Developing Culturally Competent Marriage and Family Therapists: Guidelines for Working with Hispanic Families
Bean, Roy A., Perry, Benjamin J., Bedell, Tina M., Journal of Marital and Family Therapy
As the Hispanic population of the United States continues to grow, so will the need for therapists who have been trained to work with Hispanic families. This content analysis of the available treatment literature generated several specific guidelines that can be used in training and evaluating culturally competent therapists. Guidelines included: Use family therapy, act as advocate for the family, assess immigration experience, assess acculturation, respect father, interview family subsystems separately, do not force changes, provide concrete suggestions, and warmly engage the family. Empirical and conceptual support for each guideline is discussed and several conclusions are made regarding culturally competent therapy with Hispanic families.
Hispanics, as a group, are one of the fastest growing ethnic populations in the United States. Projections suggest that the estimated 29 million Hispanics who live in the U.S. today will grow to more than 62 million by 2020 and to more than 133 million by the year 2050 (U.S. Census Bureau, 1998). Given this growth rate, it is more and more likely that therapists-especially those practicing in the larger coastal cities and in the southwest-will be working with Hispanic families in the coming years. Accompanying these demographic changes is the need for relevant and reliable information for working with Hispanics; however, the marriage and family therapy (MFT) literature is generally lacking in this area (Bean & Crane, 1996; Ho, 1987). Not surprisingly, this same deficiency has been acknowledged for many of the counseling and helping professions (London & Devore, 1988; Ponterotto & Casas, 1991; Ridley, Mendoza, Kanitz, Angermeier, & Zenk, 1994). In fact, one of the main points of consensus across the mental health disciplines is that greater attention to the training of competent multicultural therapists and counselors is needed (Hardy & Laszloffy, 1992; Ridley et al., 1994; Sue, Arredondo, & McDavis, 1992).
Multicultural competence is generally conceptualized as involving three main areas: Therapists' awareness of their own culture, therapists' knowledge of the worldview of the culturally different client, and therapists' behaviors or use of culturally appropriate treatment strategies and interventions (Sue et al., 1992). Regarding therapists' awareness, several ideas have been used to encourage and to evaluate students' increased awareness of their own culture and its influence in defining their values and biases. Hardy and Laszloffy (1992) recommended the use of cultural genograms and "storytelling" of one's own racial or ethnic history and Coleman (1997) used portfolios to help students discuss and document changes in their level of cultural awareness.
In terms of therapists' knowledge, clinicians usually have been instructed using historical accounts of the group's experience in the United States and/or popular representations of the ethnic culture (e.g., movies, books, music). Through this exposure, therapists can begin to understand how religion, education, racism, and other contextual factors affect the family and how these factors combine ecosystemically to influence the worldview of the family (Falicov, 1988; Karrer, 1989). Portfolios have been advocated as a means of evaluating therapist development in this area as well (Coleman, 1997) but the more common measure of therapist knowledge seems to be his/her ability to behave in a manner that is relevant and responsive to the client's cultural worldview (Ridley et al., 1994).
Unfortunately, this leads beginning therapists and their supervisors to the imprecision and subjectivity associated with the third area of multicultural competence-therapist behavior. Ridley et al. (1994) observed that the training process is inherently challenging because a clear set of behavioral indicators of multicultural competence is lacking. Hampered by the shortage of multicultural clinical research (Bean & Crane, 1996; Ponterotto & Casas, 1991), it has been difficult to form reliable judgements about the therapist behaviors and treatment strategies that are representative of culturally competent therapy with Hispanic families. …