Familismo: The Unseen Family in the Therapy Room

Familismo: The Unseen Family in the Therapy Room

(Please access full text for link to article in Spanish.)

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 people live.

Unfortunately, the number of Latinx and/or Spanish-speaking therapists is below the minimum needed. Thus, even if you do not speak Spanish, the odds are considerable that a Spanish-speaking Latin American will cross your path.

In this series, 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.


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Adverse Childhood Experiences: Traumas That Set the Framework for Life

Adverse Childhood Experiences: Traumas That Set the Framework for Life

Growing up in a home with physical abuse, emotional neglect, mental illness, alcohol use, or drug use are some examples of childhood adversities. The seminal work of Dr. Vincent Felitti and colleagues asked over 17,000 adults to answer questions about adverse childhood experiences — or ACEs — and current health [1]. Results were shocking: More ACEs led to poorer health in adulthood and early death.

It is important to understand that ACEs do not directly cause poor outcomes; there are likely many mediating mechanisms such as maladaptive coping, unhealthy interpersonal relationships, negative health behaviors, dysfunctional thinking styles, and insecure attachments that contribute to these outcomes. In addition to prevention efforts, these are all potential areas that therapists can intervene to mitigate the long-term effects of adversity.


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Breaking Up with OCD: Avoiding Common Treatment Barriers

Breaking Up with OCD: Avoiding Common Treatment Barriers

It takes a lot of guts for patients to make the decision to break up with obsessive-compulsive disorder. They have been living many years with tormenting thoughts and fears, dictating how they go about their days. When your patient is on board with breaking up with their OCD, you want to encourage them not to DRIFT away from OCD, but rather to look forward to how they want to live in the future, and to break up with OCD. Exposure and response prevention (ERP) is the gold standard for treating OCD. [1] The procedure is simple, but the task of breaking up is always emotionally difficult. Let’s examine the DRIFT treatment barriers (my made-up acronym) so we can support our patients in officially kissing OCD goodbye. OCD is a complicated disorder that includes intrusive thoughts, images, and urges that cause people to feel extreme distress, anxiety, disgust, and/or fear. [2] Many recognize that these thoughts are illogical. In order to cope with the distress, people generally use compulsions to reduce the experienced distress. These take the form of rituals, reassurance questions, neutralization, and avoidance behaviors. [2] Over time, compulsions become tightly linked to the initial fear, and behaviors are performed nearly instantaneously. Colloquially, some patients have...
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Working with Suicidal Clients: 6 Things You Should Know

Working with Suicidal Clients: 6 Things You Should Know

One of the scariest things therapists work with is suicidality.

Suddenly, therapy feels like, and sometimes is, a life-or-death situation, one where clinicians hold a great deal of responsibility.  To make matters worse, suicide continues to be one of the leading causes of death in the U.S. [1], and many believe the prevalence rates are a gross underestimate [2].

The numbers highlight the inevitability of encountering suicidality in our line of work.  Early-career psychologists and practicum students may feel overwhelmed by the intensity and risk of working with suicidal clients.


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Nervous about Psychosis? A First-Timer’s Guide to Treating Clients with Psychotic Disorders

Nervous about Psychosis? A First-Timer’s Guide to Treating Clients with Psychotic Disorders

I vividly remember my first experience providing psychotherapy for a patient with psychotic symptoms. In fact, not only was this patient my first with psychosis, but they were my first individual therapy patient ever. As a practicum student at a partial hospitalization program, I was caught off-guard when my patient endorsed auditory hallucinations during an initial intake. Thoughts and doubts such as “I don’t know what I’m doing” and “Could I make my client’s symptoms worse?” flooded my mind.

Ultimately, it was a rewarding experience, and I enjoyed bearing witness to my client’s growth, impressive resilience and resolve. However, there are many things I wish I had known ahead of this first experience. Therefore, this article aims to use my experience as a reference point to provide a brief snapshot of important domains to consider when treating psychosis for the first time.


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Psychodynamic Therapy 101: An Introduction

Psychodynamic Therapy 101: An Introduction

A new client recently asked me where I would be traveling for an upcoming trip as we looked at our schedules to make her next appointment. When she expressed further curiosity about the conference I would be attending, I explained that it was an annual conference of the society for psychoanalysis and psychoanalytic psychology. A fairly surprised look appeared on her face, and she questioned, “like Freud?”

I readily picked up on her discomfort with the thought of psychoanalysis or being psychoanalyzed. I clarified that she was not meeting with me for psychoanalysis and offered some explanation of basic psychodynamic principles and how these applied to our initial goals for therapy. She seemed to accept my explanation, but mostly just seemed glad to know she wasn’t meeting for psychoanalysis.

Psychodynamic therapy is one of several approaches to therapy used today. However, it is often misunderstood and dismissed as an outmoded approach or historical artifact. It is also often misrepresented in popular culture and sometimes seen as irrelevant to the quick-fix demands of the public and the limitations of insurance.


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An Introduction to Philosophical Counseling

An Introduction to Philosophical Counseling

In India, mental health problems are rising at an alarming rate. This fact calls into question the efficacy of prevailing modalities of counseling. The pandemic has shifted previously abstract concerns into more concrete problems: it is now essential to rethink our lives through a different lens. Thus, it is imperative to introduce an alternative process that works at the root of pressing issues, where doubts, confusion, and thoughts can be communicated and discussed with an expert.  Philosophical counseling is a contemporary counseling approach where the concerns of the counselee (client) are resolved using different philosophical tools and methods, enabling clients to cultivate what may be described as their inner philosopher. It is an integrated process of humanistic practice and rationality. This process works through an extensive exchange of dialogues and discussions about clients’ beliefs, actions, values, purposes, and commitments, not only what they presently are but also whether and to what extent they may or can be altered or strengthened. Understanding Philosophy “Philosophy” is a word we use in our day-to-day language, but do we understand this subject’s real essence? It encompasses the topics of epistemology (what is knowledge?),...
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5 Ways to Support Your LGBQ & Gender Non-Conforming Clients in Session

5 Ways to Support Your LGBQ & Gender Non-Conforming Clients in Session

As helping professionals, we share a united goal of empowering the individuals with whom we work to meet their goals. Though it remains important to address social issues on a large scale (e.g., protests, donations, advocating for policy change), a lot of what we do as helpers happens one-on-one. That is, most of us work to empower individuals interpersonally through therapy.

With this in mind, I would like to share tangible ways to support LGBTQQIA (Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Intersex, Asexual) and/or gender non-conforming (individuals who do not identify as cisgender, meaning they have gender identities that do not match the sex they were assigned at birth, and/or those who reject the gender binary, or do not identify as male or female) clients in session while also acknowledging the importance of social justice advocacy on a much larger scale.


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3 Ways to Maximize Your Clinical Hours

3 Ways to Maximize Your Clinical Hours

“I wish it need not have happened in my time,” said Frodo. “So do I,” said Gandalf, “and so do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given us.” You don’t have to be familiar with Tolkien’s epic works for those lines to resonate these days. This once-in-a-century plague has fundamentally changed what was supposed to be your perfect job, practicum, internship, and fellowship. We’ve embarked on an unexpected journey of therapy meetings over Zoom, with our sneaky sweatpants under button-ups and ties (oh yes, we all do it). We’ve dealt with the desolation of work-life boundaries, wrestled with the loss of connection with clients and coworkers, and persisted despite feeling like butter scraped over too much bread. There are fewer in-person events and responsibilities, and, for a significant chunk of 2020, there were fewer clients to see. The trend of people seeking mental health services appears to be going back up, but many of you are still struggling to get the clinical hours you need for program requirements, licensure, and financial stability. Know that you are not alone, and know that you have options. So, how should you use the time you’ve been given?  Let’s dive in. Making the Most Out...
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Let’s Not Re-Colonize our Clients: Exploring Brujería in Latinx Culture

Let’s Not Re-Colonize our Clients: Exploring Brujería in Latinx Culture

“A mi hijo la hicieron brujería,” stated the Mexican mother as she choked back tears. Both she and her husband sat in a therapist’s office as they made themselves present for a meeting regarding their son. The mother was saying that her husband’s parents cast a spell on her during her pregnancy with her son. The family had immigrated to the United States about five years ago, and it was evident that their traditions and culture were still strongly present within their family system and community. They told the therapist that this spell resulted in their son’s diagnosis of autism. Both mother and father had sought out multiple curanderos, or healers, to heal the child from the spell, paying thousands of dollars for his improvement and the possibility of reversing the spell. As the parents spoke, you could feel the apparent defeat and hopelessness around finding “healing” and not knowing how to move forward with the diagnosis that was given to their child.  The clinician in training was at a loss for how to help the family. The therapist had never been taught how to work with families or clients outside of Western culture. They were, however, well trained to work with clients who could understand psychoeducation within a setting that...
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