Jay Carmona was 12 years old when he experienced his first anxiety attack. He was given Xanax after his mother took him to the hospital. Following a second attack, hospital tests detected both marijuana and Xanax in his system. The doctor attributed the anxiety attacks to marijuana use and referred him to rehab. However, when the rehab determined that drugs were not the cause of his anxiety attacks, Carmona was paired with a white therapist for further treatment.
“Whenever a topic would be brought up that was very culturally specific to being Hispanic, I would have to stop the therapy session and explain to them what that meant,” Carmona said. “When I was young, I didn’t fully comprehend the significance of a therapist comprehending my cultural background.”
Carmona talked to his therapist about verbal and physical abuse in the family and tried to open up to his family about his depression, but his attempts were met with dismissal. This is a common experience in many Hispanic households due to the belief that depression is not a real condition.
The therapist prescribed Carmona various medications and urged him to establish boundaries with his family. After one year, Carmona requested a new therapist and went through the cycle again until he found a Latino therapist who was able to offer the help he needed.
Carmona’s case is very common. Many therapists misdiagnose or provide inadequate care to Latinos because of poor training in how to engage with patients from different cultures, or a lack of initiative to incorporate these principles into their practice. By embracing cultural diversity and integrating culturally responsive practices into their approach, therapists can foster a more inclusive and effective therapeutic environment for Latinos, promoting mental health and well-being within the community.
Therapy designed for white patients
According to a 2006 paper, non-Latino white cultural traditions in the United States, which prioritize individualism, autonomy, and competition, may be at odds with the collectivism, interdependence, and cooperation emphasized in Hispanic cultural traditions. For some clinicians whose cultural values clash with their patients’, they actually view cultural differences as deficits, which makes them more likely to inaccurately diagnose their patients.
When they aren’t adequately knowledgeable and attuned to Latino cultural values, therapists may also offer recommendations that are incompatible with or dismissive of their patients’ needs. For instance, a white therapist, influenced by individualistic cultural norms, might prioritize independence and self-reliance, overlooking the familial and community support and collaborative problem solving that are deeply valued in Hispanic culture.
Perhaps because of this, Latinos rarely seek psychotherapy and are only half as likely to utilize mental health services as their white counterparts—and when we do, we are more likely to drop out quickly. Furthermore, Latinos are twice as likely to be hospitalized in restrictive psychiatric facilities, which are reserved for acute and severe cases, compared to non-Latino whites. This may stem from a reluctance to seek care earlier in the course of illness due to issues like stigma, language barriers, financial constraints, and a lack of awareness about available resources. The scarcity of culturally responsive therapy is only part of this picture, but it is an important part.
“Our models of treatment are based on a lot of whiteness, and our treatment assumes a lot of privilege—this isn’t working for poor folks or marginalized communities,” says Marcella Raimondo, a clinical psychologist in Kaiser Permanente’s eating disorder clinic in Oakland. “We need to spend more time bringing in voices that we don’t usually hear and talk about what that treatment would look like.”
Culturally competent therapy for Latinos
In order to provide effective care to Latinos, therapists must prioritize services that reflect the diversity of Latino experiences. And to do so, researchers suggest that two approaches—cultural competence and cultural humility—are key.
Cultural competency involves having knowledge of and understanding cultural differences and being able to adjust your approach with people accordingly.
For example, a therapist may work with a Latino client who values strong familial connections and collectivism. Understanding this cultural context, the therapist may emphasize the importance of involving family members in the therapeutic process to support the client’s well-being. Additionally, the therapist might adapt their communication style, using more indirect and contextual cues, to align with the client’s cultural norms and preferences.
Clinicians can also demonstrate culturally competent techniques by acknowledging the racism and discrimination clients face. For instance, they might support Latino clients in challenging stereotypical beliefs associated with their ethnic group, including those influenced by the U.S. majority culture (e.g., valuing lighter skin as more attractive) and Latin American culture (e.g., marrying someone with lighter skin mejorar la raza, to “improve the race”).
In 2017, a study examined 12 non-Latino white counselors who demonstrated proficiency in working with diverse cultures. All the counselors shared their own experiences of feeling different and encountering discrimination based on factors such as gender, sexuality, religion, social class, language, and nontraditional family structures. For many, the development of their multicultural awareness—one aspect of cultural competence—stemmed from the intersection of their marginalized and privileged white identities. Participants noted that their own encounters with being different provided a firsthand understanding of the daily realities faced by individuals with diverse underrepresented identities.
By demonstrating cultural responsiveness and adapting their approach, therapists can foster a stronger therapeutic alliance, enhance trust, empower clients, and ultimately provide more effective and meaningful care for them.
Culturally humble therapy for Latinos
At times, however, the practice of cultural competency may risk perpetuating stereotypes or power dynamics between the provider and the client—particularly if the therapist assumes an all-knowing stance about a culture and imposes their belief about what is best for the client. Many therapists prefer to practice cultural humility instead because of its focus on being aware of their own cultural biases, fostering a deeper understanding of clients’ experiences, and promoting more collaborative, client-centered care.
Cultural humility emphasizes how difficult it is to truly learn about and understand all other cultures and the experiences of people from them. So, instead, this practice involves reflecting continually about your mistakes and biases, recognizing and addressing power imbalances, and acknowledging your limited expertise about an individual’s culture and experiences.
For example, through a culturally humble approach, a therapist could recognize their own limitations and biases while working with a Latino client who values strong familial connections and collectivism. They could then actively listen, seeking to understand the client’s unique cultural context and its impact on their well-being. The therapist could openly discuss potential disparities in communication styles, inviting the client’s guidance to adapt their approach and continually learning from the client’s insights. Again, the aim is to foster trust, mutual respect, and more effective and meaningful care tailored to the client’s needs and culture.
In that 2017 study, the 12 non-Latino white counselors also shared their experiences of learning to acknowledge their limitations and embrace a sense of humility while working with clients. This openness to recognizing areas of uncertainty made them more receptive to new learning and more aware of their own boundaries. They emphasized the importance of being humble enough to admit ignorance as a crucial factor in their effectiveness as counselors. Furthermore, several participants recounted moments when they were humbled by the realization of the limits of their competence in fully meeting the needs of their clients.
As one clinician in the study pointed out, it’s a lifelong learning process. “I don’t think you ever come to a point where we could say, OK, now I’m so-called ‘competent’ . . . . I’m always going to be in this struggle to have to watch myself, to be vigilant towards myself, and to try and understand what my role is in perpetuating that kind of oppression.”
“Cultural humility is entering a relationship with the intention of honoring [a patient’s] values and beliefs [as well as] acknowledging differences and accepting people for who they are,” says Bianca Barrios, Undocumented Students Program staff psychologist at UC Berkeley. “Integrating a person’s values, practices, and beliefs into a treatment plan not only allows for the person to feel seen and respected, but it increases adherence to the plan because it makes sense to them.”
Improving Latino lives
In Carmona’s experience with a Latino therapist, the therapist was able to grasp the significance of his cultural values and integrate them into an effective treatment plan.
Recognizing the importance of family dynamics, the therapist encouraged and facilitated a conversation among Carmona’s family members regarding his depression. By involving the family in this way, the therapist acknowledged the collectivistic nature of Carmona’s culture, understanding that familial support plays a crucial role in his mental well-being.
Furthermore, the therapist prescribed medication that was specifically tailored to Carmona’s needs, taking into account cultural considerations and sensitivities. This personalized approach acknowledged the potential impact of cultural factors on Carmona’s response to medication, enhancing the overall effectiveness of his therapy. Although it took time, finding the right therapist with the right approach made all the difference for him.