Exploring Dimensions of Culturally Sensitive Clinical Styles with Latinos

Abstract

This study sought to identify dimensions of culturally sensitive clinical practice by comparing the personal clinical styles of Latino and non-Latino clinicians, and their clinical decisions in respect to Latino immigrant clients. A combination of qualitative and quantitative methods were used. Sixty Latino American clinicians and 47 non-Latino (White) clinicians in Northern California completed the Achieving Styles Inventory (ASI) which yields information on direct, instrumental and relational styles. Demographic data were obtained as well as information on language proficiency and years of clinical experience. Statistical analysis included uses of t-test, ANOVA, and multiple regression analysis and revealed significant differences between the two groups in personal achieving styles within all three domains. There were no significant differences on the demographic variables. Nine clinician members of each ethnic group were interviewed in-depth through non-directive interviewing styles to assess their clinical decision making via use of a case vignette. Content analysis pointed to similarities and differences in proposed assessment and intervention strategies. The Latino group displayed more culturally relevant interpretations. The non-Latino clinicians were more directive and instrumental than the Latinos who put more emphasis on self disclosure, case management, use of Spanish with the client, and crisis intervention. This finding is consistent with both the quantitative data analysis of ASI hypotheses and the expected linguistic/cultural findings of the qualitative content analysis. Bilingual non-Latino White clinicians showed more cultural sensitivity and competence than the monolingual non-Latino clinicians. These findings suggest that linguistic/cultural match and linguistic/cultural compatibility are important in cross-cultural clinical practice.     

How Can I Become More Secure?: A Grounded Theory of Earning Secure Attachment

The purpose of this study was to develop a grounded theory of earning secure attachment. This study included 15 women and 5 men who met the criteria of having a self-reported history of attachment insecurity and demonstrated evidence of earned security. The grand tour research question, How do adults with a history of insecure attachment earn security?, was explored using constructivist grounded theory and semi-structured interviews emphasizing processes of positive attachment change. The results describe a process model of change hinging on three interrelated categories: meta-conditions of positive attachment change, making intrapsychic changes, and making interpersonal changes. Clinical implications include the importance of clients committing to the process, clients working with a clinician trained in trauma-focused therapy, and clinicians being surrogate attachment figures for clients.     

A Mexico City-based immersion education program: training mental health clinicians for practice with Latino communities

This article describes the philosophical foundations and educational methods of a Spanish language and cultural immersion program based in Mexico City, Mexico. The program is designed to assist U.S. graduate students in marriage and family therapy and clinical psychology programs to improve clinical service delivery with Latino clients. Utilizing critical pedagogy, the program works with future clinicians to develop multicultural and international competencies; acquire increased Spanish language skills; engage in self-of-the-therapist work; and expand their understanding of the historical and cultural influences shaping the mental healthcare needs of Latin American clients. A report of the themes from postimmersion surveys is provided and the implications for training are discussed.     

The Clinician's Cultural Countertransference: The Psychodynamics of Culturally Competent Practice

The purpose of this paper is to define the presence of the clinician's cultural countertransference in the cross-cultural therapeutic dyad, and describe its impact on the delivery of culturally competent services. The recognition of the contributing role of the therapist's own subjectivity in psychodynamically oriented practice cannot be more vital than in the treatment of patients whose culture, race, or class markedly differ from that of the therapist. The cultural countertransference is viewed as a matrix of intersecting cognitive and affect-laden beliefs/experiences that exist within the therapist at varying levels of consciousness. Within this matrix lie: the clinician's American life value system; theoretical beliefs and practice orientation; subjective biases about ethnic groups; and subjective biases about their own ethnicity. The author proposes that these countertransference attitudes are often: disavowed by the clinician; exert a powerful influence on the course of treatment; and though unspoken, are frequently perceived by the client.     

Cross Cultural Perspectives in Treating the Gay Male Trauma Survivor

Summary

In recent years, there has been an increased emphasis on cultural considerations in psychotherapeutic treatment. Sound psychotherapy is ideally culturally sensitive and concerned with the context within which the client developed and exists. At the same time it is often difficult for many clinicians to navigate the cultural within the psychological framework. When both patient and clinician share more than one language in common, there are a variety of subtle issues that surface. In psychotherapy, “coordinate bilinguals,” those who learn their languages separately, during different developmental stages and contexts, tend to have greater access to their emotional experiences within their first language. When the client presents with a sexual trauma history, the language spoken during the abuse will also have an effect on the language used in the psychotherapy. The case history of Lucio, a Latino gay male, is discussed in terms of the cultural and psychological elements of his treatment by a bilingual North American therapist. This therapist's psychotherapeutic conceptualizations and treatment approaches are examined and reviewed in a written dialogue/ discussion with a Latino psychologist.     

Toward a Better Understanding of the Use of Psychodynamically-Informed Treatment with Latinos: Findings from Clinician Experience

Latinos in the United States constitute a significant and sizable population that mental health professionals must serve appropriately. Therefore, the question of what types of mental health treatment approaches are useful in working with this population is of increasing concern. A strong sentiment against the use of psychodynamic treatment with Latinos persists in the literature in the absence of rigorous data that would support such a stance. Thus, it is important to examine systematically the use of psychodynamically-informed treatment with Latinos in order to address the question of its potential relevance and utility with this population. This article presents the results of a qualitative study of Latino therapists who employ psychodynamic approaches with Latino clients. Findings suggest that the clinicians interviewed have expanded the psychodynamic framework to include a flexible focus on the relationship, consideration of each client as an individual, and an acknowledgment and understanding of external reality and its impact on the client. Modifications these clinicians have made in technique, such as increased self-disclosure, support and maximize this expansion of the frame. Simultaneously, such modifications enhance the cultural sensitivity of these clinicians' work and are congruent with contemporary psychodynamically-informed relational theories.     

Culturally Competent Substance Abuse Treatment with Latinos

Abstract

The Latino population in the United States is a complex and multifaceted population. Latinos are a very dynamic and mobile cultural group. The 2000 United States Census registered Latinos in practically every state. Clinicians involved in assessing and treating Latinos must consider a complex set of environmental and systemic cultural factors that have a direct impact on their problem and potential healing. Treatment must begin by systematically assessing the cultural fit between clinicians and clients.     

Immigrant Therapists’ Unresolved Identity Problems and Countertransference

The difficult task of identify formation is greatly complicated by immigration in childhood or adolescence. This paper shows how the unresolved identity problems stemming from their immigration to Israel in childhood or early adolescence of three young therapists, two from Ethiopia and one from Russia, affected their countertransference in their treatment of their adolescent clients from their own countries of origin. The three examples are based on art works produced by the therapists and their clients in the framework of workshops on the integration of art therapy techniques into verbally based diagnosis and treatment. The paper highlights the need to help immigrant therapists recognize their own identity conflicts and resulting countertransference, as well as the identity issues of their immigrant clients.     

LATINO FAMILIES IN THERAPY: ENGAGEMENT AND EVALUATION*

General guidelines are offered for the successful engagement of Latino families in family therapy. It is suggested that a therapist's involvement of Latinos in therapy requires both skills in family therapy and sensitivity to cultural issues. Factors found to be useful in the family assessment are presented. Furthermore, issues in the engagement and evaluation phases of family therapy with Latino families are discussed, and illustrative clinical material is presented.     

Cultural Attunement in Therapy With Mexican‐Heritage Couples: A Grounded Theory Analysis of Client and Therapist Experience

There is a need for culturally attuned approaches for couple therapy with Mexican/Mexican‐Americans. This qualitative grounded theory study utilized interviews with 11 client couples of Mexican heritage and 14 marital and family therapists to shed light on how Latino and non‐Latino therapists co‐construct positive experiences of cultural attunement with Mexican and Mexican‐American couple clients. Analysis identified a model of cultural connection through personal engagement with four interrelated phases: (a) mutual invitation, (b) shared engagement, (c) expanding personal connection, and (d) creating cultural connections. Clients in this study valued professionalism and expertise of the therapist, but felt attuned to and respected when therapists demonstrated humility, shared personal stories and emotion, and engaged in a collaborative process.     

Strategies Used by Foreign‐Born Family Therapists to Connect Across Cultural Differences: A Thematic Analysis

With the growing diversity in the United States among both clinicians and clients, many therapeutic encounters are cross‐cultural, requiring providers to connect across cultural differences. Foreign‐born therapists have many areas of differences to work through. Thus, exploring how foreign‐born family therapists in the United States connect to their clients can uncover helpful strategies that all therapists can use to establish stronger cross‐cultural therapeutic connections. A thematic analysis was conducted to understand strategies 13 foreign‐born therapists used during therapeutic encounters. Four themes were identified: making therapy a human‐to‐human connection, dealing with stereotypes, what really matters, and flexibility. Findings suggest that developing a deep therapeutic connection using emotional attunement and human‐to‐human engagement is crucial for successful cross‐cultural therapy. Clinical and training implications are provided. Video Abstract     

Working with African American clients: considering the "homeplace" in marriage and family therapy practices

In this article, we discuss perspectives on the "homeplace" that are important to consider in marriage and family therapy involving African American clients. The homeplace comprises individual and family processes that are anchored in a defined physical space that elicits feelings of empowerment, rootedness, ownership, safety, and renewal. Critical elements of the homeplace include social relationships that shape individuals' and families' sense of social and cultural identity. We draw on our ethnographic and clinical research with African American families in urban and rural settings to describe typical schisms between therapists and African American clients when communicating about the homeplace. We also explore the impact of homeplace disruptions on experiences of "yearning." Recommendations for integrating a homeplace perspective into therapy practices are provided.     

Spirituality and the Gay Latino Client

An essential element in providing social services to clients form diverse communities is an understanding of cultural norms and values. The importance of acknowledging the understanding the role of spiritual beliefs and practices in working with gay Latinos is paramount when one considers the strong influence that organized religion and alternate belief systems have had on the societal, cultural and familial lives of these clients. This article looks at the role of spirituality in working with gay Latino clients, and offers suggestions for enhanced service delivery.     

Relational Quandaries in the Treatment of Forensic Clients

This article examines the sources of relational difficulties inherent in clinical work with forensic clients. Left alone, common countertransference feelings, responses, and defense mechanisms can disrupt and ultimately derail treatment. Concepts relating to the management of countertransference offer a path with which to integrate therapists’ affective reactions as a mechanism of therapy. A relational framework utilizing the affective dynamics between client and therapist to develop and promote treatment goals is introduced and the process of formulating it is described. Practice examples are offered.     

Recruitment and Retention of Latinos in Social Work Education: Building on Students’ Community Cultural Wealth

Spanish-speaking and culturally sensitive social workers are in high demand throughout the country to work with Latino clients. Latinos currently represent about 11% of active social workers, limiting the capacity of social work to effectively address the needs of the Latino population. Despite this shortage, little attention has been paid to the recruitment and retention of Latinos in social work. This article presents a case study that examines a BSW program accredited by the Council on Social Work Education, at a bilingual, private college where 90% of students self-identify as Latinos. It details how the BSW program builds on the students’ community cultural wealth to ensure continued recruitment and retention of Latino students. Implications for social work education are discussed.     

Group Treatment of Latency-Age Male Victims of Sexual Abuse

Researchers and clinicians across the country have documented increases in reports of sexual victimization of males. Awareness of the immediate and long-term needs of young male victims has highlighted the need for specialized, multi-modal treatment programs for these youngsters. Group therapy can be an important adjunct to individual and family unit therapy with this population. This article provides concrete suggestions for developing, implementing and evaluating a group therapy program for young male victims of sexual abuse. Specific areas addressed include: selection and preparation of group members; structure, phases, and salient tasks of the group; therapeutic group activities; co-leadership issues; managing transference and countertransference in the context of group; and, methods for evaluating the group's effectiveness.     

Correlates of Alcohol Use Likelihood for Latino Immigrant Youth in an Emerging Context

Using a three-wave prospective longitudinal design spanning 3 years, we assessed alcohol use likelihood trajectories and their correlates among a community sample of Latino immigrant adolescents in the emerging immigrant context of Western Oregon. Results from growth mixture modeling revealed two distinct classes: lower risk youth who reported little likelihood of alcohol use but whose trajectory was increasing, and higher risk youth who reported higher likelihood of alcohol use and whose trajectory was stable. We found significant differences between the two classes such that lower risk youth reported greater levels of Latino cultural orientation and parental monitoring, whereas higher risk youth reported greater levels of family cultural stress and delinquency. Results are discussed in terms of prior research and theory.     

Wrapping and Unwrapping Emotions: Clinical Practice with East Asian Immigrant Elders

Using the cultural norm of the way gifts are wrapped, unwrapped, and exchanged as a metaphor for interpersonal connections, this paper presents the way therapists can establish therapeutic relationships with East Asian clients who do not express emotions openly. We first discuss the ways in which emotions are conceptualized, experienced, and expressed in East Asian cultures. We then present vignettes of our work with older Chinese and Japanese immigrant women to illustrate the importance of therapist authenticity and co-construction of the therapeutic relationship. Using the framework of relational/cultural theory, which posits that healing takes place in the context of mutually empathic growth-fostering relationships, we illustrate the importance of establishing mutuality between therapist and client as a form of cultural empathy.     

Dual-Career Marriages: Implications for the Clinician*

This paper discusses the unique characteristics of dual-career marriages/families. These familial units are identified as a high stress group presenting unusual challenges to the clinician. Specific implications for the clinician include (1) values of therapist and clients; (2) critical issues; and (3) assets and liabilities. It is concluded that while dual-career couples may be demanding clients, the therapist can be sure he/she will have an intriguing, eventful, and meaningful experience along the way.     

A Bioethics Approach to Social Work Practice With Transgender Clients

Increased advocacy for the informed consent model of transgender health care specifies that patients should be in control of access to receiving medical interventions such as hormone therapy or surgery. However, in practice, mental health clinicians, including clinical social workers, are increasingly called upon by medical providers to serve as gatekeepers for these processes. It is frequently the role of social workers to assess transgender clients’ baseline mental health and their understanding of the consequences of treatment, and to forward recommendations to medical providers regarding the readiness of patients to transition. Therefore, social workers assisting transgender clients must be aware of the ethical standards that are particularly pertinent to their work with this marginalized and oppressed population. They must also be prepared to address unique ethical dilemmas that may be especially challenging to resolve. In this article we apply the most commonly utilized bioethical framework known as Principlism to describe the ethical standards and values that are particularly important to consider when working with transgender clients, namely autonomy; beneficence; nonmaleficence; and social justice. Because clinical social workers are frequently in the position of balancing client self-determination with their role as gatekeepers, a framework for resolving resulting ethical dilemmas is described (I CARE) and applied to three case examples.