Culture and Masculinity: When Therapist and Patient are Latino Men

Treating clients from diverse cultural backgrounds, and supervising clinicians who are treating clients of the same ethnicity and gender, are now common experiences in our mental health system. As the growth of minorities in the US greatly outpaces the training of minority clinicians, more attention to these situations is needed. Operating from the premise that interpersonal sensitivity is a fundamental aspect of cross-cultural and cross-ethnic sensitivity, we describe the treatment of a Latino male by a Latino male clinician, in this case both of Puerto Rican descent. We outline the contours of the therapy with a man whose life history included numerous incidents of humiliation and thwarted efforts at efficacy, mastery, agency, and competence, resulting in an adult character structure based on shame and self-doubt. We also discuss the challenges to the clinician posed by working with a man whose traditional upbringing mirrored his own, with all the positives and negatives that must be considered in the countertransference. We describe clinical and cultural reasons for various interventions, and their resulting outcome. The framework of a dynamic interpersonal therapy and the challenges of transference, countertransference, therapist disclosure, and working-through are covered.