In the small town of Huanchaco on the Pacific coast of northern Peru, a group of psychologists and graduate students are improving their Spanish skills and knowledge of local culture in an immersion program that could offer new career opportunities back in the United States.
Brie Kohrt, PhD, founded the Psychology and Spanish Elective Opportunity (PASEO) program in 2014, in a town famous for surfing and ceviche. Kohrt, who learned to speak Spanish in college, spent a year in Peru during graduate school and now splits her time between Peru and the University of Denver, where she is an assistant professor of psychology. She has approximately 15 graduate students and mental health professionals each year who complete four- or eight-week summer immersion programs, which some graduate students use for internship or externship credits.
The participants, who must already have intermediate Spanish-speaking skills, improve their Spanish and learn about culture by working with local nonprofit organizations that help migrant families, abandoned children or victims of domestic violence. Some participants want to jump into clinical work, but the program focuses on mental health assessments, educational efforts and general volunteer duties, Kohrt says.
The PASEO program is just one of a growing number of training opportunities that are helping psychologists gain the language and cultural knowledge skills required to better meet the needs of America’s growing Spanish-speaking population.
A rare commodity
More than 57 million people of Hispanic origin live in the United States, accounting for almost 18 percent of the total U.S. population and making Hispanics the nation’s largest ethnic or racial minority, according to 2016 Census dataopens in new window. By 2060, the U.S. Hispanic population will reach 119 million people, representing more than 28 percent of the population, according to Census projections.
Yet there are only about 5,000 psychologists in the United States who are Hispanic, representing 5 percent of all psychologists, an increase from 3 percent a decade ago, according to Census data. In a nationwide APA survey, only 5.5 percent of psychologists, who may be Hispanic or another race or ethnicity, said they can provide services in Spanish, making them a rare commodity.
Language barriers can limit access to quality care. A recent study found that Spanish-speaking clients often feel less comfortable sharing personal information with an English-speaking therapist, even when an interpreter is used ( Psychological Servicesopens in new window , Vol. 13, No. 1, 2016). Spanish-speaking clients also may shift from English to Spanish when recounting emotional experiences, and they may represent themselves differently depending on the language they are speaking ( Professional Psychology : Research and Practiceopens in new window , Vol. 40, No. 5, 2009).
Research also has shown that Spanish-speaking Hispanics see less need for mental health treatment, are less likely to seek treatment for themselves or their families and are more likely to terminate treatment early. A study using data from more than 232,000 people in a nationally representative sample found that Hispanics who needed to be interviewed in Spanish perceived less need for mental health treatment than did either whites or any other racial or ethnic-minority group, including Hispanics interviewed in English (Social Psychiatry and Psychiatric Epidemiology, Vol. 52, No. 8, 2017).
For immigrants, increased time in the United States is also associated with a higher risk of psychiatric disorders compared with native-born Hispanics, possibly because of discrimination or family cultural conflict, according to one study (American Journal of Public Health, Vol. 99, No. 12, 2009). In another study, native-born Latinos had significantly greater scores for patient activation, or the skills needed to manage one’s own health care, than foreign-born Latinos (Journal of General Internal Medicine, Vol. 24, Supplement 3, 2009). (This study used “Latinos” rather than “Hispanics” to describe the participants.) The National Latina/o Psychological Associationopens in new window has found a great need for Spanish-speaking psychologists who understand Hispanic culture, which is a critical component of treatment, says Melanie Domenech Rodríguez, PhD, past president of the association and a psychology professor at Utah State University.
“I frequently see job listings where Spanish language skills are a requirement, and there are many jobs out there for suitably trained individuals,” she says.
Areas of need
Children who predominantly speak Spanish often receive inaccurate assessments for special education services when those assessments are done in English, a severe problem in areas with large immigrant populations, such as Texas, says Cynthia Plotts, PhD, a professor of school psychology at Texas State University in San Marcos.
The university offers a training and certification program in bilingual school psychology called Project SUPERBopens in new window (Scholars Using Psychology and Education to Reach Bilinguals). Like the PASEO program, students build their Spanish language and Hispanic cultural awareness skills in a cultural immersion program. In Edcouch, Texas, a small town in the Rio Grande Valley near the Mexican border, project participants volunteer at the Llano Grande Centeropens in new window , which runs community development and youth education programs. The participants also create a personal digital story about cultural and language heritage and its impact on the practice of school psychology.
“The need for Spanish-speaking school psychologists is growing all the time. For much of Texas, they are in short supply,” Plotts says. “School psychologists are spread very thin, and they are often going from school to school filling in the gaps. It doesn’t leave them much time to develop relationships with parents and families.”
Project SUPERB, which is supported by a grant from the U.S. Department of Education’s Office of Special Education Programs, began in 2014 and has added eight new students each year. Plotts also has co-authored a journal article about the program and the need for qualified school psychologists to treat students from immigrant families ( School Psychology Quarterlyopens in new window , Vol. 31, No. 2, 2016). She hopes the graduates from Project SUPERB will become supervisors who can mentor other school psychologists in central Texas, but they are in such demand that they often get hired by other locales across the country. “They can definitely get jobs, and not just in Texas,” she says.
A shortage in miami
Miami’s burgeoning Hispanic population is also overwhelming the small number of bilingual psychologists there, says Lydia Buki, PhD, director of training in the counseling psychology program at the University of Miami. “A lot of people who need care and want it are not getting it,” she says. “It’s clear there is no way we can meet the needs of Latinos without having some systematic change and more programs to ensure that more practitioners are competent in treating Latinos, especially those who speak only Spanish.”
The University of Miami offers a certificate programopens in new window in Latino mental health counseling that includes cultural training and treatment-specific Spanish language skills. The 12-credit-hour program seeks to accommodate working students, and some of the coursework is taught over extended weekends with other work done online. The university’s master’s and doctoral counseling graduate programs also run an in-house training clinic, the Institute for Individual and Family Counseling, where approximately 230 people were treated during the last academic year, more than half of them Hispanic. Therapy sessions must be recorded for training and supervision of graduate students, and some undocumented immigrants with limited treatment options may not seek treatment there because they don’t want to be taped, Buki says.
Gregg A. Pizzi, PsyD, a bilingual psychologist in Miami, underscores the importance of understanding Hispanic cultural attitudes when providing treatment. “Family is a priority, and one does not offend or put the family values or family unit at risk to pursue one’s own individual happiness,” he says.
Learning Spanish and Hispanic culture isn’t just an academic exercise, says Pizzi. Watching Spanish-language TV, visiting Hispanic neighborhoods and traveling to Latin America are all great steps. And mental health professionals shouldn’t be intimidated about learning a new language later in life or the inevitable grammar mistakes they will make while talking to clients in Spanish.
“We need to be humble and ask our patients to teach us, because we can’t assume that we know everything,” he says. “We’re not perfect as therapists and we’re going to mess up, but that’s going to happen and will get better with practice.”
