Bilingual mental health services are scarce and sometimes not accessible, unless the patient is exhibiting serious acute symptoms, or the family is undergoing great crises, or, simply because these services are overwhelmed with the numbers of people in need and there are always waiting lists for the few bilingual professionals in staff. So, our group of professionals in the schools was constantly struggling to find adequate help for our students and their families in need of longer care than what we could offer in the school setting, and then the families kept coming back to the schools for help, unable to reach the services they needed. So, we applied for grants to pay consultant therapists for in home family therapy for a small number of families that we felt would have great difficulty obtaining services on their own. Unfortunately, keeping those grants beyond a few years turned out to be ultimately impossible, as well as the project too time demanding and complex for us to manage. Beyond this, there is always a shortage of qualified bilingual therapists that can work with the immigrant population, because they need on the one hand well- developed therapy and clinical evaluation skills to diagnose and intervene in sometimes difficult cases, or have available good supervision to guide them through this. They also need to develop cultural sensitivity to the struggles and values of the first generation immigrant parents and children and to learn to deal with their own struggles with the different values of the families they are servicing, with compassion, respect and self-awareness, because even though we are all Latinos, we are sometimes very different from each other. We are a very heterogeneous group, made of many different socio-political backgrounds, races, religions, rural or urban environments, cultural perspectives and histories, levels of education, indigenous natives or mixed, or European or oriental immigrant background, to mention just a few, even when we may have many common denominators. This is not a homogeneous group, as the labels appear to make us.
The language issue is also complex and difficult to explain to someone who is not bilingual, or a second-language learner. The different ways of expressing ideas and feelings in the different Latino cultures, even though through the same language, make for a process of learning for any therapist working with Hispanics from different groups. Much like Americans, who have to learn new expressions, when they go to England or Australia or Ireland, for example and of course, again, learn to navigate in a very different culture. And this gets even more complicated still, for a therapist who is not a native speaker, or for a therapist who came to this country very young, or was born here of immigrant parents and has a dominion of the Spanish language that is heavily influenced by their dominant language: English. That person tends to translate directly from English, when they get into unfamiliar territory, rather than use (without meaning to do it) what might be a very different way of expressing that idea for a native speaker given how different the roots of the two languages are. So, at times, ending up with a totally confused listener and perhaps without even being aware of the misconstruction. It brings to my mind the tittle of the movie: “Lost in Translation”. However, the sad result is a parent, or patient that has gone back to me to tell me: “I can’t understand this person and this person cannot understand me and I don’t want to go back”, even though they were listed as Spanish speaking professionals. Unfortunately, language is so important for psychotherapy, as is feeling the therapist’s familiarity with your culture, unless you have become quite acculturated to this country and that aspect can be comfortably put aside. This all reminds me of a friend of mine who wanted to go back to Chile in her old age, because she would say laughingly “she hated the idea of dying in English!” And this is not to even start addressing the many indigenous languages and the problems those pose in trying to find interpreters for them when the child or adult does not speak Spanish fluently.