Centering the Voice of the Client: On Becoming a Collaborative Practitioner with Low-Income Individuals and Families.

Despite current interest in collaborative practices, few investigations document the ways practitioners can facilitate collaboration during in-session interactions. This investigation explores verbatim psychotherapy transcripts to describe and illustrate therapist's communications that facilitate or hinder centering client's voice in work with socioeconomically disadvantaged populations. Four exemplar cases were selected from a large intervention trial aimed at improving shared decision making (SDM) skills of psychotherapists working with low-income clients. The exemplar cases were selected because they showed therapist's different degrees of success in facilitating SDM. Therapist's verbalizations were grouped into five distinct communicative practices that centered or de-centered the voice of clients. Communication practices were examined through the lens of collaborative approaches in family therapy. The analysis suggests that cross-fertilization between SDM and family-oriented collaborative and critical approaches shows promise to illuminate and enhance the challenging road from clinician-led to client-led interactions. This paper also stresses the importance of incorporating relational intersectionality with individuals and families who may not feel entitled to express their expectations or raise questions when interacting with authority figures.

A pesar del interés actual en las prácticas colaborativas, pocas investigaciones documentan las maneras en las que los profesionales pueden facilitar la colaboración durante las interacciones dentro de las sesiones. Esta investigación analiza transcripciones textuales de la psicoterapia para describir e ilustrar las comunicaciones de los terapeutas que facilitan u obstaculizan la centralización de la voz del paciente en el trabajo con poblaciones desfavorecidas socioeconómicamente. Se eligieron cuatro casos ejemplares de un ensayo grande de intervención orientado a mejorar las habilidades para la toma de decisiones compartidas de psicoterapeutas que trabajan con pacientes de bajos recursos. Los casos ejemplares se eligieron porque demostraban los diferentes grados de éxito de los terapeutas a la hora de facilitar la toma de decisiones compartidas. Las verbalizaciones del terapeuta se agruparon en cinco prácticas comunicativas diferentes que centralizaban o descentralizaban la voz de los pacientes. Se examinaron las prácticas de comunicación desde la perspectiva de los enfoques colaborativos en la terapia familiar. El análisis sugiere que la fertilización entre el esquema de decisiones compartidas y los enfoques teóricos críticos y colaborativos orientados a la familia promete iluminar y mejorar el difícil camino desde las interacciones dirigidas por el clínico a las dirigidas por los clientes. Este artículo también acentúa la importancia de incorporar la interseccionalidad relacional con personas y familias que posiblemente no se sientan con derecho a expresar sus expectativas o a hacer preguntas cuando interactúan con figuras de autoridad.

Standing and Responding in Solidarity with Disenfranchised Immigrant Families in the United States: An Ongoing Call for Action.

The status of immigrant families resettled to the United States in the past decade has been fraught with upsurges of governmental policies that have systematically increasing the levels of oppression, violence, and abuses of human rights. The socio-political-economic toll of xenophobic practices on specifically targeted immigrant populations is magnified by the psychological and relational impact they have on individuals, families, and communities. This manuscript is conceptualized as an ongoing call for social action and specific mobilization by mental health professionals in response to the increasing threats to civility and dignity faced by various immigrant communities. The paper is organized in three sections: (a) an overview of the effects of immigration policy on immigrant family experiences; (b) the impact of mental and relational health on immigrant populations; and (c) elaborations of three exemplar community projects designed to support immigrant families. The manuscript concludes with a discussion exploring avenues for promoting a stronger base for solidarity and social action.

Expanding Possibilities: Flexibility and Solidarity with Under-resourced Immigrant Families During the COVID-19 Pandemic.

The novel coronavirus has added new anxieties and forms of grieving to the myriad practical and emotional burdens already present in the lives of underserved and uninsured immigrant families and communities. In this article, we relate our experiences since the COVID-19 crisis to the lessons we have learned over time as mental health professionals working with families in no-cost, student-managed community comprehensive health clinics in academic-community partnerships. We compare and contrast the learnings of flexibility of time, space, procedures, or attendance we acquired in this clinical community setting during regular times, with the new challenges families and therapists face, and the adaptations needed to continue to work with our clients in culturally responsive and empowering ways during the COVID-19 pandemic. We describe families, students, professionals, promotoras (community links), and IT support staff joining together in solidarity as the creative problem solvers of new possibilities when families do not have access to Wi-Fi, smartphones, or computers, or suffer overcrowding and lack of privacy. We describe many anxieties related to economic insecurity or fear of facing death alone, but also how to visualize expanding possibilities in styles of parenting or types of emotional support among family members as elements of hope that may endure beyond these unprecedented tragic times of loss and uncertainty.

El novedoso coronavirus ha agregado nuevas ansiedades y formas de duelo a la infinidad de cargas emocionales y prácticas ya presentes en las vidas de las familias y las comunidades de inmigrantes marginados que no tienen seguro. En este artículo, relacionamos nuestras experiencias desde la crisis de la COVID-19 con las lecciones que hemos aprendido en el transcurso del tiempo como profesionales de salud mental que trabajamos con familias en clínicas comunitarias de atención integral de la salud gratuitas y administradas por estudiantes en asociaciones académico-comunitarias. Comparamos y contrastamos los conocimientos de flexibilidad del tiempo, del espacio, de los procedimientos o de la asistencia que adquirimos en este entorno clínico comunitario durante momentos habituales con los nuevos desafíos que enfrentan las familias y los terapeutas, y las adaptaciones necesarias para continuar trabajando con nuestros pacientes de maneras que respondan a sus necesidades culturales y los empoderen durante la pandemia de la COVID-19. Describimos a las familias, a los alumnos, a los profesionales, a las promotoras (vínculos comunitarios) y al personal de asistencia en tecnologías informáticas que se han unido en solidaridad como solucionadores creativos de problemas ofreciendo nuevas posibilidades cuando las familias no tienen acceso a wifi, a teléfonos inteligentes o a computadoras, o sufren el hacinamiento y la falta de privacidad. Describimos muchas ansiedades relacionadas con la inseguridad económica o con el miedo de enfrentar la muerte solos, y también cómo visualizar la ampliación de posibilidades en los estilos de crianza o los tipos de apoyo emocional entre familiares como elementos de esperanza que pueden perdurar luego de estos tiempos trágicos de pérdida e incertidumbre sin precedentes.

Changing constructions of machismo for Latino men in therapy: "the devil never sleeps".

This paper presents current narratives about masculinity that question simplistic negative stereotypes of machismo for Latino heterosexual men. Various models of masculinity within Latino cultures are described using evidence from ethnographic studies, research data, and clinical observation. Therapeutic advantages of including positive cultural masculine traits such as respect and dignity are illustrated with an extensive case study. The case highlights contradictions in the coexistence of constructions of masculinity and traces progressive stages for transforming these constructions. In this strength-based approach, attention is directed to elements of cultural memory that reclaim a strong relational ethic present in the indigenous cultures. "Within the culture" definitions of masculinity contribute alternative constructions toward a more empowering cultural narrative for Latino men than the usual negative stereotypes.

Commentary: On the wisdom and challenges of culturally attuned treatments for Latinos.

In this commentary, I outline the common and distinctive components in the cultural adaptation studies in this special issue and compare cultural adaptations with universalistic and culture-specific perspectives. The term cultural attunement may be more reflective than cultural adaptation insofar as the cultural additions in these studies make the treatments more accessible by adding language translation, cultural values, and contextual stressors. These additions most likely enhance the level of engagement and retention in therapy for Latino families. The work ahead requires a deeper examination of the cultural theories of psychological distress and the cultural theories of change in therapy. A final proposal is made in this commentary for considering the bicultural aspects of the cultural adaptation or attunement enterprise, insofar as the clinical research encounters with immigrants are bicultural encounters. These encounters can reach beyond the notion of cultural "adaptation" of mainstream evidence-based treatments to ethnic minorities and present a unique opportunity for mutually enriching bicultural integration of theory, research, and practice.

Working with transnational immigrants: expanding meanings of family, community, and culture.

An increasing number of recent immigrants maintain intense connections with their countries and extended families. The complexity of relationships that arise from transnational connections calls into question dominant discourses about family bonds and requires that we adopt new theory and treatment considerations. The relational stresses and the almost untenable choices that economic immigrants face take the form of separations and reunions of parents and children, and difficult gender or generation transformations that need to be considered against this new transnational backdrop. This article proposes a model that encompasses foundational approaches with new approaches in family therapy by focusing on three crucial contexts for work with immigrants: the relational, the community, and the cultural-sociopolitical. Family therapists are also encouraged to create collaborative links with migration studies, a growing interdisciplinary field.