Counseling Implications for Latinos(as): Cultural Considerations, Theory, and Treatment

1. Counseling Implications for Latinos(as): Cultural Considerations, Theory, and Treatment Lauren Beard and Keyla Stephens Wake Forest University Department of Counseling

2. “The United States has written the White history of the United States. It now needs to write the Black, Latino, Indian, Asian and Caribbean history of the United States.” -Carlos Fuentes

3. Cultural Considerations • “Policulture”: Latinos possess a vast array of beliefs and traditions that cannot be specifically categorized. Conversely, commonalities still exist: • Social bonds: parents, family • Spirituality/Religion • Collectivism/Community: interdependency, social responsibility • Acculturation & assimilation • Ideal bicultural integration largely dependent on the individual’s ability to learn the language, profess loyalty, and internalize values of the prevailing culture while simultaneously maintaining local support, native language, religion, values, and ethnic persona as the core of one’s cultural identity (Montalvo, 2009) • Lighter skinned Latinos vs. darker skinned Latinos in integration of American culture and native culture • Mental health • Racial & ethnic minorities are less likely to receive quality health services, particularly mental health care (Aguilar-Gaxiola et al., 2002) • Ethnicity is a strong predictor of termination of mental health services (Montalvo, 2009) • Depression prevalent among immigrants (Montalvo, 2009) • Traditional Values • Respect • Dignity • Interdependency • Interactive style • Centrality of family and religion (Montalvo, 2009)

4. Cultural Considerations, continued • Mexican-American population: only indigenous Latino Population of • approximately 20 groups from Latin America • Puerto-Rican: second in size • The Impact of Skin Color/Phenotype and “Colorism”: • Phenotyping: “implementing social policies that favored European features and light skin as standards for judging physical appearance, and actions that marked people for favorable or unfavorable treatment based on skin color (Montalvo, 2009). Originated in part from the Caste system in Colonial Mexico. • Colorism: internalized form of bias, used by Latinos to discriminate against other Latinos without the need for an institutionalized form of bias. Sign of dysfunction within a family. • Importance of understanding the influence of skin color on life experience. • Implications of previous studies: relating skin color to social class, health, prestige. • Lighter skinned Latinos earn an average of 15% more income than darker Latinos in a survey of immigrants (Montalvo, 2009).

5. Familismo

6. Theoretical Orientations In substance abuse: • Humanistic Approach- psychological security and supportive confrontation to focus on the emotional components related to substance abuse (Torres-Rivera, Wilbur, Phan, Maddux, & Roberts-Wilbur, 2004.) • Use of Multicultural Counseling Competency- necessary for counselors to understand clients in contexts of their culture; some Euro-American approaches do not mesh will with minority groups, such as those that focus entirely on the individual and do not involve outside influences (Torres-Rivera et. al, 2004.) • In family counseling (Smith, Montilla, & Estaban, 2006.) : • Latino family structure: hierarchical in nature, it is important to choose approaches that best fit the familial style • CBT can be effective in family approaches, changing schemas, power of positive decision making and family support (Smith et. al, 2006.) • A-B-C- theory (Smith et. al, 2006.)

7. Postmodern Approaches • Effective due to the establishment of Rogerian principles and the need to develop a working relationship with the client/family. • Narrative Therapy • Efficacy due to the need for the counselor to convey unconditional positive regard; works well with ideas of “respeto” and “personalismo” as valued ways of being. • Exploration of the story helps put attention on broadening the story to include recognition that family and community relationships are important and that the client’s values, identity, and culture(s) are significant (Flamez & McNichols, 2011). • Solution-Focused Therapy • Goal-oriented nature of SFT and the understanding that it will take work supports characteristics of high value in latino culture such as hard work, dignity, respect, and responsibility (Flamez & McNichols, 2011). • Use of the miracle question to instill hope. • Reliance of the client to come up with resources that can aide in change, thus involving the family, community etc.

8. Narrative Therapy, continued • Externalizing the problem • Track larger themes • Creation of possible stories • Re-membering conversations • Definitional ceremonies • Client as expert (Flamez & McNichols, 2011)

9. Solution-focused Therapy, continued • Client’s view of the problem • Assessment is client-determined and co-constructed • Client-counselor relationship • Collaboration • Goals promote dignity, respect, & responsibility • Recognize resources the client brings (Flamez & McNichols, 2011)

10. Important Factors of Latino Culture: personalismo respeto espiritismo

11. Clinical Techniques • Racial & ethnic identity development • Conformity (R/CID Model) • Causal (Chicano/Latino Model) • Core belief that a positive correlation exists between pride in one’s racial and ethnic identity and mental health, making it helpful to challenge distorted/negative understanding of Latino cultural identity (Delgado-Romero, 2001) • Importance of training practitioners to explore with empathy and skill the significance of events regarding skin color (Montalvo, 2009) • Critical Incident Review • Implicit Association Test • Research on psychosocial affects of phenotyping and colorism • Photo-anchored phenotype scales to improve accuracy and consistency in estimating skin color • Assessment of training in ethnoracial factors and early withdrawal from treatment • Psychologist Edward Delgado-Romera and latino client, “Mr. X” (Delgado-Romera, 2001) • Introductory statement as a foundation for treatment

12. Ethical & Professional Practice Considerations • Counselor’s racial & ethnic identity development • Multicultural competence • Importance of clinicians’ ability to analyze their own comfort discussing issues of race • ACA & AMHCA code of ethics • Hermeneutic Model of ethical decision making (Houser, Wilczenski, & Hamm, 2006.)

13. respeto

14. References Aguilar-Gaxiola, S. A., & Gullotta, T. P. (Eds.). (2008). Depression in Latinos: Assessment, treatment, and prevention. New York: Springer. Aguilar-Gaxiola, S. A., Zelezny, L., Garcia, B., Edmondson, C., Alejo-Garcia, C., & Vega, W. A. (2002). Translating research into action: Reducing disparities in mental health care for Mexican Americans. Psychiatric Services, 53(12), 1563-1568,. Delgado-Romero, E. A. (2001). Counseling a Hispanic/Latino client – Mr. X. Journal of Mental Health Counseling, 23(3), 207-221. Houser, R.A., Wilczenski, F.L.,& Ham, M.D. (2006). Culturally Relevant Ethical Decision-Making in Counseling. Thousand Oaks, CA: Sage Publications, Inc. Montalvo, F. F. (2009). Ethnoracial gap in clinical practice with Latinos. Clinical Social Work Journal, 37, 277-286. Oliver, M., Flamez, B., & McNichols, C. (2011). Postmodern applications with Latino/a cultures. Journal of Professional Counseling: Practice, Theory, and Research, 38(3), 33-48. Smith, R.L., & Montilla, R.E. (2006). Counseling and Family Therapy with Latino Populations. New York, NY: Taylor & Francis Group. Torres-Rivera, E., Wilbur, M.P., Phan, L.T., Maddux, C.D., & Roberts-Wilbur, J. (2004). Counseling latinos with substance abuse problems. Journal of Addictions & Offender Counseling, 25, 26-40.