Culturing Psychotherapy

When a gardener transplants a seedling, she provides it with light, water, and nutrients to help the young plant spread its roots and grow. With attentive care in the right environment, the plant will eventually mature and bloom.

Joan Koss-Chioino views people the same way. A cultural psychologist and professor of anthropology at Arizona State University, she works with youths and families transplanted from Mexico to the United States. Koss-Chioino says that helping adolescents to thrive and not wilt in their new homes is all about getting the environment right.

The ASU researcher’s “ecological model” of psychotherapy stems from this philosophy.

“You look at the youth’s local world,” she says. “He lives in a neighborhood. He lives in his school. He lives with his family. He lives with certain peer groups.” In each of these places, an adolescent’s “ecology” is bound up with his or her ethnic identity. Culture and environment often clash, especially when a youth or family is uprooted from one country and plopped into another.

This situation prompted Koss-Chioino to establish the Hispanic Family Center, a family and group therapy clinic devoted to helping troubled Mexican-immigrant and Mexican-American youths. Her work at the clinic was part of a six-year study investigating the effectiveness of culturally responsive mental health care.

Many standard approaches to psychological treatment were developed by European psychologists who contemplated the “human” condition rather than culture. Such approaches often work well for Caucasian patients. But they are less effective for Hispanic youths, who may have different communication styles and interpersonal boundaries, according to Koss-Chioino. Consequently, Hispanic families and other ethnic minorities can be more difficult to recruit and retain in mental health treatment programs.

By designing a research and treatment clinic specifically for Mexican-descendent and Mexican-American youths, Koss-Chioino tended to the particular needs of this ethnic group.

“To be culturally responsive is to have people better engaged and more willing to come for that service,” she says. “That was the whole key.”

Koss-Chioino started by revamping the typical models of psychotherapy, in which the therapist usually takes an impersonal, passive stance, and uses structured teaching and problem solving to teach effective interpersonal skills. Koss-Chioino found that Hispanic youths respond more positively when the therapist takes an active, supportive position and focuses on expressing emotions.

The ASU researcher also put an especially high priority on providing Spanish-language services.

“Ninety-five percent of our staff members were comfortably bilingual, so people could choose what language they wanted to use. Sometimes the family sessions were half in English and half in Spanish,” she says.

The clinic itself, a welcoming, unpretentious place where clients felt at home, was also designed with culture in mind.

“The clinic was very humble,” she explains. “We had coffee and cookies, and toys for the kids. There was a TV always blaring in Spanish-language programs. It was an informal setting.”

More than 300 teens and their families participated in the study by attending weekly therapy sessions for 16 to 20 weeks. Some youths were assigned to group therapy with other Mexican-American adolescents; others were assigned to family therapy. Each participant completed several questionnaires before and after treatment, which Koss-Chioino used to assess the success of the program.

The teens who came to the clinic suffered from problems widespread among youths from many ethnic backgrounds, including depression, anxiety, aggressive behavior, and drug use.

However, as newcomers to the United States or as children of immigrants, these adolescents also faced the additional challenge of straddling two cultures. They have Mexican families at home, and American peers and teachers at school. Often, friends and family members in these two environments understand each other poorly. The kids end up feeling out of place in both worlds. In the community, they face discrimination.

“There’s a lot of prejudice, especially in portions of the Phoenix metropolitan area, particularly against the immigrant kids,” says Koss-Chioino. “At school, the youths were often looked at as potentially troublesome. Some appeared to live up to those images.”

At home, they face misunderstanding by parents who may be naīve about the environment at school—where there can be frightening levels of violence, gang activity, and drug use.

“I think it’s just not in the parents’ own experience,” says Koss-Chioino, “especially if they came from Mexico, where there was much more control over the youth. Here, the young peoples expect to be freer.”

Unable to connect their two worlds, many teens feel ambivalent about their ethnicity. This is often a root issue for Hispanic youths with behavior and drug use problems. To counter this problem, Koss-Chioino developed a group therapy model with a strong focus on ethnic pride.

“We taught the kids that their heritage was worth having, that it is a great heritage, and that they should be proud of it. The results of many of studies have shown that ethnic pride combats substance abuse.”

Her own study results matched those findings. “Substance use decreased in almost all measures, particularly the use of inhalants and some hard drugs,” she says.

The family therapy program was just as effective, though it took a slightly different approach.

“We wanted to help the parents understand what the kids’ lives were like, what their concerns were, and help them communicate better. We definitely strengthened communication between youths and their parents,” she says.

The most positive result was that depression levels decreased among many youths and some parents. Parents, armed with a clearer understanding of what was happening to their children away from home, also saw where they needed to exercise more control.

Although few other researchers have tested the effectiveness of culture specific therapy, Koss-Chioino is convinced that it works well. By expanding the concept to fit her ecological model, she hopes to make it even more effective.

“We now have a whole new take on it. We know that we need to work with other aspects of their life and community—schools, churches, anywhere that a person can be connected,” she says. “We haven’t tested it yet, but that’s the next thing we’re going to do.”—Danika Painter