions, such as empathic listening and a strong therapeutic alliance, transcend cultural identity of counselor and client in delivering effective treatment. Santiago-Rivera et al. (2002) agree that “the Rogerian core elements of the therapeutic alliance are fundamental to counseling practice regardless of cultural differences.”

Another strategy considered helpful in working with Latino families that has been reported by several theorists (Falicov, 1998; Santiago-Rivera et al., 2002; Smart & Smart, 1994) is the “humble expert” approach. This implies approaching the family with curiosity and taking a “not knowing” stance to prevent stereotyping. Though the therapist is presumed to be an expert in his or her field, this humble a...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Contents
• About the Editors
• Contributors
• Series Editor’s Foreword
• Preface
• Part I An Overview
• Part II Strategies That Work With Latino Populations
• Part IIIResearch and Conclusions
• Glossary
• Index