Would you like to be able to provide culturally appropriate mental health services to your Latino clients?
A few days ago, I had the pleasure of attending Dr. Parra-Cardona’s workshop at the Ackerman Institute for the Family on providing an ecological and culturally relevant framework for working with the Latino population in clinical practice.
According to Dr. Parra Cardona, there are the following 3 key models (or frameworks) to keep in mind while working with Latinos:
1. Ecological Theory
2. Transgenerational Cultural Identity Formation
3. Cultural Identity
Ecological Theory (Parra-Cardona, 2013)
Within the Ecological Theory, examples of macrosystem factors to consider (Parra-Cardona, Córdova, Holtrop, Villarruel & Wieling, 2008) are:
Among [some] Foreign Born Latinos:
Macrosystem Risk Factors: stigma, intense health and mental health disparities, intense discrimination and work exploitation, anti-immigration climate.
Macrosystem Protective Factors/Pulls: economy and safety, community, cultural values and spirituality.
Among [some] U.S. Born Latinos:
Macrosystem Risk Factors: stigma, health and mental health disparities, legacies of discrimination, segregation, cultural identity cut-off (forbidden to speak mother tongue).
Macrosystem Protective Factors: citizenship (rights and benefits), access to welfare system and potential biculturalism.
Transgenerational Cultural Identity Formation (Parra-Cardona, 2013)
Transgenerational Cultural Identity Formation:
- Experiences of connection, differentiation, dynamics of oppression, and resiliency have a major impact on the process of immigration and cultural identity formation.
- Hence, Dr. Cardona recommends discussing with an individual (or family) what impact their arrival in the United States has had vis a vis these elements.
- Similarly, it is important to explore what it is currently like for the individual/family currently in terms of these elements of connection, differentiation, oppression and resiliency.
- In other words, this model looks at the pushes vs. the pulls.
- Pushes refer to the elements that that pushed the individual (or family) away from the country of origin [typically accompanied by feelings of loss].
- Pulls refer to the elements that enable the person/family to survive or thrive here.
- Some examples of pulls:
- Connection [it is important for new immigrants to establish meaningful connections with both new country’s minority and majority]
- Differentiation [i.e., what do they like/dislike about old/new country, prior social class/new social class]
- Resilience [i.e. personal qualities and use of social support networks]
The Cultural Identity framework (Parra-Cardona, Wampler & Busby, 2004) has the following 4 dimensions:
- Country of origin orientation: individuals do not want to identify with many elements of host country
- U.S. oriented: individuals consider themselves citizens of the host country and do not want many (if any) elements of country of origin
- Bicultural: individuals whose identity is based upon an integration of both cultures; they’ve incorporated elements of both cultures.
- Cultural identity search which involves three possibilities: [typically, victims of trauma are at this point b/c they are in survival mode]
- Country of origin open to expand
- U.S. oriented open to expand or
- Moratorium [not thinking about this]
In other words, the objective would be to ask your Latino client various questions so as to get a feeling on what their experiences were like in the various areas addressed in the above-mentioned models.
In so doing, you would not only be validating their historical and current stories, but you would also be demonstrating a desire to understand where they are coming from.
This, in turn, according to Dr. Parra-Cardona, is likely to yield for you both increased engagement and better clinical outcomes with your Latino clients.
For more information on the use of these models, I urge you to read one or more of the many articles he has written on the subject (note that evidence of the effectiveness of these models has been demonstrated in a number of his studies). Alternatively, you could consider attending one of his future workshops on this topic.
Dear Dorlee,
This is great!!!
I’m deeply impressed by your work and capacity to integrate information, wow!!!
You’re capturing my ideas just perfectly and I’m honored and deeply grateful for this dissemination work….you are amazing!!!!
Ruben
—
J. Ruben Parra-Cardona, Ph.D.
Associate Professor
Couple and Family Therapy Program
Human Development and Family Studies
552 W. Circle Drive, 3 D Human Ecology
Michigan State University
East Lansing, MI, 48824
How kind of you to say, Dr. Cardona!
Thanks so much,
Dorlee
I’m Mexican-American and I often see some of these issues/problems pop up with my Latino clients:
1. Disconnect with family values.
The more acculturated children of immigrants are, the deeper the rift in values is. My observation is that old school values (i.e. more conservative type). A lot of my clients have experienced issues with the majority culture’s values (which they adopt) versus their parents’ values, which they still hold.
2. Skin complexion
I understand that this can be an issue with my African-American colleagues, but sometimes the same thing happens in Latino families where the “mas güeritos” are treated differently (i.e. with more privilege) than the “prietos” (those with darker skin).
3. Male versus Female roles
Family appears to be an important value. Men have expectations to be the head of household and women to maintain it. This is not universal, but this is a conservative (i.e. “old school” value).
4. No faltas el respeto
Making it harder to rupture from the influence of family, youth and adolescents sometimes fall under the “don’t disrespect me” umbrella when opposing their elder’s values or behaviors. In some families, the cultural expectation is that elders deserve respect and challenge to this authority is considered disrespect.
5. Not everyone from Mexico is Mexican
In Greenfield, California has the highest number of the Oaxacan community outside of Oaxaca. They are the indigenous peoples of Mexico, with their own language and customs. They also face higher rates of discrimination and misunderstanding.
Thanks so much for sharing the cultural differences/experiences that you have observed with your Latino clientele.
It sounds to me like you may have intuitively been talking with your clients in a way that was taking into account the three frameworks that Dr. Parra-Cardona recommends we employ because you seem to have learned a lot from your Latino clients.
As you suggest, I think the key take-away is that in order to be attuned with our Latino clients, we need to be open, aware and curious, even if you are Latino and regardless of where they are from because every one is different (acculturation orientation, first/second generation, reason for immigration, status in country of origin etc.).
Thanks again!
By the way, Dr. Parra-Cardona will be stopping by to respond to your comment personally as soon as he has a bit of free time available… He expected to be able to do so in 10 days from now.
Hi Dorlee,
This is part 1 of 2.
As always your work and research is so important and so informative. Thank you for all your hard work.
Dorlee, I have been working with the Latino community for several years now and I have found many differences even among the Latinos themselves that is important when considering cultural competence. But, in essence they are not so different than what Dr. Parra-Cardona has explained. I will try to break it down in terms of three different cultures.
1-Mexicans, I have found that in most of these families the parents do not speak English, but their children who were born here or came to this country when they were very young feel a sense of separateness from their families.
Children will not help their parents understand what teachers, friends or if out shopping, they will not translate what the proprietors of the stores are saying. Children experience shame, fear and secrets and sometimes they don’t want to be a part of their own family.
They no longer want to speak Spanish and they are ashamed of their hard working parents. Mexican people are very humble, but the intergenerational disparities are great. They are also very caring people who want to help themselves and work hard to accomplish their goals and objectives in therapy. I have also noticed a lot of abuse between parents and children (children abusing parents).
There also exist identity roles, the men in the family (even the young sons) want to be very much in control, and the mother’s are emotionally and sometimes physically abused. The Mexicans prefer a therapist that they can identify with (even if only by language), they feel safe and are easier to engage when they feel understood.
2-Dominicans-they fear that people will look down on them because going to therapy carries many stigmas related to mental illness, so they always ask questions like (will this follow my daughter or son throughout life).
They also have difficulty setting boundaries and structure within the family. It is very much both a patriarchal and matriarchal family system. Both males and females are very strong.
Children are also very outspoken and easy to engage in therapy once they feel safe and have formed a therapeutic alliance with the therapist. They too feel comfortable speaking to a Spanish speaking therapist and are very interested in finding something that they have in common with the therapist. Once they feel safe they are compliant and work very hard towards their wellness.
This is part 2 of 2.
3- Puerto Ricans-like Dominicans they believe that therapy is only for people that are severely mentally ill, they fear the stigma associated with going to therapy; they consider themselves strong and do not believe that they can benefit from therapy.
Most of my Puerto Rican clients are mandated clients, and they truly hate attending therapy. Having something in common is what will drive them to the next therapy session; I am basically speaking about teens in the above description.
Some of my Puerto Rican adult clients want to get better and believe that therapy is the place that they will find help, but they are far and few because most Puerto Rican families believe in other methods of wellness (e.g., Santeria =White Magic)
All the above Latino families believe in giving food, and little gifts, after about 3 to 6 months of attending therapy. You will find (especially the Puerto Ricans and Dominicans not so much the Ecuadorians or Mexicans) that they will hug you after each session and most will say God Bless you.
They believe in magical thinking, spirits, ghosts, and sometimes what you might think is a panic attack is only what is referred to as ataque de nervious = attack of the nerves, and they will soon feel better. They are very emotional and sensitive people and even though the families may suffer with dysfunctional behavior and attitudes, they tend to be very close and very protective of each other.
Latinos are very loving people and I am proud to have the opportunity to work with this population because I know I have a lot of offer. It is a tough culture with a multitude of problems (e.g., drugs, alcohol, children abusing parents, domestic violence, divorce, child custody issues, school delinquency, learning disorders, etc. etc.).
Hi Nancy,
Thanks so much for coming back to share with us some of your experiences and valuable learnings from working with Latinos from different levels of cultural identity.
You’ve added some additional/new components that Dr Parra-Cardona had not mentioned such as the power of magic…
Based upon your work/experience, how would you recommend therapists who are unfamiliar with Latinos’ (or other populations’ for that matter) beliefs in magic that they approach this topic and work with clients in such a way that is respectful of their beliefs and helps move them forward in whatever way that is needed?
With much warmth and appreciation,
Dorlee
Hi Dorlee,
Because of my Latin (Puerto Rican) background, I am quite familiar with Santeria (White Magic).
If I were not familiar with the beliefs of the Latino culture, I would always allow them to verbalize their feelings, thoughts, fears, anxieties etc. I would encourage them to explore how their belief system has assisted them in resolving the issues that they are bringing to therapy.
If their belief system is getting in their way and delaying any type of recovery or improvement, I would offer alternative ways of working on solving their problems.
Latinos may not be open to change, but giving them an option will give them a sense of freedom of choice, and once they feel they have an alternative way of solving an issue, they will be open to trying different methods.
Most Latinos will continue to have magical thinking, but a therapist can show them different ways of resolving conflicts through better communication, they can also help by teaching them thought restructuring, and by assisting them in learning ways to desensitize their fears and anxieties through deep breathing and positive visualization.
It’s amazing how much people learn when their main focus is to improve their mental health. I strongly believe in natural healing, but I am also quite aware that medication can be an added necessity and in some circumstances a blessing.
Some people who want to get well naturally may be open to new suggestions. However, in the long run it all depends on the severity of their mental illness and the crisis they are experiencing.