Cuento therapy: A culturally sensitive modality for Puerto Rican children.

Abstract

Epidemiological studies indicate that Hispanics underutilize community mental health facilities in proportion to their needs and often fail to benefit from traditional psychotherapeutic services. This study investigated the effectiveness of a modeling therapy designed to be sensitive to Hispanic culture. In one version of the modality, cuentos (folktales) from Puerto Rican culture were used to present models of adaptive behavior and in another version folktales were tailored to bridge Puerto Ricans' bicultural conflict. High risk children (from kindergarten through third grade, N=2\0) and their mothers were randomly assigned to receive either cuento therapy, traditional therapy, or no therapy. Results indicated that cuento therapy significantly reduced children's trait anxiety relative to traditional therapy and to no intervention, and that this trend was stable over 1 year. The cuento modalities also increased Wechsler Intelligence Scale For Children-Revised (WISC-R) Comprehension subtest scores and decreased observer-rated aggression. The need to develop and evaluate culturally sensitive therapeutic modalities for Hispanics is discussed.Critics of mental health services in this country have voiced the need for Hispanics to have therapeutic services that take their culture into account (Padilla, Ruiz, & Alvarez, 1975;Rogler et al., 1983). Three approaches to the delivery of culturally sensitive services have been identified (Rogler, Blumenthal, Malgady, & Costantino, 1985). The first approach calls for increasing the accessibility of services by incorporating bilingual and bicultural staffinto mental health facilities. This is based on the assumption that Hispanics will thus experience less cultural upheaval in seeking and remaining in treatment (Acosta & Cristo, 1981;Scott & Delgado, 1979). The second approach argues that the therapy Hispanics receive should be congruent with their culture or should be modified to include cultural values (Cohen, 1972;Padilla et al., 1975). For example, while working with Cuban substance abusers, Szapocznik, Scopetta, and King (1978) developed a version of family therapy based on the familiocentric tradition of Cuban culture. This approach suggests that therapy should stand in an isomorphic relation to the client's culture or that cultural values should be mirrored

Ecological validity and cultural sensitivity for outcome research: Issues for the cultural adaptation and development of psychosocial treatments with Hispanics

“…In reference to the Latino family, Mufioz (1982) highlighted the importance of welcoming clients in such a way that they may feel understood, comfortable, and in familiar surroundings with objects and symbols of their culture in the office or waiting room. Additionally, the intervention itself could include culturally consonant ideas, refrains, and images such as the cuento therapy (Constantino, Malgady, & Rogler, 1986) developed at the Hispanic Research Mental Health Center in the Bronx, New York. "Dichos," that is, sayings or idioms, have been described as a useful means of introducing methapors in the therapy with Latinos.…”

Toward evidence-based interventions for diverse populations: The San Francisco General Hospital prevention and treatment manuals.

“…For instance, use of group-specific customs or values as the primary means of intervention, as in cuento therapy for Puerto Rican children (Costantino, Malgady, & Rogler, 1986), appears very promising. Our team has not empirically assessed the relative efficacy of different approaches for selecting culturally-appropriate therapeutic principles, but we believe such research would be of great benefit.…”

Recruiting and retaining low-income Latinos in psychotherapy research.

“…For example, cuento therapy, a treatment that provides ethnically appropriate role models for Puerto Rican children and adolescents to bridge bicultural conflict, has been shown to be effective ( Costantino, Malgady, & Rogler, 1986 ;Malgady, Rogler, & Costantino, 1990 ), as has bicultural effectiveness training aimed at treating cultural conflict and acculturative stress in immigrant families ( Szapocznik et al, 1986 ). Latinos do face special stresses associated with immigration, and appropriate interventions for those stresses are needed.…”