Embracing Latin America's Nuances

Latin American Culture Often Poses Challenges For Counselors, But It Also Provides Valuable Lessons

By Stacy Notaras Murphy, M.S.

A female Latino client visits a counselor for an initial session. She asks direct questions about a specific dilemma and details her plans to seek additional input from her doctor, priest and godparents. The client thanks the therapist, leaves and does not return.

Many counselors might consider this a failure. But according to Esteban Montilla, the client's Latin American heritage suggests there might be more to the story.

Counselors should not necessarily expect a traditional treatment process to unfold when a Latino client comes seeking help, says Montilla, an American Counseling Association member and director of Clinical Pastoral Education at Driscoll Children's Hospital in Corpus Christi, Texas. "What I've found in the Latino community, both in the U.S. and in Latin America, is what we call 'intermittent counseling,'" Montilla said. "When you go once, spend two hours with the counselor, you get the idea and then continue to work on that idea with some other member of the community - with physicians, with healers, with family members. One counseling session is very common."

Montilla advises that the customary counseling theory approaches frequently do not fit the Latino population. He added that counselors working with these clients often would do well to set aside their usual assumptions about human development and therapeutic alliance-building. "We have to be careful with the traditional counseling theories because most were created under a Euro-American perspective and the values are different," Montilla explained.

For example, he said, from the perspective of conventional counseling theories, a person's healthy development relates to self-actualization. "With [developmental psychologist Erik] Erikson's movement toward autonomy, you demonstrate that you have developed well when you are autonomous," he said. "But in the Latino community, you demonstrate that you have developed well when you can live with the others, when you can respect the family members, when you can relate within a community and respect its authority. It's a whole different view of development."

On the topic of building a strong therapeutic alliance, Montilla recommends being more action-oriented with
Latino clients. "In terms of counseling technique, certainly it is important to include the listening, understanding, validating," he said. "But you need more than that. You need a little bit of action. You need the Rogerian approach, but if you stay there, the consultee might think you don't know very much about his problem. You need to offer ideas and work together. It needs to be a more collaborative process."

An ACA action item

Not enough counselors understand the nuances of counseling in Latin America or working with Latino clients, but ACA President Patricia Arredondo hopes to change that by focusing on the region during her tenure. "The largest population of new immigrants to the United States is coming from Latin America," she said. "We need to better understand places of origin and what that means for those who are preparing counselors who are going to work with a really multicultural and diverse population of people."

Specifically, Arredondo noted the growing trend of partnerships between U.S. and Latin American counselor training programs. "Quite often individuals who are becoming leaders in [Latin American counselor training] programs have some connection to ACA or have had some training in counseling in the United States and want to bring these programs to the population," she explained.

In order to potentially cultivate these partnerships, Arredondo commissioned the Task Force to Explore Opportunities for ACA in Latin America. Still in the fact-finding stages, the task force members are compiling data for a report to be released later this year.

"Without raising expectations that these things can be done, the next step very possibly would be to see if there are places where we can engage in more partnerships," Arredondo said. "Maybe we can find potential new ACA members in training programs in, say, Argentina and Chile. Maybe there's an association of counselors in Venezuela that we could somehow sign on as a branch. Maybe the training programs have needs and we could partner with them to use some of our existing materials. Maybe someone would want to write a counseling theory book in Spanish. There are so many possibilities."

Task Force Chair Andrés Consoli, an associate professor at San Francisco State University and president-elect of the Interamerican Society of Psychology, noted that the group's first step is simply to get an account of the numerous programs already in operation. "It's my sense that there are many efforts throughout Latin America," he said, "but they're not necessarily knowing of each other or coming together in any fashion, which is always a real challenge. It's a huge geographical area with millions of people, which makes it really difficult to know what is going on. Part of the hope of the task force is to get enough of a sense of what is going on so that ACA can begin to think of building bridges and networks."

Lost in translations

To that end, Consoli's task force is networking to gather information about various training programs and counseling associations in Latin America, as well as seeking out books, articles and websites about counseling in the region. As he explained, simply compiling a list of Latin American counseling terms has become a major task.

"Part of the challenge in Latin America is: 'What word would people use in Spanish to capture the concept of counseling?'" Consoli said. "There's really no easy translation." He added that one of the task force's first initiatives invited counselors to identify how they define counseling. "In some countries, the word counseling translates as consejeria, but that is really a direct translation of English and is not necessarily understood as what we mean by counseling. Another translation for counselor could be consejero, but consejero is really more along the lines of an 'adviser,'" he said.

Some of the confusion comes from the fact that, depending on the locale, Latin America offers numerous approaches to counseling specialization and qualification. On the whole, mental health work in the region has taken place either in a professional, psychoanalytic environment or via a collection of community-based operations, including schools, religious organizations and government programs.

"Psychology has been much more popular in Latin America than has been counseling," Arredondo noted. "The focus on counseling has come principally by European-trained psychologists. Psychology is considered a science, and that fit in with psychology becoming a discipline of study in Latin America, but with a greater focus on psychoanalysis as the modality of treatment."

Psychology degree graduates traditionally have conducted vocational counseling in schools in countries such as Argentina, Chile and Uruguay. While a number of new counselor training programs have launched in Latin America during the last 15 years, those graduates must compete against career "coaches" and consultants when building their practices. Consoli said that by building educational partnerships in Latin America, ACA can support counselors while also learning new ways to apply counseling principles in other areas.

"We are seeking to be respectful of what already is happening in those countries and to see to what extent that can dovetail with some of the things that are being done here," Consoli said. "It's not like we're going to take this to Latin America or we're going to bring from Latin America what's there. There will be overlap, but we also know there are significant differences from which we all can learn." For example, he noted that family therapy and group therapy conventionally have been valued interventions in Latin America, with some of the groundbreaking work being done by Latino counselors who have taught their skills in the United States.

Strength from the family

"There are very significant strengths in Latin America, things we can learn from here," Consoli said, "especially along the lines of values. For example, family and friendship are very significant values in Latin America. The family is not only defined as the nuclear unit but by the extended family, and that has been a very significant buffer to the other challenges people face in these countries. Even though people may not have jobs because unemployment is high, people have learned how to share limited resources. Even though the financial resources are limited compared to those in the U.S., I would say that human capital in Latin America is phenomenal. The richness of human contact is immeasurable."

Consoli's own education was made possible through the power of the collectivist spirit in Argentina. "The library at my university only had 300 volumes," he recalled. "The only library of any consequence was the Library of Congress, but due to the military dictatorship, you didn't have access to the stacks. What I learned was that in order for me to read, I had to rely on someone to share with me. Many times it would be people who had gone overseas, or somebody who knew someone who had gone, and on and on. In order to have meaningful access, people learned that they'd have to share. Otherwise, you won't have it. People have to make ends meet with the little that they have."

By considering the strengths of Latin American cultures, Consoli believes counselors can make inroads. "The emphasis in counseling, as opposed to the emphasis in clinical psychology, is on cultivating the strengths of this person," he said. "We ask, 'What does this person have going for herself?' not 'What's wrong with this person?' Counseling as a practice really dovetails nicely with some of Latin America's historical values."

Montilla noted that counselors working with Latino populations can draw on a client's community as an asset in their work. "Latinos, by nature, are very relationship-oriented, community-oriented," he said. "Because of the idea of a collectivist society, the idea of self-help is not much out there. It's very common to seek help; the difference is from where you seek that help."

Montilla advises that "becoming part of the family" should be a key goal in counseling Latino clients. "It is from the family that we draw our strength, it is in family where we celebrate our achievement and where we lament our losses," he explained. "We get sick in family, and we get healed in family. You don't want to betray the family by telling a stranger about your personal story and family struggles. When the counselor becomes a family member by offering an environment of trust and respect, they become more effective."

"It's not just two people coming together, but a community coming together," Montilla continued. "When you are counseling in the U.S. and you see one Latino [client] there, with that one person there are at least 10 people also present. They may not be in the room, but they very much are part of the person's life. You have to keep that in mind when you counsel people in the community."

Global factors

U.S.-based counselors encountering a growing Latino client population should be sensitive to the way economic challenges are changing the Latino family structure. "The traditional idea where the wife stays home and the husband works is not common anymore," Montilla said. "The two of them are working. It's not negative in most cases. Many enjoy the space. When they come together they reconnect in a powerful way, but that is a factor that presents itself in the counseling room."

As a result, many clients come to Montilla facing marital problems, sexual dysfunction, anxiety disorders and discipline issues with children. He also reports their openness to combine medications with counseling treatment, as many Latino counseling clients first approach physicians for assistance with emotional problems.

Montilla is writing a collectivist theory of human personality. He urges counselors to be sensitive around issues of differentiation. "If you read the close connections of most Latino families through the traditional theories of counseling, you might see pathologies," he said. "For example, the mother will check on the adult daughter by calling three or four times a day. Some people might say those people are enmeshed or fused. They might see that as pathology and then work hard to help this person differentiate, to individuate and to separate in order to become an autonomous person. But that really could be destructive to what the person is all about."

Consoli noted that economic globalization is changing Latin American cultures as much as Latino immigrants are changing the United States. "In both situations, people are struggling with making sense of collectivist traditions running into capitalistic values - the power of one as the unit of analysis as compared to the family as the unit of analysis," he said. "People are finding themselves challenged by these changes. This creates more of a need for counseling, but a counseling model that is not extreme in one way or another - not just collectivist or just individualist. It has to be something that transcends that dichotomy."

For a culture so devoted to family and community, effective integration may be a healthier goal than acculturation or assimilation. "There's quite a bit of research indicating that the people who achieve some degree of integration tend to be better off across all kinds of health markers," Consoli said. "Integration is an affirmation to both - that is, my culture of origin and my host culture. My sense, and the sense of the task force, is an affirmation that culture is not static. Culture is an evolving phenomenon. We are transforming each other through our dialogue, and we can't be the same afterward."

This article originally appeared in the January 2006 issue of Counseling Today, the monthly newspaper of the American Counseling Association (www.counseling.org).