Esteban V. Cardemil

Guess Who's Coming to Therapy? Getting Comfortable With Conversations About Race and Ethnicity in Psychotherapy

The ability to conduct psychotherapy effectively with racially and ethnically diverse populations is becoming increasingly important given the changing demographics of this country. Recent estimates of population trends suggest that by the year 2050, non-Hispanic Caucasian Americans will constitute approximately 50% of the United States population, as compared with the current 72% of the population (U.S. Census Bureau, 2001). The American Psychological Association (APA) has recognized the critical nature of integrating issues of race and ethnicity into the field of psychology by encouraging attention to these issues in clinical training programs (APA, Committee on Accreditation, 2002), creating therapist competency guidelines for working with racial and ethnic minority populations (APA, 1993), and sponsoring professional meetings to identify strategies to promote sensitivity to diversity in psychology (McGuire, 1999). It is likely that most clinical psychologists have acquired an intellectual appreciation of the salience of race and ethnicity in the

Developing a culturally appropriate depression prevention program: the family coping skills program.

Depression is a disorder that can have particularly deleterious effects on individuals from racial/ethnic minority and low-income backgrounds. Culturally appropriate prevention programs offer a way to provide accessible and effective mental health services to these underserved populations. The authors introduce the Family Coping Skills Program (FCSP), a novel depression prevention program developed specifically for low-income Latina mothers. The authors present the theoretical underpinnings of the FCSP and describe their efforts to make the program culturally appropriate and to enhance recruitment and retention of participants. Initial outcome data from an uncontrolled trial were promising and support continued development and evaluation of the FCSP and other similar programs.

Family functioning and depression in low-income Latino couples.

Although extensive research has found a strong relationship between poor family functioning and depression, previous research has not examined this relationship among low-income Latinos. In this study, we examined how family functioning may be associated with depression in a sample of low-income Latino couples. In addition, we examined how acculturative stress moderates the relationship between family functioning and depression. Our results indicate that the relationship between family functioning and depression is stronger in women and that acculturative stress moderates this relationship in women. Probing this interaction indicates that women who reported high acculturative stress coupled with poor family functioning experienced more depression. Clinical implications are discussed.

Self-Esteem in Pure Bullies and Bully/Victims: A Longitudinal Analysis

Past research on the self-esteem of bullies has produced equivocal results. Recent studies have suggested that the inconsistent findings may be due, in part, to the failure to account for bully/victims: those children who both bully and are victims of bullying. In this longitudinal study, we examined the distinctions among pure bullies, pure victims, bully/victims, and noninvolved children in a sample of 307 middle school students. Analyses of cross-sectional and longitudinal results supported the importance of distinguishing between pure bullies and bully/victims. In addition, results revealed some interesting sex differences: girls in the pure bully and bully/victim groups reported significant increases in self-esteem over time, with girls in the pure bully group reporting the greatest increase, whereas boys in these groups reported no significant changes in self-esteem over time.

Interparental Conflict, Parenting, and Childhood Depression in a Diverse Urban Population: The Role of General Cognitive Style.

Research on the mechanisms by which interparental conflict (IPC) affects child depression suggests that both parenting and children’s conflict appraisals play important roles, but few studies have explored the role of general cognitive style or included both parenting and cognitions in the same design. Moreover, the effects of IPC on minority children are not well understood. In this longitudinal study, parenting was examined as a mediator of the relation between increasing IPC and change in depression. General cognitive style was included as a moderator. The combined influence of parenting and cognitions was also explored. A racially and ethnically diverse sample of 88 fifth and sixth graders from two urban schools reported their cognitive style, depressive symptoms, and perceptions of conflict and parenting at two time points separated by one year. Parental warmth/rejection mediated the relation between IPC and depression, and general cognitive style acted as a moderator. Parenting, cognitive style, and IPC did not significantly interact to predict change in depression over time. Findings indicate that both parenting and children’s general cognitive style play a role in understanding the impact of increasing IPC on children’s well-being.

Help Seeking and Help Receiving for Emotional Distress Among Latino Men and Women

In this study, we examined help-seeking pathways and help-receiving experiences among Latinos, a population that has been shown to underutilize mental health services. We used the qualitative approach of dual mode of analysis to explore the experiences of 13 Latino men and women who utilized formal as well as informal treatment and support resources. We explored three specific themes: (a) individual and family help-seeking perspectives intersecting with Latino cultural norms; (b) referral source and style, needs identification, and prior help-seeking experiences as key motivational factors for help seeking; and (c) client—therapist match and client—therapist relational style as integral to mental health treatment satisfaction. We discuss clinical implications for efforts to improve the cultural sensitivity and accessibility of mental health services.

The Latino Mental Health Project: A Local Mental Health Needs Assessment

In this article, we present the results of a local needs assessment of the mental health experiences, service needs, and barriers to treatment-seeking of the Latino population in Worcester, Massachusetts. Overall, participants reported relatively high rates of experiences with symptoms of mental health problems, they indicated using a range of both formal and alternative mental health services, and they noted a variety of instrumental, attitudinal, and culturally-specific barriers to seeking mental health services. Findings are discussed with regards to the role that community-driven research can play in advancing efforts to provide relevant services to underserved populations.

Effectiveness of cognitive-behavioral treatment for panic disorder versus treatment as usual in a managed care setting : 2-year follow-up

Eighty clients meeting criteria for panic disorder and receiving either panic control therapy (PCT; M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or treatment as usual (TAU) in a managed care setting were assessed 1 and 2 years following acute treatment. PCT was provided by therapists with little or no previous exposure to cognitive-behavioral therapies. Analyses of the full intent-to-treat sample revealed no significant differences between the treatments across the follow-up period. However, when treatment completer status was added as a moderator, those receiving PCT showed lower levels of panic severity and phobic avoidance and a greater likelihood of achieving and maintaining clinically significant change. Benzodiazepine use during follow-up was associated with greater panic severity for those clients who received PCT, but no such relationship was found for TAU clients. Results are discussed in relation to the dissemination and effectiveness of PCT as well as evidence-based psychotherapies more generally.

Effective Psychotherapy With Low-income Clients: The Importance of Attending to Social Class

The purpose of this article is to explore some of the issues associated with conducting psychotherapy with low-income clients. Throughout the article, we draw from our specific clinical experiences working with low-income Latina mothers in a depression prevention program. The themes that we address regarding class and psychotherapy are in the areas of assessment of social class, integration of class issues into the therapy process, and managing differences in social class between therapists and clients. As we discuss these themes, we provide concrete recommendations in order to advance awareness and effectiveness in working with economically disadvantaged populations.

Brave New World: Mental Health Experiences of Puerto Ricans, Immigrant Latinos, and Brazilians in Massachusetts

Depression and anxiety are of the most commonly occurring mental health disorders in the United States. Despite a variety of efficacious interventions for depression and anxiety, it is clear that ethnic minorities experience mental health care disparities in their access to mental health services and the quality of treatment they receive. Research indicates that Latino heterogeneity impacts access to depression and anxiety treatment. In addition, Brazilians are becoming an increasingly visible minority within the United States and are often depicted as Latinos. The current study sought to understand the role of acculturation and stigma in mental health symptom endorsement and treatment seeking among Puerto Ricans, immigrant Latinos, and Brazilians. A total of 250 self-identified Latinos and Brazilians were interviewed about their mental health symptom and treatment experience, acculturation, and stigma toward mental illness. Results indicated considerable variability across the three groups, with Puerto Ricans endorsing higher rates of depression and anxiety, as well as higher rates of treatment seeking, than either the immigrant Latinos or the Brazilians. Acculturation played a differential role in the endorsement of anxiety treatment seeking for Brazilians. Finally, although the three groups differed in the extent to which they experienced stigma about mental health issues, stigma did not predict symptom endorsement or treatment-seeking behavior for any of the three groups. These findings underscore the importance of attending to both between-groups and within-group differences in the mental health and mental health treatment experiences of different ethnic groups.