Interpersonal Therapy and Cultural Issues. The Case of Hispanic Patients
SAPANA R. PATEL AND ROBERTO LEWIS-FERNANDEZ
In 2002, Hispanics represented approximately 13% of the national population, becoming the largest U.S. minority group (Ramirez & de la Cruz, 2003). The majority of Hispanics in the United States were of Mexican origin (67%), followed by Central and South Americans (14%), Puerto Ricans (9%), Cubans (4%), and “other Hispanics” (7%; Ramirez & de la Cruz, 2003). A Surgeon General’s report concluded that, like other racial and ethnic minorities, Hispanics experience disparate mental health care compared to non-Hispanic whites (Department of Health and Human Services [DHHS], 2001). Although prevalence rates differ according to immigration status and levels of acculturation, mental disorders such as major depression are generally just as prevalent among Hispanics as among non-Hispanic whites (Kessler et al., 2003; Vega, Sribney, Aguilar-Gaxiola, & Kolody, 2004). The impact of major depression has been estimated to be a leading cause of disability worldwide (Murray & Lopez, 1996).
The minimal involvement of Hispanics in psychotherapy studies (Elkin et al., 1989; Navarro, 1993) has raised concern about whether empirically supported treatments such as IPT, tested mainly in samples of majority white women, apply to cultural minorities (Bernal, Bonilla, & Bellido, 1995; Bernal & Scharron del Rio, 2001; Miranda, Nakamura & Bernal, 2003). Clinicians need to adapt empirically supported treatments in order to meet the cultural needs of Spanish-speaking patients of varied national origins and to retain them in treatment. Several frameworks for adapting psychotherapy to culturally diverse populations exist. They begin by transforming knowledge about a patient’s culture into strategies used within the clinical encounter (Bernal, Bonilla, & Bellido, 1995; Bernal & Scharron del Rio, 2001; Comas Diaz & Jacobsen, 1987; Domenech-Rodriguez & Wieling, 2004; Hwang, 2006; Miranda, Nakamura, & Bernal, 2003; Rosello & Bernal, 1996; Sue, Zane, & Young, 1994). In this chapter, a brief literature review and case illustration will describe how IPT is compatible with Hispanic culture and can be adapted for working with Hispanic populations.