Latino Program Therapists Speak Patients’ Language

Fernando sat at the table and gazed sourly at the irregularly shaped pieces of colored paper in front of him. Go ahead, the therapist urged him, fit them together. Joined correctly, the pieces form a big T, she said.

“This is what we call in Spanish a rompe cabeza, “ said Fernando, a patient at Ingleside Hospital in Rosemead, still keeping his distance from the puzzle. Translated literally, the Spanish expression for “puzzle” is “head-breaker.”

“That’s right,” said recreational therapist Arcelia Vasquez-Davis. “Pero no quiero que rompen la cabeza. But I don’t want you to break your heads.”

The small group of patients laughed. Recreational therapy with a little Spanish frivolity? For Fernando--whose name has been changed for this story and who said his mind was not clear enough to match triangles and rectangles that evening--maybe it offered no great breakthrough, Vasquez-Davis said afterward. But the moment had provided a small opening for the others to reach a troubled patient.

Fernando began gamely working with a partner on the puzzle.

That, of course, is the point of Ingleside Hospital’s new Hispanic Tract program: Give Spanish-speaking or bilingual patients, who often suffer from the special alienation of living in a foreign culture, a sense of attachment to their surroundings.

Bilingual therapists, camaraderie between fellow Latinos, jokes in Spanish, cultural empathy--these are rare commodities in private or nonprofit psychiatric hospitals, says Dr. J. Eduardo Guzman, a psychiatrist and head of the Ingleside program.

They’re also immeasurably important, he said. “In general medicine, the patient comes to you with an inflamed appendix and says, ‘Please, doctor, take care of me,’ ” Guzman said. “But in psychotherapy, we are asking the patient, ‘Please let us take care of you.’ ”

Three months ago, Ingleside and another Rosemead hospital, CPC Alhambra, part of the national Community Psychiatric Centers chain, began offering those kinds of enticements to treatment for Spanish-speaking patients. They are the first such programs in the Los Angeles area.

At Ingleside, a 146-bed acute-care psychiatric facility, the Hispanic program means semiweekly sessions with Spanish-speaking occupational and recreational therapists, group therapy using both Spanish and English, and one-on-one counseling and testing by bilingual psychotherapists.

It also means having bilingual nurses on duty around-the-clock, said Guzman, who heads Hispanic Health Professionals, a Montebello-based group of Latino mental health professionals who have contracted with Ingleside to staff the Hispanic program. “It makes a big difference if, say, your aunt or your grandmother is having a heart attack in the middle of the night and she can tell someone, ‘Hey, it hurts me,’ ” the psychiatrist said.

CPC Alhambra, whose administrators say more than half the population within a 10-mile radius of their building on Rosemead Boulevard is Latino, provides its Spanish-speaking patients with bilingual therapy and a lounge where they can watch Spanish-language television shows. The 98-bed private hospital also offers Spanish-language reading materials, such as pamphlets from Alcoholics Anonymous.

“Having bilingual staff provides an immediate bonding tool,” said Jeff Thrash, program director of CPC Alhambra.

Until the two hospitals started their programs in September, psychiatrists who wanted to hospitalize Spanish-speaking patients had two choices, said Thomas Carrillo, a psychologist at Ingleside. They could send their Latino patients to county or state psychiatric hospitals, which are jam-packed with the urban poor, or to inadequately prepared private hospitals.

“The assumption is that if you’re Spanish-speaking, you’re poor, and you go to state or county facilities,” Carrillo said. “But that’s a misconception. There’s a growing Latino middle class. If something happened to my mother, I’d want her in a private facility.”

Both Ingleside and CPC Alhambra hope to attract Latino patients who are covered by third-party insurance programs, such as those provided by labor unions or large employers.

Most private facilities, even well-meaning ones, don’t have enough Latino professionals to go around, Carrillo said. “They’re worth their weight in gold.”

Therapy by Interpreter

The result is often “therapy via an interpreter--which is ludicrous,” Guzman said.

Mental health professionals say Latino patients have all the usual stress-related problems of modern life, compounded by special cross-cultural stresses.

“We see a great deal of depression,” Carrillo said. “Mexican-born women, say, who were raised in a traditional way. They’re thrown into a new environment here. Their children come home and they don’t even speak Spanish anymore. . . . Men who had been dominant figures in their families. Now they’re no longer the sole breadwinners, and they may even have a small child who speaks English serving as a go-between for them.”

Add to those disruptions an inherent reluctance to seek help for emotional problems, Guzman said, and the result could be serious mental illness. “By and large, Hispanic people are very private people,” he said. “They don’t like to share a lot of intimacies. It’s hard enough eliciting confidences from them without going through an interpeter.”

Vasquez-Davis attacks the problems with a combination of the familiar and the instructive. She said it is important for patients to be successful, explaining the need for cultural sensitivity. “One day we had a cooking activity and we made guacamole. I knew they’d all be familiar with that.”

The recreational therapist tries to connect the activities she supervises directly to the patients’ lives. How did the middle-aged woman sitting across from Fernando feel about working with a partner?

“It was OK,” said the patient self-deprecatingly. “I’m used to taking instructions.” But a few minutes later, she was confessing that she was too passive in frustrating situations. “I’m calm,” she said. “Too calm sometimes. That’s not good.”

Fernando said working out the puzzle had been satisfying--after he had sought help. “You gave me a hand,” he said to Vasquez-Davis.

“So maybe you just need to ask someone to give you a hand,” the therapist said.