CT with Latinos

As clinicians, embracing cultural dimensions enhances the ways we diagnose, conceptualize, and treat patients within Latino populations (Martinez-Taboas, 2005). Latinos are not a monolithic group; therefore, cultural awareness begins with an acknowledgment and appreciation for the group's culture and diversity. Furthermore, it is also important to understand that acculturation issues can impact mental health among Latinos (Fitzpatrick, 1971). Acculturation can influence the way Latinos embrace traditional Latino principles, with the possibility of acculturated Latinos embracing more principles valued by the American majority such as individualism (Elliot, 2000). All of these variables must be acknowledged within the context of therapy given that demographic, historical, political, socioeconomic, and psychological conditions are culturally unique across subgroups of Latinos (Casas, Vasquez, & Ruiz de Esparza, 2002).

There are many beneficial aspects of CT approaches that can be effective for Latino patients. Brief therapy that provides immediate symptom relief, advice, guidance, and problem-solving strategies is important for traditional Latino patients (Arce & Torres-Matrullo, 1982). These variables are also significant for treatment of low-income patients (Torres-Matrullo, 1982). Time spent in "role preparation" is also important, in that it allows patients to learn about the treatment process and how CBT can help them (Organista & Muñoz, 1996). Role preparation has been found to decrease premature dropout for Latino (Delgado, 1983) and low-income patients (Orlinsky & Howard, 1986). Use of psychoeducation, manuals, and home work helps to eliminate the stigma associated with utilization of mental services (Organista & Muñoz, 1996). Also, ethnic matching is associated with better treatment outcome and lower dropout rates among Latinos with low levels of acculturation (Sue, Fujino, Hu, Takevichi, & Zane, 1991).

Relevant themes that have been found to be significant among many Latino patients include marital and familial interpersonal conflicts, and traditional gender role issues (Comas-Díaz, 1985). These cultural dimensions are clinically relevant given that researchers have found cognitive and behavioral differences between depressed Puerto Rican women who embrace traditional gender roles and those who do not (Comas-Díaz, 1985). Traditional gender roles of marianismo and machismo may influence presentation issues; therefore, processing the adaptive and maladaptive aspects of these roles is important for therapy (Organista & Muñoz, 1996).

Within treatment, it is important to emphasize the links between patients' current thoughts, feelings, and behaviors and to help patients to think alternatively (Arce & Torres-Matrullo, 1982). However, the traditional ABCD cognitive model (activating events, beliefs, consequences, and dispute of irrational beliefs; Ellis & Grieger, 1977) may not be beneficial for Latino patients. Consequently, Organista and Muñoz (1996) outlined different ways that Latino patients can benefit from embracing the underlying foundation of positive and negative thinking. These researchers suggest reframing thoughts as "helpful" or "unhelpful." Also, therapists can help patients challenge their distortions with "Yes, but ..." statements, which reframe thoughts from "half-truth" negative statements to "whole-truth" positive statements. This can be particularly helpful with ethnic/minority patients who may habitually subscribe to a fatalistic perspective.

Religion is an important aspect in the lives of many ethnic/minority individuals. Organista and Muñoz (1996) have discussed ways to incorporate cognitive and behavioral therapeutic activities within a religious context, such as helping patients to be more proactive in their prayers. Time spent in prayer or religious activities can be framed as a positive activity and conceived as behavioral activation for depressed patients. Therapy itself can be viewed through a religious lens. For example, when working with a religious African American patient who felt that therapy was counterindicated by her faith and that the only thing she should need was prayer, one of us (L. K.-W) invoked the well-known (and variously told) religious parable about the man who was drowning in a flood. The man waited for God to answer his prayers. He ignored would-be rescuers in a boat and helicopter by saying that God would save him. When he died and went to heaven he asked why God did not answer his prayers. God replied that He had sent a boat and a helicopter. Therapy could be characterized as a vehicle provided by God and/or prayer to help an individual get well and live life to his/her fullest spiritual potential.

Issues of treatment accessibility and acceptance are important in treating linguistic minorities. As the nation becomes more diverse, clinicians must strengthen their cultural competence skills effectively to treat patients for whom English is not the primary language (Casas et al., 2002). Having bicultural and bilingual staff available for patients is likely to promote culturally sensitive, and more effective, treatment (Arce & Torres-Matrullo, 1982).

There is disagreement about the best way to use CBT to help Latino patients; some researchers recommend integrating patients' cultural beliefs into treatment (Martinez-Taboas, 2005), whereas others suggest challenging the functionality of certain beliefs (Castro-Blanco, 2005). This important distinction to some extent reflects a debate in the field about how best to serve ethnic/minority patients who may hold beliefs that influence mental health or compromise treatment response. Those who recommend integration of cultural beliefs feel that this is the best way to respect diversity and to improve treatment effectiveness. The lack of cultural integration or adaptation is thought to contribute to the lack of treatment seeking, less treatment compliance, and premature termination among ethnic/minority patients. Those who advocate challenging cultural beliefs suggest that because some specific beliefs are deleterious to mental health and contribute to depression, they should be considered depressogenic cognitions in need of therapeutic alteration. For example, cultural beliefs about the importance of suffering and sacrificing may contribute to depressive symptomatology among Latinas. A therapist might opt to incorporate these beliefs by acknowledging the importance of self-sacrifice but emphasizing that one can best help others by being one's best (mentally healthy) self. Alternatively, a therapist might challenge a patient's idea that he/she must suffer as a distorted cognition that should be refuted to improve mental health. Religious beliefs about the spiritual sanctity of marriage may influence a patient's decision to remain in a difficult marriage, contributing to depression. A therapist might attempt to reduce depressive symptoms in the context of the marriage or challenge the notion that God would want the person to remain in an unhealthy situation. Unfortunately, there has been no empirical comparison of these alternative approaches to therapy. Regardless, many therapists have found useful ways to bring cultural components into their work with Latino patients. In general, clinicians must strive for cultural competence by approaching their patients in sensitive ways that embrace and integrate the cultural context, yet challenge distorted beliefs that affect patients' ability to effectively manage their mood.

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Power Of Positive Thoughts In The Post Modern Age

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