Monica A. Polonyi
Sam Houston State University
Correspondence should be addressed to Jennifer Bornsheuer, Department of Educational Leadership and Counseling; Monica Polonyi, Department of Educational Leadership and Counseling, Sam Houston State University, Huntsville Texas. Correspondence concerning this article should be addressed to Jennifer Bornsheuer, 20031 Sweet Magnolia Place, Humble, TX 77338, or E-Mail: firstname.lastname@example.org
The Hispanic population in the United States has rapidly increased over the last decade and is underrepresented and cared for in mental health services (Garza & Watts, 2010). Research has illustrated that Adlerian counseling is effective in working with diverse populations, including the Hispanic population, and in various settings (Carlson & Carlson, 2000; Frevert & Miranda, 1998). According to Sue, Arrendondo, and McDavis (1992) counselors ought to demonstrate awareness and sensitivity of the cultural values, beliefs, and world views of their clients. This article examines the usefulness of Adlerian counseling tenets among the Hispanic population. For the purpose of this paper the term Hispanic refers to the ethnicity of persons who were born, have parents born, or are descendents of Mexico or other Central American countries. In this article the following four concepts are reviewed: (a) underutilization of mental health services among Hispanics, (b) an overview of Adlerian counseling tenets, (c) the integration of Adlerian counseling tenets with the Hispanic population, and (d) considerations and recommendations.
Keywords: Hispanic, Adlerian, Multicultural counseling
Adlerian Counseling with Hispanic Clients and Families
According to information from the United States Census Bureau, the Hispanic or Latino population is rapidly growing and has increased by more than 57% since the 1990s (Alvarez, Jason, Olson, Ferrari, & Davis, 2007; De La Rosa, Holleran, Rugh, & MacMaster, 2005). Furthermore, approximately 35.9 million Hispanics currently live in the United States representing 15 % of the total U. S. population (U.S. Census Bureau, 2009). This percentage is predicted to double by the year 2050, making Hispanics one of the fastest growing and largest minority groups in the United States (De La Rosa et al., 2005). According the U.S. Bureau (2009), states bordering Mexico reported a large Hispanic population. For example, currently the Hispanic population in the state of Texas is 36.5 %, and Harris County alone has an estimated 39.3% based on recent housing and demographic information (U.S. Census Bureau, 2009). With such a dramatic shift in the population, and with the prediction of growth of Hispanics in the United States, mental health professionals need to be prepared to deliver meaningful services to Hispanic clients. Based on research by Carlson and Carlson (2000), and Frevert and Miranda (1998), Adlerian based counseling is effective in working with diverse populations. Therefore this article will explore the uniqueness of the Hispanic population in relationship to Adlerian counseling tenets. Specific attention will be given to the underutilization of mental health services among Hispanics, an overview of Adlerian counseling, and the integration of Adlerian tenets with the Hispanic population.
Underutilization of Services
Minority populations are less likely to utilize mental health services, especially Hispanic families (Foulks, 2004). Further, the Hispanic population is vastly underrepresented in using mental health services which consequently leads to increased levels of untreated psychiatric and mental health issues (Bridges, de Arellano, Rheingold, Danielson, & Silcott, 2010; Garza & Watts, 2010). Bridges et al., (2010) have identified many reasons why members of the Hispanic population are less likely to receive mental health services. These reasons range from not understanding the value of the services, language barriers, limited financial resources, social consequences of accessing care, lack of culturally responsive practices, and the use of alternative healers and methods to treat mental health concerns (Bridges, de Arellano, Rheingold, Danielson, & Silcott, 2010; Costantino, Malgady, & Primavera, 2009; Garza & Watts, 2010). Further, Garza and Watts (2010) reported that there is a need for increased treatment and care for minority populations, especially in regard to care for children.
When members of the Hispanic population choose to seek mental health services, the presentation of their symptoms can appear different, and care needs to be taken by the mental health professional in determining the diagnosis and recognizing that some symptoms appear different due to cultural norms (Carlson & Carlson, 2000). This phenomenon is also corroborated within the DSM-IV-TR (American Psychiatric Association, 1994), in that care needs to be taken to recognize how different symptoms and disorders appear different due to differences in culture.
More specifically, within the Hispanic population, Cook, Alegria, Lin, and Guo (2009), reported that there are protective factors that lead to fewer mental health disorders, at the same time, there are factors that contribute to an increase in mental health issues once in the United States. Cook et al., (2009) identified both protective and risk factors related to mental health of Hispanic immigrants. Protective factors for Hispanic immigrants include being in the United States for less than 10 years, within this time frame immigrants are more likely to maintain their cultural values and norms including family connectedness and support. Risk factors for increased mental health issues include being in the United States for longer than 10 years and immigrating to the United States at a young age. These factors can lead to intergenerational value conflicts, a separation from cultural norms and values to become more aligned with the larger society, discrimination, and stress related to social status. At the same time, Cook et al. (2009) suggested that culturally sensitive treatment modalities that help protect and strengthen the family unit can also help maintain Hispanic immigrants’ mental health levels.
When Adler developed his theory, he believed that a person’s behavior was goal driven, purposive, and creative. Adler believed a person’s behavior could be understood by determining what they valued or what they wanted to achieve (Sweeney, 1981). In addition, Adler identified that people are social beings that strive to belong; from birth a child is cared for by others, and as a child develops this need for social belonging increases. The ways in which people are cared for helps them to develop an understanding of their environment and ways in which they can manage this environment (Sweeney, 1981). Every person has their own subjective view of their environment which leads a person to develop their own way of acting and reacting in their environment, this is called a person’s life style.
In creating his theory of personality, Alfred Adler postulated everyone is born with certain innate tendencies. The most important of these is that a person is born whole and complete. As stated by Dinkmeyer, Dinkmeyer Jr., and Sperry (1987) a child is born a “full-fledged” being and cannot be more human than they are currently. Two other tendencies we have at birth include people are born creative and goal oriented. Further, Adler identified the importance a child’s environment played on their development. He defined this as a person’s lifestyle which described how a person adapts to obstacles and creates solutions to various experiences. A person lifestyle is developed by the age of five and is difficult to change after this time (Sharf, 2004). A person’s lifestyle describes how an individual approaches life tasks including work, friendship, love, and spirituality.
There are four stages in the Adlerian counseling process within Adler’s theory of personality. These include developing a respectful and trusting relationship, and assessing client’s problems through analysis of early recollections, dreams, and family constellations. The last two stages of the counseling process are interpreting what clients are saying so they can develop insight into their thoughts and behaviors as related to their goals for counseling, and then reorienting the client to finding solutions and alternatives to unhealthy behaviors and beliefs. To assist the client in moving through these stages of counseling, the counselor utilizes multiple techniques including active listening, encouragement of the client, identifying client’s family constellation, perceived role in the family, client’s interpretation of their dreams, early recollections, identification of basic mistakes and personality priorities.
Adlerian Counseling: Practical Applications
Sue, Arredondo, & McDavis (1992) stated, “to some extent all counseling is cross-cultural” (p. 478). This statement clearly resonates with Adlerian counseling. Alfred Adler can be viewed as a forerunner in paving the path for social equality and respect of various cultures, genders, and minority groups. And while his perspective is referred to as Individual Psychology, Watts, Trusty, and Lim (1996) suggested Adler’s approach espouses social interest and a “genuine interest in their fellow human being and the universe as a whole” (p. 4). Therefore, it can be implied that this holistic concept takes into account the Hispanic’s environment, social group, values, beliefs, and heritage. Further, Carlson and Carlson (2000) noted that Adlerian counseling focuses on how the person perceives events and others within a social and cultural view. The counselor takes on many roles to help the client integrate cooperative and social values into their worldview rather than focusing on individual and competitive views which ties into the Hispanic cultural values (Carlson & Carlson, 2000). In this section, we discuss the various roles the counselor takes on during counseling. More specifically, we discuss the roles the counselor utilizes when working with Hispanic clients and families.
Counselor as a Facilitator
A main tenet of Adlerian counseling is the facilitation of social interest. This can include a sense of connectedness and belonging to significant others in the client’s life. According to Adlerian theory, human behavior is not an isolated entity but rather socially embedded (Carlson, Watts, & Maniacci, 2006). Adlerian theory espouses that as social beings, individuals belong to a larger social network. For those of the Hispanic culture, their social network often includes individuals within their nuclear family and also incorporates those outside their nuclear family (Duffey, Carns, Carns, & Garcia, 1998; Fervert & Miranda, 1998). With this in mind, as therapists work with Hispanic individuals, the inclusion of the whole family in the therapy process may not only prove beneficial but socially acceptable.
Torres-Rivera, Wilbur, Phan, Maddux, and Roberts-Wilbur (2004) proposed in a recent study that when working with Hispanic clients, counselors need to be aware of the bilingual and bicultural differences, while also utilizing community and family involvement in the counseling process. By engaging the family in the counseling process, the counselor builds trust and rapport with the client and their family while allowing the counselor a glimpse into the client’s worldview. Within the Hispanic culture, family is valued and this is where a person gathers their self-esteem and identity (Torres-Rivera et al., 1999). Therefore, when working with Hispanic clients, the counselor will need to use creative interventions to involve the family and possibly the larger community to help the client in the counseling process and in following through with treatment. For example, a practicing counselor working with the Hispanic population may want to attend family gatherings, include family members within the therapy session, or meet the client in a less formal location outside the counseling office (Torres-Rivera et al., 2004) as a means of facilitating connectedness with the client, as well as with members of his or her social community.
Additionally, traditional and cultural norms reflected in the interactions among Hispanic families suggest that women are often caretakers for those within the family and are often socialized to be “good wives and mothers” whose primary focus is on the family’s welfare (Alvarez et al., 2007; Duffey et al., 1998); whereas, men are traditionally perceived as dominant, authoritative and “heads of households” (Duffey et al., 1998, p. 401). Thus, counselors are encouraged to create an environment that respects the males’ worth and traditional role while also promoting the female’s voice, thoughts, and ideas within the counseling session. Lastly, when working with children, a practicing Adlerian counselor may utilize continued and frequent parent consultations or parent education vas interventions to help the parents and other family members develop skills to respond to their child, recognize the child’s goals of misbehavior, and understand how to help the child meet their need in a positive and socially acceptable way (Kottman 1997, 2001a, 2001b, 2003). Kottman also described how to work with children and families using an Adlerian framework. This model of play therapy is useful for counselors working with members of the Hispanic population.
Counselor as a Teacher
An examination of the history of Adlerian counseling will find a pattern of teaching, training, and skill building (Carlson et al., 2006). Adlerians believe that this component helps to introduce new ideas, concepts, and behaviors. Adlerian counselors and researchers support the counselor as an educator in the reorientation phase of counseling as the client and counselor work together to create a plan for new behaviors, attitudes and beliefs along with how the client will put these plans into motion. This approach fits favorably with the Hispanic culture that typically looks to those in authority and seeks directive interaction (Duffey et. al., 1998; Fervert & Miranda, 1998). Carlson and Carlson (2000) reported that counselors may take on the role of a teacher or “being in charge” to help facilitate change in the clients perceptions and behaviors (p. 220). It should also be noted that counselors need to exercise caution in not taking advantage of this power within the therapeutic relationship but rather encourage the client to develop their own ideas about how change and growth should occur.
In the role of a teacher, Adlerian counselors can help clients gain insight into their worldview through lifestyle assessments. These include a family constellation, discussion of family dynamics, the family atmosphere, and family roles (Dinkmeyer, Dinkmeyer, & Sperry, 1987). Adlerian counselors use lifestyle assessments as a means to understand the client’s beliefs, values, attitudes, and perceptions of the world around them. One such application is to assist the client in developing a family constellation and teach the client how their lifestyle and roles impact other areas of their life and their perceptions of the world.
Zapata and Jaramillo (1981) noted that within the Hispanic culture, birth order is important to the oldest male in the family because he tends to be raised to care for the family as the father does while female children are protected by the family and are taught to take care of other family members and family belongings. Fervert and Miranda (1998) also discussed the importance the Hispanic culture places on traditional gender roles along with obedience and respect to persons in authority. It is important for counselors who work with Hispanic clients to explore how traditional gender roles, perceptions of those in authority, and birth order fit into their worldview and which beliefs may be maladaptive and unhealthy to the client’s functioning. The counselor needs to pay close attention to not turn these conversations into judgments or accusations; rather they need to be explorations into how the clients’ lifestyle is effective and helps the client become more fully functioning (Dinkmeyer et al., 1987).
Counselor as an Encourager
According to 2002 Census data, it is reported that 1 in 4 Hispanic households live below poverty or 21% of all households within the U.S. (Alvarez & Ruiz, 2001; Torres et al., 2004). The condition of poverty can often cause stress, hopelessness, and unstable family relationships. Difficulties in accessing mental health services due to language, cultural, or legal barriers can also add to the stress experienced by the Hispanic individual. Accordingly, these circumstances can leave individuals with limited hope or ability to cope.
According to Dinkmeyer and Losoncy (1980), “Discouraged persons do not believe they have a chance to win a battle, solve a problem, find a solution, or even move toward a possible solution” (p. 50). Therefore the use of encouragement can serve a fundamental tool with the Hispanic population. Counselors working with the Hispanic population can utilize the Adlerian techniques of instilling confidence, reflecting feelings, demonstrating faith in the individual, and recognizing the client’s strengths and abilities as a way to create hope and movement during the therapeutic process (Carlson et al., 2006; Dinkmeyer & Losoncy, 1980). These methods can be utilized by counselors throughout the therapeutic process and serve as a component of the counselor’s role as an encourager.
Counselor as a Spiritual Facilitator
As counselors acknowledge cultural implications within the therapeutic process and work towards integrating culturally sensitive treatment, it is also important to recognize the client’s religious and spiritual beliefs as part of the client’s diversity (American Counseling Association, 2005; Sue et al., 1992). According to Watts (2008), “counseling and psychotherapy have historically been either neutral or negative regarding religion or spirituality” therefore, to overlook this aspect would be to ignore the client’s values, beliefs, attitudes, and practices (pg. 10). Moreover, literature on Hispanic individuals and families suggest that religion, particularly the Catholic faith, is often part of the individual’s identity and culture (Frevert & Miranda, 1998). Several methods for integrating clients spirituality using Adlerian therapy are described by Watts, Peluso, and Lewis (2005), and Watts and Peluso (2005). These methods include the use of the Reflecting “As If” technique and the use of Imaginary Reflecting Teams. The Reflecting “As If” technique is a mix of Adlerian and Constructivist tenets that expands on the original acting “As If” technique to help clients reflect on behaviors and thoughts that can increase the chance of success and change (Watts, Peluso, & Lewis, 2005). The use of Imaginary Reflecting Teams involves the client inviting imaginary people, who are significant to them, into the session to ask reflective questions or help identify alternative behaviors or alternatives (Watts & Peluso, 2005). Counselor utilizing Adlerian therapy with the Hispanic population can benefit from the use of these techniques to integrate the client’s spirituality into the counseling sessions.
Further, Mosak and Maniacci (1999) suggested that Adlerian counseling has “a religious tone” (p.71) and therefore may be valuable for those who wish to include their spirituality or religious faith within the counseling process. Cultural and religious values within the Hispanic context such as being self-sacrificing, helpful, caring for others, and valuing relationships have a unique similarity to Adlerian social interest. Social interest emphasizes a concern for humanity and the general welfare for others (Carlson et. al, 2006). This includes: helping others, demonstrating compassion and warmth, and considering the common good of each person. These precepts combined, the client’s religious or spiritual framework and Adler’s social interest, can allow the client to express and bring every aspect of their being into the counseling session while also demonstrating acceptance of their worldview and multicultural sensitivity.
Considerations and Recommendations
As the Hispanic population continues to grow in the United States and states bordering Mexico, so should research focusing on mental health services, and culturally sensitive counseling strategies designed to help improve the quality of life of the Hispanic population seeking professional counseling. Sue, Arredondo, and McDavis (1992) stated, “Although all of us are racial, ethnic, and cultural beings, belonging to a particular group does not endow a person with the competencies and skills necessary to be a cultural skilled counselor” (p. 478). Counselors need to be aware of the cultural differences in working with the Hispanic population. If counselors are not understanding of these differences and do not seek to connect with the client, and their family, in culturally appropriate ways, they could do harm to the client.
The 2005 American Counseling Association (ACA) Code of Ethics calls for counselors to “actively attempt to understand the diverse cultural backgrounds of the clients they serve” (p. 4). This includes acknowledging “the effects of age, color, culture…religion, spirituality” (p. 13). The ACA Code of Ethics (2005), states in sections A.4.a., A.1.a., and A.2.c., to do no harm; respect the dignity and welfare of the client; and to utilize culturally sensitive treatments. Counseling professionals are recommended to receive multicultural training and education regarding the Hispanic culture in order to have a comprehensive understanding of the population while also having the opportunity to reflect and clarify stereotypes and bias that may be associated with this group as well (Sue et al., 1992).
Therefore, the following recommendations have been made by the authors for counselors
providing services to the Hispanic population: (a) implement culturally sensitive services and treatment methods in the client’s preferred language, (b) utilize the client’s family and social networks, (c) provide educational services within the community about mental health services, (d) educate themselves and other counselors about cultural norms, values, and beliefs of the Hispanic population, and (e) demonstrate respect, sensitivity, and appreciation when working with the Hispanic population.
In closing, awareness and recognition of the Hispanic culture can be the first step in improving counseling services to this population. As the Hispanic population continues to grow in the United States, so should research measures and therapeutic strategies which sensitively enhance services and improves understanding of this group of individuals. In this article, we have provided examples of how Adlerian counseling can be effective with the Hispanic population. Adlerian counseling takes into account the social and cultural values of minority groups, such as social embeddedness, integration of family members, and spirituality into the counseling process (Carlson, Watts, & Maniacci, 2006). Finally, when considering the importance of human life, we should remember that counselors can be an instrumental part and model in these efforts by maintaining high standards within the profession and demonstrating cultural sensitivity and respect to the Hispanic population.
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