Why Culturally Competent Therapy in Your Native Language Is Important

To build a world where everyone has access to exceptional mental health care, cultural competency and humility aren’t just a nice-to-have in therapy — they are imperative. As we enter Hispanic Heritage Month and celebrate our expansion of therapy services into Florida (where around 27% of the population identifies as Hispanic or Latine and more than 4 million residents speak Spanish), we’re shining a light on some of the issues that Hispanic/Latine people may face when accessing mental health care.

There’s a significant gap in mental health care among Hispanic/Latine populations: Nearly 35% of Hispanic/Latine adults with mental illness receive treatment every year compared to the U.S. average of 46.2%, which can be due to a lot of barriers. First, there’s language — according to research, therapy is twice as effective when conducted in the client's native language. But less than 6% of psychologists in the U.S. offer therapy in Spanish. Not only can therapy in a non-native language be a more challenging experience for the client, it can also lead to misdiagnoses based on language barriers. 

On top of language, there is a range of other obstacles that people from Hispanic/Latine communities may face when trying to receive the mental health care they need, like cultural stigma, immigration challenges, and financial difficulties — in 2021, Hispanic/Latine people were among the highest uninsured in the U.S. at 17.7%. Despite participating in the workforce at higher rates than non-Hispanic populations, Hispanic/Latine adults are less likely to receive employer-sponsored health insurance.

Because of all these disparities, it’s crucial that we support Hispanic/Latine people in their mental health journey with therapy tailored to them. To that end, we’re thrilled to share that we are now offering bilingual Spanish-English care to clients in Florida. 

To celebrate this milestone, we sat down with a few of our therapists in Miami (where almost 70% of residents identify as Spanish-speaking) to talk about therapy in languages other than English, shared cultural experiences with clients, and how Two Chairs can work towards improving the state of mental health care in Florida.

What has been your experience, personal or professional, of how doing therapy in a native language impacts the experience and overall effectiveness?

Joni Dueñas: In my experience, being able to speak to a client in their native tongue helps start off the therapeutic relationship on a more vulnerable and deeper level, as the client’s worldview is already more understood by sharing language. It is easier and faster to build rapport when, as a therapist, I am able to share a part of my identity with a client.

Jessica Alonso: I am a proud first-generation Cuban-American, raised by my maternal grandmother who was a Cuban exile and who only spoke Spanish. Naturally, my first language was Spanish, and when I think about and reflect on my personal experiences, I tend to refer back emotionally, mentally, and spiritually in Spanish (i.e. praying for me occurs inside my head in the Spanish language). Neurolinguistically speaking, I feel an immediate sense of comfort and familiarity when I am able to speak to others, including my clients, in my native language. 

Majd Alsakloull:  I’m not entirely fluent in Spanish, but even with my limited Spanish, I notice how my clients are immediately more comfortable in sessions. Furthermore, when I have Arabic-speaking or Muslim clients in general, it instantly speeds up the rapport-building part of therapy sessions. Clients feel that someone who speaks their own language and practices their own religion will not have to go through the extra steps of explaining how certain things are in their life, be it cultural or religious practices.

In your experience, how have you seen cultural mental health stigma play a role in your clients’ experiences in seeking care?

Joni Dueñas: In my experience, cultural stigma exists in that there is a distrust of sharing intimate information with an outsider, which traditionally has been a professional that is a different race than the client. With more clinicians identifying themselves in their own cultures, I have seen a higher likelihood of trusting the therapeutic process. The awareness of how mental health affects people has also played a role, especially since our society as a whole has put more importance in the need for therapy. This shift also acts as a starting point to begin changing that distrust. 

Jessica Alonso: I have most definitely seen greater stigma attached to Hispanic males in particular, who have suggested the need for assistance when it comes to their feelings and overall mental health. It is very common within the Hispanic community to be viewed as “weak and/or crazy” when not conforming to the “machista” ideals. Additionally, as stated by Joni, there is an immense amount of distrust, which in my professional experience is greatly related to issues with immigration status and the fear of deportation. 

Are there any dominant cultural narratives that are embedded into the current practice of therapy that might put off people from marginalized communities from continuing to attend?

Majd Alsakloull: I think certain therapeutic practices cannot be applied broadly to all clients and cultures. For example, setting boundaries with parents is not as applicable for people of different cultures and backgrounds.

Joni Dueñas: Agreed with Majd. 

Jessica Alonso: Well said, Majd! 

According to research, Florida ranks 49th in the United States for access to mental health treatment. As a therapist in Florida, how do you see this playing out? What do you think contributes to the problem?

Joni Dueñas: I think it is evident that Florida is 49th in that there is not a lot of cohesion with providers and resources for clients. Due to lack of funding, most providers and agencies are focused on keeping themselves afloat, and there is little opportunity for building connections in the community that can help a client with every level of care needed.

Majd Alsakloull: I honestly don’t see much change happening, at least not in the near future. Mental health is not a priority in the political sphere here, it isn’t funded adequately, and there aren’t enough resources for clients and help for clinicians to avoid burnout.

Jessica Alonso: While I agree that it is indeed obvious that Florida is 49th in the U.S. when it comes to mental health services, I believe even more strongly in an amazing paradigm shift that is unfolding with younger generations demanding the services that should naturally be available to all individuals. I believe companies like Two Chairs have and will continue to be examples of the paradigm shift expressed above, where people will easily locate and access outstanding mental healthcare. 

What difference can Two Chairs make in improving access to mental health care in Florida? 

Majd Alsakloull: Two Chairs can be the voice of the voiceless, giving clients and clinicians the opportunity to feel heard and seen. 

‍Joni Dueñas: Two Chairs can and will provide quality mental healthcare for clients as well as connect our Florida clients to resources as we continue to build our presence in the state. We want to be able to help clients when they are in their most vulnerable state and empower them to move towards a healthier life balance.

‍Jessica Alonso: Two Chairs has provided such an amazing environment for its therapists overall, where the ideas of an environment that celebrates diversity, equity, and inclusion are not just “fluff words,” but rather a must! The community we reside in is incredibly diverse and very much in need of equity and inclusion, and Two Chairs will undoubtedly continue to pioneer this positive shift in perception with regard to mental health services for all.

This post has been reviewed by Kristen Colley, LMFT.