University of Southern California Dissertations and Theses

Considering the impact of culture on the therapeutic relationship: A look at Latino school-age children in a special education setting

(USC Thesis Other)

Considering the impact of culture on the therapeutic relationship: A look at Latino school-age children in a special education setting

PDF

Download a page range

Download transcript

Copy asset link

Request this asset

Transcript (if available)

Content CONSIDERING THE IMPACT OF CULTURE ON THE THERAPEUTIC
RELATIONSHIP: A LOOK AT LATINO SCHOOL-AGE CHILDREN IN A
SPECIAL EDUCATION SETTING
by
Yvette Barraza
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements of the Degree
DOCTOR OF PHILOSOPHY
EDUCATION (COUNSELING PSYCHOLOGY)
August 2003
Copyright 2003 Yvette Barraza
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
UMI Number: 3116664
Copyright 2003 by
Barraza, Yvette
All rights reserved.
INFORMATION TO USERS
The quality of this reproduction is dependent upon the quality of the copy
submitted. Broken or indistinct print, colored or poor quality illustrations and
photographs, print bleed-through, substandard margins, and improper
alignment can adversely affect reproduction.
In the unlikely event that the author did not send a complete manuscript
and there are missing pages, these will be noted. Also, if unauthorized
copyright material had to be removed, a note will indicate the deletion.
®
UMI
UMI Microform 3116664
Copyright 2004 by ProQuest Information and Learning Company.
All rights reserved. This microform edition is protected against
unauthorized copying under Title 17, United States Code.
ProQuest Information and Learning Company
300 North Zeeb Road
P.O. Box 1346
Ann Arbor, Ml 48106-1346
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
UNIVERSITY OF SOUTHERN CALIFORNIA
T he G raduate School
University Park
LOS ANGELES, CALIFORNIA 90089'1695
This dissertation, w ritte n b y
1 2 r V t j j l r L - 2 2 ^
0
U nder the direction o f h. D issertation
Com m ittee, and approved b y a ll its members,
has been presented to and accepted by The
Graduate School, in p a rtia l fu lfillm e n t o f
requirem ents fo r the degree o f
D O C TO R O F PH ILO SO P H Y
tan of Graduate Studies
D ate Q
DISSER TA T IO N C O M M IT T E E
C L '
u
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
ii
Dedication
To my clients and their families, I cannot thank you
enough for what you have taught me about childhood,
culture, relationships, and life in general. This text
is but a fraction of what I learned from engaging in
therapy with you. To my parents, thank you for showing
me the value of community and of service, it has
enriched my life tremendously. To my husband, your
support during my final scholastic endeavor has been an
absolute blessing. To my son, you have deepened the
meaning of my work and of my life.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Table of Contents
iii
DEDICATION ii
LIST OF FIGURES vi
ABSTRACT vii
CHAPTER ONE - SETTING UP THE PROBLEM
1. Purpose of the Study 1
2. Importance of the Study 3
3. Applying Experience 4
4. The Conception of the Child 16
5. Focus on School-Age 17
6. Challenges in Studying Children 19
7. The Therapeutic Environment:
Part of a Child's World 20
8. Problems with Clinical Research on Ethnic
Minorities 21
9. Defining Culture 25
10. The Latino Population 27
11. Latino Children and Their Mental
Health Concerns 29
12. Child Therapy, Culture, and Theory 33
13. Organization of the Study 39
CHAPTER TWO - LITERATURE REVIEW (Child Development,
Culture, and Therapy)
1. Development During Middle School Years 41
2. Social Learning and Culture 48
3. Research on Latino Children 4 9
4. The Therapeutic Dyad 53
5. Children in Therapy 58
6. Psychotherapy Research with Children 62
7. Latino Youth in Therapy 65
8. Ethnically Matching Clinician and Client 67
9. My Qualitative Research 73
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
iv
CHAPTER THREE - METHOD
1. Design 7 6
2. Participants and Setting 78
3. My Role as a Participant-observer 85
4. The Five Dyads 88
5. Instrumentation 96
6. Generalizability and Reliability 98
7. Validity Check 102
Material from Log
Validity Criteria
8. Procedures 104
9. Context of Filmed Therapy Sessions 106
10. Drawings 107
11. Method of Data Treatment 108
12. Pilot Study 110
13. What I Learned 110
14. New Directions 112
CHAPTER FOUR - DATA PRESENTATION
1. Cross-case Analysis 115
Themes/Findings
2. Culture: A Multifaceted Concept 117
3. Cultural Schemas and School-Age Children 121
Cultural Identification
The Importance of Cultural Issues
Communicating about Cultural Matters
4. Culture and the Therapeutic Relationship 137
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
V
CHAPTER FIVE - DISCUSSION
1. Outcome and Meaning 154
2. The Role of Culture 157
3. Existing Theory 160
4 . Limit at ions ./Del imitations 165
5. Suggestions for Improved/Future Research 169
6. Counseling Implications for Latino School-age
Children 172
Clinicians and Culture
Cultural Competence
Applied Child Psychology
REFERENCES 182
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
vi
List of Figures
Figure 1: Crucial questions in cross-cultural
child development 4 6
Figure 2: A summary of child development 47
Figure 3: Drawings by Carlos, John, and David 119
Figure 4: Isaac's drawing 129
Figure 5: Hector's drawing 133
Figure 6: Aldo's drawing 135
Figure 7: Moses' drawing 137
Figure 8: Juan's drawing 149
Figure 9: Victor's drawing 151
Figure 10: Adaptation of Bronfenbrenner's
social-ecological model 180
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
vii
Abstract
Few studies have examined children''s cultural
experiences in therapy. Typically the
sociocultural environments that have been
studied include only home, schools, and peer
groups. The current study investigated how
culture influences the therapeutic
relationship between therapists and Latino
school-age children. The study was conducted
using a participant-observer design. The
research data included clinical notes,
interviews with therapists and children,
observations of therapy, and children's
drawings. The data were gathered at an
educational therapy school which serves
children with emotional and behavioral
problems. The findings revealed how culture is
a complex concept with subjective meaning, how
children employ cultural schemas, and how
culture affects the therapeutic relationship
of Latino school-age children.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
1
CHAPTER ONE
Setting up the Problem
Purpose of the Study
The purpose of this investigation is to explore and
describe how culture impacts the therapeutic
relationship in order to provide critical data on the
research and practice of multicultural child therapy.
Specifically, I am interested in how culture influences
Latino school-age children'’ s views and/or experiences of
their therapists. There is no question that culture
plays a role in what all people bring to the clinical
setting. Culture can account for how people communicate
their symptoms and which ones they report, whether they
even seek help in the first place, what types of help
they seek, what types of coping styles and social
supports they have, and how much stigma they attach to
mental illness (U.S. Department of Health and Human
Services [DHHS], Substance Abuse and Mental Health
Services Administration [SAMHSA], & Center for Mental
Health Services [CMHS], 2001). Clients, whose cultures
vary both between and within groups, naturally carry
this diversity directly to the service setting.
Additionally, the cultures of the clinician and the
service system also factor into the clinical equation,
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
2
in that they visibly shape the interaction with clients
through diagnosis, treatment, and organization and
financing of services (DHHS, SAMHSA, & CMHS, 2001). It
is clear that sociocultural contexts, while not the only
determinants, affect the mental health of minorities and
alter the types of mental health services they use.
Although the literature on multicultural counseling in
the past two decades has been prolific on defining
cultural terms, outlining the evils of racism and
discrimination, providing various statistics on cross-
cultural therapy, pointing out the underutilization of
services by minorities, detailing treatment approaches
with different cultural groups, touting the value of
multicultural sensitivity and competence, and urging
diversity training, there is still much to be done in
respect to counseling with minority children. Thus in
this study, I explore how a particular segment of mental
health consumers, a segment that has largely been
neglected in research and practice, namely, Latino
school-age children, see culture affecting their
relationship with their respective therapists.
The research questions that will be addressed in
this study include: (1) How does cultural similarity
and/or difference affect the therapeutic relationship
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
3
(e.g., perceived closeness and distance or the ability
to connect and feel understood by the counselor)? (2)
How do children between the ages of 8-11 identify
themselves and their counselors in terms of culture? (3)
How important are cultural issues to school-age children
(i.e., cultural identity, acculturation, discrimination,
etc.)? And, (4) do these children express concerns
regarding cultural issues to their counselors or do they
hold back from communicating about these matters?
Importance of the Study
The importance of this research stems from its
theoretical and methodological novelty. In order to
address the current gaps in the literature, I have
attempted to: (a) integrate research from cross-cultural
studies and other disciplines in the social sciences to
establish theoretical grounding; (b) operationalize
culture using participants' own words; (c) focus on an
age range that has been neglected in the literature,
specifically, children ages 8-11; and (d) utilize a
participant-observer design, interviews with children
and their counselors, observations of therapy, and
children's own drawings, thus, pulling from a variety of
data sources to arrive at the current findings.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
This research comes at an opportune time due to the
mental health crisis facing our nation's children. It is
now vital to put children and culture in the forefront
of human science concerns because of the desperate need
for a psychology of practical relevance. Culturally
sensitive researchers need to use all the tools science
has to offer (i.e., quantitative and qualitative
research methodology) in order to explore people's
behavior in a variety of domains (Gergen et al., 1996),
such as the effects of culture on children. In this
qualitative study, I try to discover how Latino children
in a special education setting view their therapists
through sociocultural lenses and how this may impact
their respective relationships with their counselors.
Applying Experience
The question that arises along with any academic
endeavor concerns the social applications of education,
the channel between the university and the world. In few
fields is this question of more weight than in that of
the psychological sciences. As a Mexican-American, a
doctoral candidate in counseling psychology, and a
practicing therapist, I have observed far too many young
people in my community fail to achieve their goals. The
impetus for my own academic advancement flows largely
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
5
from my desire to channel my achievements back into my
community, from which I draw my origins, my culture, my
consciousness, and a large portion of whom I am. I
determined long ago, that my own aptitude for
psychological analysis and social service were gifts
which, with the right academic guidance, would enable me
to answer many significant needs in the Mexican-American
community, and to give back in proportion to what I have
been given. Since intentions in such contexts as these
may often rise above practicality and evade the grittier
social necessities from which they spring. I offer in
support of my understanding of the Latino mental health
reality, my own experiences as a child and family
therapist at the Salvation Army, San Fernando Child
Guidance Clinic, Aspen Youth Services, Children's
Hospital of Los Angeles, Didi Hirsch Family Services,
Greater Long Beach Child Guidance Clinic, and Miller
Children's Abuse and Violence Intervention Center, as
evidence of my already having translated education into
social action.
My experiences at these various sites rank among
those anywhere in which the satisfaction earned is
commensurate with the challenge presented in
humanitarian terms. I have first-hand experience of the
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
6
importance of therapy, I understand the need for others
to embrace the same; yet I also know, from having worked
with emotionally disturbed children, adolescents, and
their families that psychological treatment can be seen
as at best a luxury, at worst an imposition, when one is
dealing with deep emotional scars. It is not sufficient,
therefore, to preach the virtues of mental health
services; as a psychologist, I know that what is often
more important is to enable the larger social benefits
of therapy to enter those lives from which deep social
traumas and psychological wounds have if not banished at
least significantly obscured their light.
My ambition as a helping professional may thus be
seen as two-fold, and in keeping with the science-
practitioner model. Continuing research in my field
facilitates a deeper understanding of those social
demons which now menace our society everywhere, and the
direct social application of that knowledge may work
toward exorcising them and help me to join with others
in preparing the groundwork for increased education and
service within my community. My research focuses on
school-age children at a field site that I describe
later, and it incorporates academic and practical
research methods for exploration of the phenomena of
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
7
culture and the therapeutic relationship. My experiences
in family and child counseling affords me excellent
basis for analysis, and the practical knowledge
necessary both for my study and implementing possible
avenues for troubled children out of this situation.
In any movement toward a truly culturally diverse
citizenry, it is imperative that everyone have a
political voice which takes account not only individual
cultural variations but also, and perhaps more
importantly, of the whole socio-political web which
gathers together all our diverse cultural strands within
itself. The current movement toward an information-based
society necessitates the value of knowledge, and I
consider it vital that members of the Latino community
have an educated voice in decisions which will affect
them as surely as they will affect anyone else. It is
clear to me that an overwhelming problem exists; it is
even clearer that something must be done about it. The
problem is not one-dimensional, as I have already
intimated; my experiences have taught me that education
is often a step away from other psycho-social issues. A
scientist-practitioner model has enabled me both to
wrestle academically with these issues in quest of the
best possible solutions to the challenges they present
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
and to confront them head-on at the street-level, within
the community, through community services, and in our
schools and mental health agencies.
There are several determinants that have helped me
organize my understanding of multicultural counseling.
My views on mental health, people who seek treatment,
and the practice of therapy is informed by my values,
background, and experiences. I feel it necessary to name
just a few of the significant factors that make up who I
am, and thereby establish my theoretical lens; these
include (but are not limited to): gender, appearance,
ethnicity, language, socioeconomic status, religion,
education, and family environment. So that when I talk
about mental health, dysfunction, and helping, the fact
that I am a fair-skinned, bilingual Mexican-American,
middle-class, Catholic woman with a doctoral level
education is relevant to how I see the world, and more
importantly to how I interact in it. Since I contend
that one's world view affects the therapy and research
process at all times, I recognize that I cannot separate
my values from who I am as a therapist and researcher.
Accordingly, let me begin by briefly recounting how I
came to research the topic at hand, namely, the therapy
of Latino children.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
9
Prior to beginning my doctoral program in
counseling psychology I was counselor at an educational
therapy school with a large Latino population. I had
already completed a masters program in clinical
psychology, and amassed all of my hours towards a
license in marriage and family therapy. My career goal
was to be a practitioner, and the school was the setting
in which I was to jump in with both feet. However, after
being at the location for a year, I was convinced both
by my clinical supervisor and by my new experiences,
that a doctorate in the field would allow me to reach a
deeper understanding of my clients'' ailments, as well as
give me the tools to effect more extensive societal
change. Principally, I realized that I wanted to improve
the treatment of individual clients on a broader level,
and that more training/education would give me the
opportunity to make an impact on a systemic level by way
of practicing and doing research, teaching, and writing.
In addition to the encouragement to seek a
doctorate in order to find new avenues of helping
others, there were a number of critical incidents that
occurred to bring about my interest in child therapy and
multicultural counseling. The most significant of these
include my ethnic identity development, my particular
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
10
work situation, my coursework, and exposure to new
thinking by way of conferences and workshops. In my
ethnic development, I was at a stage where I was
embracing my Mexican heritage due to the natural process
of maturation, and because of the influence of family
and friends. Years earlier I had passed through a
rebellious phase where I rejected the customs and
traditions of my parents. But in college, I underwent a
period of self-examination and came out with a greater
acceptance and appreciation of not only my own culture
but that of other people's cultures as well. As a
result, I began working at a school where the majority
of the staff and students were Latino, which served to
reinforce my commitment to my community. It was also
during this time that I was being intellectually
stimulated at the university by professors, colleagues,
lectures, and readings about therapy and culture. I was
challenged to take a stance on various issues and to
choose a direction for my professional life.
I had known since an early age that I wanted to
work with children, consequently in my masters and
doctoral programs I specialized in child and adolescent
therapy. I selected field placements that offered more
training in these areas, and my first job out of my
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
11
masters program was at a site where I would have the
opportunity to practice with students. While I worked in
the educational therapy setting I was also introduced to
various literature on multicultural counseling through
the classes I took, and at meetings that I attended.
There were a few special professors, readings, and
symposiums that I believe stirred me into action. It was
as though I was caught up in a movement, and as I
integrated and applied this new knowledge with fervor, I
saw the need to explore the impact of culture on the
counselor-client interaction, and how critical this was
in order to effect positive outcomes in therapy. I am of
the opinion that cultural issues have been ignored in
psychology to the extent that they have been avoided or
suppressed in society because of the volatility of the
subject matter. All the same, I felt very strongly that
we as psychology theorists, researchers, educators, and
practitioners have the responsibility of looking at the
manifestation of cultural factors on ourselves as well
as on the psychotherapy interventions we employ.
So when I finally looked with a more focused lens
at the effects of culture on the therapy of children, it
was not at all surprising that I found something. I
remember one of the first times that it really hit me.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
12
When I began working at the school, I thought that my
clients were assigned to me because of language issues
or as a matter of convenience. I was managing a caseload
of about 18 clients and I had all the kids whose parents
spoke only Spanish, as well as those students
transferred by other therapists because they were
particularly difficult cases. Well, I soon learned that
there was method to this madness, and that I was not
simply getting these clients because I was a bilingual
counselor or because I was the low one on the totem
pole. My clinical supervisor asserted that he tried to
match students and therapists according to several
factors; he tried to come up with the best client-
therapist fit, and he believed that ethnicity and gender
were of prime importance in the therapeutic equation.
His rationale soon made sense to me with one of my first
cases. I had been treating a nine-year old boy in
English for a few months when it became necessary to
schedule a meeting with his parents because of some
trouble he was having with his teacher. In the joint
meeting I began speaking Spanish to his mother and
father, and the look of relief on their faces was only
surpassed by the look of surprise on my client's face.
Later that day, during his individual session with me he
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
13
commented how before the meeting he had always looked at
me as a "Barbie Doll". When I explored this with him I
learned that it made a difference to him that I was
actually Latina and not White. I found that it was not
so much that I knew Spanish that made the difference
(although it was indispensable to communication with
parents and kids who had difficulty with English), it
was the shared heritage that bridged the culture gap. In
fact, my client revealed that he felt like he could talk
to me now that he knew that I understood where he came
from. Thus, it became clear that his perception of my
ethnic background was of utmost importance to the
therapeutic process. Along the same lines, I realized
how crucial it was to listen to and deal with what my
clients were not saying; if I did not bring up subjects
like culture or gender, my clients were not going to,
even if they felt like it was important. From that point
on, I addressed these issues with all of my clients and
found similar results. That is to say, acknowledging
culture's place in the relationship seemed to start us
off on the right foot and opened up space in the therapy
room.
After having had the experience described above and
many more like it, I began to wonder about the cultural
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
14
counseling experiences of other therapists and clients,
I realized that my situation may have been unique, in
that I am a Mexican-American who is often confused with
an Anglo therapist because I have blonde hair, blue
eyes, very light skin, and no noticeable accent.
Nevertheless, I still felt that culture must play at
least some part in every therapeutic relationship
whether client and therapist are of similar or different
ethnicities. Since I had the framework and conceptual
background to understand this experience, I resolved to
find out more about it. What I found, or rather what I
did not find, was disturbing; after scouring the
counseling and psychology literature I learned that
there was no information specifically about culture's
influence on child therapy. I gathered together an
assortment of literature that ultimately told me one
thing, that what is out there is insufficient to answer
the question as to whether the therapy of children is
affected by cultural factors. The existing multicultural
counseling theory on adults does not speak to how
culture impacts the therapy of children, neither does
the literature of any of the related fields I perused.
There were a number of places that touched on the
subject indirectly or just slightly, and these areas of
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
15
research include literature on development, social
learning, cultural psychology, and the counseling
psychology literature on ethnic matching.
Nevertheless, it was not until I read two reports
by the Surgeon General of the United States (DHHS,
SAMHSA, & CMHS, 2001; DHHS, U.S. Department of Education
[DE], & U.S. Department of Justice [DJ], 2001) on mental
health and culture, and on children' s mental health,
that I felt like my research questions were addressed.
Dr. David Satcher (2001) was able to articulate much of
what I had experienced as a child therapist and what I
believed to be true about multicultural counseling.
Although the reports did not actually answer my
questions, the Surgeon General did summarize the
literature and outline why the issue of culture in
therapy with adults and children is important, what has
been done about it, and what needs to be done about it.
Not only did these comprehensive scientific reviews
identify the phenomena of my interest as a significant
issue in psychology, but they added to my argument that
it must be a societal imperative to discover what part
culture plays in therapy in order to improve the
treatment of children.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
16
The Conception of the Child
The notion that children are merely small adults has
been refuted since John Locke emphasized the role of
experience in shaping children (Baruth & Manning, 1999;
Holmes, 1998). Rousseau also laid the foundation for
contemporary European-American views of child
development when he theorized that children are innately
good and innocent (Holmes, 1998). Shifts in theoretical
perspectives over the last several hundred years have
contributed to an evolution in thinking and attitudes
about education, health, and general welfare of
children. Currently, attitudes toward children are mixed
with regard to segregation, protection, and supervision.
At present every child experiences many different kinds
of childhoods, which are dependent on gender, social
class, ethnicity, and geography (Holmes, 1998).
William James characterized a child's universe as "one
big, blooming, buzzing confusion" (1905). James noted
that this confusion was "potentially resolvable and
demanding to be resolved" (1905). And although we know
much more about child development, his remarks are still
relevant today regarding the cumulative research on
children's experiences and concerns. In fact, research
on child therapy and cultural psychology is distinctly
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
17
lacking. Researchers have studied children's behavior,
culture, and social identities in very restrictive ways
(e.g., simply in relation to how they present demands
upon their families, their teachers, or society in
general) or, they have ignored studying children at all.
Moreover, the studies that have focused on children's
cultural experiences either avoid middle childhood or
rely solely on observation when studying them (Connolly,
1998). The lack of interest in studying children and
their viewpoints shows that children continue to be
"seen and not heard."
Focus on School-Age
School-age children (8-11 years old) have been
neglected in the developmental, psychological,
educational, and cultural literature. Historically, the
"latency" period has been considered unimportant,
particularly because Freud characterized it as a time
when development was relatively uneventful (Benson &
Harrison, 1991; D'Andrea, 1983; Finkelstein, 1985;
Newman & Newman, 1991; Ohrenstein, 1986). As a result,
researchers have chosen to study infants, toddlers,
younger children (4-7), and adolescents (12-18)
(Astington & Olson, 1995; Connolly, 1998).
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
18
The majority of studies that have examined
multicultural dimensions in psychological development,,
look primarily at children in Piaget's pre-operational
stage, that is ages 2-7 years (Baruth & Manning, 1999).
In regards to folk psychology within the European-
American culture, there is a lack of sufficient data on
people over five years old (Lillard, 1998a). In
contrast, Baruth and Manning (1999) report that factors
that influence the onset of Piaget's concrete
operational stage typically begin at age seven; these
influencing factors include acculturation, degree of
Western-type schooling, ecological-economic demands,
socialization values, and gender differences.
Notwithstanding the idealized or stereotyped images
of latency as the golden age of childhood, contemporary
theorists insist that it is a time when a number of
important developmental transformations take place
(Benson & Harrison, 1991). The cognitive, affective,
social, and physiological changes that occur at this
stage may be less conspicuous than those associated with
earlier and later stages, but they contribute to overall
psychological health (D'Andrea, 1983; Ohrenstein, 1986;
Schechter & Combrinck-Graham, 1991). With this in mind,
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
19
□ ' ’Andrea (1983), suggests that there is a need for
increased knowledge of middle childhood development as
it relates to counseling and other services utilized by-
children .
Challenges in Studying Children
Research with children presents a number of
problems. For example, techniques, which rely on verbal
or written language, depend on the individual child's
linguistic competence (Clark & Clark, 1947; Davey,
1983). These tasks need to be simplified so that they
can be understood by child-participants. However in
conducting cross-cultural research, simplicity will not
do the job unless there are universal fundamentals
(Lillard, 1998a).
Along with concerns about technical difficulties
and the tendency to avoid in-depth interviews with
children is a set of assumptions that tends to foreclose
any meaningful study of their social worlds (Lillard,
1998a). Traditional socialization and developmental
models of childhood suggest that children are socially
and cognitively inept, that they do not have basic
skills or the ability to think meaningfully/critically
or reflect upon and adapt to their own behavior
(Connolly, 1998). Thus, it is not surprising that the
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
20
tendency to underestimate children''s abilities and
ignore their subjective experience pervades the study of
cultural themes in their lives.
The Therapeutic Environment: Part of a Child's World
Children's subjective constructions of their worlds
provide vivid reflections of their perceptions of what
is happening within the social environment. Moreover, if
children's biases and preferences continue to be
reinforced and eventually crystallize into adult
attitudes, this will make a profound contribution to the
future pattern of intergroup relationships (Davey,
1983). Thus, it becomes imperative to examine the
ramification of those reinforcements. Namely, we must
try to understand the sociocultufbl contexts of
children's environments to appreciate both child and
adult transactional patterns. Typically, the social
environments that have been studied are the home,
school, and peer group (Bronfenbrenner, 1989). However,
it is also important to examine other settings that may
serve as social reinforcements, such as mental health
services, especially since this area has been
disregarded as a source of information on child-adult
and cross-cultural relationships.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
21
Children''s perceptions may be influenced by the
therapeutic situation, which is in turn the outgrowth of
a psychological worldview. In particular, therapy can be
viewed as an icon of Western philosophy, and as such may
be a significant mode of cultural transmission to
children (and adults). Accordingly, several researchers
note that the therapeutic relationship is not a context-
free phenomenon; these researchers address therapy as
part of cultural psychology (Harwood, Miller, &
Irizarry, 1995; Roberts, Carlson, Erickson, Friedman, La
Greca, Lemanek, Russ, Schroeder, Vargas, & Wohlford,
1998).
Problems with Clinical Research on Ethnic Minorities
Along with the dearth of information on children in
the therapeutic environment, empirical data on ethnic
minorities is scarce. According to the Division 12 Task
Force (1995), no psychotherapy treatment research meets
even the basic requirements for demonstrating treatment
efficacy for ethnic minority populations, including
behavior therapy (Chambless, Sanderson, Shoham, Johnson,
Pope, Crits-Christoph, Baker, Johnson, Woody, Sue,
Beutler, Williams, & McCurry, 1996). Out of 41 studies,
none used ethnicity as a variable of interest, and most
investigators did not even specify the ethnicity of
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
22
their subjects or used only white subjects. This
situation is distressing for several reasons: (1) the
U.S. is among the most diverse nations in the world, and
most therapists will have to deal with clients from very
different cultural backgrounds; (2) there are
indications that mental health needs of racial/ethnic
minorities are high, and that these groups have been
underserved or inappropriately served by the mental
health profession; and (3) the lack of rigorous research
on the efficacy of treatment for culturally diverse
populations is poor science because it shows a lack of
attention to the limits of generalization from sample
studies (Chambless et al., 1996; Leong, 1996).
Furthermore, the Surgeon General's report
determined that disparities in mental health services
exist for racial/ethnic minorities, and thus, mental
illnesses exact a greater toll on their overall health
and productivity (DHHS, SAMHSA, & CMHS, 2001). His
report emphasized how culture affects all aspects of
mental health and illness, including the types of
stresses people confront, whether they seek help, what
types of help they seek, what symptoms and concerns they
bring to clinical attention, and what types of coping
styles and social supports they possess. In addition,
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
23
his review took into account how the cultures of
clinicians and service systems influence the nature of
mental health services. In brief, he declared that it is
now incumbent to set in motion a plan for eliminating
racial/ethnic disparities in mental health (DHHS,
SAMHSA, & CMHS, 2001).
Likewise, at the Conference on Children'’s Mental
Health, the Surgeon General outlined A National Action
Agenda because of the health crisis created by children
with mental health needs (DHHS, DE, & DJ, 2001). He
observed that there is no mental health equivalent to
the government's commitment to childhood immunization,
and that children are afflicted because of missed
opportunities for prevention, disjointed services, and
low priorities for resources (DHHS, DE, & DJ, 2001).
Among the goals on the agenda was to support research on
familial, cultural, and ecological contexts to identify
opportunities for promoting mental health in children
and providing effective prevention, treatment, and
services. Another objective was to create a forum for
promoting direct communication among researchers,
providers, youth and families to bridge the gap between
research and practice, as well as develop a common
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
24
language to describe children'’ s mental health in order
to facilitate service delivery across systems (DHHS, DE,
& DJ, 2001).
During the Conference on Children'' s Mental Health,
Dr. Glorisa Canino highlighted the lack of access to
mental health services in different settings for
minority children (DHHS, DE, & DJ, 2001) . In addition,
Dr. Margarita Alegria discussed three reasons for the
need to focus on racial and ethnic differences: (a)
Race, ethnicity, and culture of children play a major
role in shaping the care provided to them by health
institutions; (b) There are challenges in identifying
the mechanisms by which ethnicity, race, and culture
account for disparities in emotional problems and
service delivery; and (c) Efforts to address
racial/ethnic disparities in mental health service
delivery are constrained by profound socio-
environmental, institutional, and market forces (DHHS,
DE, & DJ, 2001) . Other factors that mediate challenges
in advancing equity in mental healthcare for children of
color may be related to lack of early detection by
providers and parents; untrained and culturally
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
25
insensitive providers; and lack of parent and provider
knowledge of efficacious treatments (DHHS, DE, & DJ,
2001).
Defining Culture
Due to the heterogeneity in cross-cultural
psychology it is important to delineate what is meant by
culture. There has been much confusion among researchers
regarding terminology and definitions. As a result,
misattributions occur because of the failure to
distinguish between ethnicity and culture (Holmes,
1998). At this point I must also note that because the
term race is considered by some as an arbitrary
construct whose cultural and biological meanings and
applications are imprecise, it will not be a focus of
this analysis (Baruth & Manning, 1999; Holmes, 1998;
Oetting et al., 1998). In this study, culture is
regarded as shared knowledge among members of a group,
and cultural identification is the strength of one's
affiliation with this group, which is developed
primarily through interactions with primary
socialization sources of family, school, and peers
(Oetting, Donnermeryer, Trimble, & Beauvais, 1998).
Ethnicity on the other hand is taken to be perceived
membership in a cultural group; that is, individuals
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
26
recognize a common identity and interact according to a
cultural value system (Holmes, 1998; Oetting et al. ,
1998). However, both culture and ethnicity denote a
common heritage, or set of beliefs shared by a group of
people (DHHS,1999; Zenner, 1996). Heritage includes
similar history, language, rituals, and preferences for
music and foods. Finally, minority refers to a group of
political and/or economically disadvantaged individuals
who are relatively powerless, receive unequal treatment,
and regard themselves as objects of discrimination (Ho,
1992).
In visibly multi-ethnic societies, skin color and
other physiognomic characteristics are usually the most
accessible criteria for constructing social categories
(Davey, 1983). Any characteristic, which is common to a
collection of people, is capable of being invested with
social significance. Therefore the potential range of
cues, or social markers, is enormous. The significance
that particular personal attributes have as grouping
criteria for children has been shown to vary with both
age and the social context of their membership groups
(Davey, 1983). Consequently, it is helpful to keep in
mind how children acquire their intergroup attitudes via
the processes of social comparison and differentiation
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
27
(Davey, 1983); thus, stereotyping or categorizing as a
means of simplification and managing the physical and
social world is an important concept in this study.
In order to operationalize culture and ethnicity,
study participants were allowed to describe themselves
with social markers and stereotypes. In addition, the
children and their counselors can utilize other ethnic
self-identification domains such as natal measures,
behavioral measures, subjective measures, and
situational settings. Trimble (personal communication,
January 29, 1999) suggests that these are principal ways
to specify culture and ethnicity. He talks about how
this self-identification embraces a social-ecological
model and provides a more complete picture of a person
in the world; it recognizes the importance of
microsystems (child-parent), mesosystems (school),
exosystem (mass media), and macrosystems (dominant
beliefs and ideologies), in the lives of children.
The Latino Population
Children of Latino background who live in the U.S.
come from families who share a heritage that blends
their Hispanic and Native American roots and, as in the
case of Cuba and Puerto Rico, African roots as well. The
term Latino is not an ethnic identity, but it has been
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
28
used to refer collectively to people of Indo-Hispanic
background who live in the Americas - people who are
newly arrived from Mexico, Cuba, Puerto Rico, Central
America, or Latin America or those who have been in this
country for one or more generations, and are anchored in
the Anglo-American cultural environment (Bernal &
Knight, 1997).
Since the 197 0 Census, when the government began to
rely on self-identification as a means of counting
members of racial and ethnic groups, there has been
increased interest in the psychological view of oneself
as a group member. As a result, pressures on educators,
health professionals, and mental health service
providers have spurred investigation into particular
segments of the population that may have gone previously
unnoticed. Along with this interest comes the
realization that Latino families have distinct
histories, nationalities, and cultures (Bernal & Knight,
1997) .
According to data (Garcia & Marotta, 1997; U.S.
Bureau of the Census, 1985), the Latino population is
rapidly growing, and by 2015 it is estimated will
represent at least 15% of the U.S. population. Also,
Latinos as a group are younger and they have larger
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
29
families compared to the total population (U.S. Bureau
of the Census, 1985). Statistics have also shown that
differential availability of mental health services
constitute a barrier to treatment for minority children,
especially when children and youths present with
multiple needs and problems, including developmental,
family, peer, health, vocational, academic, and
behavioral issues (Young Rivers & Morrow, 1995).
Latino Children and Their Mental Health Concerns
With the help of the Kellogg Foundation'’s Families
for Kids Initiative, the National Latino Child Welfare
Advocacy Group (1997) conducted a study on the child
welfare needs of Latino children and families. The study
centered on six states that represent the diversity
among the nation's Latino population: California,
Florida, Illinois, Michigan, New York and Texas, which
collectively make up 40% of all children in the United
States and 75% of the Latino child population. The study
discovered that Latino children make up 12% of the
nation's child population, reflecting a growth rate
approximately seven times higher than non-Latinos. By
2020, projections show, more than one in five children
will be of Latino origin. In addition, the number of
school-age children who speak a language other than
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
30
English at home and have difficulty speaking English has
doubled since 1979, making up 5% of all children in
those age groups (The National Latino Child Welfare
Advocacy Group, 1997).
Latino children face particular issues and problems
in society not encountered by European-American children
or even other ethnic minorities. As stated earlier, they
have distinct histories, traditions, and beliefs that
affect how they live their lives. There is much in the
way of demographic data, immigration data, and native
culture to support the existence of these differences.
Some specific examples of diversity from mainstream
society that may influences Latino children'' s
interaction with mental health systems include the
cultural beliefs and/or practices of: (a) familism, (b)
personalism, (c) sense of hierarchy, (d) spiritualism,
and (e) fatalism (Ho, 1992). In addition, the acceptance
of the cultural notion of machismo, and the allegiance
to Spanish as the "mother tongue" have created many
challenges for Latino children (Baruth & Manning, 1999).
Latino children also confront poverty in
disproportionate numbers; some reports find that 39% of
all Hispanic children live at the poverty level, with
71% living in homes with only a female head of the
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
31
household (Colburn & Melillo, 1987; Valero-Figeuria,
1988). Correspondingly,, educational challenges
experienced by Latino children are as follows: (a)
compared to European-American children, Latino children
begin school with less pre-school experience; (b) gaps
in Latino children's academic achievement appear at age
9 and persist through age 17; (c) the school dropout
rate, although declining, remains high for adolescent
Hispanic students; (d) Hispanic high school seniors
experience more learning disruptions (e.g., fights, gang
activity, relocation); (e) Latino children take fewer
advanced mathematics and science courses; and (f)
Hispanic Americans have lower educational aspirations
and are about half as likely to complete four years of
college ("Educating Hispanic Students," 1995).
Although the mental health issues and problems
specific to Latino youth will also be discussed later,
it is now necessary to note a number of these concerns.
In epidemiological studies, an example of increased
distress experienced by Latinos is the high prevalence
of somatization problems among Mexican-American and
Puerto Rican youth (Angel & Guarnaccia, 198 9; Escobar &
Karrer, 1986). Another example is the prevalence of
depression among Mexican-Americans in Los Angeles as
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
32
compared to Anglos (Garcia & and Marks, 1989). Clinic-
based research data has also shown differences in the
structure and interpretation of symptoms among Latino
children. For instance, in Stoker and Meadow's (1974)
study, Mexican-American boys were frequently described
as aggressive, whereas Anglo-American boys were reported
as neurotic. In addition, a review of the literature
shows that Mexican-Americans have excessively high
dropout rates (Carter & Wilson, 1991), and that these
dropouts are markedly more prone to drug use, committing
violence, and being the victims of violence than the
non-dropouts (Beauvais, Chavez, Oetting, Deffenbacher, &
Cornell, 1996). Moreover, urban gangs are an increasing
and serious problem for Latino youth.; "of 500 gangs in
Los Angeles, approximately two-thirds are Hispanic and
most of these are conflict-type gangs" (Attorney
General's Youth Gang Task Force, 1988, p.17). In
conjunction with greater gang activities, the homicide
rate for Latino youth has increased to a rate almost
three times higher that of non-Hispanic Whites (Centers
for Disease Control, 1988). The Centers for Disease
Control (1987) also found that between 1981-1987, 23% of
the nationally reported AIDS cases for children under 13
were Hispanic. And of the adolescent cases with the
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
33
single risk factor of IV drug abuse, 35% were Hispanic,
compared to 5% non-Hispanic Whites (Centers for Disease
Control, 1987). Thus, in the assessment and treatment of
Latino children/adolescents it is necessary, but not
sufficient, to understand the special issues and
sociocultural factors mentioned above. Therapists must
understand how these personal and cultural factors
translate into therapeutic behaviors that are relevant
to Latino children's needs and problems (Ho, 1992).
Child Therapy, Culture, & Theory
It is only recently that interest in the unique
developmental aspects of children and recognition of the
need for special counseling has been demonstrated
(Baruth & Manning, 1999). Children's particular way of
talking, acting, and perceiving events in their lives
suggests the need to consider the distinct culture of
childhood. Further, it is recommended that counseling
professionals who intervene with children from diverse
cultures understand: (a) the world of childhood; (b) the
physical, psychosocial, and intellectual characteristics
of developing children; and (c) the cultural differences
among children (Baruth & Manning, 1999). It is not
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
34
enough for therapists to know about developmental
studies, they need to able to think and see from a
child''s eye view.
Children learn to think about and solve problems in
their everyday lives through the appropriation, use, and
adaptation of social practices, materials, and symbolic
tools developed by their culture to address these
problems and meet cultural goals (Gauvain, 1998;
Lillard, 1998b) - one such social practice/tool is
psychotherapy. Children play an active role in this
(therapeutic) process as their developing capabilities
set the stage and boundaries for development within
cultural context. Correspondingly, Gauvain (1998, p.41)
states "The inextricable connection between human
biological processes, cultural systems of meaning and
action, and their joint passage through time constitutes
the landscape of human cognitive development".
The tenants of multicultural counseling also affirm
that ethnicity and culture have enormous implications on
the assessment and treatment of minority children (Ho,
1992). Besides shaping children's belief systems about
what makes up mental health and mental illness,
ethnicity influences children's manifestation of
symptoms, defense mechanisms, coping styles,
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
35
conceptualization of problems, and responses to "proper"
treatment. In addition, culture shapes the types of
help-seeking behaviors that parents employ in seeking
relief for their children (Ho, 1992). It is clear that
there is a difference between minority children and
those from a European-American background, but how
exactly these impact the therapeutic process is still
open for investigation. Children growing up in minority
families are exposed to different family structures and
dynamics, school and neighborhood experiences, and
community responses than children from mainstream Anglo
families (Ho, 1992). They also have to deal with socio
economic realities and barriers that profoundly limit
their prospects and negatively affect their normal
development and mental health. Children of color (i.e.,
African-American, Latino-American, Asian-American, and
Native-American) uniquely encounter many factors that
may influence their experience of mental health systems.
Some factors that have been identified by researchers
include: (a) a minority reality, (b) the impact of the
external system on their cultures, (c) biculturalism,
(d) language differences, (e) social-class differences,
(f) differences in color, (g) belief systems, and (h)
help-seeking behaviors (Ho, 1992).
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
36
The ethnic minority reality is that discrimination
and racism pervade all levels of society. This prejudice
is evident from the theories of genetic inferiority and
cultural pathology to the segregation that existed in
the South until the Civil Rights Era and the continued
inequities manifested in the U.S. today by the
disproportionate numbers of minorities who are poor,
homeless, in prison, unemployed, and/or school dropouts
(Ho, 1992). According to researchers, the processes of
racism and discrimination contribute to the
underutilization of mental health services by
minorities, as professionals are generally
monolinguistic, middle class, and ethnocentric in
problem diagnosis and treatment (Ho, 1992; Acosta,
Yamamoto, & Evans, 1982). Likewise, cultural differences
in values and attitudes lead ethnic minorities,
especially children, to believe that they are inferior
to white Americans. This negative impact of the external
system on minority cultures tends to alienate minority
individuals or cause conflict within the family.
Also, because minority children are inevitably part
of two cultures, they have no choice but to develop and
differentiate between a personal identity and a ethnic
identity in order to form a cohesive sense of self (Ho,
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
37
1992). However, when these children are forced to make a
choice between their own culture and the dominant
culture, conflict is to be expected. The stress of
straddling two disparate cultures may become
overwhelming and irresolvable to some minority children
(Ho, 1992; Welsh, 1988; & Gibbs, 1987). Similarly,
language differences can be a source of tension for
minority children. Language ability and preference are
indicators of children'' s level of acculturation and as
such reflect significant family dynamics and
intergenerational harmony or discord (Ho, 1992). Ogbu
(1985) also maintains that language problems are often
related to school problems and family conflict.
Furthermore, it has been well documented that
social class and socioeconomic issues play a significant
part in the therapy of children, but when compounded
with ethnic differences there are additional challenges
to therapeutic processes (Ho, 1992). Because of the
boundaries of class, children experience a restricted
range of opportunities. Even when ethnic minorities are
materially successful they may still experience
difficulty being accepted by white middle class society
(Ho, 1992). Similarly, conformity in appearance and skin
color is highly valued in society. For minority
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
38
Americans, skin color has many levels of symbolism;
deviation from the norm could be viewed as a source of
pride or a mark of oppression (Ho, 1992).
Finally, the influence of ethnicity on belief
systems about what constitutes mental health and
illness, as well as on help-seeking behaviors, has been
shown in several studies (Abramowitz & Murray, 1983;
Atkinson, 1983, 1985, 1986; Sue, 1988; Ho, 1992).
Children'' s symptomatic behavior and their patterns of
coping with anxiety, depression, fear, guilt, and anger
are different according to culture (Ho, 1992). Also,
various studies indicate that ethnic minority parents do
f ' j
not consider mental health services a solution to their
children'' s mental and emotional problems (Abramowitz &
Murray, 1983; Atkinson, 1983, 1985, 1986; Sue, 1988; Ho,
1992). Lastly, Ho (1992) lists eight major reasons for
the underutilization of mental health services by
minorities: (1) clients' distrust of therapists,
especially white therapists, (2) cultural and social
class differences between clients and therapists, (3) an
insufficient number of mental health facilities and
professionals who are bicultural, (4) clients' overuse
or misuse of a physician for psychological problems, (5)
language barriers, (6) clients' reluctance to recognize
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
the urgency for help, (7) clients' lack of awareness of
the existence of mental health clinics, and (8) clients
confusion about the relationship between mental health
clinics and other agencies such as welfare, courts, and
schools.
Organization of the Study
In sum, I have indicated that a problem exists;
Latino children have largely been ignored in academia
and in the world of mental health treatment. Above, I
suggested that this problem has implications for
children, minorities, mental health systems, the
psychological sciences, and society as a whole. I also
spoke about my personal and professional interest with
this problem. I then presented the literature on school
age children and discussed the challenges in doing
research with this population. I followed by briefly
considering the therapeutic environment. In addition, I
defined cultural terminology and demonstrated the lack
of research on ethnic minorities. Finally, I described
the Latino population and gave particulars on Latino
children, therapy, and theory.
In the proceeding chapters I show how culture is a
complex concept with personal and subjective meaning,
how children employ cultural schemas, and how culture
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
40
affects the therapeutic relationship of Latino school-
age children. In Chapter Two, I explore the extant
literature on children and multicultural counseling,
including developmental research, social learning
research, therapeutic literature, studies on Latino
youth, ethnic matching research, and qualitative
research. I go on to illustrate how there is not
sufficient information on the therapy of Latino children
or the cross-cultural therapeutic relationship. In
Chapter Three, I outline my method of research, which
involved data gathering and analysis of the database. I
describe the materials I used to create the text, which
consists of journal notes, interview transcripts,
videotapes, and children'’s drawings. The chapter that
follows is a report of the findings, which were
determined by a cross-case analysis and the
identification of themes among my clinical cases and the
cases of the five therapeutic dyads used as
supplementary data. Finally, in Chapter Five, I discuss
how culture pervades the therapeutic dialogue as well as
other relevant findings. I conclude by expanding on the
implications of these results for multicultural
therapeutic practice and training.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
41
CHAPTER TWO
Literature Review
Child Development, Culture, and Therapy
Development During Middle School Years
Conceptions of typical grade school children from
the ages 8 to 11 are characterized by stability,
educability, pliability, adaptability to external
demands, and by a relative calmness. However, Benson and
Harrison (1991) contend that this period is actually
akin to the "eye of a hurricane;" and that during these
years there is a major shift of psychological
organization from external action towards more personal
imagining. Other researchers have likewise challenged
the myth of quiescence in middle childhood, and have
suggested instead that it is a time of extremely active
exchange between the child'’ s inner world and the
external world. (D'Andrea, 1983; Ohrenstein, 1986;
Schechter & Combrinck-Graham, 1991). Moreover, complex
ecological forces affecting physiological and
psychological outcomes, forces which begin exerting
themselves well before birth and which determine the way
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
42
a child enters the school years, do not simply rest with
the intrapsychic processes of sexualized experiences of
the pre-latency years (Schechter & Combrinck-Graham,
1991) .
School-age children enjoy homeostasis inasmuch as
they do at any other developmental period. However,
researchers emphasize a need to recognize critical
developmental issues during this time, such as
temperament, psycho-biological givens, gender identity,
cognitive development, cultural influences, coping and
adaptive styles, and physical development (Schechter &
Combrinck-Graham, 1991). During the middle school years
egocentric thinking diminishes, corresponding with an
increase in intellectual capacity to reason. In
addition, the numerous physiological changes that occur
from the years of 8-11 result in the development of a
greater degree of autonomy from adults. Thus, children
begin to explore beyond the bounds of the family system
for the first time (D'Andrea, 1983; Ohrenstein, 1986;
Schechter & Combrinck-Graham, 1991).
Similar to other developmental researchers,
Noshpitz (1990) contends school-age children experience
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
43
special kinds of strength and particular
vulnerabilities. He suggests that the strengths derive
from children'' s increasing ability to think in concrete
but empirical fashion, to follow rules, and to learn.
The hazards come from the continuing need to be close to
and relatively dependent on the parents, from children''s
inability to solve the problems of their own world
including coping with the demands of school, and from
the requirement that children achieve a considerable
measure of impulse control. Noshpitz (1990) concluded
that common sources of stress in middle childhood are
comprised of school as stress, home as stress, and
family moves, and that coping styles are mitigated by
developmental aspects such as blending of the superego,
cognitive transformation, and supportive home and school
environments.
Furthermore, a review of the self psychology
literature by Freedman (1996) found several significant
experiences in the affective development of school-age
children, including: twinship, efficacy, cultural,
fantasy, evoked affective attunement, self-delineating,
idealizing, mirroring, and protective prohibitory
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
44
experiences. Current psychoanalytic,, developmental, and
psychosocial bodies of literature also identified five
important developmental tasks in the affective domain
for school-age children: the creation and sensation of a
sense of self as distinct from others, affect tolerance,
the capacity to manage internal urges, the development
of an internal locus-of-control orientation, and the
capacity to enter into and sustain a state of latency
(Freedman, 1996). Cognitive and physiological
development are noted as important in the child's
ability to attain these socio-emotional capacities.
According to Rubin (1998), researchers of social
and emotional development of children typically focus on
individual (e.g., temperament), interactional (e.g.,
parenting behaviors), and relational (e.g., attachment,
friendship) levels of analysis when studying
developmental norms (and deviations thereof). He argues
that they often ignore the role cultural beliefs play in
the interpretation of the acceptability of individual
characteristics and the types and the ranges of
interactions and relationships that are likely or
permissible. In like fashion, Baruth and Manning (1999)
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
45
advocate a model of minority child development that
views differences from a positive perspective, because
for too many years the minority child has been viewed
exclusively in conjunction with negative environmental
forces (e.g., poverty, discrimination, and slavery).
These researchers pose a series of questions that need
to be addressed for a more enhanced understanding of the
effects of culture on development (See Figure 1). In
addition, they present a summary of children''s physical,
psychosocial, and intellectual development (See Figure
2), but caution that children differ according to
socioeconomic class, age, and cultural factors (Baruth &
Manning, 1999).
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
46
How do culture and ethnicity affect children's development?
What developmental similarities do children share across
cultures?
How do children differ developmentally across cultures?
How do cultural beliefs about maternal and paternal parenting
affect child development?
How should professional intervention reflect both culture and
the childhood stage of development?
Do research findings of Piaget, Vygotsky, and Erikson have
relevance for minority child development?
How can mental health professionals most effectively intervene
with children of the various cultures?
Figure 1.
Crucial questions in cross-cultural child development.
Source: Baruth & Manning (1999). Multicultural
counseling and psychotherapy: A life-span perspective
(2nd ed.). Upper Saddle River.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
47
Physical development includes children
1. participating in sedentary pursuits such as fingernail biting,
hair twirling, and general fidgeting
2. needing sufficient rest periods because of fatigue from mental and
physical exertion
3. demonstrating superior large-muscle control rather small-muscle
control
4. experiencing difficulty with fine print, perhaps, actually being
nearsighted
5. experiencing increasing control over their bodies, which adds to
their confidence (thus they perhaps underestimate dangerous
pursuits)
6. experiencing a growth spurt in most girls and early maturing boys
7. approaching puberty, especially girls, and beginning development
of a sexual reproductive system, thus creating a curiosity about
sex
8. experiencing improving fine-motor coordination, enhancing both
physical skills and self-concept
Psychosocial development includes children
1. growing more selective in choice of friends (e.g., they might have
a more-or-less best friend)
2. enjoying participation in organized games in small groups and
showing inordinate concern with rules or team spirit
3. experiencing quarrels, with more words than physical aggression
4. growing increasingly sensitive to the feelings of others
5. placing value on peer group expectations and replacing adults as
the major source of behavior standards and recognition of
achievement
6. developing interpersonal reasoning, which leads to greater
understanding
7. learning to adapt socially, yet behavior disorders often peak
8. experiencing conflicts between peers and adult expectations, which
have potential for social difficulties
Intellectual development includes children
1. being eager to learn, especially between the ages 6 and 10
2. experiencing greater facility in talking than in writing
3. tending to be tattletales, especially in young children because of
their literal interpretation of rules
4. increasing ability to solve problems by generalizing from concrete
experiences
5. demonstrating sex differences in specific abilities and overall
academic performance
6. demonstrating differences in cognitive styles
7. functioning in Piaget's concrete operational stage (diversity
should be remembered)
8. dealing with abstractions around age 12, but will still generalize
from concrete experience
Figure 2.
A summary of child development.
Source: Biehler & Snowman (1993). Psychology applied to
teaching (7th ed. ) . Houghton Mifflin Company.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
48
Social Learning and Culture
Children learn the values, attitudes, knowledge,
and skills appropriate to their culture from their
specific ethnic group which stands in a particular
economic and social relationship to other groups in the
community (Davey, 1983). As a result of group
membership, children do not perceive/react towards each
other solely as individuals but as members of
recognizable social collectives. Children thus learn how
they are expected to behave towards others and how
others are expected to behave towards them.
There is a constant process of action and reaction
between the beliefs and images that one group holds of
another and the way in which its members behave towards
the minority or outgroup. This dialectical process is
integral to children's social learning (Davey, 1983).
Children are led to develop a concept of themselves
within the context of selection and biases that exist in
society. Any awareness that their perception of others
may contain a pejorative element derived from their own
group and its position in the established structure of
society is most likely absent. Despite or maybe because
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
49
of long-established patterns of power and powerlessness
between non-whites and whites persist, children and even
their parents lack historical memories of their specific
group (Davey, 1983).
Research on Latino Children
Mainstream research in psychology and education has
attempted to describe the "universal" child, but
currently there are challenges to the
decontextualization of children and efforts to penetrate
into local knowledge about children'’ s development in
their own cultures (Goncu, 1999, p.4). For instance,
more studies are going beyond reporting a standard
global measure of family, ethnicity, and income (Farver,
1999; Gaskins, 1999; Goncii, 1999; Goncu, Tuermer, Jain,
& Johnson, 1999; Haight, 1999; Tudge, Hogan, Lee,
Tammeveski, Meltsas, Kulakova, Snezhkova, & Putnam,
1999). Furthermore, these researchers propose that
variations within and across cultures is a matter of
kind as well as degree. Along these lines, I now shift
to an analysis of understanding unique cultural features
of Latino children.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
50
Long-term research of ethnic identity, particularly
that of Mexican-American children, (Bernal, Knight,
Garza, Ocampo, & Cota, 1990) has shown that this
psychological construct is a part of self-concept which
contributes to the adaptation of Latino children within
their families as well as within their European-Merican
environments. The concept of ethnic identity informs the
current study because it speaks to how children adopt
cultural attributes and how it can influence their
relationships with others (i.e., their counselors).
According to Bernal and her colleagues (1990),
children's ethnic identity is multidimensional and
composed of a number of elements, including: (1) self-
identification or categorization of oneself into an
ethnic group, which is based on one's knowledge of the
cues that distinguish the group, and on the ethnic
labels one chooses to use,* (2) ethnic knowledge, or
information regarding the cultural values, styles,
customs, and traits that are characteristic of one's
group; (3) ethnic preferences and feelings about being a
member of one's group, about own-group members, values,
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
51
and speaking the language; (4) ethnic constancy, or
knowing that one's ethnic characteristics are permanent;
and (5) use of ethnic role behaviors.
In their study, Bernal et al (1990) found that
cognitive developmental levels associated with age
account for variations in the expression of social
identities. Level of cognitive ability was measured with
an adaptation of Piaget's conservation-classification
tasks. The results demonstrated that level of cognitive
ability did not account for the age differences in
measures of ethnic self-identification or ethnic
constancy. However, they did account for differences in
ethnic knowledge. Bernal et al (1990) posited that the
age changes found in ethnic and other social identities
may be caused by other age-related changes in
development, such as changes in learning through
socialization. This would imply that other phenomena
hypothesized to be caused by changes in cognitive
ability, such as the development of in-group pride and
prejudice, may be altered by changes in the way children
are socialized by familial and non-familial agents.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
52
The work of Bernal and her colleagues (Bernal &
Knight, 1997; Ocampo et al., 1997) on the formation and
transmission of Mexican-American identity in preschool
to school-age children, has led to a model of
socialization that invites empirical study. The
implications of their findings include: (a) recognizing
restrictions on children's cognitive capacities does not
mean that they suffer from a low sense of ethnic pride,
weakened identity, cultural deprivation, or a low IQ;
(b) Mexican-American children must develop some basic
skills, such as self-identification with their ethnic
group, awareness of their ethnicity, and a sense of
permanency of their ethnic characteristics in order to
maintain a buffer against prejudice; and (c)
practitioners working with children eight years or older
should be aware that Mexican-American children are
likely to have sufficient information and cognitive
development to have an ethnic identity, which may be of
relevance to any psychological or social problem a
Latino child may be experiencing (Bernal & Knight,
1997).
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
53
Researchers studying culturally sensitive
psychotherapy for Puerto Rican children and adolescents
also found that culture may indeed influence therapeutic
outcomes (Malgady, Rogler, & Costantino, 1990). A
program of outcome research targeting anxiety symptoms,
acting-out behavior, and self-concept problems was
evaluated and confirmed the impact of culturally
sensitive modeling therapy on anxiety symptoms and other
selected target behaviors. Malgady et al. (1990) suggest
that new approaches of psychotherapy with special
populations, such as Hispanic children and adolescents,
should be buttressed by programmatic research oriented
toward the comparative evaluation of treatment outcomes
and should be attuned to therapeutic processes mediating
between culture and outcome.
The Therapeutic Dyad
Traditional research embraces a description of
children as individuals without explicit or specific
reference to their general relationships (Goncii, 1999) .
Irrespective of the emphasis of psychological theory on
the value of relationships (G. H. Mead, 1934; Piaget,
1955; Vygotsky, 1978), some of the most intimate and
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
54
possibly relevant social interactions of children have
been left out of the literature (Goncu, 1999) . Thus, I
now briefly discuss the significance and unique aspects
of the therapeutic relationship in child therapy.
The importance of the quality of the therapeutic
encounter has been widely accepted in therapeutic
practice (Ho, 1992; Prout, 1992). The universal element
in therapy has received much support in the literature,
particularly with empirical research that reveals common
factors in psychotherapy (Dawes, 1994; Lambert & Bergin,
1994; Leong, 1996;). Theorists have discovered that most
effective psychotherapeutic approaches share these set
of factors: (a) a therapeutic relationship, (b)
provision of a systemic ideology for the client' s
problems, (c) change can be initiated from any number of
starting points as long as it is consistent with the
client's belief system, (d) the therapist's personality
may have an important influence that is independent of
the treatment modality, and (e) there are common roots
to different forms of psychotherapy across the world
(Leong, 1996). However, since process research has
played second fiddle to outcome studies, there is much
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
55
we do not know about such indicators of therapeutic
success. That is, if the common factors hypothesis was
sufficient for therapy to succeed, we would not see the
stark underutilization/premature termination among
culturally different clients. Along these lines, some
would argue that the most important variable that
accounts for more than half of the variance in outcome
is client motivation (D. Polkinghorne, personal
communication, November 18, 1997).
One of the distinguishing characteristics of child
versus adult psychotherapy is that children bring a
different motivation for treatment into the counseling
situation. Children are unlikely to seek help and
initiate entering into therapy voluntarily (Prout,
1992). They may have little or no motivation to engage
in a therapeutic relationship because they do not agree
or recognize the problems or concerns that need to be
addressed. Thus, the first step in many interventions
with children is to simply establish a relationship and
come to an agreement that change is necessary. Related
to the issue of motivation is the child's lack of
understanding of both the therapeutic process and
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
56
treatment objectives (Prout, 1992). Therefore,
therapists may have to educate and negotiate with their
chiId-clients in order to set up appropriate goals and
establish the tone of counseling.
Many researchers contend that the success or failure
of therapy rests heavily on the nature of the therapist-
client relationship - it is the foundation upon which
treatment is built (Gardner, 1992). Correspondingly,
Grotstein (1990) argues that although there are other
important tools of treatment such as transference and
interpretation, the therapeutic alliance, which he
refers to as the genuine understanding between two
people (adult or child) participating in therapy, is a
powerful facilitator of change. Furthermore, he proposes
bonding and attachment theory support the understanding
that the therapeutic alliance is the conduit through
which the therapist interactionally regulates the client
until such time as the client is able to be confidently
self-regulated. Ho (1992) also asserts that the
establishment of a positive relationship dictates the
final outcome of therapy. What's more, he goes on to say
that with ethnic minority youth, this connection between
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
57
child and therapist must occur at the onset of therapy
because of several unique obstacles, including: cultural
injunctions against mental health service due to stigma,
communication problems, questions of authority and
credibility, and countertransference issues.
Like Gardner (1992), Grotstein (1990) discusses the
therapeutic relationship in terms of friendship and
parenting. They both emphasize how closeness and
distance, and connection and separation frame the
therapeutic process. Gardner (1992) also maintains that
within the context of a good therapeutic relationship,
the client and therapist both posses certain qualities.
The first of these qualities is that the client be
reasonably respectful of actual qualities that the
therapist has that engender regard, as opposed to
idealization or idolizing. Secondly, it is important
that the client be receptive to the therapist's
comments, but not to the point of gullibility. Likewise,
there should be a realistic desire to emulate qualities
in the therapist that would serve the person well in
life. Thus, there is some identification with the
therapist's traits and values, and according to Gardner
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
58
(1992) there is no therapeutic interchange that does not
involve some attempt by the therapist to transmit
his/her values to the client. The therapist must •
therefore be cognizant of these values and qualities and
employ them in the best interest of the client.
Other features of a good therapeutic relationship
involve the therapist having a sincere desire to help
the client. Therapists should have a fair degree of
sympathy and empathy with clients. In particular, when
therapists work with children, Gardner (1992) proposes
certain important characteristics that therapists should
exhibit: (1) liking children is essential; (2) the
capacity to project themselves into the child's
situation; (3) the ability to recall how it was to be
the same age as child-clients; (4) a sense of excitation
when working with children, aided by having childlike
personality traits; (5) a strong parental instinct; (6)
frustration tolerance; and finally, (7) flexibility and
creativity.
Children in Therapy
Scientists and professionals, including those in the
medical field, educators, and social workers have
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
59
largely dealt with the protection and nurturance of
children prior to the 20th century, but during the last
few decades they have begun to give more attention to
self-determination issues (Hart, 1991). Accordingly,
psychologists have put forward guidelines for child care
and discipline, measures of child characteristics, and
prescriptions for child disorders and family living
(Hart, 1991). Moreover, they have contributed to the
understanding of, respect for, and policies and
practices regarding children. Even so, Hart (1991) has
proposed three prerequisites that deserve high-priority
in psychology'’ s agenda for children, which are part of
the broader scope of this study: (a) cultivating an
empirically validated developmental approach; (b)
establishing a positive ideology of the child, and (c)
including children's perspectives and encouraging their
participation in negotiating/asserting their rights.
A number of researchers have indicated that children
and adolescents represent a large segment of the
population whose mental health needs are underserved
(Markel-Fox & Stiles, 1996; Prout, 1992; Roberts et al.,
1998). Despite continuous recognition of the service
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
60
delivery problem at the national level, there remains a
serious lack of child-focused training and a demand for
qualified mental health professionals that far exceeds
the supply (Prout, 1992). At present, the variety of
professionals in different settings that have focused on
the psychological treatment of children, realize that
although psychotherapeutic viewpoints are wide-ranging,
they are essentially rooted in adult-based theories.
Thus, child mental health workers have the unique
challenge of reconstituting therapy to fit their
clients'' needs. Since children are not miniature adults,
their treatment cannot be viewed as scaled-down adult
therapy (Prout, 1992). So, the child therapist must have
an extended knowledge base of developmental stages,
environments, reasons for entering therapy, and other
applicable factors that necessitate a different or
creative approach to therapy.1
1 For a historical perspective of child therapy, which is
beyond the scope of this study, readers can consult such pioneers as
Anna Freud, Melanie Klein, Alfred Binet, and Virginia Axline, as
well as theorists such as Freud, Piaget, Erikson, and Kohlberg.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
61
In addition to concerns regarding the application of
adult therapies to a child population, there are a
number of issues related to children's circumstances
that impact the nature of the therapeutic relationship
(Prout, 1992). These items have to do with dome of the
differences between child therapy and adult therapy.
First, the therapist may be required to provide more
education, guidance, and advice than to adults (Gardner,
1992; Prout, 1992). Another fundamental distinction
between child and adult therapy is the child's more
limited linguistic capacity, which is also related to
limits in cognitive development. In this case, the
therapist must use alternatives modes of expression
together with verbal interaction in treatment. According
to researchers, play and art therapy, and other
nonverbal techniques allow expression without creating
anxiety or frustration for the child because of an
inability to find the correct description (Gardner,
1992; Prout, 1992).
Another way children differ from adults in terms of
therapy is that a child is less likely than an adult to
be treated in isolation, and is subject to more
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
62
environmental forces and changes. That is, a child is
more dependent than an adult and has relatively little
power to change his/her situation. So in some cases, the
therapist may simply be helping the child cope with
stressful conditions rather than assuming that change
will spring from the environment (Prout, 1992). One
final factor that contributes to the difference between
child therapy and adult therapy is the fact that a
child's personality is thought to be more pliable and
amenable to therapeutic influence than an adult's
(Prout, 1992). This plasticity is both a strength and
challenge for therapists working with children because
there is great potential for change, but at the same
time a child's greater range of emotional and behavioral
responses requires much flexibility and patience (Prout,
1992).
Psychotherapy Research with Children
There are a myriad of adult psychotherapies, and
given that interventions with troubled children and
adolescents follow the model of traditional adult
therapy, it goes to reason that they are too numerous to
catalog here. However, some approaches in the treatment
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
63
of multifactorial psychiatric disorders include:
individual psychotherapy with the child, casework help
for the family, family therapy, group therapy for
children or parents, behavioral management, drug
counseling, in-patient treatment, day patient treatment,
educational measures, and removal from parental care
(Prout, 1992). The amount of treatment settings is also
vast, and is comprised of such places as hospitals,
classrooms, schools, agencies, clinics, group homes,
private offices, and in-home services. Due to the
heterogeneity of children's therapeutic experiences it
has been difficult to study the effectiveness, much less
the process of therapy. Psychotherapy research with
children is further complicated by the fact that they
are in a constant state of development which may mask,
distort, or heighten symptomatic behavior - "this makes
it difficult to sort out the effects of therapy versus
maturation" (Prout, 1992, p.27). What's more, outcome
research with children and adolescents faces some of the
same obstacles as does research on the empirical
validation of adult therapy.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
64
Randomized studies designed to evaluate the
effectiveness of child psychotherapy typically delivered
in outpatient settings produced results comparable to
nonrandomized studies of traditional child
psychotherapy. The results were similar to those found
in adult clinical trials; that is, little support was
found for its overall effectiveness (Barrett, Hampe, &
Miller, 197 8; Levitt, 1971; Lonigan, Elbert, & Johnson,
1998; Weiss, Catron, Harris, & Phung, 1999). However,
Weis and colleagues (1999) found that despite the lack
of significant differences between treatment and control
groups in regard to changes in child functioning,
parents of children who received treatment reported
higher levels of satisfaction with services than control
group parents whose children received academic tutoring.
In another comprehensive overview of the history,
agenda, and methodology of psychosocial treatment of
children and adolescents, a task force (selected by the
American Psychological Association to define/identify
specific empirically supported interventions for
children with specific disorders) found a number of
well-established or efficacious interventions (Lonigan,
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
65
et al., 1998). Nevertheless, it was determined that much
more work is needed to close the gap between research
and practice (Lonigan, et al., 1998; Weis et al., 1999).
Latino Youth & Therapy
According to the Surgeon General's Report, Latino
youth are at a significantly high risk for poor mental
health outcomes (DHHS, SAMHSA, & CMHS, 2001) . Evidence
suggests that they are more likely to drop out of
school, to report depression and anxiety, and to
consider suicide than white youth. Glover and colleagues
(1999) found that Hispanic children in middle schools,
specifically Mexican-origin youth from Texas, reported
more anxiety-related problem behaviors than white
students. Studies of depressive symptoms and disorders
also revealed more distress among Hispanic children and
adolescents, particularly among Mexican-origin youth.
This was evident in a community study in Las Cruces, New
Mexico (Roberts & Chen, 1995), as well as in a national
study within the 48 continuous States (Roberts & Sobhan,
1992).
Most epidemiological studies of Latino youth have
been conducted with symptom indices and problem behavior
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
66
checklists, not diagnostic instruments (DHHS, SAMHSA, &
CMHS, 2001). Efforts to study diagnostic factors among
Latino children in community samples have been limited.
Likewise, very few studies have addressed the use of
mental health services by Latino children and teens. One
exception is the Methods for the Epidemiology of Child
and Adolescent Mental Disorders (MECA) study (Lahey et
al., 1996). This study made a unique contribution to the
understanding of children's use of mental health
services because it obtained a measure of unmet need
that was based both on a diagnosis and on a significant
degree of impairment, where impairment was related to
key symptoms of the diagnosis (Flisher et al., 1997).
Researchers conducted another study of children's use of
mental health care in two communities in Texas:
Galveston and the lower Rio Grande Valley (Pumariega et
al., 1998). Hispanics reported significantly fewer
lifetime counseling visits than white youth (2 vs. 4).
Bui and Takeuchi (1992) also found evidence that
Hispanics were underrepresented in the use of outpatient
mental health clinics in L.A. County from 1983 to 1988.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
67
The Surgeon General's examination of studies
revealed a generally consistent pattern: Latino youth
experience a significant number of mental health
problems, and in most cases, more problems than whites
(DHHS, SAMHSA, & CMHS, 2001). It is not clear at this
time why a differential rate of mental health problems
exists for Latino and white children. However, special
focus needs to be directed to the study of Latino youth,
as they may be both the most vulnerable and the most
amenable to prevention and intervention. Given the rapid
expansion of the young population of Latinos, these
interventions could have major implications for the
ongoing health of the Nation's youth (DHHS, SAMHSA, &
CMHS, 2001).
Ethnically Matching Clinician and Client
There has been substantial debate in the counseling
literature over the effectiveness of psychotherapy for
ethnic minority clients, especially when treated by
white therapists (Sue, 1988). While some researchers and
practitioners reason that ethnic clients are less likely
to benefit from treatment, others maintain they are just
as likely as white clients to show favorable outcomes
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
68
and that ethnic matching is unnecessary. Nevertheless,
criticism of psychotherapy persists because of the lack
of bilingual and bicultural therapists who can
communicate and understand the values, life-styles, and
backgrounds of ethnic clients (Sue, 1988). The most
frequently cited explanation for the underuse of mental
health services by Mexican-Americans is the lack of
Mexican-American professionals in mental health agencies
(Atkinson, Casas, & Abreu, 1992); the idea being that
clients prefer ethnically similar counselors and
possibly believe them to be more effective. Yet evidence
reveals that Mexican-Americans do not rate Mexican-
American counselors more favorably than European-
American counselors (Atkinson et al., 1992; Atkinson,
Ponce, & Martinez, 1984). Furthermore, mixed results in
regards to preferences or perceptions may be due to the
research method utilized.
Studies that found no preference for ethnically
similar counselors used methods based on
multidimensional choice and judgment (Atkinson et al.,
1984; Furlong et al., 1979), whereas studies that
confirmed the first hypothesis typically used a single
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
69
choice method (Lopez, Lopez, & Fong, 1991). A meta
analysis of studies that employed either a judgment or
choice method revealed that ethnic minorities did prefer
ethnically similar counselors over European-American
counselors (Coleman, Wampold, & Casali, 1995). However,
findings were far from consistent, particularly owing to
the influence of participants' cultural affiliation on
their choices and judgments. This suggests that client
preference for ethnically similar counselors may go far
beyond simple demographic variables, and extend to a
complex interaction between counselor characteristics
(i.e., reputation, performance, and cultural
sensitivity) and client attributes (i.e., previous
experience, acculturation, cultural affiliation, and
cultural mistrust). For example, Abreu and colleagues
(1998) identified expectations about ethnically similar
and/or dissimilar counselors and social desirability as
factors related to counselor ratings. Thus, it is of
great importance to not only address issues of
ethnicity, race, and culture at the initial onset of
counseling. It is likewise imperative to investigate the
effects of client preference and ethnicity on the
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
70
counseling process and on outcomes. In order to treat
the influence of ethnicity on therapy justly, it is
plain that further evaluation of research methods and
researchers'1 values is necessary, as is the need to look
at more representative samples of the Mexican-American
population (Abreu & Gabarain, 2000).
The majority of all the studies on ethnic matching
have been based on college student responses to
questionnaires and/or analogue formats, where students
are asked to make judgments on case vignettes or a
simulated therapy sessions between a role playing
therapist/client (Abreu & Gabarain, 2000; Atkinson et
al., 1992; Atkinson et al., 1984; Lopez et al., 1991).
There has been almost no research done on actual
clinical treatment (Sue, 1988; Lopez & Lopez, 1993). The
one exception found in the literature was a naturalistic
study based on the process and outcome of clients at a
large county mental system over a five-year period
(1983-1988) (Sue, Fujino, Hu, Takeuchi, and Zane, 1991).
Researchers found that ethnic match with Mexican-
American adults was significantly related to fewer
dropouts after one session, a greater number of
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
71
treatment sessions, and significantly improved outcomes
as measured on a global evaluation measure. Notably,
these effects were found after Sue et al. (1991)
controlled for a number of related factors (e.g.,
gender, age, diagnosis, etc.). Yet, there has been no
research on ethnic match on the therapy of children.
To reiterate, recent studies of ethnicity and
treatment have produced conflicting findings due to
methods and conceptual limitations (Atkinson, 1986; Sue,
1988). Moreover, Sue (1988) argues that the empirical
issue of treatment effectiveness has been confounded
with the moral and ethical issue involving the shortage
of ethnic therapists and the resulting lack of freedom
of choice in selection of therapists. Correspondingly,
he believes that the issue has been misconceptualized,
and that ethnic match, a distal factor in the outcome of
treatment, has been confounded with cultural match.
Previously, Sue and Zane (1987) asserted that treatment
outcomes are more likely to be linked to proximal
variables (i.e., counselor credibility, competence,
understanding) rather than distal variables (i.e.,
ethnicity, age, education). Sue (1988) also points out
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
that ethnic matches can result in cultural mismatches if
therapists and clients from the same ethnic group hold
markedly different values (i.e., degree of
acculturation), and that ethnic mismatches do not
necessarily imply cultural mismatches, because
therapists and clients may share similar values, life
styles, and experiences. Nevertheless, Sue (1988)
maintains that ethnicity is more than just a demographic
variable, and lists three aspects of ethnicity that may
influence psychotherapy. First, the stimulus value of
the therapist or client, which may engender
expectations, transference reactions, and so on, based
on ethnicity. Second, an ethnically similar therapist
may be fluent in clients' primary language, which helps
to relate to clients. Third, and most importantly,
ethnicity may connote "meaning" to clients about
therapists' culture, ways of behaving, values, and
experiences that help them develop rapport. The current
study attempts to apply some of the suggestions given
for research in this area by examining cultural match
rather than simple delineation of ethnicity, exploring
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
73
therapeutic processes (such as rapport development and
dialogue), and looking at actual behaviors in the
therapy of real clients and clinicians.
My Qualitative Research
As in the brief discussion above on randomized
clinical trial research, mainstream psychology values
work that emphasizes cause-and-effeet relationships
between variables (Goncii, 1999) . Likewise, psychological
research values inferential statistics that seek to make
generalizations from samples to populations. These
trends are severely limited however, because this type
of laboratory research does not translate to children'’ s
natural environment. Moreover, methods of studying
children'' s needs have traditionally come from the
outside, but the idea is now emerging that perhaps
children'' s views can be assessed through direct
communication (Garbariono & Stott, 1989; Hart, 1991;
Melton, 1987).
Nelson (1996) argues that the types of tasks used in
psychological research are not like the kinds of
everyday situations in which children are called on to
understand the mind. She contends that such tasks may be
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
74
informative about children's representational and
inferential abilities but points out that they are not
representative of the types of problem solving children
face in their everyday experiences. Although these
studies appear to be social in that a researcher asks
questions of a child, the social world presented is not
the familiar, supportive context that most young
children experience (Nelson, 1996). It is more like an
"alien Machiavellian world of the manipulator" (Nelson,
1996, p.294). Strangers pose questions about the
existence or location of objects, events, or desires.
These conditions are distinct from the daily experiences
on the playground in which children are called on to
interpret others'' motives, goals, and actions (Gauvain,
1998) .
Psychologists have an assortment of research
methodologies at their disposal as they seek to answer
theoretical or applied questions. Recent research using
so-called "softer" research methods (i.e., self-report
measures of behavior, autobiographies, and retrospective
pretests) has occasionally demonstrated results superior
to studies using more traditional methods (Howard,
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
75
1993). Given the somewhat surprising findings on
alternative research, Howard (1993) and other theorists
(Hoshmand & Polkinghorne, 1992; Barresi & Juckes, 1997;
Ming-Sum, 1997) argue for the empirical application of
other underused methods, such as clinical case studies
and self-experimentation in order to advance practice
knowledge.
My qualitative study is tailored toward the
pragmatic assessment of multicultural child therapy. As
previously delineated, the multicultural literature does
not properly take into account the counseling enterprise
of children. Thus, I move beyond a statistical survey of
the problem and offer an understanding of how children
and therapists experience culture in relationship to one
another. In response to the call for a therapeutic
practice that takes into consideration biological,
social, and cultural contributors to child development,
I add to the existing body of knowledge to facilitate
researchers and mental health practitioners in
addressing the needs of Latino school-age children and
their families.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
76
CHAPTER THREE
Method
Design
The study was exploratory and descriptive in
nature. The research approach used could be called
interpretative; according to Erickson (1986) this term
covers approaches that are "alternatively called
ethnographic, qualitative, participant observational,
constructivist:, symbolic interaCtionist, or
phenomenological" (P. 119). The approach can also be
deemed a field study that employs qualitative research
methods. In particular, I was a participant-observer who
intensely examined the background, current status, and
environmental interactions of the therapeutic
relationship of selected participants (Yin, 1994). I did
this by evaluating my own experience while I was
counselor at the field site, and later conducting added
interviews as a check to my own observations. This
investigation began with my three and half years of
clinical practice at the field site and my ensuing
reflections on my work; the data consists of case
descriptions, client demographic information (i.e.,
gender, ethnicity, diagnosis, etc.), process notes,
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
77
drawings, interview transcripts, videotape, and
discussions with colleagues. For the purpose of this
study, I use the word "case(s)" to refer to clinical
therapy situations, rather than the methodological sense
of the word.
The goal of the research was to understand the
meaning of the social, cultural, and historical
interface between school-aged Latino children and
therapists. The focus on the betweenness situated in the
therapeutic environment took precedence over looking at
within-child explanations of the phenomena in question
or simply using therapists'1 perspectives. Moreover, the
design of this study is a response to the dominant
research paradigm, which at this time is inadequate to
answer questions regarding the relationship between
children, culture, and therapy (Graue & Walsh, 1998).
The research conducted here involves systemic activities
such as explicit focus, utilizing different methods to
view the phenomena from various perspectives, cross
checking hunches that develop from a variety of data
sources, counting, looking for patterns and anomalies,
and developing themes (Huberman & Miles, 1998). A
"complete" description might include topics such as (a)
how a child identifies with his or her counselor, (b) if
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
78
there is cultural identification what kind of
interaction results, (c) what are the different belief
systems and/or world views that may create distance, and
(d) what is the process or saliency of culture for each
participant.
Participants and Setting
Rather' than sampling subjects to represent a
population, I was interested in individuals, particular
individuals. Therefore, the focus of inquiry was
intensely local, and/or embedded in context; as Graue
and Walsh (1998) state, it is "right here, right now; it
is a physical and social place, a yard or a park or a
classroom" (p. 9). Additionally, in this study, I looked
for critical instances in the therapeutic process that
involved culture. For example, a child's presenting
problem may have been related to immigration status,
language difficulties, discrimination, biculturalism, or
family conflict due to different levels of
acculturation.
The site selected for this study is a valuable
source of data due to both the ethnic make-up, and the
type of therapy that is conducted at this location. As
suggested earlier, research on children, culture, and
therapy could be carried out in wide variety of
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
79
treatment settings. However, I chose this field site
after having worked at hospitals, clinics, and several
other agencies that serve children. I believe the
children at the site share many of the characteristics
of minority children found at other places, in that they
are economically disadvantaged, emotionally disturbed,
and have similar family structures. Moreover, at the
study site, there was a unique opportunity to follow
child-clients' therapeutic experience on a longer-term
basis than most other locations. Thus, it goes to reason
that we can get a better idea of not only the
effectiveness of therapy from the cases at this site,
but we can also gain insight into the process of
therapy.
Study participants were located at a non-public
school (NPS) for educational therapy which contracts
with a large municipal school district to receive
children and adolescents that have been labeled by the
district as emotionally disturbed (ED). The school is
situated in a central urban area which services a large
metropolitan population, and is set in a nice
residential neighborhood. Ninety percent of the student
body is Latino, the other 10% is African-American and
European-American. Also, 85% of the students are male.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
80
The majority of the children reside with at least one
biological parent; however,, there are some students
whose caregivers are foster parents or relatives (i.e.,
aunt or grandmother). Up to 7 0% of the parents or
guardians of the children who attend the school are
monolingual Spanish speakers. Students attending the
school are bused in from the disadvantaged neighborhoods
and projects of the Greater Los Angeles area.
Students attend the school because other public
school settings were not able to provide the adequate
services and/or structure to meet the needs of these
emotionally disturbed children and adolescents. There
are approximately 125 students enrolled in the school,
from age five to eighteen. The classrooms are divided by
educational and/or developmental level from first
through twelfth grade. What distinguishes this school
from public schools with special education classes is
that the students receive more individualized attention
for their mental, emotional, and behavioral problems.
There are no more than twelve students in a class, and
each class is staffed with one teacher and two teaching
assistants. Every child has an education plan tailored
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
81
particularly to him or her, and each child receives one
hour of counseling per week as mandated by the school
district.
All services are provided on campus during the
school hours of 8:30-2:30. The facilities consists of
ten classrooms, administrative offices, counselor
offices, three time-out rooms, a computer room, a
playing field, and a gymnasium. The specific services
offered at the school include transportation,
comprehensive and on-going assessments of students,
special education, requisite counseling, not to mention
compliance with school district curriculum. These
services are delivered by a staff of 41 people. The
administration of the school includes the CEO,
principal, vice-principal, two teacher coordinators, a
counselor coordinator, a transportation coordinator, and
a secretary. The school is also staffed with seven full
time counselors and two per diem counselors, ten
teachers (the majority with special education
experience), and sixteen teaching assistants. Two
adjunct faculty include a school psychologist and
clinical supervisor. All staff are trained in the
management of assaultive behavior. About half of the
staff have bilingual Spanish ability.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
82
The mental health part of the program is
coordinated by a licensed marriage and family therapist
(MFT) with ten years experience. Five out of the nine
counselors are also MFTs, and the other four are in the
last phase of licensure (e.g., they have accumulated all
requisite clinical hours and are in the process of
taking the state exam). Moreover, all counselors
employed at the school receive on-going individual and
group supervision from an outside/contracted licensed
psychologist. Each full-time counselor manages a
caseload of approximately 15 students. Counseling
sessions are for the purpose of mental health services
and are designated as 60 minutes a week for each child
enrolled at the school. Although counselors do have
interaction with teaching staff regarding their clients,
it is primarily centered around behavioral and emotional
concerns; the academic program is a separate entity.
Counselors also have as much or as little contact with
the parents of their clients as is necessary and/or
desired. Thus, in this respect counseling at the school
is like most mental health outpatient treatment clinics
for children. The principle difference is that access to
clients is more flexible than perhaps other settings
(e.g., scheduling sessions does not involve
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
83
transportation issues, since students are already at the
school; crisis intervention is immediate since
counselors are on site; and teachers provide on-going
behavioral information to counselors).
The Psychological Services Branch of the school
district oversees funding for many of the services that
students receive, including a complete psychological
assessment, counseling, and any special aid a student
may require (i.e., speech therapy). The school also
works in conj unction with other agencies such as
Department of Children and Family Services (DCFS),
probation, and other systems of care to treat these ED
children and adolescents. Formal program evaluation is
conducted more in terms of cost-benefit analysis, and an
audit by the school district occurred approximately four
years ago and resulted favorably for the school. The
school is also directly accountable to parents by way of
the individualized education plan (IEP) - a general
review of the IEP occurs once a year (and more often if
a parent calls for it) and full assessment every three
years, and throughout this process parents/caregivers
are regularly involved. "Success" is measured in terms
of achieving target goals and objectives stipulated on
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
84
the IEP, and mainstreaming a student is often regarded
as the maximal achievement.
The general problem that the school is trying to
address is that of responding to the needs of troubled
children and their families in a school setting - it
stands as an alternative to the assignment of disturbed
children to detention homes, hospitals for adults,
and/or institutions for the mentally deficient. Since it
became clear in the 1950s from a study by the Joint
Commission on Mental Illness and Health that a national
mental health program for children could not be based on
traditional psychotherapy for adults due to costs,
uncertain efficacy, and a demand for highly skilled
professional people (then and now in short supply), a
new approach based on educational, psychological, and
ecological strategies was conceived of by way of the Re-
ED Project.
The school in this study was established 28 years
ago. The history and organization of the school dates
back to a demonstration project that turned into a
nationwide program in the 1960s (in 1981 it was one of
three pilot programs in the state). The original program
was titled Re-ED, and this project for the re-education
of emotionally disturbed children had its beginnings at
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
85
the George Peabody College for Teachers (one of the
schools of Vanderbilt University). It was there that a
small group of psychologists and educators, in
collaboration with mental health officials in Tennessee
and North Carolina, the Southern Regional Education
Board, and the National Institute of Mental Health
(NIMH), invented a new social institution in the service
of emotionally/behaviorally handicapped children. Now,
there are approximately 20 such schools operating in
Southern California, and many more programs in the U.S.
are beginning to adopt this same principle of helping
students achieve academic competence and emotional
adjustment.
My Role as a Participant-observer
I have already touched on my qualifications as a
scientist-practitioner, however, I will review them
again in order to contextualize my role as a
participant-observer. Prior to working at the school in
the study, I had 1600 hours of clinical experience with
children, adolescents, and their families. By the time I
left the school, I had accumulated over 6000 hours. I
have gained over 3000 treatment hours since that time.
Specifically, while I worked at the school, I saw
70 separate clients. Ninety percent of all the children
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
86
I saw for treatment were of Mexican origin. Thirty-seven
of these students were my regular clients; I saw them
for a minimum of three months and some for as long as
three years. Twenty of these clients were school-age
(ages 8-11). I saw 14 children for therapy on a regular
basis who fit the criteria of this study. In particular,
these clients were Latino school-age children who
presented with concerns centered around cultural issues.
Their emotional problems were mainly related to
oppositional behavior, attentional difficulties,
learning disabilities, depression, and abuse.
Nevertheless, the threads that linked these cases were
entangled in a web of cultural issues such as problems
with communication, acculturation, and bigotry. Later, I
will elaborate on some of these cases and how culture
seemed to affect my relationship with my child-clients.
Although I worked at the site for three and half
years and had ample data based on my experience, I went
back after three years to do more research, and to ask
the children and counselors to teach me about their
experiences. Thus, my positioning, or how I placed
myself in the field in relationship to the people in the
study, was that of a learner. I began my research with
the basic assumptions elaborated by Graue and Walsh's
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
87
(1998): (1) All kids are smart; (2) All kids make sense;
and (3) All kids want to have a good life. With this
attitude, and with the relationships I had already
forged with the gatekeepers of the school, I was able to
gain entry into the field. Expressly, I was allowed to
do my research at the school because I was a former
counselor there and knew the director, the principal,
the head counselor, a good number of the staff, and even
some of the students. I was not only given access to
participants and other data sources, but I was welcomed
back as if part of the family. It was still necessary,
of course, to develop and negotiate my role as a
researcher there in order to make interaction possible.
I clarified my identity so that it was not only
comfortable for both kids and adults, but so that it was
also distinct from my persona as a counselor.
I selected additional participants in order to
create more of a balance and to check my data. My
supplementary data sources consisted of five Latino
children ages 8-11 and their respective counselors,
further observations at the school, analysis of relevant
documentation (e.g., case notes), and informal
interviews with other school staff. First, I met with
the director and principal of the school to explain the
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
study and obtain the necessary permission to conduct it.
They were supportive due to our personal association,
but also because they were accustomed to lending their
assistance to social science research projects. I was
given access to demographic information such as age,
gender, ethnicity, diagnosis, length of time in the
school, language, and socioeconomic status, from which I
narrowed down the pool of participants. The selection
process continued when I spoke to the head counselor
regarding the participation of his staff and about which
children might be most amenable to the study. Next, I
directly approached counselors, teachers and teacher
assistants to enlist their cooperation and opinions
regarding necessary characteristics of the child-
participants. Finally, I introduced myself and my study
to the children, gained their assent, and contacted
parents to acquire the necessary consent.
The Five Dyads
For the purpose of confidentiality pseudonyms are
used for all participants, including the nine
participants that comprised the five therapeutic dyads.
There were three other prospective dyads that were
approached for participation in the study but were not
included: one eight year-old Mexican-American girl left
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
89
the school prior to conducting the necessary interviews;
the mother of one 10 year-old Salvadorian-American boy
did not give consent for the study; and one European-
American female counselor with an eight year-old
Guatemalan-American client decided she did not want to
participate.
The first therapeutic dyad consisted of an eleven
year-old Mexican-American boy named Arturo and his 35
year-old European-American counselor named Anne. Arturo
came to the school in September of 1999. Arturo's
original diagnosis upon entering the school was that of
depression and oppositional-defiant disorder. He was
prescribed lOmg of Prozac for a period of eight months,
but he has not been on medication for the last six
months of his treatment at the school. When he began
therapy he also had symptoms of anxiety and a history of
family violence and family substance abuse. His parents
are divorced and he lived with his father, but had
regular contact with his mother. Spanish is the primary
language in both homes. According to case notes and the
counselor interview, the issues and goals addressed in
therapy focused on anger management. Relevant cultural
matters include acculturation and language difficulties,
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
90
however, the therapist indicated that these topics were
not addressed directly or consistently in on-going
sessions.
Arturo began counseling sessions with Anne in
October of 1999, and was his counselor for approximately
a year and a half. They have had anywhere from 40-50
sessions together. Anne's background and experience in
clinical psychology began when she graduated from her
masters program in marriage, family, and child-
counseling in 1991. She started doing therapy
immediately after completing her program and as a part
of the requirement for MFT licensure. For two years she
worked at an agency in Southern California servicing
couples, individuals, children, substance abusers, and
court mandated clients. She worked with a wide variety
of people with different ethnic backgrounds, but
predominantly with a Hispanic clientele, and in
particular with the Mexican-American population. After
two years Anne took a break from clinical practice and
taught elementary school for seven years. She returned
to doing therapy with primarily Hispanic children in a
school setting about two years ago. Her theoretical
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
91
approach is eclectic, but she subscribes largely to an
Adlerian philosophy, which according to her, is an
optimistic approach that works well with children.
The second dyad included a ten year-old Mexican-
American boy named John and his 42 year-old European-
American counselor named Janet. John enrolled in the
school in September of 2000. He was diagnosed and
continued to be treated for Attention-Deficit
Hyperactivity Disorder (ADHD). He has taken Ritalin for
the last year, but his dosage has been adjusted several
times due to side-effects. He was stable for the last
four months. John came from a single-parent home; he
lived with his mother and baby sister and has never had
contact with his father. His mother is a monolingual
Spanish-speaker. School records maintained that John is
very closed-off emotionally, and that he has a hard time
controlling his behavior and anger. Janet worked with
him on his behavioral goals, which centered on
appropriately interacting with others (i.e., following
rules, decreasing outbursts, and expressing his needs).
In addition, the counselor reported making a few
attempts throughout the course of therapy to bring
culture up as a subject but the client has shied away
from it. Janet believed the client was going through a
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
92
phase in which he is unaware of, or rejecting, his
ethnic identity due to peer pressure or other
acculturation factors.
John began therapy with one of the per diem
counselors prior to switching to his permanent
counselor, Janet, in November of 2000. Janet has seen
John in therapy for six months and has had about 20
sessions with him. Janet's therapeutic experience spans
10 years prior to coming to the school six months ago.
She finished her masters program in clinical psychology
eight years ago, but because she let her MFT
registration expire while she was doing social work for
six years, she had to start all over as an MFT intern
and take the state exam again. Janet worked in hospitals
with dual diagnosis patients and schizophrenics, in a
social work agency with families and foster children, in
private practice, and in schools doing group and one-on-
one counseling. Janet stated that in the hospital, no
particular ethnicity seemed to dominate, but in the
schools she primarily treated Asian and Hispanic
clients, Janet's main theoretical approach is family
systems, although she utilizes other techniques such as
play therapy and behavioral modification.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
93
The third dyad was comprised of an eleven year-old
Mexican-American and Cuban-American boy named David and
his 30 year-old European-American counselor named Darin.
David came to the school in May of 2000. Prior to
entering the school, he was diagnosed with ADHD and took
lOmg of Ritalin three times a day for over a year. He
was taken off his medication three months before this
study began. David's parents had been separated for
several years. He lived with his mother, but had regular
contact with his father. Spanish was the main language
spoken in both homes. David's counseling focused on
dealing with his impulsivity and disruptive behavior in
the classroom. However, the case records revealed that
therapy also tried to address deeper issues like David's
tendency toward narcissism (e.g., neediness and self-
centeredness) . In addition, his counselor noted that
David was struggling with issues of acculturation (i.e.,
the counselor reported family conflict due to the
different levels of acculturation and client's rejection
of his first language).
David began therapy with Darin upon enrolling in
the school. Thus, Darin had been David's counselor for a
year, and they have had somewhere between 30-40
counseling sessions together. Darin worked as a
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
94
counselor in a substance abuse clinic for adults and in
a private practice treating children and families two
years prior to becoming a therapist at the current
school. He came to the school three years ago after
completing his masters program in marriage and family
therapy. He recently took the state MFT exam and awaited
the results. He had treated clients of various
ethnicities, but came to work chiefly with Asian and
Latino populations due to the location of his job
settings and because he spoke Spanish conversationally.
At the school, the majority of his caseload were Latinos
(which holds true for all the therapists at the school).
Darin's theoretical orientation is integrative; he
utilizes several philosophies/ therapies, including
client-centered, psychodynamic, Laconian, Jungian, and
solution-focused.
The fourth dyad was made up of a nine year-old
Mexican-American boy named Carlos and his 29 year-old
European-American counselor named Chris. Carlos came to
the school January, 1998. He lived in a single-parent
home with his mother and older sister (he did not know
his father), and the primary language spoken was
Spanish. Carlos was diagnosed with ADHD, and was on
Ritalin, but was taken off the medication shortly after
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
95
entering the school. Other presenting problems included
his violent acting out against teachers and students.
The therapist indicated that he did not see Carlos''
impulsivity as ADHD driven; he saw it as having no
limits, and pointed out that the client'" s behavior
improved significantly upon being placed in the highly
structured school environment. On-going issues consisted
of the client's isolation from others, a strong need for
affection/attention, dealing with aggressive tendencies,
and improving social skills. Chris stated that culture
had not been explicitly discussed in sessions.
Carlos was in therapy with another counselor at the
school for a year prior to commencing therapy with Chris
in January, 1999. Chris had been Carlos' counselor for
just over two years; they had approximately 70-80
sessions together. Prior to working at the school, Chris
was a therapist at a community mental health clinic and
in private practice. He received his MFT license just a
few months ago. He previously worked with children,
adolescents, adults, and couples of various ethnicities,
but primarily with Latino clients. Chris utilized many
techniques in therapy, but subscribed to humanistic and
object-relations schools of thought.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
96
Chris was also the counselor in the fifth dyad, and
his other client was a ten year-old Mexican-American
girl named Denise. Denise enrolled in the school in
September of 2000. She had been placed with her aunt for
the last several years because of abandonment by her
mother, and because of her father's substance abuse. Her
father had monitored visitation, but she saw him
infrequently. Denise's presenting problems included ADHD
and aggressive behavior. She had never been on
medication. The primary language in the home was
English. On-going therapy focused on attachment and the
client's anger. Chris had been Denise's counselor for
eight months ago. They had approximately 25 sessions
together. Similar to Carlos' case, cultural material was
not a focus of therapy; the counselor revealed that it
only came up tangentially.
Instrumentation
As in most qualitative studies, the researcher is
the instrument of analysis, so I tried to establish
external verification of the 'instrument' by using
diverse systems of descriptions and theoretical sampling
(Denzin & Lincoln, 1998). To get a rich picture of the
phenomena in question it was necessary to use
triangulation by employing many data sources (e.g., my
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
97
log, conversations with staff, and five therapy dyads)
and multiple methods (e.g., recall, notes, audio and
video interviews and observations of therapy sessions).
Moreover, I sought credibility by employing other
checks/balances, such as: (a) keeping a log (e.g.,
consciousness through journaling); (b) consistency of
having the same interviewer; (c) articulation of my
personal background, and biases; (d) having members of
my committee check the data; and (e) conversations with
consultants (i.e., expert child therapists). Needless to
say I endeavored to maintain respect, responsibility,
and rigor in the treatment of my participants/data,
including using the proper measures to protect
confidentiality.
Observations and interviews with all participants
were conducted until a point of saturation was reached,
that is, until patterns were established in participant
responses and no new information was provided. I made
every attempt to insure that my interaction with the
children and/or instructions to them were readily
comprehensible and tasks sufficiently engaging to ensure
their willing participation (Clark & Clark, 1947; Davey,
1983). During the interviews with the children I
utilized third-person questions, hypothetical questions,
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
98
and humor. The semi-structured interview questions used
for the children and counselors were based on questions
from the pilot study of the dissertation. Also,
information was gained through informal conversations
with children and staff.
Unquestionably, this research has been a mutual
simultaneous shaping, an interactive process with
concurrent ambiguity of my experience as a research
instrument and the unfolding design of the study (Denzin
& Lincoln, 1998). I simply witnessed and made judgements
at the same time that I related to the material. As
stated before, I applied science by checking myself to
see if my notions were supported or not by the evidence.
Finally, I detailed my methodology and analysis and
included the information that I gained in my pilot
study.
Generalizability and Reliability
The verification of knowledge, according to a
moderate postmodern position, although rejecting the
notion of an objective universal truth, accepts the
possibility of specific, personal, and community forms
of truth, with a focus on everyday life and local
narrative (Kvale, 1996). In qualitative research, this
approach to verification does not reject the concepts of
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
99
reliability, generalization, and validity, but
reconceptualizes them in forms relevant to interview and
observational data. Issues of reliable observations,
generalizations from one case to another, valid
arguments, thus are brought back to the lived world and
daily language of social interaction (Kvale, 1996).
The reflexive approach of this study is based on
description and provides knowledge as understanding
rather than control. The focus is on the "definition of
a situation," which is oriented toward interpretations
of persons who live in specific historical, social, and
cultural contexts, and face numerous practical
challenges (Denzin & Lincoln, 1998). From this
standpoint, validity, reliability, and generalization
depend on "interpretative communities," or the audiences
and the goals of the research (Denzin & Lincoln, 1998) .
Thus, the issue in this research is not a quest for
conventional generalizability, but rather an
understanding of the conditions under which findings
appear and operate (Huberman & Miles, 1998) .
The shift from generalization to contextualization
causes me to point out that the findings of this study
and the related interpretation only apply to the
children and therapists at this specific field site
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
100
under particular circumstances and in a particular
setting. However, even though statistical
generalization, whereby one uses inferential statistics
to generalize from a randomly selected sample of
subjects to a larger a population, is not possible,
Stake's (1994) naturalistic and analytical
generalization may be attainable. Naturalistic
generalization develops as a function of personal
experience and leads to expectations rather than formal
predictions. Analytical generalization entails reasoned
judgment about the extent to which findings from a study
can be used as a guide to what might occur in another
situation. Stake (1994) maintains that these types of
generalizations are akin to a responsive program
evaluation that seeks to express and address concerns of
practitioners in order to improve practice in a setting.
Similarly, Kennedy (197 9) contends that practitioners
can draw on the knowledge and/or understanding provided
by case studies much the way the legal system utilizes
case law. She further argues that "like generalizations
in law, clinical generalizations are the responsibility
of the receiver of the information" (Kennedy, 197 9,
p.672). Thus, I hope to provide sufficient information
so that clinicians can make judgements on whether the
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
101
observations made here are analogous and/or valuable
enough to be used as precedent setters to their current
cases.
Corresponding to the discussion of generalization,
the goal of reliability is to minimize the errors and
biases in a study. The objective is that researchers who
follow the same procedures as described by an earlier
investigator and conduct the same case all over again,
should arrive at similar findings and conclusions (Yin,
1994). (Of course, the emphasis is on doing the same
case over again, not "replicating" the results of a case
by doing another case). Nevertheless, a frequent
complaint about case studies is that it is difficult to
make comparisons from one case to another. According to
Yin (1994), the problem lies in the notion of selecting
a "representative" case to generalize to other cases,
and suggests instead that analysts should try to
generalize findings to "theory". This is precisely why I
do not claim that my cases or the additional five cases
presented in this study apply to how all therapists deal
with culture in counseling children, instead I examine
how culture is addressed in the cases discussed here and
how this may relate to the existing literature and/or
theories of multicultural therapy.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
102
Validity Check
Material from my log. I come to this research many
years after the initial spark of interest into this
phenomena. Even so, during the creation of the database
and the subsequent analysis of the text, I found myself
becoming rather emotional. As I looked at the drawings
that my kids made for me in counseling, and I perused
the cursory process notes of my first months at the
school, a flood of memories overtook me. I found myself
in a tough position as a researcher and narrator. On one
hand, I felt like I could write a rich and in-depth
history of all my stirring cases at the school, and on
the other hand, I felt paralyzed by the joy and sadness,
the amazement and pain, comprised in each of my clients'
stories. Ultimately, I had to choose from among many
critical instances of my experience in counseling with
these remarkable children, and hope that my words do
justice to what they have taught me about children,
therapy, culture, and myself.
Validity criteria. My dialogue with the text,
produced by my notes, the children's drawings, and the
interviews and observations, continues with
interpretation (Kvale, 1996, p.296). This interpretation
is based on criteria developed specifically for
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
103
discourse analytic research and is comprised of: (a)
coherence, which is how well analysis explains both
broad patterns and microsequences of text; (b)
participant orientation, which is the way participants
themselves respond to ongoing processes as they happen
within the dialogue (allowing evaluation of whether or
not the analyst's interpretation is compatible with the
participants' own developing understanding of the matter
at hand); (c) new problems, which may arise as
linguistic resources used to construct versions of the
world help participants achieve things within
conversations (e.g., describing experiences); and (d)
fruitfulness, which is the power of an analysis to
produce novel findings, provide a new way of looking, or
in some way increase understanding of the subject matter
(Potter & Wetherell, 1987; Madill & Barkham, 1997).
Coherence was accomplished with the explanation of
the separate cases and the themes that emerged across
the cases, using excerpts of text to illustrate.
Participant orientation was shown in the instances that
children and counselors responded to the ongoing
processes within the interviews and therapy sessions.
For example, each participant was given opportunities to
comment on the research methodology and assumptions
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
104
(e.g., clarifying or adding to interview questions and
dialoguing with the interviewer). There were a number of
times that new problems arose as the children were
introduced to cultural terminology and counselors were
confronted with the effects of their own background,
therapy style, or the integration of culture into
therapy. Finally, fruitfulness was achieved in the sense
that this research provides a way of looking at
children, culture, and therapy. The strength of this
qualitative research is the privileged access to the
participants'' common understanding, understanding that
provides their worldview and the basis for their actions
(Kvale, 1996). The convergence of a responsive
political-value stance and interpretivist assumptions in
this clinically-oriented study created space for those
studied to speak (Denzin & Lincoln, 1998; Greene, 1998;
Huberman & Miles, 1998; Yin , 1994).
Procedures
After I arrived at my research questions regarding
the fascinating melange of culture, children, and
therapy, I gathered together my personal effects
associated with my work at the school in the study. In
particular, I examined the demographic information of my
previous student-clients, process notes, and client-
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
105
drawings in order to aid in the recollection of my
cases. I proceeded to write-up a description of my
counseling experience at the school, focusing on the
critical incidents involving culture. I then contacted
school officials and discussed the research with them as
stated earlier. I continued in the field with
observations and informal interviews with staff and
students for the period of two months, visiting the
campus at least once a week for three hours, at
different times of the day. After collecting enough data
to make my selection of additional participants, I
arranged times to interview the students and counselors
separately, and to videotape therapy sessions. Each
videotaped interview with the five different children
lasted approximately 30 minutes. Each audio-taped
interview with the counselors lasted approximately 45
minutes. Lastly, I videotaped a 30-minute therapy
session of each of the five therapeutic dyads. I chose
to record all the interviews in order to facilitate data
treatment (e.g., to transcribe and code data).
Videotaping was used in particular with the children
(i.e., individual interviews and therapy sessions)
because it would allow images, such as facial expression
or body language, to speak in the absence of words.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
106
Context of Filmed Therapy Sessions
The five children were videotaped during their
regular, weekly counseling routine with their respective
therapist (e.g., there was nothing that distinguished
these sessions from any other that has been conducted in
this setting, save that the participants were selected
as discussed above and were videotaped). The five
therapy sessions that were recorded on video serve as
snapshots of the therapeutic relationships. The thirty
minutes of tape on each of the five dyads was not meant
to be representative of all previous or future sessions,
but it was intended to illustrate how culture may or may
not be a part of therapy in each case at that moment in
time. Certainly the subject of culture may have been
addressed in earlier sessions, or it may even be
possible that because the therapists are employed at the
school that the children attend, that there may have
been out-of-session discussions of culture that would
influence what happened in the taped sessions. However,
during the separate interviews with each child and each
counselor, the participants revealed whether or not this
occurred. That is to say, that I asked questions
regarding previous attention to culture (in and out of
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
107
session), and the participants either informed me that
it was not part of their interaction with each other, or
told me in what way and how much it had come up before.
Drawings
Drawing is considered a significant form of non
verbal expression for children. Similar to play, it
belongs to the culture of childhood that often exists
outside the realm of adult control (Axline, 1993;
Oaklander, 1988). As a unit of analysis drawing offers
further exploration into a child's subjective
experience. Clinicians and researchers are familiar with
the use of drawing as a projective technique, and
although there are a number of critiques as to its
theoretical usefulness, there is consensus that drawing
exercises can help practitioners establish rapport with
children and get some idea of their creative faculties
(Holmes. 1998; Oaklander, 1988). Some may believe that
as a research tool, drawing may have limited application
due to disparate interpretations, however I think the
benefits of examining a primary means of children's
communication and imagination far outweighs the risks of
misunderstanding the data. Consequently, I used drawing
both to gain entry into the child's world and as a
supportive data collection method.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
108
Method of Data Treatment
In addition to my personal log, the data consisted
of 105 pages of interview transcripts from audio and
video taped interviews with children and their
counselors, 84 pages of field notes based on
observations, and 42 client drawings. My journal served
as the narrative structure of my research, while the
qualitative methodology used to determine the common
themes in the therapeutic experience of the children
consisted of a concentrated analysis of the transcripts
and observations. The coding of ideas, building of
hierarchies, and labeling of critical incidents was used
according to ad hoc approaches to meaning generation
including, meaning condensation, meaning categorization,
narrative and discourse analysis techniques (Coffey &
Atkinson, 1996; Denzin & Lincoln, 1998; Huberman &
Miles, 1998; Madil & Barkham, 1997; Strauss & Corbin,
1990).
Kvale (1996) maintains that data produced by
qualitative research is related to five central features
of the postmodern construction of knowledge: (1) the
conversation, (2) the narrative, (3) the linguistic, (4)
the contextual, and (5) the interrelational nature of
knowledge. Consequently, the data was examined in
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
109
relation to the dimensions suggested above, with
particular focus on narrative, contextual, and
interrelational realities. Thus, all audio-tapes were
transcribed by the researcher verbatim and then edited
and transformed into a more formal written style. The
transcripts were then condensed, categorized, and
analyzed. The videotapes of the child interviews and
counseling sessions were logged, or divided into short
segments using a consistent set of criteria based on
content/topic and activity. In addition, I examined
nonverbal cues to determine intimacy and/or distance in
therapy, according to Gordon's (1980) nonverbal elements
of interviewing: (a) proxemic communication is the use
of interpersonal space to communicate attitudes; (b)
chronemic communication is the use of pacing of speech
and length of silence in conversation; (c) kinesic
communication includes any body movements or postures;
and (d) paralinguistic communication includes all the
variations in volume, pitch, and quality of voice
(p.335). Field notes of other observations and informal
conversations were coded and analyzed together with
observations of the videotapes.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
110
Pilot Study
In the pilot case study for my dissertation I
explored how one particular child and counselor
responded to the role of culture in the therapeutic
relationship. I selected an 11 year-old Latino boy named
Denis, and Miguel, his 33 year-old Mexican-American
therapist, as a dyad with prevalent diversity issues. I
conducted three open-ended interviews with the child,
lasting 20 minutes each, and three with the counselor,
45 minutes each. I was allowed to observe the child in
the classroom, on the playing field, and during one
therapy session. I went back to the field to subject the
data/findings to a validity/member check. The data in
the pilot study produced 80 pages of transcripts from
audio-taped interviews and 22 pages of field notes.
What I Learned
The eight themes found in the transcripts and
observations included: (1) a multifaceted definition of
culture; (2) culture per se is not always salient to
children; (3) school-age is early in the development of
a child's cultural schema; (4) identifying and utilizing
points of cultural similarity can help establish
rapport, develop a strong therapeutic relationship,
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Ill
and/or open up new pathways in treatment; (5) one aspect
of 'cultural sensitivity' is being willing to initiate
conversations about culture; (6) a child can distinguish
between therapists who are culturally-sensitive and
those who are not; (7) preference for an ethnically-
similar therapist; and finally, (8) perception,
discussion, and/or development of cultural ideas for
ethnic minority children is different from European-
American children. In the discourse analysis certain
recurring words and phrases also illustrated the above
themes in terms of how culture and the therapeutic
relationship interact, including: familiarity, a sense
of family, Catholicism's connection to Latino culture,
the distinction of socioeconomic status, the influence
of community, and language breaking down barriers.
The accounts provided by Denis and Miguel about the
role of culture in their therapeutic relationship
suggest it is a complex phenomena. Culture was not
easily defined or grasped by therapist or child. It was
not merely operationalized by how people look, but
included how they act. Nevertheless, what was
articulated in terms of language, color, ethnicity,
religion, and other such aspects of culture that are
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
112
shared between this dyad served as points of growth in
their relationship. In addition, differences, if not
taken into account or bridged by some mutual
understanding seemingly led to resistance, such as in
the report from Denis that he preferred counselors
characterized as similar, while rejecting those that are
perceived as different and/or culturally insensitive.
New Directions
Qualitative research is an iterative process in
which one learns from the data; shifts in direction are
acceptable because one is open to the possibilities. So
as a result of what I found in the pilot study, I was
able to correct some of my previous assumptions and
expectations. The most significant difference from the
pilot study to the dissertation research is that in the
former I looked at one Latino-client-Latino-therapist
dyad, whereas in the latter my focus shifted to my own
clinical experience and the interactions of the five
supplementary cross-cultural dyads. This modification
came about because of both necessity and interest.
First, I realized I had a lot to say based on my own
work with this population and that my experience was
unique. Secondly, I used the experience of others as a
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
113
sort of sounding-board. It just so happened that the
counselors working at the school during the time of the
study were of European-American descent. Accordingly it
became important to examine cross-cultural dynamics both
because Anglo therapists counseling minority populations
is the norm, and because the effects of cross-cultural
match has not been researched with children.
Another example of a change in direction, is that
in this study I did not make cultural transmission a
focal point, instead I looked more at cultural
compatibility or the lack thereof. That is, I provided
more specific instances of how cultural mismatch affects
the therapeutic experience/dialogue in order to
capitalize on the actual study findings. I also
tightened the age range and the ethnicity of the child-
participants. What's more, I structured and focused some
of the interview questions even further. Because of
trouble with terms in the pilot study, I avoided the use
of specialized concepts like ethnicity and prejudice
with the children, due to the limitations in vocabulary
and/or understanding, however, because the staff
maintained that the students were exposed to some
cultural terminology, I elected to ask about it again.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
114
In this study I also tried to evoke children's responses
about "culture," rather than relying too heavily on the
counselor's perspective. Finally, I tried to develop the
themes found in the pilot study, elaborating on some and
discarding others.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
115
CHAPTER FOUR
Data Presentation
Cross-case Analysis
After working at the school for over three years, I
learned some things that I did not know before regarding
child therapy and the influence of cultural factors. I
believed these insights would be useful to other
therapists working in multicultural counseling contexts.
Thus, I attempted to detail some of my recollections,
as well as utilize the knowledge gleaned from the five
therapeutic dyads to support what I had come to learn
about culture and therapy.
First, however, I must qualify my findings as
pertaining explicitly to my cases and the cases of
Arturo/Anne, John/Janet, David/Darin, Carlos/Chris, and
Denise/Chris. That is to say, other therapists with
other clients may, and presumably do, deal with the
cultural contexts of the therapeutic relationship in
unique ways. It is even fair to say that my clients and
I, and the five dyads in this study, have contended with
culture, ethnicity, diversity, and related subjects
differently in the past, and will treat it distinctly in
the future. Nevertheless, the slices of data from the
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
116
observations and interviews serve to give readers an
idea of my experience, and of what was going on for the
five dyads during a particular time and at particular
place.
Themes/Findings. I examined commonalties and/or
differences, and integrated themes across the cases in
order to create a gestalt of the phenomena in question.
Specifically, I looked at and discovered: (a) how
culture is defined by each participant, and what is the
process or saliency of culture for each; (b) how the age
of the child influenced the development of cultural
schemas; (c) how each child identifies with his or her
counselor, and if there is cultural identification what
kind of interaction results; and (d) how different
belief systems and/or world views create intimacy or
distance in each dyad. The narratives, observations, and
interview excerpts that I cite work to support the
central meaning categories within the larger
classification of culture, school-age, and the
therapeutic relationship. I now elaborate on the major
themes found across all the data, as well as discuss
critical incidents and other related findings.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
117
Culture: A Multifaceted Concept with Subjective and
Established Meaning
The first finding suggests that participants in
this study, including my clients and me, had both a
personal concept of culture and ideas that overlapped to
form a general definition of culture. This conclusion
does not directly answer the original question regarding
how culture influences the therapeutic relationship,
however, knowing what culture means to each participant
is necessary in order to understand its significance in
these therapeutic relationships. Case in point, if I
exclaim, "Love changed my life," and the person I am
talking to does not know what I mean by "love," that
person could believe that I was speaking of romance,
friendship, the kindness of a good Samaritan, or the
love of God. Thus, I would have to spell out what love
means to me so as to communicate its effect on my life.
Likewise, it is important to know how culture is viewed
by children and therapists in an attempt to find out how
this thinking may impact their relationships.
Accordingly, there is both uniformity and
idiosyncrasy in the personal definitions of culture
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
118
offered by participants. For example, I view culture as
a guiding force behind my behavior, and see it as
intermingled with family, religion, and language. When I
think of culture text book definitions may come to mind
but so do all these other associations with history,
learning, customs, and relationships. Similarly, my
clients had a hard time separating socialization
practices (food, music, dress, etc.) from these cultural
institutions. Also, during the interviews all four
counselors, Anne, Janet, Darin, and Chris, specifically
alluded to values instilled early in life, and included
descriptions of familial ties, beliefs, religion,
ethnicity, language, food, literature, and art. Be that
as it may, Darin and Chris expressed difficulty in
identifying any one culture as their own, yet they chose
to talk unreservedly about their varied ethnic
backgrounds in the interviews. Likewise, three out of
five of the children gave explanations of culture that
were similar to each other, and included drawings of
their home, their neighborhood, their community, their
world (See Figure 3). John, David, and Carlos delineated
culture as a way of living and identified various ethnic
groups as examples of such. And while Arturo and Denise
were not as familiar with certain "cultural" words, they
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
119
lumped other concepts such as race, skin color and
appearance, family, and ethnic identification to show
their recognition of group differences.
DC,
I
-
L
Carlos' Neighborhood
Tbsic SacWs
John's Home
^WS'tc-id
! K e . \ » i a s . r f e S : f e d ; ? ,
David's Troubled World
Figure 3.
Drawings by John, Carlos, and David
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
120
Subjective meanings of culture that the
participants embraced varied; nonetheless, their
characterizations could be linked together to produce a
practical description of the concept. For my part, I
have always had difficulty isolating culture from race
and ethnicity, no matter how much I know intellectually
about these concepts. And my clients' views on culture
were so diverse that I would not know where to begin,
other than to say that it was how they identified
themselves and others as different. Anne, the counselor,
stated "it's who I am," as she explained that
understanding patterns of culture helps to know another
person and do the work of therapy. Her client, Arturo
was perhaps not as articulate, but managed to convey
that culture is one way in which he knows his counselor,
and that it is also one way in which he distinguishes
himself. Janet acknowledged that being from the majority
culture makes it difficult to relate with minority
clients, but regardless put much significance in her
interest and connection to Latinos due to her marriage
to a Latino man. Whereas her client, John seemed to be
struggling in terms of what culture he is a part of; he
knew that Latinos are different from whites, but he did
not seem to feel he completely belonged in either
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
121
category. The counselor, Darin deconstructed the concept
of culture to what he called bastard nomadism, which in
his mind is an assimilation of various cultures, much
like the way he appropriated Latino symbolism for his
own personal interest and research. His client, David
talked about his culture as his people, Cubans,
Mexicans, and Americans without much elaboration. Chris
spoke of an identity crisis as far as culture was
concerned; he wrestled with the definition of culture,
his own and the general concept. While his clients,
Carlos and Denise varied in their ideas and strength of
identification with culture. Carlos even went as far as
to say that it was more than just about skin color,
whereas, Denise was not clear about her own heritage or
its meaning to her.
Cultural Schemas: How They Function in School-age
Children
The second theme that emerged deals with how the
school-age children in the study conceptualize culture.
I discovered that, similar to adults (Abreu et al.,
1998; Abreu & Gabarain, 2000; Sue & Zane, 1987), these
children may well hold expectations and/or stereotypes
of their therapists, and that the labels they use may be
part of the their cultural world view. As in therapy
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
122
with adults, child-clients may have different approaches
to therapy based on stereotypes. For example, families
in some Hispanic groups, such as the Mexican-American,
often teach children to regard European-Americans with
distrust and hostility, so a child-client taught such an
attitude may have a hard time disclosing personal
information to a white counselor (Baruth & Manning,
1999).
In the five therapeutic dyads the children's
cultural schemas revolved around a number of elements,
namely, how their representations were affected by their
cognitive and emotional capabilities and the central
concerns in their lives. The counselors described what
they saw as the emotional and cognitive abilities of
school-age children, as well as what issues may be
important to the kids during this particular
developmental stage.
Anne stated that although she believes this middle
school stage to be more serene than adolescence, she
recognized that the kids understand more and reflect on
their lives to a greater extent than before, including
focusing on culture. Janet discussed how limitations in
attention span and interest dictates what kind of work
therapists can do with these kids; school-related
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
123
issues, not cultural issues, seemed to be a priority for
her clients and modes of treatment included behavior
modification and play therapy. Darin echoed that play
and art have been central processes of exploration for
these school-age kids, however, he added that their
transparency is not a limit but an advantage. He
contended that because their unconscious is so readily
accessible in their play and drawings, we could explore
issues like culture in natural and supportive ways.
Likewise, Chris agreed that therapists can engage
school-age kids on a play level, as well as work on a
more verbal plane with them. However, he suggested (as
Anne and Janet also hinted in their feedback) that the
kids do not voluntarily bring up culture in session for
several reasons. Number one, the kids often have too
many competing concerns to sort out cultural issues;
they may only be aware of their problems or treatment
issues, such as poor academic progress, ADHD, and so on.
Secondly, the kids at the particular school in the study
are so immersed in their own Latino culture that they
are not forced to think about it. Finally, Chris
suggested that he, and other counselors, perhaps did not
address cultural issues with the younger children
because most therapists have been educated in the
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
124
Western tradition and think in psychological terms
rather than in a social and/or cultural language.
With regard to how the children themselves
exhibited cultural schemas in their interviews and
therapy sessions, I found a replication of the accounts
given by the counselors. That is to say, the kids were
able to think about and verbalize their views on
culture, however brief. They showed understanding of
certain terms, identified themselves ethnically, and for
the most part were aware of their counselor's culture.
The five children differed in their attention span
during the interviews and their main preoccupations were
indeed centered around play, class work, and their own
behavior/treatment issues (by and large in that order).
There was also evidence that they are immersed in their
own culture, as they were all observably aware that
Latinos are in the majority at the school. However,
there is the implication that culture is important to
most of these kids, supported by their choices in the
counselor selection exercise. Without any prompting by
the interviewer, Arturo, David, and Denise made it known
that a Mexican therapist was vital to the school. Carlos
not only chose an African-American female counselor for
clearly cultural reasons, but also said during his
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
125
interview that it was necessary for people to discuss
cultural matters. John was the only child who did not
specify ethnicity of the counselor, but he also did not
specify gender or any other distinguishable
characteristics. Finally, during the therapy sessions
all five children engaged in at least some talk of a
cultural nature, and Carlos was the only one who, not
only initiated this type of conversation, but extended
it into an actual dialogue with his counselor.
Even though the findings suggest that these five
children express themselves in cultural ways, their
schemas were not very sophisticated. For instance, they
could not offer precise definitions of concepts (i.e.,
ethnicity, prejudice). They seemed to understand
discrimination, but did not talk much about it or offer
their own experiences. And finally, in the interviews,
talk of differences and similarities between themselves
and their counselors did not always include cultural
diversity.
I have chosen a few of my more compelling cases in
order to illustrate how cultural schemas operated in
some of my Latino school-age clients. First, I
articulate how Stephen and Isaac identify themselves in
terms of culture, as well as how they perceive me in a
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
126
cultural context. Next, I talk about how culture can be
either a peripheral or central concern as with ray
clients Christina and Hector. Finally, Aldo and Moses,
show how children can express themselves regarding
culture rather than hold back from communicating about
these matters.
Cultural identification. Stephen was eight-years
old when his parents enrolled him in the school. I
remember my first meeting with the family. Stephen's
Cuban mother and Mexican father were somewhat
overbearing. Although they spoke Spanish in the home,
they were insistent that Stephen speak English at school
and assimilate into the American educational system as
soon as possible. They were in denial of his ADHD
diagnosis (believing he just did not try hard enough to
behave), and claimed that their son had been expelled
from his previous school because of staff discrimination
and incompetence.
When I met Stephen it was clear to me that he did
suffer from attentional problems and hyperactivity. It
was also obvious that this very light-skinned Latino boy
was facing acculturative stress. Stephen had a pretty
thick Spanish accent, but at home he was given the
message that Spanish was not acceptable in public.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
127
However, many of his classmates, who looked typically
Hispanic, would freely break out in their native tongue.
And in session, I would have to alternate between
English and Spanish just to make it easier for him to
understand.
Stephen was undoubtedly confused. He knew he was
Latino, as was a good percentage of the school,
including his therapist, but he had trouble reconciling
his cultural identity to what was expected of him at
home. I think it may have even been harder on him
knowing that I was Latina and proud of it, because this
flew in the face of what his parents thought. Without
directly contradicting his parents, I tried to encourage
Stephen to appreciate his heritage, but he seemed to
mimic what he learned at home and actually made
derogatory remarks about prietos and wetbacks (dark ones
and Mexican immigrants). I believe his parents were
struggling with their own pressure to assimilate and
would often project feelings of shame and/or resentment
onto Stephen. All in all, Stephen's self-identification
as Latino, topped by my cultural liberalism was
problematic for the family. Likewise, after nine months
of trying to convince his parents that he needed special
assistance and possibly medication for his ADHD, they
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
128
decided to pull him out of the school because they did
not see eye to eye with me or the rest of the staff.
Isaac was 10-years old when I first met him. He was
a smallish boy of mixed ethnicity. He understood
Spanish, but could not speak it. His mother was Mexican-
American and he believed that his father was African-
American and Puerto Rican. Isaac was brought up by his
single mother in a high-crime neighborhood. He was
diagnosed with oppositional-defiant disorder and was
expelled from his former school for aggressive behavior.
He was in therapy with me for two years, and during this
time it was apparent that he was trying to discover who
he was and where he belonged. In fact, he would often
get into trouble because he was hanging around with the
wrong crowd and would try too hard to please his new
found "friends".
Isaac would often talk about people in his
community and was continually trying to decipher which
group he fit in with the best. He also communicated to
me (and others) that he was concerned as to how I, as
his therapist, was perceived by others in the school. It
was important to him that I was the cool Mexican
counselor who looked white and could play basketball.
Concepts of machismo and respect, which are significant
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
129
in Latino culture, were a large part of his psyche. Even
though I knew Isaac in session as a sensitive and
insecure child, in the schoolyard and neighborhood he
took on the fagade of a tough and reckless kid. He
dressed like a gangster and bragged about tagging,
however, most of this was just posturing.
Isaac put on this affectation partly because of the
influence of his environment, and I believe, partly as
an attempt to shock me. He regularly drew and talked
about themes related to the Latino gang culture (See
Figure 4).
Figure 4 .
Isaac's Drawing: The Tagger and His Call Sign
And even though he struggled as to how to relate to his
ethnic group it was clear Isaac was striving to do so;
he wanted to understand and participate in the practices
of what he believed were his people. Consequently, when
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
130
I accepted/appreciated where he was coming from with
this strong desire for group membership, he allowed me
deeper into his reality. I then took the opportunity to
confront him on what the gang lifestyle meant to him, as
well as to challenge him to find more positive ways to
express his identity. I even introduced him to various
Latino artists and familiarized him with other Mexican
traditions (i.e., related to food, music, etc.). So it
is reasonable to assume that Isaac knew how I identified
with my cultural heritage, and I believe this gave him
the chance to explore other aspects of his culture.
The importance of cultural issues. Christina was
10-years old when she entered therapy with me. I saw her
five months prior to her relocation to a new city. She
endured severe abuse at the hands of her natural parents
and suffered from a psychotic disorder as a result.
Christina was moved around from foster home to foster
home; she stayed at four different places within a two-
year period. She also had a speech impediment and
learning disability.
This petite girl had a sweet demeanor that hid the
hurt and anger she had inside her. When she came to the
school, she was significantly behind academically and
did not have adequate social skills. With all that was
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
131
going on in her life, it's safe to say that cultural
issues where not among the foremost things on her mind.
Christina's world consisted of more basic concerns like
trust, personal safety, and developmental issues. She
did not seem to think about the fact that her mother was
white and Native-American and her father was Mexican-
American. The concepts of ethnicity, discrimination and
such, were foreign to her. She did not know Spanish, and
she did not seem to care one way or the other that her
foster mom did. All that was important to her at the
time was that she have someone to look after her,
protect her, love her. Thus, the issues addressed in
therapy were related to healing Christina's wounds,
meeting her fundamental human needs, and helping her
integrate into her new learning environment.
Hector was nine-years old when I first began to see
him for treatment. He was a victim of sexual abuse and
suffered from depression. He also had a slight speech
impediment, which seemed significantly worse in English
than in Spanish (although he was bilingual). Like
Christina, Hector did not have a stable home
environment. While he was at the school he was under the
care of a foster parent who did not have much patience
for his emotional and behavioral problems.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
132
Despite, or perhaps because of his attachment/trust
issues, this fair-skinned Latino boy tried very hard to
please people. However, he would often come off as
clingy and immature. Hector was often the object of
ridicule because of his needy behavior. But he was also
picked-on by his classmates because he looked and acted
different. He appeared to be of European-American origin
and was evidently fascinated by popular American
culture, yet he spoke a lot of Spanish and was very
conservative in his dress and behavior. Even though
Hector grew up in the same indigent conditions as many
of students at the school he veered away from the Latino
street culture that was prevalent at the school. So he
was looked down-upon by other Hispanics, and this
discrimination was certainly an issue for him in
therapy.
Hector and I openly discussed in Spanish how he
felt pulled by both the American and the Mexican
culture. He would often talk about his love of American
food and TV shows, and he would draw his favorite
cartoon characters for me (See Figure 5). At the same
time, he revealed that he watched novellas (Spanish soap
operas) and enjoyed traditional Mexican cuisine. He did
not understand why he did not fit in with other Hispanic
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
133
kids, and why the gang lifestyle was so important to so
many of his classmates. I empathized with him and tried
help him understand that people had different levels of
acculturation. I worked with Hector to accept and
appreciate his own stage in the process of cultural
identity development. After some time, he seemed to be
more comfortable in his bicultural world, but he would
have to adapt once again because after nine months at
the school he was forced to relocate to a new foster
home.
m '..tznyz
Figure 5.
Hector's Drawing: Favorite Cartoon Show
Communicating about cultural matters. One ten-year
old boy I had in counseling, named Aldo, was rather
expressive and inquisitive about most things, including
cultural issues. This boy was a victim of abuse, and was
diagnosed with ADHD and conduct disorder. He and his
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
134
younger brother were raised by his single mother, who
was a monolingual Spanish-speaker. Aldo picked up
English from watching television, going to school, and
from a few of his mother''s different boyfriends. Even
though he apparently felt more comfortable speaking
English, he was not exactly proficient at it. Like many
of the other kids at the school, Aldo was walking the
tightrope between American and Mexican cultures.
Accordingly, it was only cool to speak in Spanish if you
were keeping a secret from staff and/or other students,
or if you were swearing at someone. In fact, Aldo
declined to speak Spanish in therapy, yet he would often
get in trouble for cussing at his teacher in Spanish.
Aldo would tell me in session that he felt like his
teacher and one of her assistants were prejudiced
against him because they were white. He undoubtedly had
a chip on his shoulder about being a minority, and from
talking to his mother, I am convinced that she planted
these seeds of cynicism in her son. Without discounting
the reality of racism and discrimination in society, and
perhaps even at the school, I tried to work with Aldo
and his mother to dispense with the victim role and
empower them to take responsibility for their actions
and make better choices. Moreover, I used movies and art
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
135
with Latino actors and themes to connect with Aldo, and
encouraged his exploration of Mexican traditions.
Several months passed, and he seemed to feel safe enough
to lower some of his defenses. He began to get along
with students and staff not only of his own ethnicity,
but of various cultures. However, after some time he got
caught up again in a battle with authority both at
school and in his community, and his mother did not
provide the proper supervision or example. Aldo became
involved with the gang lifestyle and got in trouble with
the law; he was expelled a year and a half after first
coming to the school (See Figure 6).
Figure 6.
Aldo's Drawing: The Original Gangster
My client, Moses, was 8-years old when I first
began seeing him in therapy. He was a small, dark, and
rather shaggy Latino boy who was diagnosed with ADHD.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
136
Moses, his four siblings, and his parents immigrated to
the U.S. from a rural town in Mexico. He mainly spoke
Spanish, and the little English he knew he learned at
school. In session, Moses tried hard to speak the
English he gleaned from class, but would often revert to
Spanish.
Like many other young clients, Moses used play and
art to express himself. Although he spent some time
telling me stories about life in a small town, he mainly
liked to draw pictures of his home (See Figure 7). Even
though I surely asked questions about his background, as
I did of all my kids, he volunteered much information
regarding his way of life, his culture. I believe
allowing him to deal with the loss of his home, as well
as giving him permission to enjoy the richness of his
heritage, gave Moses the opportunity and strength to
throw himself into his new surroundings and integrate
into American culture without losing his culture of
origin. Accordingly, he learned English, while remaining
proficient in Spanish, and he was eventually
mainstreamed back to public school.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
137
Figure 7.
Moses' drawing: Life on the Ranch
Culture and the Therapeutic Relationship
It has not been an easy task to tease out how
culture impacts the therapeutic relationship, especially
with kids and this kind of therapy. This study does not
purport to isolate culture as a variable of interest
with statistics as in quantitative research. Instead,
with narrative text derived from observations,
interviews, journal notes, and other data sources, I
show how culture made a difference, one way or the
other, in the therapy of the Latino school-age children
mentioned in this study. It follows that, the third and
most significant theme, is that cultural factors were
indeed present in these therapeutic relationships, and
this was demonstrated most clearly when these factors
were acknowledged by the therapist. This finding is
supported by literature that maintains that therapists
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
138
need to be sensitive to cultural issues, regardless of
whether or not they are of the same ethnicity as theirs
clients.
Again, in keeping with the participants' own
definitions, culture influenced their therapeutic
relationships. The finding indicates that how the
children differentiated themselves from their counselors
according to ethnicity, language, and other such
factors, did, at times, affect the closeness and/or
distance between them. The ability to connect and feel
understood by their counselors depended on each
therapist's approach and each child's responsiveness,
and to some extent cultural acknowledgment. Presently, I
submit instances of how culture manifested itself in the
therapeutic dialogue of the five dyads, and show how my
clinical work with Beto, Juan, and Victor was imbued
with cultural themes.
In Case 1, with Arturo and Anne, there were signs
of a positive relationship between the two. The
counselor maintained that this type of therapeutic
relationship was established because she laid the
foundation of trust and because of her role as an
advocate. From Arturo's eyes, however, it was also very
important that his counselor was fun and funny. He
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
139
talked about being able to play sports with her and go
on outings, as well as having conversations with his
counselor about school and family, which at times
included a cultural dialogue (i.e., talking about how
his black classmate gets teased, or how he made and ate
caldo on a fishing trip). In the client's description of
the "ideal therapist," he also indicated that being
happy, playing, and talking to kids was a necessity. In
addition, Arturo thought it would be beneficial to have
a Mexican male counselor that speaks Spanish. This
particular finding was also supported by Anne's own
admission that it was difficult to fight the negative
stereotype of a white female counselor in the beginning,
and how the language barrier continued to be an obstacle
in treatment. Nevertheless, in Case 1, there were
indications of intimacy and disengagement that could be
attributed to various other factors. For example,
analysis of the nonverbal cues between the dyad during
the videotaped therapy session suggested both closeness
and distance. There was a literal separation between
therapist and client, as Anne sat behind her desk the
entire time, which could be due to the therapist's
inhibitions or to a power differential (commented on by
the client in the interview). In addition, the chronemic
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
140
communication was somewhat awkward, as Anne's pace of
speech was hurried and directive, and she seemed
uncomfortable with silence in the room. However, Arturo
maintained good eye contact with his counselor and a
fairly even keeled conversation; both participants had
an engaged quality in their voices. Of course, the
process of the therapy session may have been affected by
the presence of the video camera, not to mention
countless other details (i.e., client's hunger, past
sessions, therapist's schedule, etc.).
The dyad in Case 2, John and Janet, appeared to
have an unremarkable therapeutic relationship,
characterized primarily by the flat affect of the
client. Janet has attempted to work at level of the
child by forming a base of commonality and friendship.
She has tried to connect with John's quiet yet
competitive nature, but has had trouble due to the
client's emotional and behavioral problems. John has
ADHD and is significantly medicated, which may make it
difficult for him to establish meaningful long-term
relationships. He has also confessed that he does not
relate well to adults and that his socialization with
peers is centered around games/sports. Although John
recognized some cultural terminology and talked briefly
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
141
about it in the interview, he seemed on the whole
detached from not only this topic, but even subjects
ostensibly directly related to him. In addition, he gave
very little description of his view of the "ideal
therapist"; the only characteristic of this person was
that he/she should not be mean. Correspondingly, meeting
this minimum requirement suggests that Janet may be as
close at the moment as any counselor could be to John.
There is evidence of this in the therapy session when
John elected to sit close to his therapist and respond
to all her questions. Ultimately, with this particular
dyad, there is no indication that culture has created
either intimacy or distance.
Case 3, consisting of David and Darin, was marked
by the disparate experiences of both parties. David had
discernible ambivalent feelings towards his counselor,
whereas Darin seemed to relate to him as he did his
other clients, in a supportive and deferential way.
Darin's approach has been to treat his clients as his
teachers and be genuine with them. He also spoke of the
mixing of his Germanic and Celtic heritage with the
kids' Latino culture. In spite of this, or perhaps
because, as Darin stated "kids have a good bullshit
meter" and see "becoming Mexican as inauthentic," David
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
142
has had a low frustration tolerance for his counselor.
As Darin has also pointed out, therapists often have to
overcome the oppression of the Anglo culture on clients.
Specifically, the counselor referred to David's struggle
with acculturation and language and his beginning to see
Darin as "the other". Thus, in this therapeutic
relationship it is clear that culture plays a
significant part. Darin asserted that he initiates
conversations around culture with kids, including talk
of family traditions, religion, food, language,
prejudice, and racism, and David acknowledged conversing
with his counselor about family, food, and stories.
David likes playing and walking with Darin, but other
times gets bored and focuses on how "strange" or
different his counselor is from himself. David's "ideal
therapist" had some qualities he attributed to his
counselor, such as being calm and good with kids, as
well as some very striking differences, such as being a
Mexican-American woman who listens better. During the
therapy session there was further evidence that David
has conflicting feelings about his counselor. For
example, he sat near him and seemed to enjoy playing
cards and reading to him, but at other moments in the
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
143
session he moved away, fidgeted, and had a
frustrated/sarcastic tone in his voice. And so, the dyad
struggles with the impact of culture on their
relationship, as Darin stated, consciously and
unconsciously.
The therapeutic dyad of Case 4, Carlos and Chris,
epitomized a fairly stable and positive therapeutic
relationship. Chris has provided a unique adult
relationship for Carlos within the context of a safe and
consistent therapeutic environment. Carlos seems to have
responded well to his counselor''s spontaneity and
interest in him. He demonstrated his strong connection
to Chris by self-disclosing to him about his problems,
school, home, and virtually every aspect of his life.
They shared common interests, and although Carlos was
aware of differences between he and his counselor, he
reported that they do not bother him. The counselor, on
the other hand, believed that some of these differences
may be difficult for his client, including not being
athletic, the generation gap, and the language barrier
between Chris and Carlos'' mother. In addition, Chris
came to the realization that he does not explore his
clients'' cultural heritage enough. However, he seemed
determined to correct this. Carlos also became aware
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
144
during the study that he does not talk to his counselor,
or anybody else for that matter, about certain cultural
issues and stated that he would like to change this. He
showed this in the exercise regarding the "ideal
therapist," by purposely selecting an African-American
woman for the sake of diversity/equality. Both Carlos
and Chris further exhibited their commitment to more
cultural dialogue by having one during their videotaped
therapy session. Thus, it was evident that even if
culture was not a visible player in their relationship
before, it rapidly became one.
In Case 5, Denise and Chris, revealed that shared
interests enhanced rapport and trust, while differences
in experience caused a rift or impasse in the
relationship. Chris reported a good connection with
Denise due to the commonality between the two. Denise
resonated her counselor's belief in their
identification, particularly in the areas of sports,
computers, and culture. Not only did she consider Chris
fun and funny, but she actually integrated his ethnic
heritage with hers. Chris questioned himself again as to
whether he explored her diversity enough, but eventually
came to the conclusion that he touched on cultural
issues with Denise and other kids without even realizing
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
145
it. It was plain then, that culture did play a role in
their relationship, especially when we see that Denise
thought it was important to have a Mexican counselor for
Mexican kids (i.e., the therapist selection exercise).
However, it was also evident that other differences
and/or challenges are prominent in the relationship
between Denise and Chris. That is to say, it seemed more
troubling to Denise that her therapist is a male, most
likely because of the treatment issues related to her
own father. What bothered the client most was her
counselor'' s persistent insistence on talking about her
dad; on every other point she seemed content and
compatible with her counselor. Consequently, with this
therapeutic dyad, cultural issues may have gotten pushed
aside at times or at least down-played due to more
pressing concerns.
As I have already intimated, culture has pervaded
many of my cases and individual sessions, however, there
are three cases that stand out in my mind at this point
in time. One of my first clients when I started working
at the school was this rather shy eight-year old boy
named Beto. During the three years that I saw him in
therapy, I watched this lanky and anxious child grow
into a healthy and confident boy. Beto had already been
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
146
at the school for two years prior to my employment
there, and was transferred to me by a European-American
therapist that felt like he had made very little
progress with this student. It was clear that Beto had
an attentional problem and suffered emotionally due to
trouble at home. However, it was not until I took the
case that I was able to help diagnose him with a
learning disability and place him in the appropriate
classroom. I also found out that he was exposed to
domestic violence in the home and was a victim of
neglect. I reported the abuse and worked with the family
to get help.
Certainly, it could be argued that I was simply
more adept than the other counselor at handling these
challenges in this particular case, or even that my
ability to speak Spanish was the main reason I was able
to assist this client and his family. But without
discounting therapeutic skill or bilingualism, I contend
that culture played a significant role in our
therapeutic relationship and the resulting progress made
by the client. To be precise, I believe that Beto was
more genuine with me due to our shared culture. He let
down his guard, thus, I was able to discern his
difficulty with auditory processing when it had gone
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
147
unnoticed for so long. Perhaps he hid it from his
previous white counselor and white teacher because he
was afraid of judgement or consequences. According to
his first counselor, Beto was so eager to please that he
just pretended to understand what he was saying most of
the time, and he also observed that in the classroom
Beto tried to overcompensate his academic deficiencies
with his agreeable personality and athleticism. Maybe my
client simply did not have to try so hard to fit in with
me because I already knew where he was coming from, and
he knew that because I brought it up in session.
Similarly, Beto''s former counselor, teacher, and I
had all seen him come to school looking tired and
unkempt. Yet, I did not chalk it up to the client's
culture and lower socio-economic status; I challenged
the stereotype of what it meant to come from "the
barrio," and confronted his mother about what was going
on at home. As a result, of dealing with the cycle of
violence and cultural issues such as machismo (i.e.,
masculine pride) and familism (i.e., sacrificing oneself
in the interest of the family), we were able to move on
and tackle other therapeutic issues and eventually
mainstream Beto back into public school with a improved
self-concept.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
148
Another boy whom I treated for a year also came to
me with some cultural baggage so-to-speak. Juan was
diagnosed with depression, ADHD, and a learning
disability at age seven. He spoke primarily Spanish, so
it was natural that I would be his therapist. However,
having language in common was only the start of
developing rapport. Juan was a new immigrant whose
parents brought him and his six older siblings with them
to this country in order to find work. He grew up on a
ranch in Mexico and desperately missed his home.
Although I know another therapist would be sensitive to
the client's issues of loss, I suspect that a European-
American therapist might have had a harder time truly
understanding what it meant for Juan to have to live in
a new place with completely different customs. But I was
his therapist, and I was able to identify with him.
Being very familiar with Mexican traditions, I was able
to make him feel comfortable by greeting him in a
culturally appropriate way. My office was full of Latino
artifacts, and stood out like a sort of cultural oasis
in center of his new sterile educational institution.
Juan even wanted to add his drawing to complement my
decor and be a part of my "family" of clients (See
Figure 8). Correspondingly, I expressed a sense of
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
149
personalismo (which is a preference for personal contact
and individualized attention in dealing with power
structures), which I think made Juan's transition to
American life a little bit easier.
Figure 8.
Juan's Drawing: Juan's Family
Juan quickly learned English and seemed to adapt
very well to his new environment. He no longer suffered
from depression and had no more signs of ADHD either. He
received special assistance for his learning disability
and improved academically. Sadly, his parents were not
fortunate at finding long-term work and did not have an
adequate support system to remain in the country. The
family decided to return to Mexico and try to make a
living there again. Typically, when clients have
terminated treatment, especially because of distant
relocation, I do not have much recourse when it comes to
follow-up. However, because of my connection with Juan
and his parents I was not surprised when they wrote me
to update me on his progress several months later.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
150
One final example of how cultural affinity can lead
to a deeper therapeutic relationship comes from my
treatment of a ten-year old boy named Victor. He was in
therapy with me for over a year. Victor was physically
abused by his mother'' s boyfriend and neglected by his
mother. He suffered from depression and a childhood
psychosis. Even so, this very small ten-year old was in
the habit of taking care of his mother ever since he
could remember. Not only would he try to protect his
mother from abusive men, but he was also her only link
to the English-speaking world. This was a classic case
of both a parentified child and of the disparity in
acculturation levels within a family.
As a result of being raised in an unstable
environment, it was obvious that Victor would have
serious issues with trust. Thus, establishing a
relationship was going to be tricky, especially because
this was a very intelligent boy who could sense any
disingenuousness on the part of an adult. So I looked
for every point of connection I could find and
discovered several. First, even though he was proficient
in English, I initially greeted him in Spanish so that
he would know that I was at least somewhat familiar with
his way of life. He responded with surprise and delight;
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
151
he seemed to appreciate being able to communicate in his
native tongue with someone other than his mom. On the
whole, therapy was conducted in English, but every now
and then we would burst into Spanish for a joke or to
express a feeling or thought that was not easily
translated into English. Second, I made him aware that I
knew much about popular youth culture. In particular, we
talked about music, cars, and clothes that were in style
in his predominantly Latino neighborhood (See Figure 9).
Lastly, we related to each through games, sports, and
art.
Figure 9.
Victor's Drawing: Low Rider Cars are "the Bomb"
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
152
After I made some initial reports to DCFS as to the
violent family situation and medical neglect, Victor's
health and conduct improved drastically. For a long time
he thrived at the school, his aggressive behavior was
non-existent and his depression dissipated. He quickly
became the top student in his class. I'm sad to say,
however, that his condition did not remain positive.
About ten months after Victor came to the school it was
looking as though he was ready to return to public
school, when circumstances at home took a dramatic turn
for the worst. He began to act out violently towards
staff and students. In fact, three rather large male
staff members had a hard time restraining this scrawny
little boy during one of his outbursts. I was called in
on a number of occasions to de-escalate the situation,
and each time I was involved he responded favorably.
Victor immediately calmed down in my presence and I
believe that because of the relationship we had built he
made more of an effort to regulate his behavior.
Unfortunately, the stress he endured at home was too
much for him. After struggling in this abusive setting
for so long and without any recourse, Victor mentally
decompensated and had a psychotic break. He was
immediately hospitalized, and eventually he was taken
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
153
from the home and put into residential care.
Notwithstanding the tragic events that led to the
termination of therapy,. I am convinced that the
closeness that he experienced with me eased the burden
of his pain and gave him the strength to eventually find
the safe structure he so sorely needed.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
154
CHAPTER FIVE
Discussion Section
Outcome and Meaning
I chose to explore the phenomena of culture with
particular participants at a particular institution
because it gave me the opportunity to see real clients
with severe problems, observe on-going therapy in a
comprehensive milieu, and examine cultural issues, which
may have been masked by more conspicuous behavioral
symptoms in clients. The results of the study were that:
(a) culture is a multifaceted concept, (b) cultural
schemas play a part in how school-age children respond
to their therapists, and (c) cultural match affects the
therapeutic relationship. These findings are important
because researchers have not empirically studied the
interaction of child therapy and culture, and if they
have done so, they have done it independently of an
actual clinical situation.
Moreover, in providing an answer to the question of
how culture impacts the therapeutic relationship of
Latino school-age children in a special education
setting, analysis focused on my participant-
observational experience at the field site and the
supplementary data furnished by the five therapeutic
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
155
dyads. I examined all the evidence, including field
notes, interview transcripts, videotape logs, and client
drawings. In addition, I cited a few instances of rival
interpretations, where cultural issues were not as
prevalent as in other cases.
What I found by doing the study was that something
was going on in the therapy of Latino school-age
children that changed the dynamics of the therapeutic
relationship and thereby changed the
quality/effectiveness of treatment. In the course of my
work at the school, I was able to recognize that my
child-clients were perceiving and responding to me via a
cultural lens. When they stereotyped me as a white
counselor many of them reacted by shutting down, but the
moment they found out that I shared and/or understood
their culture of origin, they seemed to let me into
their confidence. As suggested earlier, this
transformation in how they related to me occurred
directly after I, as the therapist, broached the subject
of culture in some way. This finding has important
implications for practitioners. It indicates that for
treatment to be more effective therapists may need to
take the lead and attend to what child-clients are
saying and doing within the context of culture.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
156
Therapists must understand a child-client' s culture
without making assumptions about it, and if they do not
understand something, they need to ask their clients
about it. The importance of culture may vary from client
to client and from moment to moment, still, it is
incumbent upon therapists to tackle these issues head
on. Therapists, for whatever reasons, may steer away
from discussions of culture, but to avoid cultural
factors can be detrimental to therapy. In fact, ignoring
cultural issues has been known to contribute to the
underutilization of services by minorities, as well as
to the high treatment drop out rates for Mexican-
Americans (Atkinson, Casas, & Abreu, 1992; Acosta,
Yamamoto, & Evans, 1982; Ho, 1992; Sue, 1988). Existing
research also supports that cultural sensitivity goes a
long way in trying to establish rapport and develop a
therapeutic relationship (Baruth & Manning, 1999; DHHS,
DE, & DJ, 2001; Ho, 1992; Sue et al., 1991). Presently,
other implications for counseling Latino children will
be discussed, but this is preceded by a brief discourse
on the role of culture, details on existing theory, the
study limitations, and suggestions for future research.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
157
The Role of Culture
I believe the findings in this research point to
how the role of culture is different for different
people. In the study I discovered common factors, but
the diversity and complexity of the meaning of culture
for each participant stands out. This makes sense when
we look at the seemingly endless range of subgroups and
individual variations within society. Although I
recognize that society and culture overlap in ways that
are difficult to disentangle through research (DHHS, DE,
& DJ, 2001), I have tried to shed light on how culture
has played a part in the treatment of my clients and the
therapy of the five Latino school-age children in the
study.
If we apply Cortez's (1999) levels of
multiculturalism to the study we can see a wide range of
cultural issues occur within the therapeutic dyads,
including: (a) the equity issue, (b) the balance
question, (c) the limits dilemma, (d) perception, (e)
interaction, and (f) change. Although some of these
features were not prevalent in all cases, each dimension
is made plain when viewing the research as a whole.
Taking the equity issue into consideration, I am
conscious of the power dynamics in society and how they
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
158
can get played out in therapy. Although I have not
always been successful in dispelling the image of an
authority figure, I have made a concerted effort to try
to relate to my clients at their level rather than
taking an expert position. In talking to the four
counselors, I noted how they each recognized differences
between themselves and their clients and how they
suggested that a struggle takes place on a vertical
plane (e.g., power disparity between majority and
minority cultures) (Cortez, 1999). Three of the kids
(Arturo, John, and David) also identified the
disproportionate power relationship with their
counselors, although they seem more likely to attribute
it to a matter of adult-child authority rather than to
cultural disparity.
The balance question can be read as assimilation
and acculturation vs. enculturation (Cortez, 1999).
Being a bicultural therapist, the dilemma of e pluribus
unum (out of many, one), is not always easy to stomach.
In a "melting pot" something has to melt away! For
example, can you compel a child to learn English without
devaluing his/her native language? All four counselors
also grappled with similar issues. Darin and Chris
especially had trouble coming to grips with their own
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
159
unique cultural backgrounds while maintaining a
curiosity about the cultures of their clients. And all
four counselors found it difficult to deal with the
different levels of acculturation of their clients and
their families. It was also evident that some of the
children wrestled with the question of whether to
assimilate to the majority culture or advance their own
heritage (e.g., acculturation vs. enculturation). For
instance, Arturo, Carlos, and David seem to be in the
midst of recognizing their ancestry, while John and
Denise seemed to have foreclosed on their ethnic
identity for the time being.
The limits dilemma relates to the point where the
zeal of multiculturalism gets carried away (i.e., too
many hyphens, too outside mainstream) (Cortez, 1999).
Although none of the participants directly addressed
this issue, there were intimations on the part of some
of the counselors that culture could not or should not
be the central concern in therapy at all times. I
believe that a therapist ought to always endeavor to be
multiculturally sensitive and competent, but I agree
that there must be a balance with other important
therapeutic goals.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
160
According to Cortez (1999), the last three
dimensions are strongly interrelated. Perception
involves the challenge of multiplicity, which we hear it
clearly in the diverse voices of the participants.
Interaction touches upon acceptable ways of dealing with
each other, and again we are privileged to get a glimpse
of how the Latino school-age children and their
therapists manage to come together with their
similarities and differences (i.e., gender, age,
ethnicity, etc.). And finally, change is innate to the
preparation for answering cultural questions. In the
study, both children and counselors seemed up to the
demand for flexibility, illustrated not only by their
willingness to participate in this research, but by
their readiness to confront their own cultural issues,
even if only within the context of the study.
Existing Theory
The findings supported much of what has been
written about culture for adult populations. According
to Oetting et al (1998), primary socialization theory
indicates that simple determinations of culture and
ethnicity are not likely to be found in the 'real world'
for a number of reasons: (1) All members of an ethnic
group do not have the same level of cultural
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
161
identification and may not, therefore, have the same
conformance to norms. (2) Primary socialization sources
are embedded in subcultures, and subcultures have norms
that may differ from those of the larger ethnic group.
(3) The individual may experience and report differing
levels of cultural identification and different norms in
different social contexts. (4) For an individual,
ethnicity and cultural identification may derive from
different primary socialization sources than norms. All
four of the above points were undoubtedly borne out in
this study. Furthermore, I know now that not having a
label for "culture" does not mean that children do not
perceive it - it may simply be better to talk about
culture and within it distinguish the adult from the
child understanding of the term.
In addition, as research suggests, the interaction
that takes place in the therapy of children may serve
two purposes: (1) directing children toward an
understanding of their own mind and its effects, and (2)
providing knowledge as to what is important when
thinking about the mind of another person in the child's
immediate environment (Gauvain, 1998). In the study we
have some idea of how children conceptualize (and in
some cases do not even think about) the idea of culture.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
162
Nonetheless, corresponding with existing research, we
find how more experienced social partners, such as
therapists, help define what causal explanations of
behavior and assumptions about mental states are
culturally viable (Goodnow, 1990). This information is
vital for predicting actions in such settings as
therapy, and it is thus that culture mediates
understanding of the world (e.g., it helps ensure that
meaning and mental understanding are shared by people
who have regular contact).
In her work on development and ethnic identity,
Phinney (1999) also found that global terms related to
culture are not as useful as the meanings individuals
ascribe to their own identity. Moreover, she contends
that there are significant psychological well-being
implications to ethnic identity development (i.e., self
esteem) . Her work supports the results in this research
by showing that ethnic identity is a dynamic,
multidimensional construct that refers to one'’ s sense of
self in ethnic terms within the larger context that
claims common ancestry, language, or what is generally
known as culture (Phinney, 1999). She utilizes two
theoretical strands in her empirical research on
multigroup ethnic identity in adolescents: (1)
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
163
developmental psychology (i.e., Erikson's stages and
James Marsh's conceptualizations), and (2) social
psychology (i.e., Taj fel's social identity) (Phinney,
1999). This is similar to my use of developmental
psychology (i.e., Bronfenbrenner and Vygotsky) and
cultural psychology (i.e., social learning) to aid in
the delineation of cultural factors in school-age
children.
The work of Bernal and her colleagues (1990) on
ethnic identity of school-age children also demonstrates
that culture is a multidimensional construct. The
results of their study showed that cognitive ability did
not account for the age differences in ethnic self-
identification or ethnic constancy, however, they did
account for differences in ethnic knowledge. Again,
there are indications of this same trend in this
research, as cultural schemas were recognizable in the
school-age children, but their cultural knowledge was
not highly developed. Bernal and colleagues (1990;
Ocampo et al., 1997) also hypothesized that other
phenomenon, such as the development of in-group pride
and prejudice in children, may be altered by changes in
the way young children are socialized by familial and
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
164
non-familial agents. Although there was not clear
evidence of this last speculation, it is reasonable to
assume this occurred.
In regards to other existing research on therapy,
Sue and colleagues (1991) studied community mental
health centers in Los Angeles in order to examine
ethnically matched service providers versus nonmatched
service providers. Ethnic match resulted in longer
duration of treatment for Mexican-Americans, as well as
better client response to treatment based on a global
indicator of functioning (Sue et al., 1991). This
suggests that ethnic match of provider and consumer can
be important in providing services for some Latinos
(DHHS, DE, & DJ, 2001). Many of my clients voiced a
preference for an ethnically similar therapist, as did
three of the children in the five dyads. Another child
purposely selected an ethnically diverse therapist not
of European-American origin, and the fifth child had no
preference of any kind. Of course, a limitation of
ethnic match research is that there is no direct
assessment of a clinician's cultural understanding or
skills. Therefore, it is not clear if the cultural
competence of the practitioner is related to the
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
165
positive findings of ethnic match. Thus, direct study of
cultural competence is still needed (DHHS, DE, & DJ,
2001).
In addition, even though this study confirms other
findings on Mexican-American preference for ethnically
similar therapists, it may well be as Abreu et al (1998;
2000) contend, that factors like expectations, social
desirability, counselor characteristics (i.e.,
performance), and client attributes (i.e., cultural
affiliation) are related to preferences. In this study,
it was evident that ethnicity, like culture, has many
aspects to it that may influence therapeutic processes
(i.e., rapport and dialogue) as suggested by Sue (1988).
Thus, client-therapist cultural match becomes as, or
more important to research, because it signifies similar
experiences, values, and lifestyles, including shared
expectations, meanings, and even using a common
vernacular.
Limitations/Delimitations
Hastrup (1994) asserts that the main condition of
knowledge is still related to individual fieldwork,
which cannot be conceived independently of the subject;
'there is no experience apart from the experiencer, no
knowledge without a knower'. Still a daunting problem in
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
166
this qualitative study, is that of researcher
subjectivity. Different researchers may see different
patterns in the data, therefore come up with different
theories to account for it. However, the discursive
perspective rejects the notion that there is one true
understanding of any text. In fact, different
understandings are useful in opening up new
possibilities for therapeutic intervention (Kvale, 1996;
Madill & Barkham, 1997). Nevertheless, in anticipation
of this type of critique, I take a cautionary tone with
my knowledge claim, by restricting my language and
taking the children's and therapists' sociocultural
context into account. In addition, I state my own
cultural lens up front, by acknowledging my interest in
this subject as a bilingual/bicultural child therapist,
with a multicultural counseling orientation. I have also
tried to address objections to the nature of my study by
discussing the limitations of the research.
One such limitation is that discourse analysis
focuses on relatively short pieces of transcript rather
than research incorporating more material or a larger
number of cases. This narrow focus can be said to have
limited representativeness, thus findings are not
generalizable. But the goal in qualitative research is
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
167
not the positivist version of generalizability, but
rather a contextualization and transferability of
knowledge (Denzin & Lincoln, 1998; Kvale, 1996).
Specifically, the rich understanding gained is available
to be drawn on flexibly and at appropriate times by
practitioners (Madill & Barkham, 1997).
It could also be said that I did not produce an
exhaustive account of the phenomena in question; that
excerpts may have been inadequate for the purpose of the
study. Here I could only say that I was restricted due
to the time-intensive nature and costliness of in-depth
interviews with multiple participants. Validity could be
improved in future studies with methodological changes,
such as diversity of extract-selection or multiple
raters/interviewers (Madill & Barkham, 1997). Similarly,
in doing research with children, I was required to
simplify and translate concepts into another conceptual
system, which proved problematic. At times I could not
find effective ways to evoke a child's response about
culture. However even without universal, fundamental
concepts, a researcher can perhaps work through her own
concepts to those of another culture to make a good
approximation of those concepts (Lillard, 1998a).
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
168
Although the translation process may not have been
extensive and is necessarily imperfect,, I believe it was
possible to at least make good enough sense.
Another drawback in the study is the dearth of
rival explanations. I realize that I did not fully
elaborate on or explore the differences between myself
and my clients, or the difference between the five
dyads, along the lines of gender, age, socioeconomic
status, acculturation, and other seemingly important
factors. Although there is mention of some of these
variables, I admittedly did not want to stray too far
from the focus of the study. In cases where these
differences may have been prominent, such as gender
issues between Arturo and Anne, and Denise and Chris, I
did make a point of illustrating this.
One final shortcoming in this research was the fact
that culture and ethnicity were at times interchangeable
terms and/or concepts. I acknowledge that this could be
confusing both practically and theoretically speaking.
However, since culture is held to be the main stimulus
behind the behaviors and material products associated
with a group of people, and ethnicity refers to a group
identity based on culture, language, religion, or
attachment to kinship ties (Cross, Dennis, Isaacs, &
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
169
Bazron, 1989), it is understandable how this
misattribution arises. Even though there is a
distinction between the two, where culture is the shared
knowledge of a group, and ethnicity is the perceived
membership in a group, they are both relational concepts
that are connected by association to a common heritage
(DHHS, SAMHSA, & CMHS, 2001; Holmes, 1998; Oetting et
al. , 1998). As stated earlier, when delineating the
terminology and definitions that would be used in this
research, this kind of mix-up is common, that is why I
chose to use the most accessible criteria for
constructing social categories, stereotyping and social
markers. Thus, the kids and counselors provided me with
their definitions and understanding of culture, however
much it overlapped with ethnicity or like terms.
Suggestions for Improved/Future Research
Unquestionably, there may be other, better ways to
try to answer questions regarding how Latino school-age
children view therapists in the context of culture. For
example, experimental tasks can be utilized, such as in
the seminal work by Kenneth and Mamie Clark (1939;
1947), where they used modified doll play with black
children aged 3-7 to formulate theories about ethnic
identification and preference. There is also the study
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
170
by Bernal et al. (1990), where Mexican-American children
compared and contrasted pictures of Mexican-American
children and Anglo children. Surveys or questionnaires
could be developed based on adult models of
acculturation, ethnic matching, and preference. I could
have also examined outcome and/or process variables
quantitatively by employing measures of symptom
reduction, self-report inventories of client
satisfaction, or other types of paper-pencil evaluations
of therapeutic rapport or relationship. However, I chose
to collect data in the manner that I did for several
theoretical and practical reasons. First, and most
importantly, children' s own voices are significantly
absent in not only the counseling literature, but also
in research on multicultural psychology. Thus, I wanted
to hear directly from Latino children within the
particular age range of 8-11, seeing
how they have generally not been attended to during a
uniquely formative part of their lives. Secondly, I
interviewed therapists to get their perspective on not
only the treatment of their clients, but the
relationship that exists. In addition, I offer a glimpse
into the world of "real" therapy by reporting on my
sessions and one session between each dyad. Albeit, I
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
171
conducted only one interview with each participant and
videotaped only one session, this type of triangulation
of data has not been attempted and can possibly add
something to the literature. If I had more time and
resources I may have tried to do a longitudinal study or
included participants at different locations, but
unfortunately I was limited in this respect.
Another recommendation for studying cultural match
is to operationalize it into units that can be related
to the therapy process (Sue & Zane, 1987). For example,
it can be examined in terms of three variables -
conceptualization of the ethnic client's problems, means
for solving problems, and goals for treatment. These
matched or mismatched variables can then be related to
therapeutic processes (e.g., therapist credibility,
expectations, rapport development) and outcome. Such an
approach can take into consideration individual
differences, because ethnic clients themselves exhibit
variability in cultural orientation and degree of
acculturation (Sue & Zane, 1987).
Other suggestions for enhancing the validity and
reliability of this type of study include using multiple
observers, coders, and/or interpreters, especially
diverse in ethnicity, gender, age, etc., as researchers
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
172
can cross-check each other and control for inaccurate or
biased subjectivity in analysis (Denzin & Lincoln, 1998;
Kvale, 1996). Likewise, by following an analytic
inductive methodology, researchers can test emergent
propositions in search for negative cases in order to
generate assertions that are perceived to be more
grounded and universal (Denzin & Lincoln, 1998).
Researchers could also vary time and place, as in test-
retest comparisons, in order to ensure the widest range
of observational consistency. Furthermore, in choosing
to continue with qualitative research in this area,
researchers could take a more ethnographic approach
and/or use verisimilitude, or vraisemblance, a style of
writing that draws readers closely into the world of the
participants (Denzin & Lincoln, 1998). Finally, in
utilizing interviews and observations, researchers could
repeat questions in different ways to test the
reliability of the answers and critically check
observational evidence for logical consistency. In this
way, follow-up/leading questions can be used to "test
the limits" of participants'’ statements (Kvale, 1996) .
Counseling Implications for Latino School-age Children
The questions posed in this study were oriented
toward the multicultural therapy of Latino school-age
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
173
children. Specifically, they dealt with how culture was
defined by the participants and how salient it was for
them; the relationship between the age of the children
and the existence of cultural schemas; and the effect
cultural differences had on intimacy/distance between
clients and therapists. The findings may be of import to
researchers and practitioners alike. Although the
results cannot be generalized to a large population, the
themes found in the cross-case analysis may provide
practitioners something of value when looking at their
own multicultural cases. For instance, the findings: (a)
culture is a multifaceted concept with subjective and
conventional meanings, (b) cultural schemas are
recognizable in school-age children, and (c) cultural
differences may present challenges in the development of
the therapeutic relationship, not only corroborating
existing literature on the subject, but may confirm
practitioner's own impressions. The results of the study
could also be used to encourage changes in the current
mental health services for minority children.
According to a report in the Los Angeles Times
newspaper, in California non-Latino whites no longer
makeup the majority (Vobejda, 1998). In many
communities, these changes are igniting a debate over
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
174
services. As stated previously, culture and language
affect the perception, utilization, and potentially, the
outcomes of mental health services (DHHS, DE, & DJ,
2001). Therefore, the provision of culturally and
linguistically appropriate mental health services is a
key ingredient for any provider planning to meet the
needs of diverse racial and ethnic client populations.
Reiterating the implications from the work of
Bernal and her colleagues on Mexican-American identity
in preschool to school-age children (Bernal & Knight,
1997; Ocampo et al., 1997), we need to: (a) recognize
that restrictions on children's cognitive capacities
does not mean that they do not understand or care about
culture or suffer from a low sense of ethnic pride; (b)
understand that Mexican-American children must develop
some basic skills, such as self-identification with
their cultural group, awareness of their ethnicity, and
a sense of permanency of their ethnic and cultural
characteristics in order to maintain a buffer against
prejudice they are likely to experience; and (c)
practitioners working with children eight years or older
should be aware that Mexican-American children are
likely to have sufficient information and cognitive
development to have a cultural identity, which may be of
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
175
relevance to any psychological or social problem a
Latino child may be experiencing.
Clinicians & Culture. At this point it is also
necessary to consider the implications of therapists'
culture on therapy. Most therapists share a worldview
about the interrelationship among body, mind, and
environment, informed by knowledge acquired through the
scientific method (DHHS, DE, & DJ, 2001). This also
means that therapists view symptoms, diagnoses, and
treatment in a manner that sometimes diverges from their
clients. Due to the professional culture of the
clinician, some degree of distance between clinician and
client always exists, regardless of the ethnicity of
each (Burkett, 1991) (this was confirmed by a number of
the counselor-participants in this study). Therapists
also bring to the mix their own personal cultures (Hunt,
1995; Porter, 1997). Thus, when a therapist and client
do not come from the same ethnic background, there is
greater potential for cultural differences to emerge.
Therapists may be more likely to ignore symptoms that
the client deems important, or less likely to understand
the client's fears, concerns, and needs. Cultural
misunderstandings between client and clinician,
clinician bias, and the fragmentation of mental health
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
176
services deter minorities from accessing and utilizing
care and prevent them from receiving appropriate care
(DHHS, DE, & DJ, 2001) . The therapist and client may
also hold different assumptions about what a therapist
is supposed to do, how a client should act, what causes
mental health problems, and what treatments are
available. For these reasons, the Diagnostic and
Statistical Manual for Mental Disorders, 4tn edition
(First, 1994) exhorts clinicians to understand how their
relationship with their clients is affected by cultural
differences (DHHS, DE, & DJ, 2001). In fact, the
"Outline for Cultural Formulation" in the DSM-IV
systematically calls attention to five distinct aspects
of the cultural context of illness and their relevance
to diagnosis and care. Of particular interest in this
study is how the clinician is encouraged to critically
examine cultural elements in the clinician-client
relationship to determine differences in culture and
social status between them and how those differences
affect the clinical encounter, ranging from
communication to rapport and disclosure (DHHS, DE, & DJ,
2001).
Therapists' awareness of their own cultural
orientation, their knowledge of clients' backgrounds,
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
177
and their skills with different cultural groups is
critical to improving access, utilization, and quality
of mental health services for minority populations.
While no rigorous, systematic studies have been
conducted to test these hypotheses, early evidence
suggests that culturally oriented interventions are more
effective than usual care at reducing dropout rates for
ethnic minority mental health clients (DHHS, DE, & DJ,
2001). While the efficacy of most ethnic-specific or
culturally responsive services is yet to be established,
models already shown to be useful through research could
be targeted for further study, and ultimately, for
dissemination to mental health providers (DHHS, DE, &
DJ, 2001).
Cultural Competence. Even with the several models
and the growing interest in cultural competence, much
work needs to be done before cultural competence will
positively impact mental health service delivery for
Latinos and other ethnic groups (DHHS, DE, & DJ, 2001).
At present, cultural competence is largely a set of
guiding principles that lack empirical validation.
Therefore, an essential step in advancing culturally
competent services for Latinos is to carry out research
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
178
to test the guidelines, standards, or models proposed by
expert clinicians and administrators (DHHS, DE, & DJ,
2001).
According to one set of principles which was based
on research funded by the National Institute of Mental
Health and put out by Cross et al (1989), culturally
competent mental health service providers and the
agencies that employ them are specially trained in
specific behaviors, attitudes, and policies that
recognize, respect, and value the uniqueness of
individuals and groups whose cultures are different from
those associated with mainstream America. In addition,
culturally competent providers are aware and respectful
of the importance of the values, beliefs, traditions,
customs, and parenting styles of the people they serve.
They are also aware of the impact of their own culture
on the therapeutic relationship and take all of these
factors into account when planning and delivering
services to children and adolescents and their families
(Cross et al., 1989). There are also a unique set of
mental health issues for Americans who are bicultural or
multicultural that must be recognized and addressed.
While some providers are moving toward more culturally
competent service, much more is needed. Increased
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
179
opportunities must be provided for ongoing staff
development and for employing multicultural staffs.
Improved culturally valid assessment tools are vital.
Ultimately, more research is essential in determining
the effectiveness of programs that serve children and
families from a variety of cultural backgrounds (Cross
et al., 1989).
Applied Child Psychology. Mental health
professionals are currently coming up with ecological
and narrative approaches to address the needs of
children and their families (Strier, 1996;
Bronfenbrenner, 1989 Howard, 1991; Stacey & Loptson,
1995). The intention of this sort of therapy is to offer
practices that allow children to be authorities on their
own lives and subjects of their own narratives. It is as
Stacey and Loptson (1995) suggest, the first attempt at
questioning the unheard. Bukowski and Sippola (1998)
also argue that: (a) multicultural research needs to be
predicated on a model of how culture interacts with the
forces that underlie and guide development; (b) the
interpretation of cross-cultural research is severely
limited without the direct measurement of the specific
culture-related variables and processes that are
hypothesized to account for diversity in development;
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
180
and finally, (c) within-culture variability needs to be
studied in conjunction with between-culture variability
so that a full model of development and diversity can be
constructed. Therefore, it may be helpful to review such
cultural-ecological frameworks (Bronfenbrenner, 1989;
See Figure 10) to facilitate a more accurate and useful
understanding of the importance and influence of
cultural contexts on children's development.
f Home X
Child-parent
.Child,
Figure 10.
Adaptation of Bronfenbrenner's social-ecological model.
Source: Cole & Cole (1993). The Development of Children
(2nd ed.). New York: W. H. Freeman and Company.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
181
In conclusion, understanding the relationship
between children's development and culture can help
therapists to intervene when children have problems,
feel helpless to change life situations, and experience
discrimination (e.g., due to their cultural or
developmental diversity). On that account, we must
utilize cultural-ecological and narrative approaches,
and pursue qualitative research that allow children a
voice, and work so that it does not continue to fall on
deaf ears.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
182
REFERENCES
Abramowitz, S. I. & Murray, J. (1983). Race effects in
psychotherapy. In J. Murray & P. Abramson (Eds.),
Bias in psychotherapy (pp.215-255). New York:
Praeger.
Abreu, J. M., Barraza, Y., Wollard, C., & Opochinsky, K.
(1998, April). Mexican-American counseling
expectations of an ethnically similar and dissimilar
counselor. Paper presented at the Joint Convention of
the Western Psychological Association & Rocky
Mountain Psychological Association, Albuquerque, NM.
Abreu, J. M. & Gabarain, G. (2000). Social desirability
and Mexican American counselor preferences:
Statistical control for a potential confound. Journal
of Counseling Psychology, 47, 165-176.
Acosta, F., Yamamoto, J. & Evans, L. (1982). Effective
psychotherapy for low-income and minority patients.
New York: Plenum.
Angel, R. & Guarnaccia, P. (1989). Mind, body, and
culture: Somatization among Hispanics. Social Science
and Medicine, 28, 1229-1238.
Astington, J. W. & Olson, D. R. (1995). The cognitive
revolution in children's understanding of mind. Human
Development, 38(4-5) 179-189.
Atkinson, D. R., (1983). Ethnic similarity in counseling
psychology: A review of research. The Counseling
Psychologist, 11, 79-92.
Atkinson, D. R., (1985). A meta-review of research on
cross-cultural counseling and psychotherapy. Journal
of Multicultural Counseling and Development, 1, 138-
153.
Atkinson, D. R., (1986). Similarity in counseling, The
Counseling Psychologist, 14, 319-354.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
183
Atkinson, D. R., Casas, A., & Abreu, J. M.
(1992). Mexican-American acculturation, counselor
ethnicity and cultural sensitivity, and perceived
counselor competence. Journal of Counseling
Psychology, 39, 515-520.
Atkinson, D. R., Ponce, F. Q., & Martinez, F. M. (1984).
Effects of ethnicity, sex, and attitude similarity on
counselor credibility. Journal of Counseling
Psychology, 31, 588-590.
Attorney Generalfs Youth Gang Task Force. (1988). Report
on youth gang violence in California (Report
No.1620). Sacramento, CA: Author.
Barresi, J. & Juckes, T. J. (1997). Personology and the
narrative interpretation of lives. Journal of
Personality, 65(3), 693-719.
Barrett, C. L., Hampe, I. E., & Miller, L. (1978). In S.
L. Garfield & A. E. Bergin (Eds.), Handbook of
psychotherapy and behavior change(2nd ed.).New York:
John Wiley and Sons.
Baruth, L. G. & Manning, L. (1999). Multicultural
counseling and psychotherapy: A life-span perspective
(2nd ed.). Upper Saddle River, NJ: Merrill.
Beauvais, F., Chavez, E. L., Oetting, E. R.,
Deffenbacher, J. L., & Cornell, G. R. (1996). Drug
use, violence, and victimization among White
American, Mexican American, American Indian dropouts,
students with academic problems, and students in good
academic standing. Journal of Counseling Psychology,
43, 292-299.
Benson, R. M. & Harrison, S. I. (1991). The eye of the
hurricane: From seven to ten. In G. H. Pollock & S.
I. Greenspan (Eds.), The course of life: Middle and
late childhood (Vol.3) (pp. 355-364). Madison, CT:
International Universities Press.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
184
Bernal, M. E., Knight, G. P., Garza, C. A.,
Ocampo, K. A., & Cota, M. K. (1990). The development
of ethnic identity in Mexican-American children.
Hispanic Journal of Behavioral Sciences, 12 (1), 3-24.
Bernal, M. E. & Knight, G. P. (1997). Ethnic identity
of Latino children. In M. C. Zea & J. G. Garcia
(Eds.), Psychological interventions and research with
Latino populations (pp. 15-38). Boston: Allyn & Bacon
Bui, K.T.& Takeuchi, D. T. (1992). Ethnic minority
adolescents and the use of community mental health
care services. American Journal of Community
Psychology,20, 403 -417.
Bukowski, W. M. & Sippola, L. K. (1998). Diversity and
the social mind: Goals, constructs, culture and
development. Developmental Psychology, 34, 742-74 6.
Bronfenbrenner, U. (1989). Ecological systems theory. In
R. Vasta (Ed.), Annals of child development
(Vol.6)pp.187-251. Greenwich, CT: JAI.
Burkett, G. L.(1991). Culture, illness, and the
biopsychosocial
model. Family Medicine, 23, 287-291.
Carter, D. J. & Wilson, R. (1991). Ninth annual status
report: Minorities in higher education. Washington,
DC: American Council on Education.
Centers for Disease Control (1987). AIDS weekly
surveillance report - United States. Atlanta, GA:
Author.
Centers for Disease Control (1988). High-risk racial and
ethnic groups- Black and Hispanics, 1970 to 1983.
Atlanta, GA: Author.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
185
Chambless, D. L., Sanderson, W. C., Shoham, V.,
Johnson, S. B., Pope, K. S., Crits-Christoph, P.,
Baker, M., Johnson, B., Woody, S. R., Sue, S.,
Beutler, L., Williams, D. A., & McCurry, S. (1996).
An update on empirically validated therapies. The
Clinical Psychologist, 49(2), 5-18.
Clark, K.B. & Clark, M. P. (1939). The development of
consciousness of self and the emergence of racial
identification in Negro preschool children. Journal
of Social Psychology, 10, 591-599.
Clark, K.B. & Clark, M. P. (1947). Racial identification
and preference in Negro children. In T. M. Newcomb &
E. L. Hartley (Eds.), Readings in social psychology
(pp. 169-78). New York: Holt, Rinehart, & Winston.
Coffey, A. & Atkinson, P. (1996). Making sense of
qualitative. Thousand Oaks, CA: Sage.
Coleman, H. L. K., Wampold, B. E., & Casali, S. L.
(1995). Ethnic minorities' ratings of ethnically
similar and European-American counselors: A meta
analysis . Journal of Counseling Psychology, 42, 55-
64.
Connolly, P. (1998). Racism, gender identities, and
young children: Social relations in a multi-ethnic,
inner-city primary school. New York: Routledge.
Cortez, C. (1999, April 10). Multicultural competence.
Symposium conducted at the Student Affiliation for
Multicultural Mental Health Conference, "Future
Directions in Multiculturalism". Los Angeles, CA.
Cross, T. L., Dennis, K. W., Isaacs, M. R., & Bazron, B.
J. (1989). Towards a Culturally Competent System of
Care [Monograph]. Washington D.C.: National Technical
Assistance Center for Children's Mental Health at
Georgetown University & National Institute of Mental
Health.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
186
D'Andrea, M. (1983). Social development during
middle childhood: Clarifying some misconceptions.
Elementary School Guidance & Counseling, 17 (3), 214-
220.
Davey, A. (1983). Learning to be prejudiced. London:
Edward Arnold.
Denzin, N. & Lincoln, Y. (1998). Introduction.
Collecting and Interpreting Qualitative Materials
(pp.1-34). Thousand Oaks, CA: Sage.
Educating Hispanic students. (1998). Education Digest,
61(5), 15-19.
Erickson, F. (1986). Qualitative methods on research on
teaching. In M. Wittrock (Ed.), Handbook of research
on teaching. Chicago: Macmillan.
Escobar, J. & Karrer, T. (1986). Symptoms of
schizophrenia in Hispanic and Anglo veterans.
Culture, Medicine, and Psychiatry, 10, 259-276.
Farver, J. M. (1999). Activity setting analysis: A
model for examining the role of culture in
development. In A. Goncu (Ed.), Children's
engagement in the world. New York: Cambridge
University Press.
Finkelstein, B. (1985). Schooling and the discovery of
latency in nineteenth-century America. Journal of
Psychohistory, 13(1), 3-12.
First, M. (Ed.). (1994). Diagnostic and statistical
manual of mental disorders (4th ed., Rev.).
Washington, DC: American Psychiatric Association.
Flisher, A.J., Kramer, R.A., Gorsser, R.C., Alegria, M.,
Bird, H.R., Bourdon, K.H., Goodman, S.H., Greenwald,
S., Horwitz, S.M., Moore, R. E., Narrow, W.E. &
Hoven, C. W. (1997). Correlates of unmet need for
mental health services by children and adolescents.
Psychological Medicine,27,114 5 -1154.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
187
Freedman, S. (1996). Role of self-object
experiences in affective development during latency.
Psychoanalytic Psychology, 13(1) 101-127.
Furlong, M. J., Atkinson, D. R., and Casas, J. M.
(1979). Effects of counselor ethnicity and
attitudinal similarity on Chicano students'
perceptions of counselor credibility and
attractiveness. Hispanic Journal of Behavioral
Sciences, 1, 41-53.
Gardner, R. A. (1992). The psychotherapeutic techniques
of Richard A. Gardner (Revised Edition - 1986). New
Jersey: Creative Therapeutics.
Garcia, J. G. & Marotta, S. (1997). Characterization of
the Latino population. In M. C. Zea & J. G. Garcia
(Eds.), Psychological interventions and research with
Latino populations, (pp. 15-38). Boston: Allyn &
Bacon.
Garcia, M. & Marks, G. (1989). Depressive symptomology
among Mexican-American adults: An examination with
the CE-5-D Scale. Psychiatry Research, 27, 137-148.
Gaskins, S. (1999). Children's daily lives in a Mayan
village: A case study of culturally constructed roles
and activities. In A. Gdncii (Ed.), Children's
engagement in the world. New York: Cambridge
University Press.
Gauvain, M. (1998). Culture, development, and theory of
mind. Psychological Bulletin, 123, 37-42.
Gergen, K., Gulerce, A., Lock, A., & Misra, G. (1996).
Psychological science in cultural context. American
Psychologist, 51(5), 496-503.
Gibbs, J. (1987). Identity and marginality: Issues in
the treatment of biracial adolescents. American
Journal of Orthopsychiatry, 57, 265-278.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
188
Glover, S.H., Pumariega, A.J., Holzer, C. E.,
Wise, B.K. & Rodriguez, M. (1999). Anxiety
symptomatology in Mexican American adolescents.
Journal of Child and Family Studies,8,47 -57.
Goncii, A. (1999) . Children's engagement in the world.
New York: Cambridge University Press.
Goncii, A., Tuermer, U. , Jain, J. , & Johnson, D. (1999) .
Children's play as a cultural activity. In A. Goncii
(Ed.), Children's engagement in the world. New York:
Cambridge University Press.
Goodnow, J. J. (1990). The socialization of cognition:
What's involved? In J. W. Stigler, R. A. Shweder, &
G. Herdt, G. (Eds.), Cultural psychology (pp. 259-
286). Cambridge, England: Cambridge University Press.
Gordon, R. L. (1980). Interviewing: Strategy,
techniques, and tactics. Homewood, IL: Dorsey.
Graue, M. E. & Walsh, D. J. (1998). Studying children in
context: Theories, methods, and ethics. Thousand
Oaks, CA: Sage.
Greene, J. C. (1998). Qualitative program evaluation:
Practice and promise. In N. Denzin & Y. Lincoln
(Eds.), Collecting and Interpreting Qualitative
Materials (pp.179-210). Thousand Oaks, CA: Sage.
Grotstein, J. S. (1990). The contribution of attachment
theory and self-regulation theory to the therapeutic
alliance. Modern Psychoanalysis, 15(2) 169-184.
Haight, W. L. (1999). The pragmatics of caregiver-child
pretending at home: Understanding culturally specific
socialization practices. In A. Goncii (Ed.),
Children's engagement in the world. New York:
Cambridge University Press.
Hart, S. N. (1991). From property to person status:
Historical perspective on children's rights. American
Psychologist, 40 (1), 53-59.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
189
Harwood, R. L., Miller, J. G., & Irizarry, N. L.
(1995). Culture and attachment. New York: The
Guilford Press.
Hastrup, K. (1994). Anthropological knowledge
incorporated. In K. Hastrup & P. Hervik (Eds.),
Social experience and anthropological knowledge (pp.
224-240). London: Routledge.
Ho, M. K. (1992). Minority children and adolescents in
therapy. Newbury Park, CA: Sage.
Hobbs, N. (1993). Troubled and troubling children. New
York: Basic.
Holmes, R. M. (1998). Fieldwork with children. Thousand
Oaks, CA: Sage.
Hoshmand, L. T. & Polkinghorne, D. E. (1992). Redefining
the science-practice relationship and professional
training. American Psychologist, 47 (1), 55-66.
Howard, G. S. (1991). Culture tales: A narrative
approach to thinking, cross-cultural psychology, and
psychotherapy. American Psychologist, 46(3), 187-197.
Howard, G. S. (1993). I think I can I think I can:
Reconsidering the place for practice methodologies in
psychological research. Professional Psychology:
Research & Practice, 24(3), 237-244.
Huberman, A. M., & Miles, M. B. (1998) . Data management
and analysis methods. In N. Denzin & Y. Lincoln
(Eds.), Collecting and Interpreting Qualitative
Materials (pp.179-210). Thousand Oaks, CA: Sage.
Hunt, G. J. (1995). Social and cultural aspects of
health, illness, and treatment. In H. H. Goldman
(Ed.), Review of general psychiatry. Norwalk, CT:
Appleton & Lange.
James, W. (1905). Textbook of psychology. London:
Macmillan.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
190
Kennedy, M. M. (1979). Generalizing form single
case studies. Evaluation Quarterly, 3, 661-678.
Kvale, S. (1996). Interviews: An introduction to
qualitative research interviewing. Thousand Oaks, CA:
Sage.
Lahey, B.B., Flagg, E.W., Bird, H.R., Schwab-Stone,
M.E., Canino, G., Dulcan, M.K., Leaf, P.J., Davies,
M., Brogan, D., Bourdon, K., Horwitz, S.M., Rubio-
Stipec, M., Freeman, D. H., Lichtman, J.H., Shaffer,
D., Goodman, S.H., Narrow, W.E., Weissman, M.M.,
Kandel, D.B., Jensen, P.S., Richters, J.E. & Regier,
D. A. (1996). The NIMH methods for the epidemiology
of child and adolescent mental disorders (MECA)study:
Background and methodology. Journal of the American
Academy of Child and Adolescent Psychiatry,35, 855-
864.
Leong, F. (1996). Toward an integrative model for cross-
cultural counseling and psychotherapy. Applied and
Preventive Psychology, 5, 189-209.
Levitt, E. E. (1971). Research on psychotherapy with
children. In A. E. Bergin & S. L. Garfield (Eds.),
Handbook of psychotherapy and behavior change. New
York: John Wiley and Sons.
Lillard, A. (1998a). Ethnopsychologies: Cultural
variations in theories of mind. Psychological
Bulletin, 123, 3-32.
Lillard, A. (1998b). Ethnopsychologies: Reply to Wellman
and Gauvain. Psychological Bulletin, 123, 4 3-4 6.
Lonigan, C. J., Elbert, J. C., & Johnson, S. B. (1998).
Empirically supported psychosocial interventions for
children: An overview. Journal of Clinical Child
Psychology, 27(2) 138-145.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
191
Lopez, S. R. & Lopez, A. A. (1993) . Mexican-
Americans' initial preferences for counselors:
Research methodologies or researchers'’ values? Reply
to Atkinson and Wampold (1993). Journal of Counseling
Psychology, 40, 249-251.
Lopez, S. R., Lopez, A. A., & Fong, K. T. (1991).
Mexican-Americans' initial preferences for
counselors: The role of ethnic factors. Journal of
Counseling Psychology, 38, 487-496.
Madill, A. & Barkham, M. (1997). Discourse analysis of a
theme in one successful case of brief psychodynamic-
interpersonal psychotherapy. Journal of Counseling
Psychology, 44(2), 232-244.
Malgady, R. G., Rogler, L. H., & Costantino, G. (1990).
Culturally sensitive psychotherapy for Puerto Rican
children and adolescents: A program of treatment
outcome research. Journal of Consulting & Clinical
Psychology, 58(6) 704-712.
Markel-Fox, S. & Stiles, P. G. (1996). State mental
health policy: Effect on outcomes for priority
populations. Administration and Policy in Mental
Health, 24, 25-38.
Mead, G. H. (1934). Mind, self, and society (C. W.
Morris, Ed.). Chicago: University of Chicago Press.
Melton, G. (1987). Children, politics, and morality: The
ethics of child advocacy. Journal of Clinical Child
Psychology, 16, 357-367.
Ming-Sum, Tsui (1997). A child's conception of another
world: A Chinese boy's view of Canada. Child &
Adolescent Social Work Journal, 14(2) 79-93.
The National Latino Child Welfare Advocacy Group (Winter
1997). Latinos and child welfare Spectrum. The
Journal of State Government. Lexington.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
192
Nelson, K. (1996). Language in cognitive
development: The emergence of the mediated mind. New
York: Cambridge University Press.
Newman, B. M. & Newman, P. R. (1991). Development
through life: A psychosocial approach (5th ed. ) ,
Pacific Grove, CA: Brooks/Cole Publishing.
Noshpitz, J. D. (1990). Developmental sources of stress:
Latency. In R. D. Coddington & J. D. Noshpitz (Eds.),
Stressors and the adjustment disorders (Wiley series
in general and clinical psychiatry) (pp. 217-237).
New York: John Wiley & Sons.
Ocampo, K. A., Knight, G. P., & Bernal, M. E. (1997).
The development of cognitive abilities and social
identities in children: The case of ethnic identity.
International Journal of Behavioral Development,
21(3), 479-500.
Oetting, E. R., Donnermeryer, J. F., Trimble, J. E. , &
Beauvais, F. (1998). Primary socialization theory:
Culture, ethnicity, and cultural identification (The
links between culture and substance use: IV).
Substance Use & Misuse, 33(10), 2075-2107.
Ogbu, J. U. (1988). Black education: A cultural-
ecological perspective. In H. P. McAdoo (Ed.), Black
families (pp. 169-186). Beverly Hills, CA: Sage.
Ohrenstein, L. (1986). There is nothing latent about
latency: Its impact on parents. Child & Adolescent
Social Work Journal, 3(3), 143-150.
Piaget, J. (1965). The moral judgement of the child. New
York: The Free Press.
Phinney, J. (1999, April 10). Adolescent ethnic identity
development. Symposium conducted at the Student
Affiliation for Multicultural Mental Health
Conference, "Future Directions in Multiculturalism".
Los Angeles, CA.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
193
Porter, R. (1997) . The greatest benefit to
mankind: A medical history of humanity. New York:
Norton.
Potter, J. & Wetherell, M. (1987). Discourse and social
psychology: Beyond attitudes and behaviour. London:
Sage.
Prout, H. T. (1992). Counseling and psychotherapy with
children and adolescents: An overview. In D. T. Brown
and H. T. Prout (Eds.), Counseling and psychotherapy
with children and adolescents: Theory and practice
for school and clinical settings (2nd ed. ) (3-36) .
Brandon, VT: Clinical Psychology Publishing Co.
Pumariega, A.J., Glover, S., Holzer, C. E., III &
Nguyen, H. (1998). II. Utilization of mental health
services in a tri-ethnic sample of adolescents.
Community Mental Health Journal,34,145 -156.
Roberts, M. C., Carlson, C. I., Erickson, M. T.,
Friedman, R. M., La Greca, A. M., Lemanek, K. L.,
Russ, S. W., Schroeder, C. S., Vargas, L. A., &
Wohlford, P. (1998). A model for training
psychologists to provide services for children and
adolescents. Professional Psychology: Research and
Practice, 29, 293-299.
Roberts, R. E. & Chen, Y. (1995). Depressive symptoms
and suicidal ideation among Mexican-origin and Anglo
adolescents. Journal of the American Academy of Child
and Adolescent Psychiatry,34, 81 -90.
Roberts, R. E. & Sobhan, M. (1992). Symptoms of
depression in adolescence: A comparison of Anglo,
African, and Hispanic Americans. Journal of Youth and
Adolescence, 21, 639 -651.
Rubin, K. H. (1998). Social and emotional development
from a cultural perspective. Developmental
Psychology, 34, 611-615.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
194
Schechter, M. D. & Combrinck-Graham, L. (1991).
The normal development of the seven-to-ten-year-old
child. In G. H. Pollock & S. I. Greenspan (Eds.), The
course of life: Middle and late childhood (Vol.3)
(pp. 355-364). Madison, CT: International
Universities Press.
Stacey, K. & Loptson, C. (1995). Children should be seen
and not heard? Questioning the unquestioned. Journal
of Systemic Therapies, 14(4) 16-31.
Stake, R. E. (1994). Case studies. In N. K. Denzin & Y.
S. Lincoln (Eds.), Handbook of qualitative research
(pp.236-247). Thousand Oaks, CA: Sage.
Stoker, D. & Meadows, A. (1974). Cultural difference in
guidance clinic patients. American Journal of Social
Psychiatry, 20, 186-202.
Strauss, A. & Corbin, J. (1990). Basics of qualitative
research: Grounded theory procedures and techniques.
Newbury Park, CA: Sage.
Strier, D. R. (1996). Coping strategies of immigrant
parents: Directions for family therapy. Family
Processes 35(3) 363-376.
Sue, S. (1988). Psychotherapeutic services for ethnic
minorities. American Psychologist, 43, 301-308.
Sue, S., Fujino, D., Hu, L- T., Takeuchi, D. T., & Zane,
N. W. (1991) . Community mental health services for
ethnic minority groups| A test of the cultural
responsiveness hypothesis. Journal of Consulting and
Clinical Psychology, 59, 533-540.
Sue, S. & Zane, N. (1987). The role of culture and
cultural techniques in psychotherapy: A critique and
reformulation. American Psychologist, 42, 37-45.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
195
fudge, J., Hogan, D., Lee, S., Tammeveski, P.,
Meltsas, M., Kulakova, N., Snezhkova, I., & Putnam,
S. (1999). Cultural heterogeneity: Parental values
and beliefs and their preschoolers' activities in the
United States, South Korea, Russia, and Estonia. In
A. Goncii (Ed. ) , Children's engagement in the world.
New York: Cambridge University Press.
U.S. Bureau of the Census & U.S. Department of Commerce.
(1985, March). Persons of Spanish origin in the
United States. Current Population Reports, Series P-
20, No.403. Washington, DC: U.S. Government Printing
Office.
U.S. Department of Health and Human Services. (1999) .
Mental health: A report of the Surgeon General.
Rockville, MD: U.S. Department of Health and Human
Services.
U.S. Department of Health and Human Services, Substance
Abuse and Mental Health Services Administration, &
Center for Mental Health Services. (2001). Mental
Health: Culture, Race, and Ethnicity - A Supplement
to Mental Health: A Report of the Surgeon General.
Rockville, MD: U.S. Department of Health and Human
Services.
U.S. Department of Health and Human Services, U.S.
Department of Education, & U.S. Department of
Justice. (2001). Report of the Surgeon General's
Conference on Children's Mental Health: A National
Action Agenda. Washington, DC: U.S. Department of
Health and Human Services.
Vobejda, B. (1998, July 15). Latino children outnumber
blacks in U.S. The Los Angeles Times, p.5.
Vygotsky, L. S. (1978). Mind in society. Cambridge, MA:
Harvard University Press.
Weiss, B., Catron, T., Harris, V., & Phung, T. M.
(1999). The 8effectiveness of traditional child
psychotherapy. Journal of Consulting & Clinical
Psychology, 67(1) 82-94.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
196
Welsh, P. (1988, May 1). The Black talent trap.
Washington Post, p. Cl.
Yin, R. K. (1994). Case study research: Design and
methods (2nd ed.). Thousand Oaks, CA: Sage.
Young Rivers, R. & Morrow, C. A. (1995). Understanding
and treating ethnic minority youth. In J. F. Aponte,
R. Young Rivers, & J. Wohl (Eds.), Psychological
interventions and cultural diversity. Boston: Allyn &
Bacon.
Zenner, W.(1996). Ethnicity. In D. Levinson & M. Ember
(Eds.),Encyclopedia of Cultural Anthropology (pp.393
-395).New York: Holt.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Linked assets

University of Southern California Dissertations and Theses

Conceptually similar

PDF

Integration of science and practice: A collective case study of scientist -practitioner programs in counseling psychology

PDF

An investigation of a new diagnostic sub-type: Post traumatic stress disorder with psychotic features

PDF

Impact of language and culture on a neuropsychological screening battery for Hispanics

PDF

Anorexia nervosa: A developmental perspective

PDF

Assessment of racial identity and self -esteem in an Armenian American population

PDF

Development and validation of the Cooper Quality of Imagery Scale: A measure of vividness of sporting mental imagery

PDF

Effects of test interpretation style and need for cognition on elaboration, favorability, and recall

PDF

Gender differences in motivation for sexual intercourse: Implications for risky sexual behavior and substance use in a university and community sample

PDF

Hispanic culture, acculturation, and distress among caregivers of dementia patients

PDF

A cluster analysis of the differences between expert and novice counselors based on real time training

PDF

A phenomenological inquiry into the essential meanings of the most intense experience of religiosity and spirituality

PDF

Family functioning, intergenerational conflict, and psychological symptomology of Asian American college students

PDF

Emergent literacy differences in Latino and African American children: Culture or poverty?

PDF

Acquisition of Spanish verb morphology by bilingual children. A longitudinal study between the ages of 2;9 and 3;3

PDF

Identity in midlife lesbians: A kaleidoscopic view

PDF

Ethnic identity, acculturation, self-esteem and perceived discrimination: A comparison study of Asian American adolescents

PDF

Identifying aggressive victims in Chinese children's peer groups

PDF

Collective efficacy, anxiety, creativity/innovation and work performance at the team level

PDF

Effects of parenting style and ethnic identity on European American and Asian Indian adolescents' academic competence and self esteem

PDF

Gender role conflict, personality, and help -seeking in adult men

Asset Metadata

Creator Barraza, Yvette (author)

Core Title Considering the impact of culture on the therapeutic relationship: A look at Latino school-age children in a special education setting

School Graduate School

Degree Doctor of Philosophy

Degree Program Education (Counseling Psychology)

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Education, Guidance and Counseling,OAI-PMH Harvest,psychology, clinical

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Polkinghorne, Donald (committee chair), Abreu, Jose (committee member), Farver, JoAnn (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c16-628332

Unique identifier UC11340130

Identifier 3116664.pdf (filename),usctheses-c16-628332 (legacy record id)

Legacy Identifier 3116664.pdf

Dmrecord 628332

Document Type Dissertation

Rights Barraza, Yvette

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA