For Latinos, New Dawn in Psychology : Therapy: An unusual program uses elements and symbols of Spanish-language culture to treat emotional problems.

The man stood with his hands dangling at his sides, staring vacuously at the woman before him, as the audience watched from folding chairs placed in a semicircle.

“I get sick of not seeing you working,” the woman said in Spanish. “I want you to do something.”

He shrugged. “I’ve changed,” the man said. “I’ve come back because I want to be a family again. I’m not the furniture you thought I was.”

The action was interrupted by a young man in shorts who jumped up from one of the chairs and pretended to do a commercial. Then came the ponderous voice of an offstage narrator asking the big questions of the moment.

“Will Rosendo find a job? Will he get sick again? Will he learn to be a man?”

The stuff of soap operas?

Certainly.

But also the stuff of an unusual therapy program using elements of Latino culture--in this case the Spanish-language soap operas popular in Southern California and Mexico--to treat the problems of Latinos.

Except for the absence of a camera, the format was pure television. The actors were patients with psychological problems, playing roles crafted for them by the therapist.

The situations were real, taken from the lives of the participants.

Rosendo, a Guatemalan immigrant, had stopped going to his job as a laborer months before, complaining of back pains. Instead of working, he had stayed home in a funk, sitting on the couch until his wife threatened to leave him unless he got professional help.

Another member of the group, a woman from Mexico, had been referred by a psychiatrist after her 17-year-old son fatally stabbed her husband, who had abused her for years.

The problems are not uniquely Latino.

But, said Ignacio Aguilar, the appropriate treatment just might be.

“Traditional psychotherapy is (non-Latino),” said Aguilar, 63, a licensed clinical social worker who coordinates the program at Bellwood Health Center, a private 67-bed facility in Bellflower. “We have to use cultural ways of dealing with them.”

The goal: by using elements of the culture familiar to them, to reach Spanish-speaking people who cannot relate to traditional psychotherapy.

It’s a tall order, of course. Even traditional therapy, based on the belief that people can master problems by openly exploring and confronting them, is, at best, an iffy proposition. Most therapists concede that mental health is in many ways subjective, and that progress is not always steady, obvious or measurable.

Adding culture to the equation makes it even more complex.

While traditional psychotherapy encourages self-exploration as a means of personal growth, experts say, many Southern California Latinos come from backgrounds in which the daily struggle for survival makes therapy seem luxuriously self-indulgent.

In such a context, problems are borne stoically rather than solved, and one’s “fate” is seen as one’s master.

But culture introduces a whole new element to the mix, Aguilar said.

By inculcating would-be patients with the forms and symbols of their own culture, he maintains, experts can create naturally therapeutic situations.

Soap operas are a case in point. While popular in many cultures, they seem to have special significance to Latinos, some of whom relate to the soaps more than they do to their own lives, he said.

So performing psychodramas patterned after soap operas, he said, creates a non-threatening environment in which patients feel free to act out their problems, and, thus, to begin to deal with them constructively.

In addition, Aguilar said, the program uses Latin American proverbs, folklore, poetry, crafts, music and dance to treat patients suffering from depression, anxiety, panic and alienation.

It also uses symbols from the Aztec calendar to characterize specific ailments and to chart the patients’ progress.

To be sure, this isn’t the only mental health program struggling to accommodate the rapidly expanding ethnic diversity of Southern California. Several area centers feature programs tailored to the needs of Southeast Asian refugees. And a number of centers--including El Centro in East Los Angeles--attempt to treat Latinos by employing therapists who are bilingual and bicultural.

But Aguilar is seen by many as ahead of the field.

“We talk about utilizing these techniques,” said Rebecca Bejar, a licensed clinical social worker at El Centro, “but Ignacio (Aguilar) has been one of the forerunners in actually implementing them.”

Geraldine Esposito, executive director of the Sacramento-based California Society for Clinical Social Work, the largest group of its kind in the state, sees Aguilar’s work as “marvelous” and “trend-setting” because “it approaches people with respect.”

And, said Sergio Martinez-Romero, a social psychologist who teaches at Cal State Los Angeles and president of the California Hispanic Psychological Assn., the Bellwood program goes a step beyond most by not only translating traditional therapy into Spanish, but also by using symbols and imagery of the culture itself to get patients involved in the therapeutic process.

“It is able to reach people where they are and bring them to a place where they can be treated,” Martinez said.

As a group, Latinos are not always easy to treat.

While, in general, their symptoms are not unique, mental health professionals say, the problems, especially for recent immigrants, are often made worse by the experience of trying to fit into an intolerant, alien culture.

“Here the (Latinos) are part of the landscape,” said Aguilar, who was born in Mexico. “Their culture hasn’t been recognized; it’s been put down.”

As a result, he said, many Southern California Latinos who were born in other countries suffer a wide range of problems in adjusting.

Some who experienced traumatic political conditions in their home countries react with a natural distrust of the institutions and authority figures they encounter in the United States, said psychologist Jorge Cherbosque. Besides feeling guilty for leaving loved ones behind, he said, some immigrants who came from war-torn countries suffer post-traumatic symptoms, such as flashbacks and sleep disturbances.

“What we’re discovering is that many immigrants from Latin America are developing symptoms which many therapists are overlooking,” said Cherbosque, who teaches cross-cultural psychology at Antioch College’s Marina del Rey campus.

While the symptoms are understandable, he said, they still can be serious.

The immigrants are “coming to a society where they feel they don’t belong,” Cherbosque said. “They don’t identify with America and they feel secretly guilty for abandoning their homelands.”

Bellwood patients, who are often referred to the program by therapists, social workers or physicians, voluntarily admit themselves to the facility for stays averaging a month, Aguilar said.

But cultural differences sometimes interfere with therapy, he said. For instance, Latino culture emphasizes collective values and family interdependence, while U.S. culture is geared more toward individualism, he said. Thus, Latinos, who often hold fast to traditional male and female roles, tend to submerge individual problems rather than disrupt family unity, while Anglos find it easier to muster the self-absorption necessary for therapy.

And while most Anglos are entirely comfortable with the idea of psychotherapy, Aguilar said, most Latinos see the process as sterile and cold.

“In Hispanic culture, there is no such thing as mental health care--you’re either crazy or you’re not,” Aguilar said.

In many Latin American countries, and often among Latinos in Southern California, he added, those who can’t be cured by herbs or spiritual healers called curanderos are taken into their families’ bosoms and kept apart from society.

Aguilar began developing his unorthodox approach to therapy during a 17-year career at Metropolitan State Hospital in Norwalk, where, he said, some of his methods initially met with resistance from colleagues.

Among the more controversial of his ideas, he said, was offering private “spiritual” healing sessions to patients for whom such rituals seemed meaningful. The practice, while not violating the conditions of his license or professional ethical code, did exceed the sympathies and understanding of some fellow therapists.

He left the hospital for Bellwood last year, he said, because he believed the private facility would offer more latitude in pursuing his cultural techniques.

In the six months since the therapy program--called Amanacer, or “a new dawn”--began, more than 40 patients, most employed in blue-collar jobs, have been treated, Aguilar said. While the cost of treatment, including room and board, is about $560 a day, an administrator said, most of the charges are covered by insurance.

Aside from the soap-opera psychotherapy, Aguilar said, other therapy methods employed are craft sessions, in which patients create colorful Mexican weavings while informally discussing problems; Latino music and dance classes to release tension and increase self-esteem, and sessions utilizing Spanish poetry, folklore and myths containing universal themes that speak to patients of situations in their own lives.

“We have lots of myths in our culture, and they trigger feelings,” Aguilar said. “Sometimes the best method of treatment is a metaphor.”

One group, the therapist said, uses seasons of the year to connote points on the road to mental health and such symbols as turtles, flowers and cactus from the Aztec calendar to indicate specific personal qualities--sluggishness, delicacy, abrasiveness.

Although no data yet exists on Amanacer’s success at returning people to functional lives, Aguilar said the program is working--an assessment shared by many of his patients.

“I’m very appreciative,” said the woman whose teen-age son was imprisoned for her husband’s murder.

Speaking through an interpreter, she said: “The program has given me value and self-worth. If I had found this earlier, I would have been able to stop what happened.”

Said Teresa, a depressed patient who came to Bellwood after years of unsuccessful treatment by Anglo therapists: “We can understand each other. It’s a big relief to be able to talk to someone who comes from the same culture.”

Back in the soap opera, Rosendo, about to return home to his wife after a month of treatment, seemed to be getting a new lease on life.

“I feel stronger,” he said. “I didn’t want to face the rock that I was. I’m ready to go to work.”

Off to the left, Aguilar, playing the narrator, interjected a series of solemn questions.

Would Rosendo, he wondered aloud, be able to solve his problems? Would he be able to find a job? Would everything be OK?

Tune in next week.