NCE STUDY – Counseling Latino Clients

(((I am currently studying for a licensure exam & completing an internship.  This blog post is intended as a study exercise.)))

The term Latino/Latina is an ‘umbrella-notion’ that encompasses a wide variety of cultures that can include societies from Central American Indians, to Cuba, and Puerto Rico. Learning more about this minority group is essential when you note the wide diversity found within it. Including a variety of countries, each has its own unique culture and history.   Also notable are the varied stories of acculturation for the many subgroups and individuals in this community. A complexity of sociocultural and individual factors, blend together to determine experiences of acculturation, identity formation, and overall well-being for this minority group. As a byproduct of rich racially-mixed societies, varied socioeconomic histories, and unique degrees of political disempowerment in American society, each Latino individual and family has their own story, (Organista, 2007; Santiago-Rivera, et al, 2002).

In light of all this, I have a few concerns for my future career in counseling with this unique minority group. Understanding the issues at hand for my Latino clients will mean more than understanding factors such as sociocultural history and family background; although this is a good starting point.   I believe these factors can help a counselor to begin to understand how the process of acculturation and identity formation affect overall mental health (Organista, 2007; Santiago-Rivera, et al, 2002). When assessing these issues, it also becomes vital to note variations in value systems and worldview between counselor and client. Understanding how these factors affect ongoing dynamics during the counseling process and any intervention methods utilized, is also important.

In this paper I will begin by discussing key concerns to address during assessment to better understand the client.   I will continue with a discussion of Latino cultural values and worldview. I conclude with strategies and insights that would prevent me from making any overarching assumptions be made about my client’s cultural identity.

Understanding the Problem

“The ecological niche or unique combination of multiple contexts and partial perspectives define each individual’s and each family’s variation on major cultural themes. The ecological niche guides the evolution of values and behaviors…given its link to the social and physical environment…as well as access to power and the resources for healthy development.” (Hays & Iwasama, 2006, P73).

The concept of an ecological niche, as discussed in our Hays & Iwasama textbook (2006), sheds light on a key fact that is the source of concern for me in my future practice. Ultimately it’s the interaction of individual and sociocultural factors that influence the development and overall well-being of an individual.   In the case of the diversity in this group, this factor is that much more critical.

In his book titled “Solving Latino Psychosocial and Health Problems” Kurt Organista provides a historical background for Mexican Americans, Puerto Ricans, Cubans, and Central Americans, (2007). In this discussion the sociocultural histories of Latino communities described as influencing identity and acculturation stressors for individuals.   For example, it is interesting to note the differing degrees of adaptation to American culture between the Cuban and Central American communities, (Organista, 2007; Santiago-Rivera, et al, 2002).   Whereas the Cuban community received unprecedented support the Central American immigrants have been met with high degrees of resistance, (Organista, 2007; Santiago-Rivera, et al, 2002).   It’s also not a coincidence that these differing degrees of support vary with economic background and phenotypic appearance amongst the two groups (Organista, 2007). Examples such as this shed light on the importance of understanding within-group diversity of the Latino population.

In this section I discuss research on concepts of identity formation and process of adaptation for this varied minority group. Having an understanding of such research is a first step to effective counseling and assessment for Latino clients.

Concern One: Cultural & Ethnic Identity Formation

Viewing individuals holistically means understanding the relationship between person and their unique sociocultural context, (Santiago-Rivera, et al, 2002).   This requires more than simply taking time to learn about a clients unique sociocultural history. It also means developing a cursory understanding of identity, as a multidimensional construct with variances in progression between individuals (Organista, 2007).

Identity Defined.

Identity can be thought of as an internalized set of standards regarding beliefs about the self, or self-concept, (Santiago-Rivera, et al, 2002, p156). With this in mind, what follows is a useful definition of ethnic identity:

“Ethnic identity is defined as one of several role identities within the self-concept, eachof which varies in importance depending on the differential context of experience.” (Organista, 2007, p165-166).

With this definition in mind it seems our many roles, as reflected in the “addressing model” fit as components of a fluid ever-changing hierarchy within our self-concept, (Hays, 2008 & Organista, 2007).   It is useful to consider identity as highly personal subjective construct we develop to understand ourselves as individuals in an ever-changing sociocultural context. Understanding the identity formation process as it relates to this diversified minority is vital when you consider their consequences in the following quote:

“I believe that psychological pain is often the result of a lack of integration and that racism; prejudice and oppression are forces that can lead to disintegration of the sense of self. These negative forces can be overt, covert and internally based, or externally, which makes oppression a highly personal and difficult issue to deal with. (Delgado-Romero, 2001, p209.”

Addressing & Dimensions of Personal Identity Model.

The first theoretical perspective that intrigued me is the “Dimensions of Personal Identity Model” (Santiago-Rivera, et al, 2002).   It describes identity as having three key dimensions that appear to coincide well with the Addressing Model discussed in our Hays textbook (Hays, 2008).

  1. Dimension A” (Santiago-Rivera, et al, 2002) consists of factors are least changeable, and are usually ascribed at birth. They consist of factors such as gender, race, physical disability, sexual orientation, social class, and age.
  2. Dimension B” (Santiago-Rivera, et al, 2002) consists of factors that are more developmentally related and include factors such as income, marital status, citzenship and educational background.
  3. Dimension C” (Santiago-Rivera, et al, 2002) consists external sociocultural factors. These factors can include immigration experiences as related to the political-oriented historical context in which it occurred.

RIDM & Helms Models.

While the above model is effective in understanding identity formation as it occurs in a general sense, still other theoretical perspectives are useful in understanding how identify formation occurs for many Latinos. For example, the “Racial & Cultural Identity Developmental Model” describes five stages of identity development including conformity, dissonance, resistance, immersion, and awareness, (Delgado-Romero, 2001). Effective in describing identity development of “oppressed people experience as they try to understand themselves in terms of two cultures” (Delgado-Romero, 2001, p209) it describes identity as a subjective internal construct.   Still other models such as the Helms Racial Identity Model, (Delgado-Romero, 2001), help describe identity development as an interactive process.   With four stages of interaction (parallel, regressive, progressive, and crossed, (Delgado-Romero, 2001)) throughout identity formation process, it effectively contextualizes family dynamics and other common relational patterns. For example in the case of progressive interaction the “counselor operates from a more sophisticated ego status than the client. Energy and growth producing intercourse are the results of this type of relationship” (Delgado, 2001, p210). Conversely, a crossed interaction exists when the “ego status of counselor and client are in direct opposition”, (Delgado-Romero, 2001, p21). As you might guess the results are more problematic.

Concern Two: Acculturation & Adaptation Processes

Alongside issues of identity formation, the manner of adaptation to two sets of cultural influences exists as another important concept. Understanding a person’s overall orientation to their own culture (i.e enculturation) as well as dominant culture (i.e acculturation), (Delgado-Romero, 2001), is also vital.

Dimensions to Cultural Adaptation.

Overall there are a wide variety of potential orientations visible in clients contending with the influence of competing cultures. For example, our textbook briefly describes five models including “assimilation, acculturation, alternation, multicultural and fusion” (Hays & Iwasama, 2006, p10).

“Which form of adaptation an ethnic minority eventually experiences depends on a number of factors, including the original conditions of contact, the degree of conflict between groups, and the dominant society’s tolerance for cultural diversity.” (Organista, 2007, p8).

Further adding to the complexity of the situation are the variations seen as a result of this orientation including unique resultant social experiences, psychological mechanisms utilized and strengths/obstacles, (Hays & Iwasama, 2006, p10).   Understanding how the sociocultural history, family history and individual factors blend together into this adaptive style is also important.

Acculturation Process & Influences.

“acculturation is consistently related to higher levels of a broad array of diagnosable mental health problems…..Mental health differences between Latino groups reflects their acculturation histories, which vary considerable in terms of degree of acculturative stress and challenges to adaption.” (Hays & Iwasama, 2006, p75).

As the above quote conveys, the adaptive processes utilized in relation to American culture have a huge impact on overall well-being and warrant closer examination. Defined as “socialization into an ethnic group other than one’s own” (Delgado-Romero, 2001, p211), acculturation can be thought of as a process including three factors described as follows:

“Contact refers to the conditions under which two cultural groups meet….conflict refers to the predictable tension and fighting that results when one group attempts to dominate another…and adaptation refers to the eventual form of accommodation between groups that is intended to reduce conflict.” (Organista, 2007, p5)

The Latino Model of Ethnic identity helps to contextualize the Acculturation Process for this diverse minority, (Delgado-Romero, 2001, p211). Encompassing five stages (including causal stage, cognitive stage, consequences, working through stage, and resolution), this theory indicates marginality and forced assimilation are negatively correlated with mental health, (Delgado-Romero, 2001). Conversely, promoting a pride one’s identity and freedom of chose are key to effective adaptation (Delgado-Romero, 2001)

With this in mind, trends are visible when examining how acculturative stressors vary within differing Latino subgroups, (Organista, 2007).   As a result of such research, it is clear that acculturative stress inversely correlated with cultural and behavioral similarity, as well as socioeconomic status (Organista, 2007, p8). Additionally it is possible to correlate immigration policies and other political factors at the time of immigration with acculturation stresses (Organista, 2007)

Latino Cultural Values & Worldview

Individual worldviews and value systems exist in us as largely automated and subconscious factors we rarely consider.   In light of this fact, a lack of awareness regarding value differences between clients and ourselves can cause misunderstandings to occur.  With this in mind, what follows are value differences that I would need to be aware of during the assessment process:

  1. Individualism vs. Collectivism: Growing up in American culture my own personal value system is one that emphasizes individualism. In this respect, self-expression, personal rights, and privacy are ideals that are important. Collectivist ideals that emphasize respect, sacrifice, and emotional suppression for the sake of harmony can be easily overlooked.
  2. Verbal Expressiveness vs. Stoicism: This key difference is one that has troubled my relationship with my mother. Stoicism is a value that is often correlated with a collectivist perspective in which harmony is a priority. This can be misunderstood, easily from an American perspective which values verbal expressiveness.
  3. Personalismo vs. Task Orientation: In those instances in which I have cared for Latino clients in a hospital setting, I have been made acutely aware of these value differences. As someone who is task oriented I set about checking things off my to-do list.   This can be experienced as highly impersonal at times from a Latino values perspective. Taking time to provide personal attention, build trust, and simply converse casually, are key in building a therapeutic relationship with Latino clientele.
  4. Egalitarian vs. Traditional Gender Roles: Coming from a highly egalitarian background, it will be important to understand traditional gender roles as they relate to counseling Latino families. Being aware of this factor, gauging interactions and interventions accordingly will be vital.
  5. Science Vs. Religion: Having been raised by two doctors and being agnostic, my value system is clearly one-sided. In an attempt to engage in an honest self-assessment, I will need to further educate myself on the importance of religion in the counseling context. Participating in religious practices, relevant volunteer work and internship opportunities are possible solutions to address this issue

In concluding this section, the above listing of cultural value differences is certainly an overview of key issues and an in-depth self-assessment. This list appears to me as an example of issues that can potentially stand in the way of any culturally sensitive empathy.   Essentially defined as an ability to put yourself in another’s shoes and understand their frame of reference, empathy is definitely culturally relevant (Chung & Bemak, 2002). It entails understanding the internal world, cultural identity, and value systems of clients while simultaneously holding onto my own. Affectively communicating it and addressing issues relative to cultural context also communicate empathy. Clearly, throughout this process, value system differences need to be attended to

Counseling Strategies to Address Therapist Assumptions the Need for Eclecticism In Counseling.

“Eclecticism in psychotherapy can take two general terms. The first involves an integration of diverse theories into one transtheoretical mode. The second, known as technical eclecticism, describes the increasingly common practice of systematically choosing and using a wide range of interventions and procedures.” (Hays, 2008, p176-177)

As is well known, counseling’s history has encompassed a longstanding under-emphasis in sociocultural factors and over-emphasis in empiricism.   Consequently, many traditional theories and techniques are based on a value system that is highly Euro-American in scope. Preventing any assumptions regarding a client’s identity as a member in the Latino community requires a eclectic approach.

While I know this is a slight reiteration of previous paper assignment, there are three theoretical perspectives that provide a great start-off point for multi-culturally competent counseling. Firstly, it will be beneficial to slightly modify the Axis-6 Addressing Model approach as mentioned in our Hays-textbook (2008) for the new DSM-V. Considering sociocultural context alongside a DSM perspective can provide a critical balance of cultural relativism and empirical soundness.

Still other insights from the “MAP – Multicultural Assessment Procedure” (Thomas, 2007, p65) and the “FACTS” Method, (Johnson, 2013) are useful. The Multicultural Assessment Procedure is useful as an assessment that involves a process of continually testing and revising a working hypothesis, (Thomas, 2007).   The FACTS Method is a five part approach that involves (1) formulating questions, (2) utilizing assessment methods, (3) addressing culturally-responsive issues, and (4) providing treatment based on scientific evidence. (Johnson, 2013, p19).

Multicultural Competency & Empirically Based Insight.

In concluding this paper, I feel it is useful to mention briefly an article titled “Counseling a Hispanic/Latino Client – Mr. X.”.   It describes a hypothetical scenario of case conceptualization for a Latino client.   The article begins by providing an overview of relevant theoretical perspectives, while also describing how it is relevant to client “Mr-X”.

Starting out with the first therapy meeting, mention is made of any value-based differences between counselors and Latino clients. Cautioning against the potential for misunderstanding, attending to these differences throughout client interaction is critical, (Delgado-Romero, 2001).

Still other initial considerations in our hypothetical case scenario include addressing issues of cultural and racial identity, and family roles.   Continuing through therapy, there is a description of how identity and acculturation theories, described above, can relate to assessment and effective case conceptualization for “Mr-X”. Finally, therapy goals such as validation and education are vital to help the client understand self-development in a greater sociocultural context. Additional considerations such as providing homework that is culturally relevant are also mentioned.

To summarize, this article is effective in describing how multicultural counseling might occur in an intriguing hypothetical scenario.   I would hope to utilize a very eclectic method that would allow for culturally relevant contextualization of theoretical perspectives of issues such as identity development and acculturation. Additionally, assessing clients in this diverse minority group, would best be served when the utilization of the DSM-5 is put within a culturally relevant context.

“I am about to go to the waiting room and meet Mr. X for the first time. I am feeling nervous, yet excited, especially since I have had time to review a general racial and ethnic identity development theory….I feel that I have reviewed the variable that might be important in conceptualizing, assessing, and treating Mr. X. But an air of mystery still remains, the unknown of how we will work together. I guess that’s why counseling is still an art.” (p220)

References

Chung, R. C., & Bernak, F. (2002). The relationship of culture and empathy in cross-cultural counseling. Journal of Counseling and Development : JCD, 80(2), 154-159. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://search.proquest.com/docview/219015671?accountid=28125

Delgado-Romero, E.A. (2001). Counseling a Hispanic/Latino Client – Mr. X. Journal of Mental Health Counseling. 23(3). 207-221.

Hays, P. (2008). Addressing cultural complexities in practice. (2nd Ed.) Washington, D.C.: American Psychological Association.

Hays, P., & Iwasama, G.Y. (2006). Culturally Responsive Cognitive-Behavioral Therapy: Assessment, Practice, & Supervision. Washington, D.C.: American Psychological Association.

Hernandez, A.M., & Curiel, Y.S. (2012). Entre nosotros: Exploring Latino diversity in family therapy literature. Contemporary Family Therapy. 34, 516-533.

Johnson, R. (2013) Forensic and Culturally Responsive Approach for the DSM-5: Just the FACTS. Journal of Theory Construction & Testing, 17(1), 18-22.

Organista, K.C. (2007). Solving Latino Psychosocial and Health Problems: Theory, Practice, & Populations. Hoboken, N.J.: John Wiley & Sons, Inc.

Santiago-Rivera, A.L., Arredondo, P, & Gallardo-Cooper, M. (2002). Counseling Latinos and La Familia: A Practical Guide. Thousand Oaks, CA: Sage Publications, Inc.

Thomas, J. C., Hersen, M., Sage eReference (Online, s. (Online service), & Sage Publications, (2007). Handbook of Clinical Interviewing with Adults. Los Angeles: Sage Publications.

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