Meagan 0:28

Adriana, thank you so much for being here and talking with me today about culturally inclusive counseling. Can you just take a moment and introduce yourself to our listeners, tell 'em a little bit about you.

Adriana 0:40

I am Adriana Martin de Tore, and I'm pronouncing it this way because this is the proper way to pronounce my name, but in America they pronounce it differently. And I am a bilingual bicultural therapist who serves clients here at her time therapy, and another nonprofit outside working with refugees and immigrants.

Meagan 1:02

That's vitally important work now more than ever. So thank you for the special work you do and all of the expertise that you bring to us at her time. It's truly valued.

Adriana 1:13

Thank you. It's an honor and a privilege to serve these communities.

Meagan 1:17

Absolutely. So we're here to talk today about culturally inclusive counseling and the role of language and culture within the therapeutic space and how it can sometimes be really beneficial for people to do a little bit of extra work to find a counselor that really understands their culture and is inclusive. Sometimes that will include the counselor speaking their native language, or sometimes it can look a lot of different ways and there's maybe some pros and cons to working with a counselor from a different cultural background too. I'd love to start by hearing your thoughts on why it's important in the therapy space to have a counselor. That is culturally inclusive and that really understands the culture that the client comes from.

Adriana 2:04

Yes. That's a really great question. And I think just as anyone who was born in the US we're constantly influenced by culture and society and culture influences how we view ourselves, the relationships around us and the world around them. So when we're talking about clients, if we don't understand the context to where they come from, it's gonna be really hard to be able to. Understand what they value and how they manage whatever it is that they practice. When we take the time to understand and respect an individual's cultural background, it allows the client to feel validated within their own lived experience and the. Multiple identities that intersect with who they are. And when that is left unchecked and not acknowledged, it can leave a client feeling like they're being dismissed or they're feeling misunderstood. A great example I can think of is any individual who comes from a collectivistic culture may prioritize family and community over individual needs. And if a therapist really misses that. It's going to really shape how. Harmful it will feel for the client when it comes to discussing coping mechanisms that don't involve the community or the family. And it makes me think of the concept of boundaries. I think Western culture many times removes people and I. Pushes them out to do what's against cultural norms within a client's culture. And as a therapist, if we don't know how much a client values interdependence and the roles within a family system, we're teaching them how to cope in ways that are gonna further isolate them and create more distress within their own wellbeing, and it's gonna create more tension in their own families as well.

Meagan 3:57

Yeah, you did such a wonderful job summarizing that, and that's really interesting to hear you frame it in that lens of, and maybe this is a summary of what I'm understanding you're saying is for one client, you can talk about setting boundaries that are more individualistic and focused on them and what they need in their life, and it works great. But that same intervention for a client from a more collectivist culture that. Really views the family dynamic as the priority it can actually serve to isolate them and even be harmful. Whereas an intervention is great for one person, it can be harmful to the other if you're not paying attention to the differences in culture.

Adriana 4:38

Yes, a hundred percent. It's gonna further perpetuate the distress that they're already experiencing within their family, especially if we're pulling them to differentiate, rather than helping them lean more into their culture and engage in cultural adaptations that fit their value system. And it's gonna take exploring that together with a client rather than making assumptions. And of course, our role as therapists is to learn a little bit about their culture, but most importantly, the client is ultimately the expert and there's a fine balance in navigating that.

Meagan 5:12

Yeah, absolutely. And here at hard time we do specialize in working more with those who are women and identify as women. So I'd love to hear your thoughts a little bit about how the cultural issues apply specifically to your female clientele. And are there any presenting issues that you see often in your work with women and how you maybe change your interventions for them?

Adriana 5:36

Yes. A lot of the common themes that I notice specifically with immigrants or daughters of immigrants, it's very common for them to feel a sense of guilt and betrayal as they're assimilating into US culture. Whether it's like them not being born here or being first gen, which. First generation, which means you are the first born in this country and the tensions that you can experience when there is mixed legal statuses within the family on top of what this country requires of you to be successful versus what. A family considers to be successful can look very different across cultures. And speaking specifically to like Mexican American woman or women that were born in Mexico, it's very common for them to feel pulled to different directions when it comes to their assimilation process and what their parents want for them versus what they want for themselves. And that differentiation process is what? Brings a lot of anxiety and depression because there's this sense of I really want to please my family and I want to honor the family values that I was raised in, and I also want to have my own values and how can I create a balance and integrating. Both, and that can be very distressing as these women are developing their identity, especially when they're moving on to become professionals and they're not meeting up to the standards and expectations that they're held to culturally.

Meagan 7:17

Wow. So it really does set up this situation where it's almost like they can't win. If they fully Americanize themselves and become quote unquote successful from the dominant American perspective, they're disappointing and isolating family members. But if they please family, then they're not functioning in this other domain. So it's very hard to win. In the big sense,

Adriana 7:42

it really is, it's really hard to win because on one hand you wanna be successful and your perception of success is not gonna reflect what mom and dad perceive as success. And that's where more tension can be created and it can be really hard. To dismantle all of that and be able to create your own sense of self. And this is where I believe Western therapy comes into play, where the key focus is on individual needs and boundaries. But a lot of the times those disconnect us from connection in the unity and harmony that these families expect of these young women who are. Just wanting to strive and thrive to be successful, whatever it is that may be for them. But then they're grappling with what mom and dad are saying is successful, and it's not even just mom and dad. Oftentimes, a lot of immigrant families come with extended families, so now they're also getting that external pressure when they see their own cousins living up to the standards that the family expects, the culture expects, and sometimes both can be conflated because family. Has their own values. That's its own little system. And then there's also culture. And if we think of it like here in the US there's also other systems that continue to oppress these marginalized groups of people. And I wanna throw these in here because these are other systemic barriers and challenges that these women face on top of navigating what culture says, what this culture says in the us. What their family says, what the extended family says. And then if we throw in religion, that's like another thing that also layers it more. So there's a lot of systems that we're working with. And when it comes to women navigating these, and many times I would say oftentimes women just feel like they're not doing enough and they feel pulled to wanting, needing to be superwoman and. Having to navigate being this and this. And I think that's where identity crisis can happen often because we're constantly wanting to serve this culture and we're dismissing ourselves, and that's where we get lost in our identity. And we don't know who we are because we want to be someone, but we also don't wanna dismiss our roots and where we come from. And I know. Speaking for myself, that can be something that I experience where it's

10:08

like,

Adriana 10:09

I really want to do this because this is what's gonna be best, and I don't want to submit to a dynamic that's not helpful and dysfunctional and at the expense of losing this relationship which is best for me. I think that's the hardest part, because we're also working with grief as layers are being peeled.

Meagan 10:29

Yeah, absolutely. As you were mentioning all of these systems that women are grappling with, one of the things that came to mind is how in a lot of my sessions, so many women will come in and say this person says this, but then this other expectation says this, and I don't know who to listen to. And oftentimes I'll ask. Them. What do you think? Because I hear what you know, 10 other people in your world are telling you to do and what they think, but what do you think? And sometimes that's the first time they've ever been asked that and been challenged to actually listen to themselves. Rather than all of the people that are a part of all these other systems. I'm curious if you've also found that to be true in sessions and how you work across all of these domains where we wanna build up the personal empowerment and personal autonomy to hear your own voice, but also recognizing that especially in more diverse cultures, we really do need to incorporate the family and the family system beliefs as well.

Adriana 11:27

That is a really great question because, oftentimes I would think just even asking the question, what do you think can be so overwhelming? Because their whole life, they were literally making choices. That supported the whole system. It was never about them, but it was always about the family. It was never about how is this gonna benefit me before I even consider my family? It's how is this gonna benefit my family before I even consider myself? There's so many voices that are taunting them about where do I move next? And that's where guilt shows up. A lot of guilt is. Just manifest of I feel bad if I. Think about myself and what it is that I need. How are my parents gonna look at me? Are they gonna stop talking to me? Does this mean that the relationship I have with them is conditional based off of how I'm benefiting them? And I think this also brings it to socioeconomic status, right? If we're working towards healing and we're wanting to support someone, find their voice. It's really hard to find that voice when there's other layers and barriers that are keeping you from moving forward. Because if you don't have the resources and you don't have the finances, self-care is out the window. If you're just in survival mode and you're trying to live up to the standards of your parents and you have no room to be able to move forward. So I don't have a specific answer to your question of how to navigate strategically what that means other than. Framing it more how do you think your family would respond to this? Or what do you think your family would be most supportive of? Incorporating one of the individuals from the family system? Because when we're talking about families, especially women, if we're gonna throw in gender roles. Every single person in the family has a role. And speaking for Mexican families, there's a hierarchy. So oftentimes when a woman is asked, what do you think it it's stripping off things that they have. It's difficult for them to even consider because their whole life, they've been dominated by someone else making the choices for them because they never really had a choice. Even when they gave their own input, it wasn't always considered. It opens up a can of worms, in other words, and the most helpful ways to integrate family. But I think ultimately it comes back to the client and identifying where are they in their assimilation and acculturation process in this. Country and that will give you all the information to know, is it safe for me to start to individualize this individual and move them towards this way, while also acknowledging like, Hey, if you start to move more towards Western values, this is gonna be a threat to your family system. There's going to be responses because you are dancing a whole nother rhythm than what your family has been your whole life. So be prepared and I'm here to support you to walk with you.

Meagan 14:24

As you're describing that a question that came to my mind was where do you tend to start with clients? But as you kept talking, it was like there is no one starting point. It really seems as a therapist, you meet with your clients and just see where are they at in that process of being completely ingrained within the family system, or how much of a individualized self are they? Able to recognize and starting with their highest point of distress and figuring out where to go from there.

Adriana 14:53

That is one of the ways I would say what I do with most of my clients is I like to ask 'em about their migration journey. Even if they were not the ones who were the first to migrate into this country, their parents' migration journey had a huge impact on them, and that's where we bring in intergenerational trauma and some of the presenting symptoms that they may be experiencing. And when we. Spend time exploring that migration journey that gives me more information about when the date that they arrived and if I know the date that they arrived. That gives me information about how many years they've been in this country and how assimilated they are. And I also ask about their home life. And what a typical day looks like for them. And one of the greatest questions that helps inform me of how assimilated they truly are, aside from how long they've been in the country, is when it comes to decision making. Who's involved? Is it just you or is your family involved? And once I have all these pieces to the puzzle that I'm formulating in my mind, it's when I bring it back to goal setting. And because I am more client centered, I don't like to structure therapy in any way. I let them guide me in where we're going next, as soon as we have specific goals, and start working towards that direction. All of the background I gain is just for me to know what am I working with and how can I ensure that when we ever have a conversation about boundaries or boundaries ever comes up. Does it mean we're gonna do more Western boundaries, or is it gonna be more bicultural boundaries, or we bring in your cultural and family values and adapt whatever Western therapies have to say about creating boundaries. And rather than teaching coping skills where we separate you and isolate you from the stressor, can we bring in some of those values like family? To engage in some of these coping skills with you. So if we're gonna have someone complete a technique for the stress response cycle, for example, rather than telling my client, I want you to go hike and jog down the mountain so that you can complete that cycle in your nervous system can get regulated. I would instead invite them to have a family get together and go hike together.

Meagan 17:18

That's such a great example of still pulling in a evidence-based strategy, but making it accessible and honoring their culture in doing it. I really love this approach that you're taking and even just the question of what's your migration journey, even if you were born here. That is really powerful to get a sense of their bigger picture worldview. And in a lot of ways I imagine just exploring the answer to that question really helps them learn the connection between that migration journey and some of the distressing symptoms they're feeling and are impacting them today. And I think that's a lot of the work we do as counselors is helping people connect the dots in their own lives. And even just figuring out like, why am I this way? Why am I struggling in this particular fashion? And being able to connect those dots helps give them a little bit of empowerment to say I'm not just crazy. I'm not broken. There's nothing actually wrong with me. This actually all makes a lot of sense when you look at it in the big picture.

Adriana 18:17

A hundred percent. And as you're describing all of those pieces that help contribute to their story and integrating who they are, which is amazing to see it all unfold in therapy. One of the things that came to mind when exploring the migration journey and goal setting is language. I think language is. So important because in my experience in working with different cultures, there's so many idioms that do not translate well in English. And when we're working with someone whose native language is Spanish, there's a lot of idioms in Spanish that dictate how an individual's internal world is that cannot be understood in English. The best example I can think of that I heard many times, and I know a lot of my clients heard it when they were teens. Speaking directly to Latinas is a lot of Latina moms would say, which translates to, don't you come home with your Sunday seven? And if you hear that, you're like, what the heck does that even mean? Essentially it's like an idiom. And what it means is mom is saying, I hope you don't come home pregnant. It makes no sense when you translate it word by word. And I wanna highlight language as. Something that is very crucial to just the therapeutic relationship and ensuring that you're both understanding each other when it comes to emotional expression. Idioms are a great way for a lot of cultures to express themselves other than religion and what they use within their religion to and instill hope for one another. But research shows that. An individual's native language is their best way of being able to express how they feel. So if I have someone who's bilingual and their first language was Spanish and English was second, I have even noticed things in my own clients that even though they prefer to do therapy in both English and Spanish, I have found that when they're. Describing very painful experiences and they're describing and naming their emotions. It's in their native language. And research reflects that we do our best expressing ourselves in our native language, and when we don't have to offer that other language, it makes it really hard for a client to emotionally process what they're coming into therapy for.

Meagan 20:42

Wow, that's really impressive. And I didn't know about that research. That's really interesting. I'm even thinking as, I process things with my husband. We're always communicating in English and that's not his primary language. So I'm even learning how that can impact my marriage. I mean it let alone it a therapeutic relationship. I am curious for someone listening who's realizing for the first time how much culture, language, and lived experience can impact the therapy process. It might feel overwhelming to figure out what kind of therapist would really be the right fit. Maybe they're wondering how to even start looking, especially if there aren't many options that seem to reflect their background. What would you recommend for someone trying to find a therapist who feels culturally affirming and supportive, even if they don't check every box?

Adriana 21:30

Especially in Colorado, I have found that it is not very saturated with a bilingual therapist. It is a great challenge. It's what I've heard with clients that I'm working with directly right now. They said, oh, I found you because you speak Spanish and you work with immigrants, and my parents are immigrants, so you get it. And although I may not a hundred percent get it right, I don't have the lived experience, but I was a witness. And some of the questions that I would ask myself or give to someone who was looking for someone that met some of these boxes, because it's gonna be really hard to find someone who checks all of 'em. But most importantly is oftentimes I would say most therapists do offer a consultation call. And some of the questions that I have trained, some of my young adults that I used to mentor in college were asking do you speak Spanish? What is your professional experience like? What populations did you serve?

Meagan 22:27

And that's such an important point consultations can really help you get a feel for a therapist's approach, what training they've done and their comfort level in working with your community or your set of values, even if they don't share your background or have the same lived experiences. It's not only about identity, it's about cultural awareness, humility, and safety.

Adriana 22:48

The number one thing that helped me find someone who was not bilingual or is bilingual but is not from my culture, is someone that I knew that worked in community mental health served. Spanish speaking Latino families for 10 years, had the professional experience, studied the Spanish language, so she spoke Spanish. I knew she would understand and be able to speak Spanish with me in session. And ultimately what drove me to consider seeing her was those reasons. Now, in my work with her, do I feel a hundred percent seen and comfortable? Honestly I call myself a pinto bean in session and she's Azo bean. I call her bean because I know it's derogative to call a Mexican beaner, but. That's how I associate myself in a form of endearment. But I would say that does she fully understand and grasp what it is like to be a daughter of immigrants? Probably not, primarily what's most important is do they have the professional experience? I think a lot of the exposure and lived experience essentially is what moves me towards. Wanting to work with someone who may not identify with the same culture as me. And when you're looking for someone who is the same culture as you, it doesn't necessitate that it's going to be a good fit. Being a daughter of immigrants speaking Spanish and having experience working with refugees and immigrants does not dictate how well I will do working with you. At the end of the day, what matters most to me is the relationship. Are we understanding each other? And if that's not present, it's not gonna work. So even if we took out all those boxes, I think those are important things to consider as well.

Meagan 24:37

Absolutely. I think that's so well said, and you're right, I can absolutely see how there's so much nuance to it. It is not just about finding a therapist who's the closest match to your identity or your background. In fact, sometimes that can be limiting because you may miss out on a helpful outside perspective from a therapist that doesn't exactly match your identity or background. So maybe the best fit is actually a therapist who we know has the training and or background and lived experience to understand your culture, be respectful and culturally appropriate, and can also adapt their interventions in a way that resonate, but also bring a different lens that helps you see your situation from new angles. There's really no perfect formula it's about how you feel with that therapist. A lot of people don't realize that you can use a consultation call to ask meaningful questions about your therapist's experience, background, and approach. That's your time to get a sense of whether they're the right fit for you, not just in terms of identity, but how they show up in the room and how they'll support and interact with you.

Adriana 25:44

One of the things that oftentimes people ask is if I am not a therapist of color, Latina, black, et cetera, you name it how do I ensure that I take really good care of someone who's sitting across from me that is very different from me? And essentially there's no black and white answer to that. Just there's no. Specific black and white answer to how to find that therapist. That is a good fit because I have found many of my friends that are Latinas that have found white therapists that have been a way better fit than Latina therapists that they have worked with. And there's just too much nuance to really get to the little bits and pieces to address that. But essentially, when it comes to working with someone who looks very different from you, I mean it. It also lands on me because I'm working with people who are from different countries, like when we talk about Mexico. Mexico has various different states and there's still like a slight difference in dialect, in food, and how people communicate and what certain words mean, and it varies across other cultures as well. That are in Latin America or Central America like I think of in Spanish, like in Mexico means like right now. So if my mom tells me. Go clean your room. I that like it means now, go do it now. Whereas in Cuba, when someone says I that it just means, oh, I'll take care of it later. There's there, there's a big distinction in that and I come back to the source of, okay, what equips me to be able to show up for individuals that look different than me? I do not believe in the concept of. Being culturally competent because in the same way as therapists, no matter how much modalities we learn and how much training we get, I don't necessarily believe that we're ever gonna be competent in all areas. We're constantly learning, and that's the same perception I have when it comes to working with. Someone who's different. Any white therapist who's working with another white client, how often are they consulting about that individual? Because every single person that you're working with, the treatment is so individualized. And what takes me to the core of this is, although I do not believe on ever being culturally competent. I do believe in cultural humility, which is essentially you recognizing that you don't fully understand another person's experience because of your background and that you're willing and open to learn from your client and having that mindset when you're working with someone different from you. It allows the client to be the expert in their own life, within their own culture experience, rather than us going in and making assumptions from all the generalizations and stereotypes that people have made about that culture. It makes me think of even multicultural counseling. When I took multicultural counseling, I cannot tell you how many times in the book when it talked about working with Hispanic clients, there was so much generalizations and stereotypes that don't fit every single family. It's not the truth of the. Human. We need to involve ourselves and get curious about who's sitting in front of us rather than relying on what Google says or the generalizations you've read on that multicultural counseling book, or the assumptions that you've made as a result of surrounding yourself with these communities and making assumptions about what you have heard.

Meagan 29:22

I really appreciate your reframing of what it means to be culturally competent for so many of us, especially those of us with privilege, it's really helpful to let go of the idea that we can ever master being a hundred percent competent in someone else's culture. Cultural humility reminds us that the work is really ongoing. It's about being open, willing to learn, and creating space for clients to lead us through their lived experience. That's such a good point to look at the limitations of multicultural counseling as it stands right now. We definitely need so much more research and more development in that area. I. I know even through my grad school experience, our multicultural counseling class and the multicultural counseling textbook that we used, had exactly one paragraph on counseling women and the entire thing. And I don't know if I went and started a women's based mental health practice, almost in response to that, but it was like, wow, that is vastly under-explored and underserved. And if it was that way, and I noticed it so clearly for women, of course it would be that way for other demographics as well. And in so many ways, we've just scratched the surface. But I think as a white therapist too it's almost a relief to hear you say that we can never be fully culturally competent. 'cause I think so many of us who recognize our white privilege, and we're really trying our best to be culturally inclusive and respectful of our clients cultures and adapt interventions the right way. It's the sense of you're never gonna be good enough at it. And maybe that's just part of the process is. Accepting that and appreciating that we can never truly have that lived experience. So we can never be perfectly a hundred percent culturally competent at it. And it's more about trying to get there and doing your best along the way, rather than ever reaching that perfect level.

Adriana 31:12

Yeah. I think a lot of what you mentioned of what you learned in your grad program and how there was only one paragraph, that is. Very synonymous to working with refugees and immigrants. There's no specific modality that tells me this is how you work with the Somalian refugee and this is how you work with an Afghan, and this is how you work with someone with Iran, and this is how you work with someone who's from Congo. There's no. Specific way to maneuver and figure out what to do. And at the end of the day, it's core to be open to growth and learning. And when it comes to working with these clients that are so diverse, one of the things that we do as therapists, while I would hope every therapist does this, is. Validate validation. If we validate our client's experiences, whether individual or within group settings with whatever it is that they have survived, I. Is going to allow them to feel far more safe and seen and open to being more vulnerable. Because what I have learned in my journey in working with refugees and immigrants is there are certain practices that sound very bizarre. And clients can see our reactions and how we respond to some of the things that they're sharing that have helped them persevere, that help them be resilient and that have helped them move forward. And although what we're hearing may sound bizarre, our role is not to judge what is working for them, but to come back. To validate and take proactive steps outside of our session with them to educate ourselves about that specific practice. Rather than making assumptions of how harmful or not harmful this is being to them, and it moves us away from making assumptions and rather in session we can get more curious and demonstrate genuine interest and understanding their background and their practice and their traditions and their values.

Meagan 33:21

Yeah, that need for validation, and I love the word curiosity as a counselor showing up with curiosity and a complete lack of judgment, being able to validate different cultural norms and in the way different coping skills work for different people from different areas. That's so important, especially in the United States, given that we are a melting pot and a country founded by immigrants. The fact that this country was built by immigrants is the beauty of it. Diversity is the beauty this country, and I wish it was better reflected in the mental health field and all medical fields. We have so much research to do and such a long way to go, but I think a lot. That you've shared here today is paramount and key to that process. And as we're closing out and getting to the end of our time, I am wondering if you can share a little bit to the clients who are listening to this and saying yes, I totally am on board. I really feel like I need to do the work to find a really good counselor that matches me and understands my culture enough to support me. What would you say are maybe some red flags for those clients to look out for? When they're searching for a therapist, or maybe even if they're already working for with a therapist and are not feeling like it works out, what are those red flags of a therapist who is not culturally inclusive?

Adriana 34:40

I would be curious to know about are there any culturally relevant approaches that they have to therapy? Are they utilizing techniques that resonate within a client's value system? Whether that's narrative therapy because narrative therapy, like just even narrative exposure therapy that was created in the Middle East, like a lot of collectivists and cultures are storytellers and they wanna bring in stories and they wanna unpack those stories. Are we integrating that? Are we integrating their. Spiritual frameworks that exist within their culture. Are they making attempts to engage in cultural adaptations? Because the modalities that we work with here within Western therapy, there's, they're very westernized, but do they make the effort to bring in culture? Into those Western modalities, and at the end of the day, are they willing to be curious to learn about the context of where they come from, to ensure that I and the client speaking for myself or the person who's looking for the therapist can feel safe? Most importantly, seen and heard.

Meagan 35:52

Well said. You are just such an inspiration, Adriana, and I thank you so much for coming onto the podcast today to share your wisdom about this. It is clearly something that is, so inherently personal and important to you. It's. Something we can feel your passion in and you just have so much to offer to your clients and to your fellow therapists as well. I wanna thank you for your time and wanna invite you to share if you have any last minute thoughts for other Latinas out there who may be listening. If there's anything you wanna share to them,

Adriana 36:24

all I wanna say to all you Latinas is

Meagan 36:29

Thank you, Adriana.

36:30

Today's conversation reminds us that therapy is never one size fits all. A therapist culture, language, and lived experience matter, but so do continuing education, humility, curiosity and safety. whether you're a client seeking care or a fellow clinician doing the work, their relationship is at the heart of healing.