Frank X. Acosta

SELF-DESCRIBED REASONS FOR PREMATURE TERMINATION OF PSYCHOTHERAPY BY MEXICAN AMERICAN, BLACK AMERICAN, AND ANGLO-AMERICAN PATIENTS

This study investigated reasons given by Mexican American, black American, and Anglo-American patients for prematurely terminating psychotherapy. 74 patients who had prematurely left therapy in a public psychiatric outpatient clinic were interviewed. The three ethnic groups did not appear to be significantly different in their responses. However, dominant reasons reported for terminating therapy included negative attitudes toward therapists and perceiving therapy as of no benefit.

Effective Psychotherapy for Low-Income and Minority Patients

The poor, the working-class, or the minority person who needs psychotherapy is characteristically underserved by mental health establishments, which are primarily geared to the needs of middle- or upper-class and nonminority patients (Acosta, 1977; Sue, 1977; Yamamoto, James, & Palley, 1968). Therapists who make up the mental health establishments often lack the knowledge necessary to work effectively with minority populations and subgroups (President’s Commission on Mental Health, 1978). Given this lack of knowledge and the existence of racism in the United States, it is not surprising that many mental health professionals have prejudicial attitudes to-ward minority groups, which can be manifested either in outright rejection or in the provision of less intensive, less interested, unenthusiastic care (Lorion, 1974). These patients will continue to be underserved until mental health professionals become better trained to deal with the unique problems of these patients more effectively.

Barriers between mental health services and Mexican Americans: An examination of a paradox

The paradox of underutilization of mental health services by Mexican Americans is critically examined. It is argued that Mexican Americans live under high levels of psychological and environmental stress that would ordinarily lead to mental health problems and an increased utilization of mental health services. A number of barriers to the use of mental health services by Mexican Americans are examined. Included among these barriers are such factors as the relationship between social class and treatment offered, stereotypes concerning Mexican American folk psychiatry, limitations imposed by language differences, and the effects of stereotypes between Anglo Americans and Mexican Americans. Paradoxical findings in some studies which show a positive perception of mental health services by Mexican Americans are seen to further underscore the need for more research on the Mexican Americans position. Stereotypes and generalizations about Spanish-speaking and bilingual Mexican Americans approaches to psychotherapy are challenged in the light of recent empirical findings. Recommendations for future research directions and for improving the delivery of mental health services are presented.

Using the brief symptom inventory to profile monolingual spanish‐speaking psychiatric outpatients

As part of a larger study (Acosta, Evans, Hurwicz, & Yamamoto, 1987), a translated version of the Brief Symptom Inventory (BSI) was given to 153 monolingual Spanish-speaking psychiatric outpatients in the Los Angeles area. The raw mean scores on the nine primary symptom dimensions and the Global Severity Index (GSI) of the Spanish-speaking population were compared with the published raw mean scores of a normative sample of English-speaking psychiatric outpatients. Results suggested that the Spanish-speaking population had higher symptom levels on several dimensions and the GSI. It was suggested that the BSI could be a potentially useful instrument for self-reported psychiatric symptomatology among the Spanish-speaking population if an appropriate translation of the BSI were used.

Self-reported psychiatric symptoms among black, hispanic, and white outpatients

Examined ethnic differences among black, Hispanic, and white applicants for outpatient psychotherapy, using symptoms self-reported on the Symptom Checklist 90-Revised (SCL 90-R). The relationship between self-reported severity of symptoms and therapist-reported severity of psychiatric diagnoses also was examined in order to assess the utility of SCL 90-R as a predictor of diagnostic severity for these ethnic groups. One hundred sixty-five patients completed the SCL 90-R. The patients were predominantly in the low-income social classes. A significant ethnic effect was found on several symptom dimensions, with black patients less likely to report symptoms than Hispanic or white patients. Hispanic patients were found to report the highest symptom levels on 8 of 11 measures. While, overall, therapist diagnostic severity was related significantly to self-reported symptomatology, the relationship was strongest for white patients, significant but less strong for Hispanic patients, and not significant for black patients.

Psychological testing for Hispanic Americans

Abstract The need for culturally responsive mental health services for Hispanic Americans has never been greater. This population will soon become the largest of all U.S. ethnic minority groups, and recent epidemiologic studies suggest that Hispanics have rates of mental health need that are similar to those found in the general population. Developing culturally relevant mental health services, including diagnostic and assessment procedures, for this population is essential. A synthesis of extant literature pertaining to psychological testing for Hispanics is presented. It is limited to the adult literature and discusses issues related to personality, neuropsychological, and intellectual assessment. The importance of language as it influences the assessment process has also been discussed. Based on clinical and research experiences and the results of the literature review, a set of general guidelines is proposed for those working with this population.

Self-disclosure in relation to psychotherapist expertise and ethnicity.

The self-disclosure styles of Mexican Americans and their possible role in the limited participation of Mexican Americans in mental health services were explored. Ninety-four Mexican American and 93 Anglo American junior college students listened to one of four therapist introductions, then responded to questionnaires designed to measure self disclosure and self acceptance. Both groups indicated a substantial willingness to disclose about themselves to therapists. Mexican Americans proved lower in self-disclosure scores than Anglo Americans. Mexican Americans were found to disclose less to Mexican American therapists than did Anglo Americans to Anglo American therapists. Sex differences in self-disclosure were negligible. Both Mexican Americans and Anglo Americans scored in the direction of high self-acceptance. The findings held for comparable socioeconomic levels.

The Hispanic-American Patient

This chapter will discuss sociocultural characteristics of the Hispanic community and show how these characteristics relate to mental health and mental health services. Specific recommendations for treatment approaches and psychotherapy will also be presented. It is important to focus on Hispanic Americans because they constitute the second largest minority group in the United States and the fastest growing ethnic group in our country (Russell & Satterwhite, 1978). It is of further importance since Hispanic Americans in our country have been severely underserved by mental health facilities (Acosta, 1977; Padilla, Ruiz, & Alvarez, 1975; President’s Commission on Mental Health, 1978).

Patient Requests: Correlates and Therapeutic Implications for Hispanic, Black, and Caucasian Patients.

A patients reason for coming to a psychiatric outpatient clinic (his/her request for service) should be the focal point as a therapist develops an appropriate therapeutic plan for that patient. Data have been collected on 173 Hispanic, Black and Caucasian patients with regard to their reasons for coming to the clinic and selected demographic and process/outcome variables. A factor analysis of the patient request data generated three conceptual factors, which account for 13 reasons for coming to the clinic. The relationship of these factors with selected demographic and therapy outcome variables was tested statistically, and implications for therapy with low income and minority patients are discussed.

Bilingual-bicultural interpreters as psychotherapeutic bridges: A program note†

A unique bilingual interpreter program aimed at expanding professional services to Spanish-speaking patients is described. Bilingual-bicultural community aides were trained to interpret for monolingual Spanish-speaking patients and non-Spanish-speaking therapists. Training emphasis and experiences with therapists and patients over a 5-year period are discussed. Particular benefits and difficulties encountered with the therapist-interpreter team approach are presented.