A Holistic Approach to Counseling Mexican American Adolescents

A Holistic Approach to Counseling Mexican American Adolescents Among adolescents in the U.S., Mexican American youth have the highest rates of depression and suicidal ideation. Acculturation theory was used as the framework in developing a comprehensive counseling approach to address the mental health needs of Latino adolescents in the United States (U.S.). The Holistic Approach for Counseling Mexican American Adolescents incorporates acculturation issues and familial relationships, while working towards the improvement of Latino adolescents’ well-being. The authors provide professional counselors with recommendations for increasing cultural competence to effectively work with the Latino population. For future research, exploration of relationships between adolescent well-being, familial relationships, and acculturation is suggested. A Holistic Approach to Counseling Mexican American Adolescents It has been reported that Latino adolescents experience more anxiety, depression, and daily stress often leading to disruptive behaviors and poor mental health than their non-Latino White peers. In particular; Mexican American youth were found to have the highest rates of depression and suicidal ideation among U.S. adolescents (Aldridge & Roesch, 2008; Garcia, Skay, Sieving, Naughton, & Bearinger, 2008). The Latino population makes up about 16.3 percent of the total U.S. population and continues to increase as more families migrate to the U.S. from their countries (Pew Hispanic Center, 2011). Mexican Americans comprise the majority of Latinos (i.e., 67%), the largest ethnic minority group in the U.S., and one that has grown rapidly over the past two decades (Updegraff, Delgado, & Wheeler, 2009). Latino American adolescents aged 10 to 19 make up about 16 percent of the adolescent population in the (U.S.) (National Adolescent Health Information Center, 2003). Current research has explored Mexican American adolescents’ development and mental health in relation to their familial relationships, and acculturation issues independently (Chung, Chen, Greenberger, & Heckhausen, 2009; Garcia & Saewyc, 2007). These studies suggest that there is a positive correlation between familial relationships and adolescent development and well- being, and a negative correlation between acculturation and adolescent development and well- being. Despite the findings that show familial relationships and acculturation are significant factors in an adolescent’s development and well-being, majority of research fails to 2 provide professional counselors with effective ways to counsel this population (Caldwell, Silverman, Lefforge, & Silver, 2004; Christenson, Zabriskie, Eggett, & Freeman, 2006; Pasch et al., 2006). Acculturation theory takes into account the clients’ cultures, interaction of the cultures, and effects of the interaction of the cultures on the clients’ well-being. Acculturation theory is used as the theoretical framework of this paper as it emphasizes how cultural issues affect adolescent individuals and their families (Berry, 2008, p. 330; Love & Buriel, 2007; Pasch et al., 2006; Ramos-Sanchez & Atkinson, 2009; Sullivan et al., 2007). The purpose of this paper is to outline a new, more effective approach for counseling Latino adolescents to better meet their needs. This paper includes: (a) review of literature, (b) current counseling efforts, (c) proposed counseling approach based on acculturation theory, (d) implications for practice, and (e) future research suggestions. Literature Review Adolescent Development & Well-being Adolescence is a developmental stage that takes place around the ages of about 12 to 18 where males and females go through numerous physical and psychological changes including puberty, relationship dynamics with peers and family members, and other social and educational changes (Wigfield, Lutz, & Wagner, 2005). These stressful changes can significantly impact adolescents’ mental health. All adolescents experience normative stress related to daily hassles, school transitions, and social relationships (Choi, Meininger, & Roberts, 2006). In addition to normative stress, immigrant adolescents or those who have moved to the U.S. from their country of origin experience further social stress related to acquiring a new language, establishing new peer relationships, and adjusting to cultural norms that differ from their parents’ and country of origin (Garcia & Saewyc, 2007). Adolescents belonging to an ethnic or cultural minority group are also more likely to experience traumatic stress due to discrimination and hegemony, which is the dominance of one social group over another (Author, 2010; Carlson, 1997; Carter, 2007). Traumatic stress refers to events that are experienced as negative, sudden, and uncontrollable, which may be moderated by an individual’s social context, life events, and developmental level (Carlson, 1997). Traumatic stress may affect an adolescent’s school performance, self-esteem, and mood. Newly immigrated Mexican adolescents’ development and mental health differs greatly to their White counterparts. These immigrant adolescents experience different types of stress in their environments related to cultural factors that White adolescents may not experience. Such stressors may include work and family obligations, maintaining employment, and acquiring English language skills (Love & Buriel, 2007). Martinez (2009) explored how Mexican American youth, both pre-immigration and post-immigration, understand their life stages and development. Overall, she found that the childhood and adolescent stages are shortened greatly, and transition into adulthood is propelled. Transition into adulthood may be characterized by 3 full-time employment, immigration- accompanied or unaccompanied, family dependence, and financial obligations. These youth may spend most of their time working to support their families (Martínez, 2009). Mexican American adolescents also reported experiencing a limited childhood that is characterized by play, irresponsibility, and being carefree. Instead experiences of these adolescents are characterized by full-time work, family obligation, anxiety about maintaining employment, and the absence of leisure. The experience of life stages and development in Mexican American youth is very different to that of middle-class White adolescence, where they often experience this developmental stage (10-20 years) as lacking major responsibilities, and being carefree. These experiences along with other factors affect Latino adolescents’ identity formation. Pahl and Way (2006) examined how gender, ethnicity, immigrant status, and experiences of discrimination affect identity exploration and affirmation in Latino adolescents. Their research found that by mid- adolescence, ethnic identity exploration is at its highest and then it starts to decrease as adolescents begin to clarify the meanings of their ethnic group membership. Latino youths’ decrease of ethnic identity exploration over time suggests that they progressed toward the resolution of their identity crisis. Social support from same-ethnic peers and living in neighborhoods where the majority of individuals are of the same ethnicity may contribute to the resolution of their identity crisis, feelings of security, and high levels of affirmation (Sánchez, 2009). In addition, higher racial and/or ethnic density in geographic areas contributes to higher personal self-esteem, furthermore promoting the well- being of Latino adolescents. Several factors have been found to affect the mental, social, and emotional health of Latino American adolescents such as circumstances of immigration, social-economic status, levels of acculturation, levels of acculturative stress, familial acculturative gaps, previous education experiences, context of host culture, and the perception of community belonging (Blanco-Vega, Castro-Olivo, & Merrell, 2008). Cultural pressures, perceived discrimination, levels of parental involvement, and levels of acculturation all affect the psychological well-being of Latino adolescents (Tapia, Kinnier, & MacKinnon, 2009). Furthermore, immigrant youth need the support of the host culture in order to maintain and enhance their cultural identity. However, despite all of the stress and hardship these immigrant Latino adolescents experience, many of them are still able to succeed and persevere in life. Parental or familial involvement, positive community support, positive self-concept, intergenerational transmission and biculturalism are all sources of social and emotional resiliency for Latino adolescents (Author, 2010; Blanco-Vega et al., 2008; Tapia et al., 2009). Familial Relationships Various studies have explored how familial relationships are related to adolescents’ behaviors and emotional adjustment (Caldwell et al.,, 2004; Crockett, Brown, Russell, & Shen, 2007; Dumka, Gonzales, Bonds, & Millsap, 2009). Positive relationships were found between parental emotional support, parental involvement, and emotional adjustment in adolescence, and negative relationships were found between parent-child conflict and adolescent mental health. In addition, adolescents’ psychological adjustment and behaviors depend greatly on the meaning they attribute to parental behaviors and in turn, adolescent adjustment affects family functioning (Crockett et al., 2007). Caldwell et al. (2004) defined familial emotional support as adolescents’ report of their ability to seek out emotional support and/ or advice from family members. Familial emotional support has been negatively associated with delinquent behavior in Mexican 4 American adolescents and positively correlated to adolescents’ emotional well-being. How Mexican American adolescents view positive parent-child relationships may be very different to their White counterparts. Familismo refers to the concept of family being an extension of self along with feelings of loyalty, reciprocity, and solidarity towards the family and preserving those close family ties (Crockett et al., 2007; Villalba, 2007). Respeto means maintaining respectful hierarchical relationships within the family and extended family which may be determined by age, gender, and social status (Crockett et al., 2007). Additionally, a strong emphasis on family may influence a young individual’s decisions about work and school later on in life, taking into consideration the family’s well-being (Sánchez, Esparza, Colón, & Davis, 2010). Crockett et al. (2007) found that cultural values, such as those defined above, influenced adolescents’ perceptions of good familial relationships. The adolescents discussed concepts, such as respect, viewing family positively, open communication, and parental control, in regards to positive familial relationships. The researchers suggested that cultural influences operate at multiple levels, and that the Mexican American adolescents’ views and practices in their own relationships were consistent with particular Latino cultural themes (Crockett et al., 2007; Villalba, 2007). Research showed high levels of parental warmth (defined as closeness, nurture, and acceptance) and parental emotional support in Latino families (Chung et al., 2009; Crockett et al., 2007; Updegraff et al., 2009). Contrary to other cultural groups, Latino American parents were perceived to provide continuous emotional support and warmth, regardless of adolescents’ level of depressive symptoms. This may be indicative of the strong collectivistic culture and family orientation in Latino culture. Individuals from collectivist culture value interdependence and family reliability more and are expected to reach independence and autonomy later in life than persons from individualistic cultures (Chung et al., 2009). Furthermore, higher levels of parental warmth and parental emotional support have been shown to be related to better positive adjustment, such as higher school achievement, engaging in less risky behaviors, and less depressive symptoms in Mexican American adolescents than their counterparts (Updegraff et al., 2009). Strong, positive parent-child relationships, along with familial support, are important in adolescents’ overall well-being. Acculturation Acculturation plays a major role in familial relationships and adolescents’ well-being (Pasch et al., 2006). Acculturation is defined as “when groups of individuals having different cultures come into continuous first –hand contact, with subsequent changes in the original culture patterns of either or both groups” (Berry, 2008, p. 330). Usually, the non-dominant group is strongly influenced to take on cultural norms of the dominant group (Smokowski, Rose, & Bacallao, 2008). Acculturative stress results from the anxiety and distress of adapting to cultural differences (Aprahamian, Kaplan, Windham, Sutter, & Visser, 2011). Sanchez (2009) discussed the concept of transnationalism and the positive implications for personal and familial attachments that are bicultural. Biculturalism, where adolescents adopted American and Latino cultural practices, was associated with parental involvement, positive parenting and family support and bicultural adolescents reported the most favorable perceptions of their families (Sullivan et al., 2007). Staying in touch with one’s culture of origin helps to authenticate a positive Mexican identity in adolescent youth that aids in positive adjustment and acculturation to a new host culture. A positive Mexican identity in adolescent 5 youth can help to maintain a cultural home and their ethnic language, minimize the intergenerational gap between children and parents, and reduce acculturative stress (Sánchez, 2009). Family leisure involvement in Mexican American families plays an important role in the acculturation process (Christenson et al.,, 2006). Bicultural, or less acculturated, youth spent more time in core leisure activities with their families than high acculturated youth. Core family activities, such as reading together, playing card games, gardening, and eating together, were also found to be related to increased feelings of closeness and family cohesion (Christenson et al., 2006). Less acculturated youth spent more time with family and have more respect for parental authority (Love & Buriel, 2007). This was related to increased family cohesion, better parent-child relationships and less parent-child conflict, and thus, better adolescent adjustment overall (Christenson et al., 2006; Smokowski, Rose, & Bacallao, 2009). Minimal research focuses on acculturation’s role in Latino families and adolescents, and how the factors of acculturation and familial relationships work simultaneously in affecting Latino adolescents’ well-being. Moreover, most professional counseling efforts among the Latino adolescent population are not incorporating the important aspects of family and acculturation issues in their counseling services. Current Efforts Current literature suggests a need for school and mental health counselors to be aware of the multiple challenges experienced by Latino students; challenges such as language and cultural barriers, racism, dropout rates, acculturation, and pressure to assimilate (Malott, Paone, Humphreys, & Martinez, 2010; Peeks, 1999). Despite, the many needs of Latino adolescents, they have one of the lowest rates of utilization of counseling services, especially Mexican American adolescents (Malott et al., 2010). Culturally irrelevant therapeutic approaches contribute to low rates of Mexican Americans using counseling services (Ramos-Sanchez & Atkinson, 2009; Yznaga, 2008). It is extremely important for professional counselors to have culturally congruent interventions when working with this population and deter from the traditional North American culture-bound trained assumption that culture is a set of cognitive schema that are superimposed on individuals (Lewis-Fernandez & Kleinman, 1994; Yznaga, 2008). One approach to providing counseling services to Latino American youth is through group counseling. Group counseling helps build a strong ethnic identity (Malott et al., 2010), which leads to better overall well- being of Latino adolescents. Author Peeks (1999) stated that group counseling is a modality that allows adolescents to understand each other, model real life interactions and situations, and basically build a sense of community. Furthermore, group counseling is a restorative process that helps deal with issues of alienation, self-blaming, loneliness, and limited interpersonal skills. While aiming to provide culturally competent services to Latino youth, mental health professionals need to understand the importance of family in Latino culture. Extensive research talks about the centrality of values and traditions honoring family, close family ties, and communalism (Constantine, Kindaichi, & Miville, 2007; Malott et al., 2010; Peeks, 1999; Villalba, Akos, Keeter, & Ames, 2007). Villalba (2007) discussed the use of a strength-based, person-centered approach to counseling Latino students and stated that one out of the three culture- specific strengths is family bond. Biculturalism, and resiliency were other strengths 6 discussed. Most importantly, Latino youth looked to family members for answers to difficult questions, help with schoolwork, and learning a new language. Despite the fact that scholars have emphasized the importance of family in Latino culture, counselors seldom include family members when counseling Latino adolescents (Villalba, 2007; Yznaga, 2008). Therefore, a more effective approach to counseling Latino adolescents needs to incorporate Latino adolescents’ parents/legal guardians. Additionally, facilitating communication in a safe counseling setting can also serve as modeling for effective communication between adolescents and parents. Holistic Approach for Counseling Mexican American Adolescents Developed by the authors based upon a review of the literature and clinical experience with this client population, the Holistic Approach for Counseling Mexican American Adolescents is an inclusive, method of counseling Mexican American adolescents, focusing on late adolescents (15-18 years) and their parents/legal guardians (see Figure 1). This approach incorporates six different dimensions to advance progress in therapy with Mexican American adolescents and their parents/legal guardians: Strength-based Using a strength-based approach to counsel Latino adolescents and their parents is optimal as it will empower clients, highlight their strengths, and build a strong therapeutic relationship. Social justice- and advocacy-focused Social justice focuses on issues of oppression, privilege, and social inequity. It implies counselors taking on more active roles as leaders, collaborators and advocates for their clients in schools and in their communities (Lee, 2007). Culture-centered It is important that counselors understand their clients’ worldview and subsequently offer culturally appropriate interventions. Counselors can also address acculturation and familial issues that affect Mexican American adolescents and their family members. Practicing in a culturally centered manner can also allow adolescents to voice their concerns, whether it is issues associated with school, social interactions, and/or family dynamics. Empowering Professional counselors work with their clients to help them feel empowered and autonomous. It is important for adolescents to feel a sense of empowerment, as many Mexican American adolescents may be experiencing social stress due to cultural adjustment and discrimination. Incorporating empowerment in counseling can help Latino youth can start to develop a healthy sense of self, where they have a strong, positive identity. 7 Community-oriented It is important for counselors working with the Mexican American population to value the importance of communal support and connections. Continued support from parents and community for Mexican American adolescents should be encouraged to help build a sense of community for the clients. Developmental The Holistic Approach to Counseling Mexican American Adolescents is developmental and progressive, as counseling services start during high- school entry and continue throughout their high school education. The therapeutic services grow and change along with the clients’ growth and development throughout high school. Professional counselors practicing in a variety of settings, such as community agencies, private practices, or schools, can utilize the Holistic Approach for Counseling Mexican American Adolescents. One recommendation is that this approach can be part of a family-school collaboration initiative wherein counselors utilize a group counseling modality in an after school program. Counselors may also be able to utilize community centers, local after-school programs, or faith-based institutions to employ this method. Stringer and Dwyer (2005, pp 14-16), emphasize relationship, communication, participation, and inclusion when discussing the working principles of action research. The steps to implement the Holistic Approach for Counseling Mexican American Adolescents are influenced by action research (Stringer & Dwyer, 2005) and wraparound counseling (West-Olatunji, Frazier, & Kelley, 2011) principles and involve establishing connections, researching, developing treatment plans, and using culturally centered interventions: STEP 1. Develop rapport in a Mexican American community by attending community events, scheduling meetings with representatives in community such as school administrators, peer counselors, and key stakeholders to establish relationships. STEP 2. Schedule a meeting with community members to discuss issues related to Mexican American adolescence. STEP 3. Create different focus groups for parents and adolescents to discuss issues they are experiencing from both perspectives. STEP 4. Compile information gathered from focus groups and previous meetings to identify major issues affecting both parents and adolescents. STEP 5. Research literature to gain knowledge on implications of issues on mental health of Mexican American adolescents and families, and effective interventions. STEP 6. Develop a treatment plan to outline the stages and progression of counseling for Latino youth and their parents. STEP 7. Include culture-centered interventions when working with Latino populations. Some examples are use of: (a) invite extended family members involved in Latino adolescent’s life to session to also provide them educational training and psychotherapy on relevant issues (copadres), (b) use Spanish words or phrases during counseling to stimulate associated feelings, and emotional reactions (una palabra), (c) allow clients to re-tell their positive and negative experiences to increase self- acceptance (nombre), (d) focus attention on feelings and nonverbal communication (el grito), and (e) family genograms with adolescents and their 8 parents to depict familial relationships and roles of family members (Dana, 1998; Ruiz, 1975). Other culturally appropriate activities can also be incorporated during sessions, such as dancing, art and crafts, convening with food, and other special days or activities. STEP 8. Finally, evaluate process and outcome of services provided to Mexican American population by eliciting verbal feedback from Latino families or administering surveys. Counselor educators can also teach the concepts of the Holistic Approach for Counseling Mexican American Adolescents to graduate students through coursework and specific training, and also other counselors through workshops and presentations. Counselor educators, counselors, and counselors in training may all benefit by integrating the Holistic Approach for Counseling Mexican American Adolescents in their clinical and academic work. As professional counselors do extend counseling services to the Mexican American population, it is crucial for counselors to receive supervision in order to maintain their own mental health and maximize their skills as a culturally competent counselor. Discussion The Holistic Approach for Counseling Mexican American Adolescents can accelerate the progression of cultural competence among professional counselors because it is taking a holistic approach to address the needs of Latino youth. Parent participation can incorporate a central aspect of Mexican American culture (familismo) that has been shown to have a substantial effect on youth (Crockett et al., 2007; Yznaga, 2008). Addressing acculturation concerns provides students a safe space to talk about stressors, such as immigration issues, cultural barriers, language barriers, and discrimination (Garcia & Saewyc, 2007; Martínez, 2009). The relationships formed among counselors, parents, and adolescents can provide supportive, normative, and validating experiences through storytelling. This holistic approach can give adolescents a source of stability, comfort, and a place for them to express themselves without reservations. Including parents in counseling Latino youth is beneficial because it allows youth and parents to relate to each other, gain support, normalize and validate their own feelings, and ultimately foster an overall sense of community. Further, adolescents and parents can continue processing and communicating with each other outside of counseling sessions, thus promoting sustained healthy development and growth. Recommendations for Practice Professional counselors should take proactive steps to reach out to this marginalized population and open communication with parents and families as well as adolescents. Counselors can schedule meetings in settings within Mexican American communities, such as churches, community centers, or schools to talk to key stakeholders about the issues that relate to Mexican American adolescents. Counselors can benefit in that they can become aware of the issues in the community. Additionally, counselors can establish rapport with community members, increase their comfort level with this client population, and become a resource to the community. Counselors are encouraged to become agents of change for Latino adolescents and their families. Counselors can spread knowledge and awareness about the acculturation issues Latino 9 adolescents may experience by: (a) facilitating workshops or education sessions for parents, teachers, administrators, and students and (b) implementing one-on-one sessions to consult, ask and answer questions, and discuss related issues. These activities can ensure that counselors are serving as advocates for their Latino adolescent clients by working with the individual, family, and community. The Holistic Approach for Counseling Mexican American Adolescents provides a unique, culturally relevant, and empowering way to counsel Latino adolescents and their families. This approach allows clients to express themselves in a safe, comfortable place, thus improving their mental health by reducing the different forms of social stress they may be experiencing. Future Research Future research can attempt to determine the relationships between acculturation issues, familial relationships, and development and well- being among Latino adolescence. This research can explore how acculturation and familial relationships influence adolescent wellbeing in terms of anxiety, depression, social stress, self-esteem, and self-concept. Such research could explore the relationship between: (a) acculturation and Latino familial relationships, (b) Latino familial relationships and adolescent development and well-being, and (c) acculturation and Latino adolescents’ development and well-being. Through quantitative methods such a study could show the strengths and direction of these relationships. In summary, due to a multitude of systemic and ecological factors, Latino adolescents experience more social, acculturative and traumatic stress than their White peers, often leading to depression and suicidal ideation. Acculturation issues and familial relationships, in particular, have been show to affect the well-being of Latino adolescents. The authors offer a Holistic Approach for Counseling Mexican American Adolescents as a new, inclusive approach that incorporates acculturation, social justice, and a strength-based, empowering lens to counsel adolescents and their parents. Counselors can employ this approach in community agency, school, and private practice settings and are encouraged to continue educating themselves and others on the multiple issues Latino adolescents face. Future research on the relationships between acculturation issues, familial relationships, and adolescent development and well-being will increase understanding about Latino adolescence development and well- being. Figure 1. Holistic Approach for Counseling Mexican A Dimensions Strength-Based Social Justice & Advocacy Focused Culturally Centered Empowering Community-Oriented Developmental Mexican American Parents *Collective sharing *Parent-child communication Mexican American Adolescents *Acculturation *Identity issues *Expression *Validation