The number of Mexican immigrants is growing rapidly in the United States. While culturally sensitive psychological services may be a luxury in United States clinics, they are a necessity in places where Spanish-speaking peoples live.
Unfortunately, the number of Latino and/or Spanish speaking therapists is below the minimum needed, and even fewer therapists speak indigenous Mexican dialects. Thus, even if you do not speak Spanish or have no goal to ever speak the language, the odds are considerable that a Spanish-Speaking Latin American will cross your path. In this series, Counseling Mexicans, I will cover some issues that may help you in being more culturally appropriate regarding Latin Americans, especially those from Mexico.
I will first explore the term familismo, a value that refers to the development of close ties within the immediate and extended family of many Mexicans.
In the book Counseling Latinos and La Familia: A Practical Guide, the authors suggest that Mexican immigrants value interdependence versus independence and will seriously consider other members’ opinions in very personal issues. Mexican clients often can be hesitant to explore family problems in the session due to the fact that it can be seen as a betrayal to the loyalty fostered in a familismo setting.
In counseling literature, familismo is a descriptive concept free of judgment; however, in Latino countries, it can be a negative term for some feminist writers, who argue that familismo also fosters machismo and marianismo. These other two values will be addressed in future posts.
Some expressions of familismo are: young adults (both sexes) living at their parent’s home until getting married; newlyweds living in one of their family’s homes until they can afford their own place; personal problems solved by the entire family; and finally, important celebrations and decisions including the presence and opinions of the whole family.
The emotional benefits of living in a communal setting are early stages of depression and suicide ideations being less likely to develop, and divorce rates are considerably lower in such settings in comparison with societies that promote individualism.
I remember with nostalgia those days in Mexico when having a cold was a perfect time for having a movie marathon with friends rather than going to work. Friends were less concerned about catching my cold and more concerned about companionship; if one of them happened to catch my cold we then had another reason to watch more movies together. Now, in the United States, if I dare to have signs of an oncoming cold, I am socially confined, alone at my residence, answering e-mails or phone calls from friends who are on a tight schedule and would not be available to watch even one movie.
Examples of Familismo
Let’s use a Mexican client for an example, and I will call her Petra. If Petra feels depressed and asks her family for her to be left alone, she may alarm them and cause them to feel challenged to alleviate her sadness rather than leaving her alone. A common belief is that “being left alone is not good during tender times – it is not good for the soul.” This may sound awfully disrespectful at first, but there are positive things about it.
People with depression, like Petra, will have less opportunity to harm themselves and the positive presence of family members may even lower depression symptoms. Therefore, in familismo, opportunities to be antisocial are limited, because there is always a person around to make their life more enjoyable . . . or miserable. If, at this point, you argued about the dangers of cold viruses mentioned in the earlier example, then you now certainly have the right to argue for the downside of communal living when dealing with serious mental illness or intense emotions.
Yes, there is a downside! If somebody is struggling with serious depression or suicidal attempts, there is a likelihood of family members being burned-out or exhibiting other symptoms of stress. Therefore, if Petra’s case were more serious or prolonged, I would be curious about how her family members would deal with it and whether they would need help.
Now let’s imagine that Petra speaks English and comes to you. Do not be surprised if she has a hard time adapting to a stranger at the intimate level that a therapeutic process requires.
Who thinks about going to a counselor if there are family and friends willing to talk and provide company? Of course, the concept of paying for “talking to a person” is just nonsense. Once you gain Petra’s trust, she may consider you as extended family in the loose sense of the expression and may ask personal questions with no thought of violating therapeutic limits.
If Petra is an elder, you may get some “advice” from her, because in her eyes, you are younger and less wise than her, no matter how many degrees you may have. This does not mean she disrespects you. Rather, she is concerned about you, and you are no longer the “distant” physician who has all of the authority. Finally, do not be surprised to see her other family members in the waiting room, and Petra from time to time may ask if they can come inside without previous arrangement.
How Familismo can Work Against You
Familismo can work against progress if you show no respect for it. Sometimes sessions will be cancelled because family is coming to town or friends need extra help. For instance, if grandpa is in the hospital, all family members will be there for him. Individual sessions are less important than the larger group’s concerns. Cancellations may occur because they have a Quinceañera or a baptism or something similar. Family gatherings are extremely important.
In addition, if you dare to challenge an elder’s opinion or somebody with more hierarchy than your client in the session, you are taking the risk of competing for hierarchy and you may not have those strong points in your favor. My best approach in these cases is to help the clients come up with their own answers and let them challenge the group opinion themselves. After all, this is part of our unattached role as a therapist, is not it?
Other useful considerations to work with familismo are:
- Explain in detail the therapy rules that are important to you.
- Be aware of your gestures or responses to statements involving family members.
- Take time to get the whole picture before designing an intervention.
- Explain that you as a therapist have some tools that may offer a different perspective of family members and friends and it is okay to disagree with you.
- State clearly that independent thinking is not only allowed but also desired.
- Clarify your role as mandated reporter since bringing extra help from other agencies may be seen as betrayal of your loyalty to them.
With friendly reminders and education about therapeutic limits, most misconceptions will fade away.
I hope this post is helpful. Upcoming articles will be inspired by your questions or anecdotes sent to: firstname.lastname@example.org or comments on this page. I am looking forward to the next post.
Santiago-Rivera, A. L., Arredondo, P., & Gallardo-Cooper, M. (2002) Counseling Latinos and la familia: A practical guide. Thousand Oaks, CA: Sage.
Gil R.M., & Vazquez C.I. (1997). The Maria Paradox. New York, NY: Random House.
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