CSS Hispanic Counseling Is Addressing Critical Needs

By PRISCILLA GREEAR, Staff Writer

Published: August 21, 2003

ATHENS—A “star pupil” of therapist Carmen Quezada, LCSW, is a young Latina who went from earning poor grades and being influenced by bad friends to ending the eighth grade with honors.

Quezada, a counselor in Athens with Catholic Social Services’ Village of St. Joseph Counseling Services, said that the girl’s Mexican parents acted wisely in bringing their daughter in quickly for therapy when she began back-talking and her grades began dropping, instead of waiting until her behavior became uncontrollable. He parents came to realize their need to be more involved in her education and extracurricular activities.

“They brought her to me and said, ‘Help us. We have this great kid and we don’t know what’s happening with her,’” Quezada recalled. “This girl made a turnaround. She realized the friends she was hanging out with were not taking her where she wanted to go. She just decided this is what she wanted to do. She changed all around, started going back to church ... It took her parents getting involved and making some changes.”

Outreach to youth is just one component of the CSS counseling program, which has six bilingual counselors to offer services in Spanish around the archdiocese-which seem to be desperately needed.

Fifty-five percent of CSS’s clients are now Spanish-speaking; it reports having the largest low-cost, quality Spanish counseling services in the metro area.

Quezada, who largely counsels immigrants from rural Mexico, gave empowerment talks to middle school Hispanic students in the spring on the importance of education. Through a grant from the University of Georgia College of Education, she also spoke to teachers and school staff on understanding cultural issues with Latina youth.

“My main message was trying to help them understand the culture of the Latinas. Latinas are pretty much groomed to be wives and mothers and education is not part of that. If we want them to be educated, we have to partner with parents to get them to see the importance of education for their daughters.”

CSS Village of St. Joseph Counseling Services staff members counsel couples, families and individuals. Areas commonly addressed are marital and family conflict, adolescent issues, depression, anxiety and stress, and the difficulties of different life stages.

Various studies report that one in six Americans will experience a major episode of depression in his or her lifetime, according to a recent National Public Radio report. Overall, the percentage of people receiving medical treatment for depression is rising. But according to a report by the U.S. Surgeon General, barriers like the stigma of mental illness, poverty and language prevent many immigrants from obtaining care. Hispanics are also a minority among mental health professionals.

The 2001 Surgeon General’s report entitled “Mental Health: Culture, Race, Ethnicity” reported that, while the percentage of Spanish-speaking mental health professionals is not known, only about 1 percent of licensed psychologists who are members of the American Psychological Association identify themselves as Hispanic.

Moreover, there are only 29 Hispanic mental health professionals for every 100,000 Hispanics in the United States, compared to 173 non-Hispanic white providers per 100,000.

The report also states that among Hispanic immigrants with mental disorders, fewer than one in 20 uses services from mental health specialists, and that one study found that only 24 percent of Hispanics with depression and anxiety receive appropriate care compared to 34 percent of whites. Connected to their high poverty rate, nationally 37 percent of Hispanics are uninsured compared to 16 percent for all Americans.

The CSS program is doing its part to fill that need, offering sliding-scale fees. Locations are at the central office at 1961 North Druid Hills Road, at St. Thomas Aquinas Church, Alpharetta, St. Joseph Church, Athens, St. Patrick Church, Norcross, and The People’s Center, Gainesville.

Five of its Spanish-speaking therapists are usually booked, receiving referrals from parishes, hospitals, schools and Departments of Family and Children’s Services. However, a newly hired counselor still has openings.

The demand for Spanish counseling “has been growing very, very rapidly,” said Eglee Treber, LPC, CSS’s first Spanish-language counselor who came in 1995.

Regarding the stigma, Treber said the traditional belief in Latin America has been that counseling is for “crazy people” and the weak, and typically people turn more to a priest or family member for help. But gradually counseling is becoming more accepted and understood both here and in Latin America.

Treber said the overwhelming process of learning a new language and culture naturally evokes depression among some immigrants, and can also cause Latino youth to fall behind in school. Acculturation often intensifies other struggles and may also bring suppressed or ignored psychological conditions to the surface. It has been compared to post-partum depression. Just as depressed mothers can come to experience joy from the new life, immigrants, as they adapt to the United States, can come to experience the joy of becoming bicultural.

“(Migration) brings a lot of sadness for what you left behind. It also brings a lot of anxiety of having to adapt to a new culture, learning a new language and making new friends,” said Treber, who immigrated from Venezuela at 26, when her father came for a sabbatical at the Centers for Disease Control and Prevention.

“A lot of people feel very lonely because they don’t have a support group or because they’re not close to family anymore. These are very, very important support systems of Hispanics.”

Sometimes they “feel like a different person” as they lose hobbies or are forced to take jobs outside of the field in which they worked in their homelands.

Or they may just struggle with culture differences. Hispanics, for example, tend to be more family- and community-oriented and it’s culturally acceptable for adult children to live at home until they marry.

“During the process of acculturation, I’ve seen how they progress from being afraid and anxious and scared to being more adapted and being able to learn from the culture ... make a difference in the country and have more relationships and increase the quality of their job,” Treber said. “A big issue is to help them to adapt to become the person they want to be here in this country ... At the end, after they adapt, it’s a wonderful experience, being bicultural.”

One woman from Uruguay, who works with Treber, expressed gratitude for the counseling in Spanish, which is not covered by her health insurance. She said counseling is uncommon in Uruguay. Until a friend at church suggested it, she hadn’t thought about seeing a counselor when she felt unable to manage her family life and work. It’s helped her to improve her self-esteem, manage relationships and become organized.

“I’d say it’s hard for Hispanics to see a counselor because they’re not used to it,” she said. “It took me a long time to get me to make a decision to see a counselor because of the idea that if you need a counselor it’s because you’re sick ... Sometimes when you go through difficult times or even everyday situations you can feel that it’s hard and you don’t know exactly how to manage them. I find seeing a counselor is helping me find a way to solve these situations in a positive way, to think about myself in a positive way and improve my relationships.”

Treber, Quezada and other CSS Spanish-speaking counselors hope to give more talks to Hispanics on mental health issues. Treber now leads a support group for women, works with at-risk youth in schools and offers a parenting class.

“The prevention part of counseling is a big thing. It’s not just treatment when things get very, very bad,” she said. “I’ve had couples get to know each other better or improve communication skills because they’re planning to get married.”

There’s also a need for more Spanish-speaking psychiatrists in county health departments to whom counselors can refer people for medication without interpreters. Also, it’s important for therapists to understand Hispanic culture or they may misinterpret behavior, like thinking a young adult has dependency issues just because he’s living with his parents.

Some of CSS’s clients are undocumented immigrants, frustrated with the lack of access to health care and living with a sense of insecurity and instability. “They are here, but it’s like they always hope to go back. They don’t make an effort to completely adapt. They see it like a transition situation.”

Both Treber and Quezada have worked with many women who have fallen into depression, as they came to the United States to be with their husbands who came to work. Some come seeking help with their marriages that they don’t know how to repair.

“It’s not their decision to migrate so it’s more difficult to adapt ... I help them to get a life here and to continue growing as a person, to find activities to be involved in and to continue having goals,” Treber said.

Because children are in school they generally adapt better than their parents and speak better English, which can sometimes create barriers between the two generations. And problems can arise when parents use their children as interpreters, giving them inappropriate adult responsibilities, Treber continued.

While they may speak more English than their parents, many Hispanic youth are struggling academically, reflected in how today one of every three Hispanic Americans has dropped out of high school. To address that issue, the CSS Community Outreach Center in Athens just received a $50,000 grant to begin a new Juvenile Justice Delinquency Prevention /Treatment Grant Program working with Hispanic youth at risk of dropping out of school and joining gangs. Bilingual and bicultural psychologist Adan Alvarez will meet with gang members at their street hangouts to work with them and propose positive activities and lifestyle changes, and lead empowerment groups in public schools on values, self-esteem and education.

The grant will also make counseling available for more families. Quezada said that while Anglos may be unfamiliar with gangs “most of the Latino kids you talk to all know about the gangs, how many there are and where they’re located. For Athens it’s a big problem and if it’s not taken care of it’s going to be a huge problem.”

The therapist said that other conditions that make youth at risk for joining gangs are defiant behavior and a sense of alienation.

“Truancy is a big problem or running away. We’re seeing a lot of that with girls, especially, leaving school and trying to come back to catch the bus,” she said. “They feel unconnected. They might not know the language or not be doing well in school. The gangs give them a sense of belonging, some protection there. When you belong to a gang nobody touches you.”

The CSS Athens Center director, Stella Sailors, said that CSS is covering new territory with the grant.

“Working with the court, we know a lot of the kids are gang members. They feel the community doesn’t understand them, the society doesn’t understand them,” said Sailors. “This is a completely new project for us. I am a tough woman trying to do this. I don’t know the field at all. I’m learning.”