InvisALERT Solutions – ObservSMART

What Gets in the Way: Latinas Who Don’t Access or Stay in Treatment

As social workers in urban settings, we often hear about the traumas our female clients endure. These include experiencing or witnessing: sexual assaults, parental abuse/neglect, domestic violence, child fatalities, and life-threatening illnesses/injuries (Gaillot 2010). Women are more likely to develop Post-Traumatic Stress Disorder (PTSD) in response to trauma (Gaillot 2010). While the need for mental health treatment for women in general is great, this article will focus on the obstacles Latinas face when accessing and remaining in treatment.

The primary barrier preventing Hispanic women with unresolved traumas from entering or continuing treatment is their role as parents. When overwhelmed by their children’s acting out, women first seek treatment for their children. It was through treating Jacqueline, a 12-year-old exhibiting behavioral problems, that I discovered that her mother, Joanna, had had her nose fractured by Jacqueline’s father when she was pregnant. Once, because of another mother’s judgmental attitude towards her daughter, Samantha, my sassy client, I grew angry with the mother. Two years into treatment, when I found out Samantha was conceived by rape, I began to empathize with her mother. A woman who I felt lacked adequate parenting skills had endured a horrific trauma and was expected to deal with the result of it – a child – for the rest of her life.

Even Hispanic women who enter treatment for themselves may focus sessions on their children.  The trauma(s) a woman endures will undoubtedly affect how she parents her children.  A mother might not know how to demonstrate affection, resulting in poor parenting. This can become the main topic of sessions, preempting the focus of trauma. Enid and Gabriela, both Latinas in their 30s, have difficulty displaying affection to their children.  Enid, who began wearing prosthetic legs as an infant, was verbally abused by her mother because of her disability. She did not experience maternal love, so she does not know how to demonstrate it. Gabriela, who was molested as a child by her brothers, felt awkward bathing her son because she feared being accused of molestation. In addition to facing challenges in caring for her children, an Hispanic woman may go to extremes to protect her children or may become too permissive. Selena, 43, molested by her uncle and experiencing intrusive trauma symptoms, utilized much of her sessions to discuss the issues that resulted from her permissive parenting.

When an Hispanic woman does not have childcare or has limited finances, this further impedes treatment. Kathy, 28, was held hostage by a female friend and the friend’s father.  When we commenced treatment two years ago, Kathy attended sessions with her children who were too young to be left in the waiting area.  Despite her partially speaking Spanish (so the children could not understand) and whispering some words, the circumstances did not allow her to freely express her emotions. It was not until Kathy’s homemaking services were put into place that she and I were able to explore her feelings about this tragic event impacting her ability to trust. A woman’s limited finances can also hinder treatment.  She may not have health insurance or her finances for co-payments and carfare may be limited (Davis et. al. 2008). Annabelle, 24, was sexually abused by her mother’s boyfriend and her adoptive uncle. One way that her PTSD manifests itself is in her inability to travel alone. She cancels sessions because she lacks travel expenses for her and her family.

Women with PTSD are twice as likely as men to report concern over being judged for their trauma(s).  One reason for this disparity is that women and men experience different traumas. Women are more likely to experience rape and molestation, which may be perceived as more stigmatizing (Gaillot 2010).  Women who have endured sexual traumas may become promiscuous, which is a form of detachment from the trauma. The woman no longer views sex as a connection between individuals who care for each other; it is simply a physical act.  Myrna, 49, experienced multiple traumas, including domestic violence, rape and a home invasion. She engaged in risky, unprotected sex with multiple partners. Myrna did not disclose this until many months into treatment, indicating that she felt shame about this behavior. Latinas may also be hesitant to speak openly about sexual traumas, out of fear of being disloyal to the family or being perceived by their community as disloyal.

PTSD symptoms of avoidance and hyper-vigilance may cause women to terminate treatment prematurely. A client who is normally very compliant may avoid sessions once she is processing her trauma(s) (Davis et. al. 2008).  Hispanic women may experience this in a more conflicting manner. On the one hand, they want to avoid painful feelings, yet they want to uphold the cultural value of “saving face.” Case in point, as a child, Tanya, now 33, was sold for sex by her mother, enabling her mother to purchase drugs. As our work intensified, Tanya began to skip sessions. When this avoidance was addressed, Tanya said “I did not want to disappoint you.” She valued me as her therapist and thought I would be bothered by her not wanting to explore her trauma. Clients may also dread the realistic fear that hyper-arousal symptoms will resurface or get worse as the treatment progresses. A mother’s symptoms of hyper-vigilance, which had dissipated, resurfaced when she became increasingly concerned about her daughter. The mother’s fear that someone would break into her home caused her to sleep with a knife under her pillow.  This was her way of gaining back control.

Other barriers to accessing treatment for a Latina survivor of trauma include a lack of therapists who speak her native language, ineligibility for services, active self-mutilating behaviors/being actively suicidal and past or current substance abuse (Davis et. al. 2008). Dealing with one’s trauma(s) can trigger a relapse, as can any crisis. An example is Alma’s grief over the death of her 21-year-old nephew, who hung himself. During stressful times, Alma’s unresolved grief compelled her to consume more alcohol to escape painful emotions. Another example is a mother who resumed drugs when she realized her daughter’s hyper-sexuality mirrored her own behavior that resulted from her traumas. An additional obstacle is that the therapeutic relationship is built on trust, and a Latina’s traumatic history can make establishing such a rapport difficult. Hispanic women who have experienced sexual traumas and whose perpetrators were men will have an extremely hard time opening up to male therapists, if at all.

When treating Latinas with traumatic histories, clinicians must take into account the aforementioned barriers. The following are practice considerations when working with Hispanic women: 1) When a Latina’s sessions revolve around her children, the therapist must acknowledge the importance of her family, while assessing whether her focus is resulting from avoidance. 2) An Hispanic client who lacks childcare may need the therapist to help her obtain childcare. Or, the therapist may postpone dealing with emotionally laden issues while waiting for such services. 3) In order to remove the burden of traveling with limited finances, the therapist might consider home visits. 4) The therapist must uphold the Latino value of “respeto” (not bringing shame to one’s family/community) that a Hispanic woman may feel when processing her trauma. Of equal value is acknowledging that silencing painful traumas will not help her feel better. 5) A woman receiving Trauma-Focused Treatment must be informed that she will likely feel worse before she feels better. A Latina experiencing avoidance may feel the double bind of not wanting to deal with the pain of the trauma and not wanting to disappoint her therapist. The therapist will need to acknowledge this and possibly allow the processing of the trauma to slow down. As therapists, we must commend Latinas who, despite all these barriers, are able to effectively process their traumas.

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