Running Head: FAMILY THERAPY STIGMAS ASSOCIATED WITH LATINOS 1

0710341677

Family Therapy Stigmas Associated with Latinos

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FAMILY THERAPY STIGMAS ASSOCIATED WITH LATINOS 2

Family Therapy Stigmas Associated with Latinos

Statement of the Problem/Purpose

According to the US Census Bureau, Latina/os made up about 56.5 million of the total

US population on July 1, 2015, making them the country's largest ethnic or racial minority.

Latina/os are predicted to reach 120 million by 2060. Mental Health America (2018) conducted a

study on the prevalence of mental health illnesses among Latinos in order to determine the effect

of stigma on seeking help or treatment for such challenges. According to MHA, 17.8 percent of

the population identified as Latino/Hispanic in 2016. While most, if not all, cultures stigmatize

mental health issues, Latinx culture seems to be the most stigmatizing and treatment resistant.

Most Latinx families that are deeply ingrained in their culture find it difficult to consider going

to therapy or sending a member of their family to counseling because they do not believe

anything is actually wrong or that the problem will resolve itself with time. Despite the fact that

Latinx in America have begun to acculturate and become more conscious of the critical nature of

seeking treatment for mental health difficulties, the stigma persists in society. According to the

American Psychological Association, approximately half of those seeking therapy discontinue

treatment after the first session and never return. Numerous cultural attitudes contribute to the

high dropout rate and apathy toward non-treatment seeking.

The purpose of this paper is to look at the stigma surrounding family therapy in Latino

families, as well as how cultural perceptions may impact treatment seeking. This is concerning

since neglecting to address the problem may have a negative impact on a child's behavior by

preventing them from acquiring effective coping skills as a consequence of the neglect.

Furthermore, since children are unable to cope with their mental health issues, developmental

periods are disrupted when this happens. Latino families are recognized for their strong bonds,
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which might be used to persuade them to work together to help family members who have been

diagnosed with a mental illness. When all members of a family participate in family therapy, the

overall outcomes are considerably better. One technique of eradicating stigma among these

groups is to provide psychoeducation on family therapy and mental health to Latino families in

need of treatment.

Literature Review

This review will look at the aspects that impact latinos' stigmas in family therapy.

Scientists have realized that socioeconomic class and cultural background may have an influence

on the results of mental health therapy. Some families may be refused mental health care because

they do not qualify for health insurance due to their immigration status. Familismo is a crucial

component of mental health stigma among Latino households, as indicated by Kapke et al.

(2019) and Lawton (2011). The word "familismo" refers to family members' commitment to one

another. Because informing anybody outside of the family would be considered disrespectful in

their views, Latino cultures urge family members to keep their concerns inside their own family.

Familismo

Numerous studies indicate that the cultural value of Familismo, or the collective ideal of

family togetherness, may contribute to the shaping and perpetuation of family therapy stigma.

According to multiple research, this value is related with increased emotional connection and

openness within the family, which may help alleviate stigma associated with ADHD (Mallet &

Garcia, 2021). On the other hand, family has been recognized as a significant source of bias

towards people with mental diseases in a number of Latino families. Family and extended family

members' hostile attitudes, as well as family members' underestimation of another's skills, are all

instances of negative family qualities. Another study found that the majority of Latino and
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Hispanic families would hide a family member's ADHD unless the individual was unable to

manage the disease or the symptoms were life threatening (Fadus et al., 2019). According to the

same study, many survey respondents believed that their children's ADHD was caused by their

parents' unethical behavior.

Additionally, a 2013 study found that the value placed on Familismo may motivate

people to hide their disease in order to protect their family (Esses, 2021). Family members may

also discourage persons from seeking treatment or utilizing medicines due to a lack of

knowledge or spiritual or cultural views.

Parents Beliefs

Parents' beliefs about what causes ADHD have an effect on how their kids act when they

need help ((Mallet & Garcia, 2021, Esses, 2021)). Research shows that attention deficit

hyperactivity disorder (ADHD) can be caused by a combination of biological and psychological

factors (Faraone et al. 2015). However, not all Latino parents are aware of or agree with this

position. 74 Latino parents in the United States were asked about their children's ADHD

behaviors, and more than three-quarters of them said that their child's behavior was caused by a

lack of discipline and/or attention from their parents (Gerdes et al. 2014). However, only about a

third of the people who took part in the study said that their behavior was linked to their genes

(Gerdes et al. 2014).

Gerdes (2014) surveyed 74 Latino parents who had at least one kid diagnosed with

ADHD between the ages of five and twelve. Parents were required to see a video of a Latino

youngster with ADHD symptoms followed by an interview on their thoughts about the child in

the video. Additionally, the study's participants' families had a worse socioeconomic position.

The findings indicated that parents place a high premium on familialismo, conventional gender
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roles, religion, and respect. The findings indicated a connection between cultural values and

biopsychosocial functioning. It demonstrates that parents are aware of their child's conduct yet

refuse to seek help for it. Socioeconomics, familialism, and conventional gender norms all

influenced ADHD views.

Unlike earlier studies, Gerdes (2014) emphasizes the influence of socioeconomics on

Latino families' demand for assistance. For instance, insufficient insurance coverage and

language hurdles may discourage families from obtaining treatment. If the therapist does not

speak English or if there is no translator available, it inhibits Latino families who only speak

Spanish from obtaining adequate therapy and disincentivizes them from seeking more assistance.

In some Latino households, parents struggle to discern what constitutes acceptable conduct for

their child's developmental stage and behavioral indications of ADHD. Parents who are unaware

of their kid's ADHD tendencies are unlikely to seek treatment for their child. The study's

participants were less likely to be classified as inattentive or hyperactive/impulsive.

cultural attitudes.

Social stigma and discrimination/racism may make it more difficult for Latino families to

get the health care they need, as well as for health-care professionals who don't speak their

language or understand their culture. It has been reported by Gerdes et al. (2014) that in a mixed-

method study, 40% of Latino parents said that sociocultural barriers to getting help for their

child's ADHD included unrealistic expectations about the level of support, understanding, or

attention they would get from the treatment providers (Gerdes et al. 2014). Almost a third of the

people who took part in the study said that a parent or family member was preventing them from

taking care of their child, such as not being able to accept their child's disability (Lawton et al.

2014). This may be because many people in Latino culture don't like the idea of
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psychopathology. Following recent efforts to bring accessible, evidence-based, and culturally

appropriate ADHD health treatments into schools, in response to the many problems with

treatment that were mentioned above, new activities have been taking place (Pfiffner et al. 2011;

Pfiffner et al. 2016; Haack et al. 2015).

Case Study

Clients in my field placement are mostly Latinos seeking family and individual therapy.

Only a few children were enrolled without a recommendation after being recommended by their

primary care provider. Three children in a Latino family I work with have been diagnosed with

Post Traumatic Stress Disorder and have been referred by their doctor. When I initially met the

parents, they said they had never been to therapy before and were unsure what to anticipate. The

kids eventually admit that they didn't think they'd like therapy since they thought it was just for

"mad" people. These youngsters improved with time and were able to maintain appropriate

coping methods while also strengthening their bonds with their families. This family has spoken

about the stigmas they had about therapy in the past, and how by giving it a try, they were able to

discover the value of their mental health and manage with their symptoms in a healthy manner.

The significance of gender roles in Latino households is also shown by this family. Only the

mother, not the father, will be present during the family sessions. The mother and children, on

the other hand, display their relationship within their family and the activities that they

participate in with their father. Another Latino client I meet has been in therapy for almost two

years and has been diagnosed with ADHD. The mother puts the kid on a behavioral chart and

uses it to praise him when he manages his ADHD behaviors well and completes a task. If the

youngster has been good all day, he may go outdoors and play with his sibling. On Saturdays, if

the youngster has been good all week, the father takes him out to do something fun. Only the
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mother participates in the family sessions, not the father. The mother, on the other hand,

emphasizes her son's father's engagement in his treatment, such as establishing incentives and

participating in activities together. When there is structure in place, this family operates better.

Structural Family Therapy (SFT)

Minuchin pioneered structural family therapy, which is now one of the most widely used

methodologies in systemic family intervention. The goal of this method is to create a healthy

hierarchical family structure with distinct subsystems that have their own limitations and bounds.

According to this approach, the adolescent's difficulties reflect: (1) a family structural imbalance;

(2) a dysfunctional hierarchy within the family system, which is frequently characterized by

difficulty establishing boundaries between the parental and child subsystems; and (3) a

maladaptive response to changing demands. As a consequence, the intervention focuses on

strengthening the parental subsystem, stressing the need of presenting a "united front," and

establishing a distinction between it and the parent–child subsystem. Additionally, it emphasizes

the need of altering the rigidity of restrictions and the connectivity between subsystems based on

the life cycle stage. While the parental subsystem maintains influence throughout adolescence,

its exercise cannot be the same as in earlier developmental stages, and the borders between the

subsystems must be more malleable while being clear. While the major components of this

technique are well-known and often used in clinical practice, few studies have examined its

effectiveness in adolescents with mental health problems.

With dysfunctional families, structural family therapy is often used. While the parents are

at work, the oldest kid in a Latino family may take care of the younger siblings, which may entail

dropping them off at school, babysitting them while no one is home, cooking supper, and so on.

Children with these tasks are not as frequent in other homes. After a therapist puts up a safe and
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secure therapeutic platform, SFT encourages family members' abilities to discover methods of

coping with their family obstacles and difficulties, as pioneered by Salvador Minuchin (1974).

The purpose of therapy is to help the family in identifying and confronting family structures or

practices that are preventing them from resolving problems. The therapist guides the family

through the healing process in four steps: (1) identifying the current complaint; (2) emphasizing

problem-maintaining interactions; (3) reviewing the past via a structural lens; and (4) considering

alternate ways of connecting (Minuchin, Colapinto, 2018).

Latino families with children with ADHD often approach developmental issues from an

individualistic perspective: a kid with ADHD is the family's problem-bearer, and so they must be

altered. Aware of this propensity, the therapist invites the family to jointly investigate the

relational patterns that may have led to and aggravated their problems with care, inquiry, and

humility. In one home, an ADHD kid may have been triangulated into the couple's marital strife

and became the family's scapegoat. In another household, a child's symptoms might be a result of

the family's many pressures, such as unemployment, poor mental health, financial issues, and

social prejudice.

If the therapist is unable to understand why contemporary relationship patterns are so

inflexible and difficult to modify, the therapist may look back in time. When a therapist notices a

recurring relationship pattern between a scared son (with ADHD) and a self-righteous father, for

example, they could look at the following: Has the father ever physically abused his son? If such

was the case, did the mother attempt to shield her son? Is the marital relationship affected by the

mother's rescue attempt(s)? The therapist may give new alternatives and opportunities for family

members to relate to one another after gaining a better knowledge of the relationship between the

family's past and current dynamics.

Discussion

Acculturation, the study found, has a major influence on the lives of Latino children and

their families who display symptoms of attention deficit hyperactivity disorder. Caregivers of

Latino children who participated in a school-based ADHD intervention discovered a link

between acculturation and childrearing style and family practices, with language playing a

special role. Among the social-emotional issues to consider are poor working conditions, stigma,

and confrontations with racists. Acculturation, family dynamics, and social determinants all seem

to influence how Latino caregivers perceive, manage, and seek treatment for their child's ADHD-

related impairments, the researchers found.

Others have discovered a link between traditional Latino gender roles of "machismo" (in

which fathers serve as head of household and make decisions while mothers sacrifice and

provide for the family) and parents' under-recognition of ADHD behaviors in their children as

concerning rather than indicative of normal childhood development. As a consequence,

recommendations for designing culturally responsive parent training include consideration of the

influence of traditional gender roles on treatment maintenance and outcomes (Barker et al.

2010). Extensive family involvement in treatment will aid in the acceptance and implementation

of alternative parent control tactics to those often utilized in Latino households (Barker et al.

2010; Gerdes et al. 2015)

Acculturative gap stress, as it is referred to in the research, refers to the difficulties that

families face when children assimilate more slowly than their parents to mainstream American

society. Social standards are shifting as a result of this phenomenon. Given that previous

research has linked linguistic and acculturative gap stress to a variety of negative outcomes for

Latinos, including increased family conflict and a higher prevalence of child behavior problems,
FAMILY THERAPY STIGMAS ASSOCIATED WITH LATINOS 10

it seems reasonable to incorporate these difficulties into family-based ADHD treatment. Latino

families are encouraged to complete assessment instruments such as the Acculturation Rating

Scale for Mexican Americans or the Socio-Emotional, Familial, and Environmental,

Acculturative Stress Scale (SAFE) prior to commencing and continuing parent training. As a

consequence, we will get insight into the degree to which these characteristics influence how

families approach ADHD treatment and overall adjustment (Barker et al. 2010). For families

with large parent-child acculturation gaps, it may be good to examine how such pressures impact

care provider practices taught in parent training, such as positive attendance time, homework

monitoring, and peer playdate promotion.

Latinos exacerbated their isolation as a consequence of their child's public misconduct.

Latino children are not treated or appreciated equally with other pupils in their schools. Students'

requests and concerns were often overlooked in the classroom environment due to their skin

tone. Historically, institutions considered that Latino parents were incapable of navigating the

educational and legal systems of the United States, so restricting their capacity to get government

benefits, enroll their children in schools and health facilities, and protect their constitutional

rights. Given these recent trends, it's unsurprising that a previous study identified prejudice as a

barrier to Latino families receiving government help (Mallet & Garcia, 2021, Esses, 2021).

Regrettably, previous research has shown a correlation between Latino attitudes about racism

and the development of more serious child behavior problems. This is particularly true for

youngsters of color. This is quite alarming. While some clinicians (particularly those from non-

minority backgrounds) may feel uneasy discussing racism and discrimination with Latino

families in the United States, acknowledging these possible experiences and their impact on
FAMILY THERAPY STIGMAS ASSOCIATED WITH LATINOS 11

ADHD conceptualization and help seeking in Latino families in the United States may be

affirming and constructive for these families.

Instead of symptom reduction, a strengths-based approach (Tse et al., 2019) should be an

integrated element of family evaluation and therapy, emphasizing outcomes of competence,

adjustment, and well-being for children with ADHD. The children looked to be preoccupied and

inattentive in the group, but when asked to create artwork or a screenplay for a puppet

performance or a surprise party, they were just as creative and artistic as normally developing

youngsters. Due to the bias inherent in the pathological lens, most parents did not recognize

these talents in their children with ADHD. The parents had a better understanding of their

children's abilities and talents as a result of the ongoing input from children and parents from

other families, as well as the group leaders' on-site evaluation. Couple and family therapists are

more qualified to treat children with ADHD than other mental health practitioners because they

are trained in systemic intervention and can use FBT knowledge and abilities.

Conclusion

It's possible that a number of factors contribute to Latino families' perceptions that family

therapy is ineffective. This report contains a substantial amount of data about Latinos with little

financial means. A future study should look into Latino families' various perspectives and

customs, as well as their financial status, religion, and access to resources, among other things.

Mental health professionals should avoid assuming that all Latinos believe the same things

because Latino countries have such a diverse range of cultural traditions. According to the

American Psychological Association, the use of theories to assist clients in therapy should be

done with regard and respect for other cultures and traditions (APA). They must also adhere to
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all safety regulations. When dealing with Latino families, structural family therapy is helpful

because it helps everyone remain connected while maintaining healthy limits.

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