Culturally Competent Therapy: The Value of Personalismo

Many Spanish-speaking Latinos are surprised to find a non-Latino therapist who is fluent in Spanish. In my own practice, I have often been asked questions such as “What country are you from?” or “Where did you learn Spanish?” Self-disclosure regarding my experiences traveling and living in Latin America often creates a bond between myself and the Latinos with whom I work, especially those who have recently immigrated. Many express joy at encountering a therapist with first-hand experience of the customs and cultures of their native countries. As a culturally competent therapist, I place value on recognizing the role of distinct cultural norms while working with Latinos and creating a genuine therapeutic alliance based on mutual interpersonal respect and trust. Colloquially, this emphasis on relationships is also known as personalismo.

I have worked and studied in several Latin American countries, and in each case the importance of personalismo was made clear to me by the families with whom I lived. When interviewing family members of those who disappeared during Augusto Pinochet’s dictatorship of Chile, I quickly realized that before I could have even a perfunctory discussion about the lasting impact of the regime, I had to gain my host family’s trust through a period of formal friendliness. From my first day, I engaged in small talk with my host family and was asked a variety of questions regarding my life in the United States: Who did I live with? What did I study? What did I do for fun? I also showed appreciation to my host family in Chile by giving them a small gift of T-shirts from the United States. As a therapist, I follow a similar approach while working with Latinos.

How to Use Personalismo in Therapy

Accepting small gifts may seem to fall outside the purview of expected ethical behavior for therapists, who are often discouraged from accepting gifts or disclosing personal information on the grounds that it violates professional boundaries. A therapeutic relationship is professional, not personal, and any action that is perceived to take attention away from the needs of the person receiving the service is usually frowned upon. Therefore, breaching these norms while working with Latinos should always be done with the person in therapy’s best interest in mind.

While working with Latinos in my practice, I have found that accepting small gifts and advice as a form of appreciation for my services helps build reciprocity into the therapeutic relationship. It is not uncommon for me to receive, from a Latino person under my care, a small gift of herbal tea or a recommendation of a place to buy the best ingredients for a specific dish. Some recent research also encourages this practice as a form of exhibiting multicultural competency (Machucha, 2014). When a therapist discloses appreciation for a small gift or accepts advice about the best remedy for the common cold, the therapist may be contributing to the therapeutic alliance with a person who is Latino.

When honoring the cultural value of personalismo, physical touch may be appropriate in certain cases. For example, some people may respond positively to a hand shake, and—when clinically appropriate—even a hug (Clance, 1998). Of course, it is always important to ask before engaging in any form of physical touch. As a therapist, I have often found it useful to welcome a person during the first session with a handshake, to hug an individual who is crying, or even to offer a brief pat on the back. As part of my understanding of personalismo, such gestures may be expected by some of the Latino individuals I work with.

Regarding personalismo, the use of self-disclosure may also vary depending on the age of the person in therapy. I have found that a high school student may respond well to a therapist who can identify with the challenges of balancing greater high school freedom with more traditional values at home. Similarly, a senior citizen may respond well to a therapist who emphasizes the importance of taking care of one’s elders. Some Latinos I have worked with comment that they are also sometimes expected to show respect and reverence for parents or grandparents by taking care of an elderly grandparent at home.

How Not To Use Personalismo in Therapy

An ethical therapist is expected to give undivided attention to the person in treatment. Dual relationships, in which the therapist and person in therapy enter into a relationship outside of therapy, not only have the potential to blur professional boundaries but may also become exploitative. Those who seek therapy services must be certain that their emotional and personal needs are the exclusive interest of the therapist. The outside expectations inherent in a friendship or business relationship may violate the nature of the therapeutic relationship. Examples of behaviors Self-disclosure, if not done in the interest of the person in therapy, also exemplifies how the value of personalismo can be misunderstood and inappropriately implemented. Disclosure that promotes the therapist’s own agenda or status is never useful, and it can be especially damaging when it appears disrespectful of a person’s cultural norms and values.associated with dual relationships might include:

• A therapist asking a person in therapy to meet for coffee
• A therapist asking a person in therapy to do work for the therapist
• A therapist accepting an invitation to attend the birthday or holiday party of a person in therapy

Even if the person in therapy is the one who offers a gift or service, many would argue that to accept would be starting down a slippery slope of encouraging a nonprofessional relationship (Zur, 2011). A therapist must always be mindful of the power dynamics in the therapeutic relationship, even while stepping away from the traditional therapeutic role when practicing personalismo. The power dynamics in the therapeutic relationship may cause some to question the appropriateness of touch, gift giving, and advice. Therapists are viewed as authority figures within some Latino cultures (Perez-Stable, 2001). As such, a therapist carries power to influence the person in therapy to meet the therapist’s needs for personal validation or affection, even when these practices seem clinically appropriate and are requested by the person in therapy. Also, the therapist should be aware that the person in therapy may be attempting to win the trust and favor of the therapist through gifts and advice.

Self-disclosure, if not done in the interest of the person in therapy, also exemplifies how the value of personalismo can be misunderstood and inappropriately implemented. Disclosure that promotes the therapist’s own agenda or status is never useful, and it can be especially damaging when it appears disrespectful of a person’s cultural norms and values. Some examples include the therapist speaking to an adolescent or the adolescent’s parents about the personal freedoms the therapist enjoyed while growing up, quickly providing a diagnosis that may seem stigmatizing, or mentioning personal opinions on sensitive subjects such as politics and religion.

Awareness of the value of personalsimo may help preserve and sometimes bolster the therapeutic alliance, but it is important to keep in mind that each person also brings a unique set of needs to therapy. Therapists working with Latinos from a variety of cultural backgrounds should be prepared to have their own conceptions about self-disclosure challenged.

I remember my own experiences working with a young mother and her daughter who had been living in a homeless shelter. They gave me a small short-sleeved shirt at the conclusion of our therapeutic relationship. I was honored to receive the gift, and when asked how it fit me, I told them that the shirt was perfect and that I would be wearing it on the first day of my new job. My awareness of personalismo guided my response in this situation, even if it was outside of traditional expectations and boundaries in the therapeutic relationship. There may be no one way to interpret or implement personalismo, but awareness of its value in everyday psychotherapy with people who are Latino is a wonderful first step.

References:

1. Avieria, A. (2015). Culturally sensitive and creative therapy with latino clients. American Psychological Association , 1-2.
2. Carteret, M. (2011). Cultural values of latino patients and families. Dimensions of Culture: Cross-Cultural Communication for Healthcare Professionals. Retrieved from http://www.dimensionsofculture.com/2011/03/cultural-values-of-latino-patients-and-families/
3. Clance, P. A. (1998 ). Therapists’ recall of their decision making process regarding the use of touch in ongoing psychotherapy. Touch in Psychotherapy: Theory, Research, and Practice (pp. 92-105). New York, NY: Guillford Press.
4. Machucha, R. (2014). Boundary issues in counseling latino clients. Boundary Issues in Counseling: Multiple Roles and Responsibilities (pp. 100-103). Alexandria, VA : Wiley.
5. Perez-Stable, E. M.-S. (2001). Physical health status of latinos. The Latino Psychiatric Patient: Assessment and Treatment (pp. 29-31). Washington D.C.: American Psychiatric Publishing, Inc.
6. Zur, O. (2011). Gifts in psychotherapy. Zur Institute: Innovative Resoures & Online Continuing Education. Retrieved from http://www.zurinstitute.co/giftsintherapy.html                                                                                

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