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No Nos Entienden: Cultural Themes for Latina/o Populations in an Integrated Health Clinic

Posted By Karla V. Caballero, Wednesday, November 15, 2017

“I think that when parents realize that using words like shame and guilt and promoting those ideas. I think they realize in doing that it affects the child even more…so at some point you start noticing a shift from blaming talk or problem saturated talk to more positive uplifting supportive talk. I think that change in view has a lot to do with reclaiming of self”1 


Not too long ago, I completed a year of training as a doctoral student therapist at an integrated specialty clinic in San Antonio, Texas. This clinic provides physical and medical evaluations for children and teens that have experienced some form of sexual abuse. The integrated team includes therapists, social workers, medical doctors and nurse practitioners. As standard practice, the team offers opportunities for acute or crisis therapy services the same day of the initial visit as well as scheduled appointments. 

 

The population I worked with was primarily Latina/o and consisted of bilingual and monolingual Spanish speakers. While there, I assisted the clinic in moving towards more culturally appropriate warm hand offs, as well as considerations for working with this population in the context of trauma. This reflection will highlight my work with a Latina/o family whose 11 year old son, dubbed Niño, had experienced sexual maltreatment by a male family member. 


The mother and son were reluctant to trust the assistance of the medical profession; they were afraid to be judged and looked down on. Needless to say, they were referred to me for assistance in treatment participation. Cultural humility and competence are buzz words in the field of psychology, but what is not often discussed are the points of pride and shame that cultures seem to adhere to, especially in regards to trauma. In terms of shame, families at the clinic often expressed feelings of being sucio or dirty, they sought their child’s reclamation of innocence and an urge to maintain family honor.  

 

At 11 years old, Niño understood what had happened to him was awful and he knew he was safe now that everyone knew. That was not his concern. He was troubled that his family felt ashamed of him and of the event due to their religion. Religion coincides with purity, his mother explained, and it is an important aspect of their culture. Additionally, he felt dirty and would bathe obsessively since the incident, almost 3 months. This was another reason he was encouraged to see me. 


His mother shared that she felt as though she lost her son, he was no longer innocent; he had been defiled and was fearful that her happy child was gone. She doubted that such a clinical setting would understand these aspects and was hesitant to return for follow up appointments and treatment. “No nos entienden,” they don’t understand us. We decided that since Niño would return a few more times for medical follow-ups, we needed to address these themes as a team; the doctors, nurses, social workers and therapists.

 

The family was concerned that the doctors and nurses would see them just as they saw themselves: broken. Together we met with the team and discussed the themes and concerns that had come up and how we could clarify the treatment plan so that the family felt comfortable in returning. The team reflected that their aim was to build up patients with follow up and recommendations so that patients can return to a stable life. The team was excited to adapt their approach with cultural considerations by checking in with the family each step of the way to not only heal the body, but to treat the self too. 


The family was then asked what they needed from the team. Nino’s mom simply stated, “queremos ser puros otra vez y escuchados,” to be pure again, to be listened to. This novel idea, of listening to the story first, of considering those feelings of being dirty, shame, guilt and a loss of innocence may be more important than the physical. Finally, to acknowledge that honor is crucial to Latina/o families. Since then, the site has adapted their initial intake and assessment interviews to include discussions of the emotional changes these families may have incurred as a result of the abuse. This is owed all to the bravery of a little boy and his mother, to be heard first above all else.

References

Baldwin, M., & Caballero, K. (August 2017). Reflections of a therapist: Informing psychotherapy with Latino families of sexually abused children. Accepted for poster presentation at the Minority Fellowship Program at the 125th Annual Convention of the American Psychological Association (APA), The Society of Counseling Psychology Division 17 in Washington, DC

 

Karla Caballero, M.S., LMFT is a counseling psychology doctoral student from Our Lady of the Lake University in San Antonio, Texas. She also earned her Masters of Science in Counseling Psychology from the same institution.  

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