Cultural differences among individuals must be recognized in order to create an effective match between those who deliver services and their clients. There are three important cultural values that have been emphasized in research in terms of their potential to influence mental health outcomes for Latinos: familismo, personalismo, and respeto. Ideally, each of these values is implemented into models of prevention and early intervention for Latinos.
For Latinos, the contributions of the extended family are an essential part of individual and family wellness (Cabassa, 2007; Snowden, 2007). As such, this cultural value focuses on family cohesion and is a critical factor for providers to consider when working with Latino clients and families. In order to assess mental health help-seeking behaviors among Latinos, researchers and providers alike are called to also evaluate the extent to which the role of family support impacts the individual’s perception of their presenting problem. For example, Latino clients may approach the counseling office only after being told by family members/ friends to seek professional help. In other words, self-perception and family/social perception of need for care are both important predictors of service use, and, perhaps, of engagement. Consequently, Latinos in need of services may be more receptive to the advice of friends, family, and community leaders whom they trust and confide in.
A way of being and interacting within interpersonal relationships, personalismo is central to Latino culture. This personal approach to communications emphasizes warmth and leads to trust. Therapists who recognize the importance of honoring the cultural value of personalismo may find themselves venturing outside of expected ethical behavior for providers. For example, Latino clients often times expect some level of self-disclosure from their therapist before themselves opening up. Likewise, acceptance of small gifts and physical touch are also elements of personalismo that are important to developing and maintaining a therapeutic alliance that is built on trust. Practitioners offering culturally sensitive therapy should be prepared to have their conceptions about what constitutes elements of dual-relationships challenged. By accepting either, and always within the proper ethical boundaries, therapists are contributing to the preservation and strengthening of the alliance and exhibiting multicultural competency.
The value of respeto customarily places emphasis on authority figures within and outside of the family. For example, ultimate decision-making power is given to parents, grandparents, and other elders, but also to teachers, healthcare providers, and government officials. In counseling, the client may be hesitant to disagree, express doubt or concern, or even speak up about their confusion related to any or all parts of the treatment process. In some cases, even attrition may be likelier than bringing questions to the therapist. The mutual regard that develops between Latino consumers and their providers requires that therapists gain an understanding of the hierarchical system within the culture. Therefore, providers will benefit from paying particular attention, during the assessment and throughout treatment, to the established structure as it relates to gender or generational hierarchy. Therapists who wish to work with Latinos and ensure compliance with treatment and retention must use active listening skills as well as ask questions to ensure that he or she has a clear picture of the client’s individual perspective and experience regarding this and other important values.
In the context of families, respeto emphasizes obedience and delineates the boundaries between children and parents. Cross-cultural studies (Harwood, 1992; Harwood, Schoelmerich, Schulze, & Gonzalez, 1999) have observed, for example, that Latino parents are more likely to socialize their children to be respectful by asserting parental authority, discourage autonomy and exploration, and use physical restraint. By comparison, their white counterparts model, praise, and suggest as opposed to using direct mediations in parenting. Clinicians will need to adjust their own views of parenting and be able to incorporate more traditional Latino views into interventions.
Religion and Spirituality
It has long been established that religion and spirituality can provide support and help individuals and families deal with different challenges, including mental health conditions. According to the Pew Research Center (2017), about 55% of Latino adults identify as Catholic, 22% as Protestant, and less than 18% are religiously unaffiliated or identify with other non-Christian religions. Although these numbers continue to change as Latinos continue the journey of acculturation, 91% of Latinos state that religion is important to them.
In addition to ascribing to mainstream religions, many Latino subgroups also include elements of spiritual and folk healing. Curanderos, Santeros, and Espiritistas represent folk healers and religious/spiritual belief systems. Curanderos are often called on to treat physical, mental, or spiritual ailments using herbal remedies, messages, and cleansing rituals. Santeros are also folk healers, and blend African and Catholic beliefs usually practiced by Cubans and other Caribbean ethnic groups. Espiritistas are healers who primarily treat mental illness and is a term used primarily by Puerto Ricans. This belief system includes reincarnation and mediums. Latinos are likely to seek help from primary care providers for most illnesses, including mental and emotional concerns, but in many cases, they may also turn to clergy and folk/spiritual healers in conjunction with or as an alternative to Western care. Therefore, clinicians must be informed about how Latino cultural values and attitudes are often heavily influenced by spiritual beliefs.