Latino/Hispanic AmericansCritical Incident Case #4 Multicultural Counseling Dr. Adekson June 10, 2008 Priscilla Edwards, Veronica Williams and Mari Howard
Critical Incident #4 During family therapy, a Puerto Rican mother indicated to her son, “You don’t care for me any more. You used to come by every Sunday and bring the children. You used to respect me and teach your children respect. Now you go out and work, you say, always doing this or that. I don’t know what spirit (que diablo) has taken over you.”
Hispanic Americans Today • Approximately 35.3 million people self-identify as Hispanic Americans. • This number is expected to increase by over 97 mullion by year 2050. • Over 60% of Latinos live in California, Arizona, New Mexico, Colorado, and Texas • Only 56% of Latinos (over 25) have completed high school.
Hispanic Family Values • Implications Resources from the extended family and close friends must be exhausted before outside help is sought Emotional involvement and obligations with a large family may function as additional stressors Family relationships are of most importance and decisions may have negative impacts Differ in process of mediating disputes Indicates the need to adapt mediation procedures
Hispanic Acculturation Conflicts • Conflicted with maintaining traditional orientation and assimilating to values of the host culture. • Bicultural individuals appear to fair better due to ability to accept and negotiate aspects of both cultures. • Few Hispanic American role models.
Common Themes in Hispanic Culture • Family tradition is one of the most important aspects of Hispanic culture (familismo). • Traits such as respect and loyalty are stressed amongst members. • Hispanics tend to be cooperative with family members rather than competitive. • Hispanics tend to be religious, prayer plays a major role in Hispanic life. • Hispanics also focus on the present rather than the future, counseling needs to happen in the here and now.
Counseling Hispanic Americans • Hispanic families follow a hierarchical familial model. • Special authority is given to the elders and males (especially fathers). • The roles of women and children vary from nurturers to providers. • A majority of Hispanic problems come from exterior sources including: • homelessness • unemployment • poverty
Counseling Hispanic Americans • It is essential to fully assess the sources of the client problems before engaging in the therapeutic process. (ie.) recommending medication. • Finding ways to help female clients empower themselves without causing issues amongst the family (especially the male dominate figure.) • Utilizing an Existential approach to therapy is ideal with this population • Other things that may help the counseling process with Hispanic clients: • Find positive role models • Helping them network (if necessary) • Discussing short term goals (limit sessions if possible) • Musical Therapy • Family Therapy
Counseling Hispanic Americans • Building rapport is paramount to the client-counselor relationship, trust is a key factor. • Help them assess problems from outside sources. (Be an advocate when necessary).
Client Demographic Information: CLIENT ONE: Name: Carmen Mendoza Address: 243 Hagen StreetBuffalo, NY 14215 Phone: 893-1252 DOB.: 8-13-59 Chronological Age: 49 Grade Level Completed: Eighth grade Date of Initial Interview: May 12, 2008 Present for Interview: counselor and Carmen CLIENT TWO: Name: Miguel Mendoza Address: 260 Colonial Drive Hamburg, NY Phone: 856-1212 DOB: 6-18-75 Chronological Age: 33 Grade Level Completed: Juris Doctorate Date of Initial Interview: May 26th, 2008 Present for Interview: counselor, Miguel and Carmen
Reason for Referral: Identification of the problem: Family issues due to the mother’s (Carmen) perspective that her only son (Miguel) is not only upholding traditional family values. She is feeling ostracized from him and his family and believes that his work is taking precedent over his family obligations. Carmen came to counseling alone at the urging of her family practitioner. Miguel later agreed to come to counseling to appease his mother. Carmen’s priest acknowledged and supported her physician’s referral.
History of Problem: Father, mother (Carmen) and son (Miguel) moved to the United States when son (Miguel) was 5 years old. Father died in an automobile accident when son was 7 years old. Upon their arrival in the United States mother spoke no English, only Spanish is spoken in the home. Son (Miguel) adapts to the English language very well. Mother (Carmen) is forced to learn the language in order to provide for herself and her son. Mother (Carmen) is forced to enter the workforce shortly after the death of her husband. She is bitter over the circumstances she has found herself in. Mom’s world revolves around Miguel and she is finding it difficult to allow Miguel to fully participate in American society. Miguel was determined to do so. Miguel was a very dedicated student who excelled in academics. He graduated with honors with his Juris Doctorate. He is a practicing criminal attorney, striving to make partner in a prominent law firm. He is very dedicated to his family and wants to be the provider that his father was unable to be due to his untimely death. Miguel’s wife, Sela, is very supportive of his career and is very involved in the lives of their two children. As is consistent with the Hispanic culture, Sela values the opportunity to be a full time mother and nurturer of her children.
Educational History: Carmen: Degrees or Diplomas: none Behavioral Issues: none Hx of Learning Dis.: noneMiguel: Degrees or Diplomas: BS, MBA, JD Behavioral Issues: none Hx of Learning Dis: none
Family History: Carmen: Lives alone Miguel: Wife Two children: boy (4) girl (3) Medical History: Carmen: Prior Mental Health treatment: none Current Medical Problems: lack of appetite sleep deprivation irritability fainting spells Previous Medications: none Substance Abuse: none *total hysterectomy at age 20 due to female issues
Miguel: Prior Mental Health treatment: none Current Medical Problems: none Previous Medications: none Substance Abuse: none Employment: Carmen: hotel laundry Miguel: criminal attorney Quality of friendships: Carmen: is somewhat reclusive, she has a few acquaintances at work that she refers to as friends. She enjoys few social outlets. Relies heavily on next door neighbor for friendship and support. Depends heavily on Miguel for social connectedness. Miguel: has a very outgoing personality. He has many friends in many social circles. He has a family membership to the local country club. He feels a strong family bond to Sela’s extended family. He has strong relationships with two college friends that are considered part of his extended family.
Support Network: Carmen: neighbor, Miguel, Priest, Co-Workers Miguel: strong supports both at work and socially. Strong immediate family support from Sela and their children as well as Sela’s extended family. Miguel has many friends, who are very dedicated to their friendship and enjoy reciprocal relationships with him. He is very involved in the local community and spends a great deal of time volunteering for non-profit organizations. Miguel is also involved with his church and has a nice relationship with his parish priest. • Results of Mental Health Status Exam: Carmen: Speech: coherent Appearance: withdrawn, irritable Demeanor: reluctantly cooperative Dress and Hygiene: clean, well-groomed Behavior: polite but closed Relationship to counselor: doesn’t appear to be overly happy to be here Miguel: Speech: coherent Appearance: confident, talkative, open Demeanor: cooperative Dress and Hygiene: clean, well-dressed Behavior: well-mannered, engaging Relation to counselor: appears to be willing to receive counseling to appease Carmen
Mood: Carmen: Symptoms of Depression: yes Fatigue/Lethargy: yes Irritability: yes Chronic tears: at times Withdrawl: none Anhedonia: yes Evidence of suicidal ideations: none Previous hx of suicidal ideations: none Evidence of risk: none Evidence of mania/hyperactivity/attention problems: none Miguel: Symptoms of Depression: none Fatigue/Lethargy: none Irritability: none Chronic tears: none Withdrawl: none Anhedonia: none Evidence of suicidal ideations: none Previous hx of suicidal ideations: none Evidence of risk: none Evidence of mania/hyperactivity/attention problems: none
Symptoms of Anxiety: Carmen: Obsessive Compulsive patterns: none Chronic worry: yes, she worries about losing her son and her grandchildren no identifying with their Hispanic culture. Panic attacks: none PTSD: none Hx of physical/sexual abuse: none Miguel: Obsessive Compulsive patterns: none Chronic worry: yes, constant worry regarding life balance with work and obligations to family. Recognizes that Carmen is often upset and depressed due to his inability to fulfill the obligations she feels should be his priorities. Panic Attacks: none PTSD: none Hx of physical/sexual abuse: none Evidence of Thought Disturbance: None noted for either client
Diagnosis: Given the information provided during assessment, there is evidence that Carmen is experiencing serious depression. Miguel appears to be suffering from anxiety directly correlated to his relationship with his mother, Carmen.
Treatment Plan Presenting Problem: Carmen feels uninvolved, isolated, and unappreciated.
Problem: Mother feels son is not putting the family first, as her cultural values would expect him to. Goal: Assist mother and son with strengthening their relationship. Interventions: 1) Begin first session by asking client how she would like to be addressed: (ie.) Latina, Hispanic, Puerto Rican. 2) Explain your role as a counselor and what counseling is. Keep an objective position, don’t be judgmental-remain neutral but have empathy. 3) Explain that your knowledge of the clients culture is limited, but that you are very willing and interested in learning more in order to be more helpful and understanding of their particular needs. 4)Ask the client to talk about their perception of counseling and any hesitations they may have about being there. 5) Ask client to share with you what they hope to gain from the counseling sessions and what expectations they have of you as the counselor.
6) Determine through conversation if the client is expecting medication to alleviate their stress. Explain that although it may be an alternative at some point, it is likely not a treatment method that will be utilized immediately but will be evaluated for us over time. Failure to address this issue may lead the client to believe the counselor is not a good healer. 7) The counselor should explore the client’s commitment level to spiritual factors. Many Hispanic clients believe that spiritual factors can cause emotional problems (including the susto or a magical fright, the mal puesto or the hex, and the mal de ojo or evil eye). The information obtained should be used to facilitate the assessment and treatment of clients holding these beliefs. In addition, the counselor should explore the clients religious involvement. 8) Determine the clients country of origin, ethnic identification, degree of acculturation, language preference, length of stay in United States, migrational history of the client and her family, nuclear and extended family composition.
9) Acknowledge the culture-specific value among Latinos of familism. This is the strong identification with and attachment to both nuclear and extended family members. Acknowledge to your client that this value produces strong feelings of loyalty, reciprocity and solidarity among members of a family. Express your understanding that these (3) value orientations accompany familism: a) a perceived obligation to provide material and emotional support to the members of the extended family. b) The reliance on relatives for help and support . c) The perception of relatives as behavioral and attitudinal referents. 10). Express your understanding of collectivism which is also a central value in the Latino culture. This value empathizes: a) interdependence b) field sensitivity c) conformity
d) Mutual empathy e) Willingness to sacrifice for the welfare of others f) Trust members of the group. Discuss the clients perspective on collectivism and how much it influences his/her thoughts and actions.
Problem: Mother feels son is not putting the “family” first. Goal: Reach an understanding with son on how they can improve their relationship. Interventions: • With clients permission, invite son to join the counseling process. • Allow mother (Carmen) and son (Miguel) to speak about the nature of their relationship. (Positive and negative aspects). • Ask mother to spend some time between sessions making a list of the things she would like her son to do for and with her that would make her feel better about their relationship. • Ask the son to do the same. • At following session, allow some time at the beginning of the session to recap the previous session, ask each client if they would like to add anything. Ask each party to read through their list of ideas for strengthening the relationship and give one another respect by listening without comment while each of them share their lists.
Attempt to facilitate a collaborative effort to narrow the lists of both parties and devise a plan of action that both parties can agree to going forward. • Be prepared for a great deal of discussion around the following points: * How important is this relationship (mother/son) to the two of you? * How much effort are you willing to put into a resolution to these bad feelings? * What misperceptions might each of you have with regard to each others ability to fulfill your expectations?
Problem: Mother believes son is not making discipline of children a priority. Goal: To assist mother in recognizing her cultural perspective (machismo, respeto, etc.) on gender roles is directly correlated to her lack of acculturation as compared with her son. • Discuss why she feels the children are not being taught respect. • Assist mother with acknowledging the role of son’s wife (Sela) and her dedication to the children and their up-bringing and the differences between the perspective of paternal authority is Puerto Rican culture versus the gender roles in United States culture being blended. • Ask mother to cite specific examples of when the children showed disregard for respect and how she would liked to have seen it dealt with. Explain the role of parents in partnership in the United States culture. • Ask mother to describe occasions when the children showed respect and assist her with understanding the expectations of children who are 3 and 4 respectively.
Problem: Mother doesn’t feel that son loves her as a son should love his mother due to his lack of attention and dedication of time with her. Goal: Assist mother with understanding son’s level of acculturation and his perspective that he is showing his love for her by striving to be as successful as he can so he can provide (financially) for her future and the future of his wife and children. Intervention: • Discuss the expectation in Puerto Rican culture that we are defined by who we are, not what we do, the “value of time differential” between cultures and the expectations in the United Stated culture to plan for the future and future needs of the family versus the living for today culture of the Puerto Rican culture and all the associated perspectives that this might evoke emotionally. • Ask both parties to discuss their feelings on these issues and devise a plan with the counselor’s assistance to work on a “wish list” to alleviate the bad feelings that are generated as a result of the “cultural” differences.
Discuss that it’s okay to have differing perspectives and that finding a common ground to remedy the situation will assist each of them with feeling better about themselves and one another. The counselor may suggest some possible ideas. Such activities as: 1) Attending church as a family 2) Sharing dinner together on Sundays 3) Inviting mother to share in the children’s school activities and social activities 4) Expose mother to son’s work life through a tour of the office or an office gathering. 5) Depend on mother to assist with children whenever convenient for both parties.
Problem: Mother feels that son has allowed too much western influence into his world and that of his children and he is at risk of losing his Hispanic culture. Goal: To assist mother with recognizing that Miguel’s cultural heritage is important to him and that he would like her to recognize that he maintains a “delicate balance” between the two (bi-cultural) cultures with which he identifies. • Assist mother with accepting Miguel’s biculturalism by understanding that he speaks Spanish with her exclusively and he and Sela are teaching their children Spanish as well as English. • Expose mother to some of Miguel’s social circle, inclusive of wife’s Puerto Rican family and friends. • Assist mother with recognizing that she is living in isolation and depending on Miguel to provide her with her life connections. Provide an opportunity for discussions about mother’s interest in participating more fully in her community.
Involve mother’s parish priest (with her permission) in the discussions. Perhaps assisting mother to connect to her “parish family” will fill the void she feels by being isolated from her extended family back in Puerto Rico. Often a family of choice can provide much needed support when a family of origin is lacking. The Catholic Church connection may be just what she needs to gain a healthy perspective on Miguel’s dedication to her and his family and the misperceptions of her worldview. • Mother may also join a social club, a card club, a cultural social group, or get involved with her grandchildren’s activities to feel more connected and complete.
Guidelines for Clinical Practice Engage in respectful, warm and mutual introduction w/client Give brief description of what counseling is and the role of each participant Explain notion of confidentiality Have client state in his own words the problem as they see it Assess acculturation level Consider if there are cultural or societal aspects to problem Determine positive assests and resources available to the client and family
Guidelines for Clinical Practice Help clients prioritize problems, determine what they perceive important Discuss possible participation of family members, consider family therapy Assess possible problems from external sources Explain treatment to be used Determine mutually agreeable length of treatment Personalismo Evaluate the effectiveness of therapy
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