Despite the growing need for Spanish-language mental health services, there is a shortage of bilingual clinicians, as well as inadequate training for them [1,2].

Does this mean you have to brush up on your Spanish to provide Spanish-language services? Not necessarily.

Here are some helpful tips for working with Spanish-speaking patients if you don’t know Spanish. And if you do know Spanish but are hesitant to use it for clinical work, scroll down for tips to help make that transition as smooth as possible.

Tips for all Clinicians Working with Spanish-Speaking Patients

1. Stay focused on the patient when working with interpreting services.

There are several things you should keep in mind when using interpreter services in your therapy session.

Eye contact is key. It can be easy to look at interpreters when they are translating patient information. However, I would suggest making as much eye contact with your patient as possible, both when you speak and when you are listening to the interpreter. This will let your patients know that you are there for them and that you’re having a conversation with them and not the interpreter.

Speak slowly and in chunks. Interpreters have the challenging task of decoding one language, retaining that information, and reiterating it as precisely as possible in another. Do not overload the interpreter with too much information. This will ensure that all the information you said gets translated accurately.

Notice patient’s facial expression when they speak. Although you might not have verbal information while the patient is speaking, affective expression can still be valuable data. It can give you a sense of the severity and distress the patient might be feeling.

2. Help patients cope with not knowing English.

Imagine it’s vacation time and you travel to a foreign country where you don’t know the language. You can’t read road signs, so driving might be difficult. You can’t understand most of what’s on TV and if you decide to go to a restaurant, you can’t decipher the menu unless someone tells you what it means.

Now imagine that it’s not a vacation – it’s just a day in the life of you. It can be incredibly frustrating not being able to interact with your surroundings. These are just some of the things monolingual Spanish speakers struggle with on a daily basis. Fortunately, there are some things you can discuss during session that may help mitigate your patient’s frustration.

Encourage patients to expand their social networks with other Spanish-speaking individuals. Joining Spanish-speaking organizations or clubs can foster a sense of community. This can help offset some of the isolation they may feel being surrounded by an English-dominant society.

Suggest that your patient take an English as a Second Language course. Not only will this help them learn English, but it can also improve self-esteem and provide a sense of self-efficacy. It can feel alienating not knowing English, but understanding that they’re not alone can help validate the frustration that goes with not speaking English.

Validate their frustration. Let them know that learning a new language is hard – especially later in life. It can also be helpful to remind your patient that living a country where they don’t know the language speaks to their level of resilience. Recognizing this can help patients gain a sense of pride and fulfilment.

3. Pay close attention to culture-bound syndromes.

Culture-bound syndromes are clusters of symptoms that are more frequent in some cultures. Spanish-speaking individuals might reference an ataque de nervios, which is a condition in which patients experience intense emotional upset, including anger and acute anxiety. Patients might also experience uncontrollable screaming and shouting with attacks of crying, trembling, and aggressiveness.

Knowing when to spot ataque de nervios can be important as it can influence your treatment and diagnosis. For instance, knowing your patient is experiencing ataque de nervios and not panic disorder might allow you to incorporate techniques that manage aggression and dissociative symptoms, since these are more characteristic of ataque de nervios than panic disorder [3].

So what can you do to help identify an ataque de nervios?

Listen closely to how the patient describes symptoms. It can be difficult to differentiate ataque de nervios and other clinical diagnoses, such as panic disorder. Although there is substantial overlap between these conditions, some key differences in an ataque de nervios include dissociative symptoms, the occurrence of interpersonal disputes in activating episodes, and relief after experiencing an ataque de nervios [4,5].

In addition, there is some evidence indicating that somatization is quite prevalent among Spanish-speaking patients [6]. Therefore, if the presenting problem isn’t immediately clear and you want to parse out these symptoms from ataque de nervios, it can be helpful to inquire about the duration and frequency of somatic complaints. For example, you might ask how long and how frequently patients have had headaches, stomach aches, or back aches.

When using interpreter services, make sure to verify that the patient meant ataque de nervios and not a panic attack. Since “attack of nerves” is rarely used in English, some might translate ataque de nervios to panic attack. Simply asking the interpreter to clarify the direct translation can give you a better understanding of the patient’s description of symptoms.

In addition to asking the interpreter, ask the patient as well. Don’t be afraid to ask your patient if he or she meant ataque de nervios. Doing so can show that you are interested in your patient’s treatment and that you have gone the extra mile in learning about possible ailments that might be affecting him or her.

Tips for Spanish-Speaking Clinicians Hesitant to Provide Services in Spanish

1. Don’t be afraid to take that leap.

I’ve spoken to many bilingual therapists whose first language is Spanish, and yet they were scared to provide those services because they never had formal education in that language. Having the formal education in Spanish is useful, but not necessary. Although many clinicians practice in Spanish without formal training in that language, they must pass required Spanish fluency exams to work in schools or hospitals.

If you’re unsure about whether you’re ready to provide services in Spanish, I’d suggest first taking those exams. In addition, some fluency exams provide feedback about your proficiency so you can get a better idea of where your level of Spanish falls.

I also recognize that you might work in settings where Spanish-speaking therapists are not available or interpreting services are non-existent. In these situations, you might be implored by other professionals or supervisors to provide services in Spanish in order to meet patient needs.

If you find yourself in this situation, I recommend you weigh the ethical considerations at play. You should ask yourself:

  1. Are you competent enough to provide services in Spanish?
  2. Since there are no other Spanish-speaking therapists, would patients benefit from seeing you in the short term while searching for another Spanish-speaking therapist?
  3. Should you hold off on seeing Spanish-speaking patients because you don’t feel ready to provide such services?

These can be difficult things to grapple with and I strongly suggest you not worry alone. Speak to your supervisor about how ready you are and whether patients would benefit from waiting for more appropriate referrals.

2. Don’t fear not knowing the psychological jargon in Spanish.

Not knowing the technical terms was something that kept me from providing services in Spanish. In order to address that limitation, I created a running document of English to Spanish psychology terms and studied it every night. I’m not the first one to come up with this strategy. In fact, if you search online, there are countless free guides and workbooks that list those psychological technical terms for you.

Moreover, I would also suggest reading peer reviewed articles in Spanish. There are several psychology articles published each month in Spanish with valuable information that can help you get acclimated to the scientific terms. In addition to learning technical terms, you’ll also keep up with the current news in the field. Talk about two birds with one stone!

3. If you’re still unsure, take a psychology course in Spanish.

Some graduate school programs now offer clinical courses entirely in Spanish. Although these are few and far between, I would highly suggest taking one if it is offered near you.

References

[1] Office of the Surgeon General (US, & Center for Mental Health Services (US. (2001). Mental health: Culture, race, and ethnicity: A supplement to mental health: A report of the surgeon general.

[2] Castaño, M. T., Biever, J. L., González, C. G., & Anderson, K. B. (2007). Challenges of providing mental health services in Spanish. Professional Psychology: Research and Practice38(6), 667.

[3] Febo San Miguel, V. E., Guarnaccia, P. J., Shrout, P. E., Lewis-Fernández, R., Canino, G. J., & Ramírez, R. R. (2006). A quantitative analysis of ataque de nervios in Puerto Rico: Further examination of a cultural syndrome. Hispanic Journal of Behavioral Sciences28(3), 313-330.

[4] Lewis-Fernández, R., Gorritz, M., Raggio, G. A., Peláez, C., Chen, H., & Guarnaccia, P. J. (2010). Association of trauma-related disorders and dissociation with four idioms of distress among Latino psychiatric outpatients. Culture, Medicine, and Psychiatry34(2), 219-243.

[5] Lewis-Fernández, R., Guarnaccia, P. J., Martínez, I. E., Salmán, E., Schmidt, A., & Liebowitz, M. (2002). Comparative phenomenology of ataques de nervios, panic attacks, and panic disorder. Culture, Medicine and Psychiatry26(2), 199-223.

[6] Caballero, L., Aragonès, E., García-Campayo, J., Rodríguez-Artalejo, F., Ayuso-Mateos, J. L., Polavieja, P., … & Gilaberte, I. (2008). Prevalence, characteristics, and attribution of somatic symptoms in Spanish patients with major depressive disorder seeking primary health care. Psychosomatics49(6), 520-529.

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David C. Talavera

David C. Talavera

David C. Talavera is a Clinical Psychology Ph.D. candidate at the University of Houston and is a member of the Culture, Risk, and Reliance Lab. He is currently completing his pre-doctoral internship at Harvard Medical School/Cambridge Health Alliance where he works at the Latino Mental Health Program, Primary Care Mental Health Integration, and Psychiatric Emergency Services. Before entering graduate school, David graduated with honors from the University of California, Berkeley with a B.A. in Psychology. His research interests include examining the effects of race/ethnicity and acculturation in the development of internalizing disorders and adverse health outcomes. His broader interests involve developing culturally sensitive interventions for those suffering from chronic illness/pain. David’s clinical interests include behavioral health medicine, culturally competent care, behavioral health integration, and Spanish-language mental health services. In his free time, David enjoys running, playing basketball, and trying to improve his salsa and taco making skills.
David C. Talavera

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