You Don’t Have To Be a Latino to Provide Services to Latino Populations: Enhancing Transcultural Mental Health Care

December 4, 2017

Emily Maynard, PhD

Post-doctoral fellow
University of California, Santa Barbara

Three facts you need to know about Latinos and mental health care in the United States:

• Eighteen percent of the U.S. population is Hispanic or Latino (56.6 million) (US Census Bureau, 2016)
• Only 5% of American psychologists are Hispanic or Latino (American Psychological Association, 2015).
• Approximately 3% of American social workers are Hispanic or Latino (National Association of Social Workers, 2003).

See: How the U.S. Hispanic population is changing/Pew Research Center

With the number of Latinos in the United States at a high and growing, and after recent natural disasters that have impacted Latino populations in the Caribbean and Gulf areas, we may see more Latinos than ever accessing mental health services. Therefore, it’s likely that many non-Latino clinicians will be asked to work with Latinos, especially in border states and the Gulf region. Some familiarity with this group is helpful to provide appropriate, cross-cultural mental health services to Latinos.

See related news stories:

After Hurricane Maria, mental health specialists see toll among U.S. Puerto Ricans

Statement of the National Alliance for Hispanic Health

U.S. Local Authorities Expecting Influx of Puerto Ricans after Hurricane Maria

What do non-Latinos need to know to work effectively with Latinos?

Nine things to keep in mind.

1. Latinos are diverse! Just like the United States, Latin American countries have long histories of colonization, conquest, slavery, and immigration. There are individuals of European, African, indigenous, Asian and Middle Eastern descent across Latin America. Don’t assume that someone is or is not Latino because they look a certain way or have a certain name.

2. Take the time to learn about the recent history of the countries/regions where your patients come from. A professional-class patient fleeing Venezuela may have a very different background than a Puerto Rican laborer or a Chilean graduate student. Newspapers, magazines, films, novels, and even Wikipedia are great sources of information about your patients’ countries of origin.

3. If you speak Spanish, seek out professional opportunities to train and receive supervision in Spanish.

Have you ever taken any Spanish classes? Spanish is by far the most-taught second language in the United States, with more students enrolled in Spanish than in all other foreign languages (Goldberg, Looney, & Lusin, 2015). If you have even a passing familiarity with Spanish or with Latin American cultures, use what you know of it to inform your work with patients. (For example, use the formal usted form of address unless your client invites you to use the informal tú.)

4. Be willing to acknowledge your own racial/ethnic identity. If you speak Spanish and are not Latino, patients will have curiosity about how you acquired it. To not answer questions about language acquisition or race/ethnicity may be perceived as hostile, strange, or may invoke paranoia. Be prepared to give a brief explanation, e.g., “I lived in Chile and Argentina for a few years,” and move on. 

5. Be on the lookout for complex trauma and trauma-related disorders when working with Latinos. Latin America is now considered the most violent region in the world, with the highest homicide rate (U.N. Office on Drugs and Crime, 2013). Latinos endorse high rates of exposure to violence, including political violence (Fortuna, Porche, & Alegria, 2008). 

Day of the Dead shrine in guest blogger's office

6. Distinguish between psychopathology and culturally-normative behavior. For instance, a person who appears to be paranoid may be in fact behaving very adaptively if they were raised under a dictatorship (as, for example, in Chile, Argentina, Brazil, Dominican Republic, Cuba, to name just a few). Signs of anxiety/panic/nerves must also be considered in the context of recent changes to immigration policy and raids on immigrants across US.

7. Interpersonal boundaries are different, but still exist with Latino patients! Don’t be fooled into thinking that a more affectionate style among Latinos means that they don’t respect interpersonal boundaries. I have found that Latinos are often keenly aware of professional hierarchies and are very respectful when working with therapists. They will also expect a similar level of professionalism and respect from their clinicians.

8. Family is important. Most Latino cultures have a greater focus on family functioning rather than on autonomous individualism (Cauce & Domenech-Rodriguez, 2002; La Roche, 2002). Some ways to acknowledge family role in therapy:

• Routinely ask about significant family members.
• With children/teens: “Mándale saludos a tu mamá”/“Say hi to your parents for me.”
• Allow parents of infants or small children to bring children into psychotherapy with them.

9. Show up. For non-Latinos, it is important to demonstrate an ongoing commitment to working with Latinos. Linguistic and cultural knowledge are markers for commitment, but so is showing up!

• Be present at public events in the Latino community; let yourself see and be seen. 
• Take university-level classes in Spanish, or courses on Latin American history and culture.
• Visit Spanish-speaking neighborhoods.
• Acknowledge important holidays and traditions with patients: Día de los Muertos, December 12 (Day of the Virgin of Guadalupe) and quinceañeras for Mexican patients

About our guest blogger

Emily Maynard received her Ph.D. in clinical psychology from Fordham University. Her pre-doctoral internship was conducted at NYU-Bellevue Hospital Center in New York City, where she completed rotations in medical psychology, substance abuse treatment, and inpatient psychiatry. Dr. Maynard received her undergraduate degree in Spanish and Portuguese from Princeton University, with a minor in Latin American Studies, and she was later a Fulbright Fellow to Brazil. Dr. Maynard is bilingual in Spanish and fluent in Brazilian Portuguese.

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Immediate help in Puerto Rico: National Hispanic and Latino ATTC
Latinas in Recovery: Understanding the Evidence to Bridge Gaps in Service 
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Linking Hispanics and Latinos to Health Care: Promotora Programs

Suggested readings:

Akhtar, S. (1995). A third individuation: Immigration, identity, and the psychoanalytic process. Journal of the American Psychoanalytic Association, 43(4), 1051-1084.

Anzaldúa, G. (1987). Borderland/La Frontera. San Francisco: AuntLute. Ch. 1-3.

Correal, A. (2015, October 2). On Sunday nights, New York’s busboys become cowboys. The New York Times, pp. MB1.

Falicov, C. J. (2014). Latino families in therapy. Guilford Publications. Ch. 2: Latino Diversity: Contexts and Cultures; Ch. 9: The Challenge of School and Work.

Grinberg, L., & Grinberg, R. (1989). Psychoanalytic perspectives on migration and exile. Yale University Press. Introduction and Ch. 1-3.

Kirtley, B. (1960). "La Llorona" and Related Themes. Western Folklore, 19(3), 155-168.

McGoldrick, M., Giordano, J., & Garcia-Preto, N. (Eds.). (2005). Ethnicity and family therapy. Guilford Press.

Ricciardi, G. (2006). Telling Stories, Building Altars: Mexican American Women's Altars in Oregon. Oregon Historical Quarterly,107(4), 536-552. 

Vallejo, C. (1993). “Los heraldos negros/The black riders.” Neruda and Vallejo: Selected Poems. Trans. Robert Bly. Boston: Beacon Press.