Jaime Torres has been seeing his school social worker, Theresa Jones, for individual and family therapy for some time now. The bright, timid high school senior grappled with feelings of hopelessness and panic attacks for several years. His struggles started with palpitations, night sweats and an overwhelming sense of the room spinning out of control. Jaime also experienced a sense of desperation and sadness. He could not gain control of his thoughts and struggled with suicidal ideation. Eventually, he decided to seek help.
Concerned with his parents’ reactions, Jaime chose not to share his decision to try psychotherapy at school. His parents did not believe in therapy, especially his father, David, who would often say to Jaime that he needed to be strong. Unfortunately, these attitudes regarding men and mental health are common in the Hispanic/Latinx community.
David also believed that Jaime’s religion and faith in God should be enough to manage his struggles with mental illness. He would often say: “los hombres no lloran?” — “don’t you have faith?”
However, Jaime found the help he needed in Theresa, who integrated his faith and culture into his treatment.
The Importance of Culturally Competent Care
What separates Theresa from many counselors is her sensitivity to the Hispanic/Latinx community beliefs and attitudes surrounding mental health, which are complex and often misunderstood. She educated herself on religion, faith and spirituality serving as strong protective factors for the Hispanic/Latinx community, and she familiarized herself with the possibility that men share negative perceptions about discussing mental health conditions and seeking treatment.
This sensitivity directly informed Theresa’s approach. While Theresa used some cognitive behavioral techniques to help Jaime understand his negative thinking patterns, she was also able to incorporate a valued Bible passage that he could refer to when managing his symptoms. These evidence-based practices provided Jaime with validation and specific ways to cope.
Jaime is one of the lucky ones who was able to receive culturally competent treatment. Unfortunately, many school-based mental health professionals fail to address these values. In New York City, teachers like Leidy Garay have worked alongside school social workers and school counselors to better understand her students and families’ spiritual and religious beliefs.
Leidy has witnessed how often schools fail to asses’ students and families’ various determinants of health. Many Hispanic/Latinx students enter the school system with a multitude of traumas, intense loss, exposure to violence and a background of extreme poverty. Additionally, Hispanic/Latinx students are experiencing mental illness at increasing rates and struggle with thoughts of suicide up to eight times higher than their peers. Additionally, they are at a higher risk of trauma due to immigration and acculturation.
Jaime argued that school mental health providers are not practicing ethically when they leave out religion and spirituality.
“If you ignore how these inform, influence, and affect my environment and life, mental health professionals are not fully addressing and breaking down barriers which could lead to me or my family accepting and understanding treatment of mental disorders,” he said.
The Importance of Engaging Parents
The educational system often confuses Hispanic/Latinx communities’ perceptions and beliefs with lack of parent engagement in their child’s treatment — or a complete denial that their child/adolescent has a mental health condition.
According to Leidy, “it is not that parents do not want to engage with school-based mental health professionals, it is more like we are not properly engaging them. If our engagement does not include an assessment of all their determinants, cultural identity, values and their beliefs as well as family stressors, our assessments are invalid.”
Theresa explained it took time for Jaime’s parents to understand and accept his mental health condition and treatment needs. But once Jaime was ready and in agreement, Theresa began the journey of engaging his parents. It involved a genuine desire on both ends to go on a journey that, at times, was uncomfortable and challenging.
Theresa was constantly needing to develop her skills, assess her competency, build her knowledge, examine her own biases and keep her personal beliefs in check. Jaime talked with his parents about his mental health condition several weeks after starting treatment with Theresa. At that point in time, he felt comfortable and empowered to begin a conversation.
Jaime shared that his parents hit a turning point when Theresa allowed them to share their beliefs about mental health in the context of their faith. For example, David and Elena Torres shared they felt as if they were doing something wrong by seeking therapy — that they were putting God second, or that professional help was against God’s will. David explained that they felt validated, understood and accepted by Theresa. Ultimately, they appreciated that she allowed faith to have a role in Jaime’s treatment.
Theresa also learned from Jaime’s mother that faith for many Hispanic/Latinx parents is an incredibly strong protective factor, and some believe it is their faith that “saves” them when struggling with mental illness. Holding on to their faith in God, using prayer and meditating on the biblical word are important coping mechanisms she explained. It is their faith that gives them strength to get through the “bad days” and informs their resilience.
School-based mental health providers can no longer ignore the role culture and faith has in the Hispanic/Latinx community. We can no longer decide not to integrate this into treatment because we are fearful or because we lack competency. The ask here is not for school providers to practice religion, but rather, to provide students with the opportunity to observe their personal faith and be able to integrate their culture with their mental health treatment.
Integrating Spirituality and Religion Into Counseling (3rd ed.) A Guide to Competent Practice by Craig S. Cashwell, & J. Scott Young
Handbook of Religion and Spirituality in Social Work Practice and Research1st ed. by Sana Loue
The Therapist’s Notebook for Integrating Spirituality in Counseling I: Homework, Handouts, and Activities for Use in Psychotherapy by Karen B. Helmeke, Catherine Ford Sori
Incorporating Spirituality Into Core Counseling Courses: Ideas for Classroom Application
A Treatment Improvement Protocol Improving Cultural Competence
Developing Spiritual Competencies in Counseling: A Guide for Supervisors
Faith and Field: The Ethical Inclusion of Spirituality within the Pedagogy of Social Work
Cultural Competence In Service Delivery
Martha Rodriguez, LCSW, received her MSW from the Wurzweiler School of Social Work at Yeshiva University. Mrs. Rodriguez has more than 15 years of experience in both private and public sectors. She previously served as the Service Manager in Recovery at Marjory Stoneman Douglas High School, facilitating the delivery of mental health services. Currently, her role is Mental Health and Social Work Consultant for the Student Services Project at the University of South Florida.