Counseling Today, Features

‘Border culture’ counseling

Jonathan Rollins September 1, 2006

Selma Yznaga was born and raised in Brownsville, a city situated on the southernmost tip of Texas and separated from Matamoros, Mexico, only by the Rio Grande. She left Brownsville to get a college education and “stayed away, like many of us did when we found out there was another world.”

Settled happily in San Antonio with her husband and children, Yznaga was nonetheless eventually drawn back to Brownsville by family; both of her parents were seriously ill at the time. “That sense of responsibility — taking care of the generation in front of you — is very, very strong in my culture,” explains Yznaga, a member of the American Counseling Association and an assistant professor in the Department of School Specialties at the University of Texas at Brownsville (UT-B).

Even the Rio Grande’s strongest current proves to be no match for the pull of family in border communities such as Brownsville. Ninety-three percent of the students at UT-B are Hispanic. Most of them are first-generation college graduates, and nearly 100 percent of those who go on to earn a master’s degree will be the first in their family to do so, Yznaga says. The great majority of the university’s students are there because their parents or grandparents made a decision years earlier to cross the U.S.-Mexico border in hopes of establishing a better life for their families. Thousands of Mexican nationals continue to use Brownsville as a portal to the United States each year.

But the pull of those family members “left behind” also leads many immigrants to return to Mexico — again and again. “Since we’re on the border, people go back and forth a lot,” Yznaga says. “There is a lot of instability. Part of the narrative of their story is being displaced, of not being able to find the right spot, because they still have family in Mexico. I like to use the metaphor of these people being stuck in the river. They have difficulty putting down roots in either Mexico or the United States.”

But something remarkable is happening along the border in Brownsville, where the struggles of immigration — both legal and illegal — play themselves out every day. The Community Counseling Clinic operated by the UT-B Counseling and Guidance Program is successfully reaching across barriers and impacting a population not known for its openness to the counseling process. The clinic began tracking client outcome with the Outcome Questionnaire and the Youth Outcome Questionnaire in 2005. “After one year, results indicate that 55 percent of our clients, including adults and minors, showed reliable change,” says Manuel Xavier Zamarripa, an assistant professor with the Counseling and Guidance Program in the university’s Department of School Specialties. “It seems like we’re achieving higher than average numbers for a population that is often described as more difficult to serve. … Given that the field of counseling emphasizes the need to provide culturally responsive services, our work with a largely Latino clientele — mostly immigrant — and our positive outcomes are important because the Latino population continues to grow in the United States.”

Overcoming challenges

The clinic offers free counseling services for up to 12 sessions to community members. In the process, the clinic serves as the primary training ground for master’s counseling students at UT-B. In August, the clinic moved into a state-of-the-art facility that features two group counseling rooms, two rooms for individual counseling, a playroom, an observation room with one-way mirrors and closed circuit video, administrative offices, a waiting room and a kitchen. But much like the clientele it serves, the clinic had very humble beginnings.

The UT-B Counseling and Guidance Program opened the clinic in 2002 in preparation for CACREP accreditation. Up until that time, the university’s community counseling track wasn’t very strong, and the Counseling and Guidance Program had no control over supervision. Yznaga, who had been a school counselor herself and had no experience with community counseling, was hired by the university at that time. “We really did start from the ground up,” says Yznaga, now coordinator of the community counseling training lab.

In its first year, the clinic consisted of two rooms for counseling and a waiting room. It was open two nights a week for four hours each night. After a year, the clinic was allotted two additional rooms, but not without opposition from within. The university already had a student counseling center, and the thought from many in the school community was that the two clinics would be in competition. Happily, those fears were eventually dispelled.

The graduate students played a major role in development of the community counseling clinic, Yznaga says. Because of the population it aimed to serve, it was important for the clinic to have a safe, homelike feel, she explains. In an effort to “warm it up,” the students went to garage sales, painted, wallpapered and brought in artwork to decorate.

The students also went to community social service agencies, hospitals and elsewhere to advertise the clinic’s free counseling services and to educate the local population about mental health services. “The concept of mental health wellness in the Hispanic community is not very strong,” Yznaga says. “In Mexico, there are strong systems of psychology and psychiatry. It’s the medical model — ‘Something is wrong, and a doctor can fix it’ — instead of a wellness model.” This conceptualization of behavioral or emotional problems as an “illness” contributes to the stigma attached to seeking professional help, Yznaga says. In an ongoing effort to educate the community and destigmatize counseling services, the clinic continues to hold an open house each semester.

To make inroads in the Hispanic community, Yznaga says, the clinic has to appeal to the community’s sense of family. It’s not uncommon for Hispanic clients to bring their entire family with them to counseling sessions, she says. “In our culture, the inclusion of family in any kind of treatment is common,” she says, “so we try to make the clinic as homey as possible and try to deinstitutionalize it.” All the rooms in the clinic are designed to look and feel like salas or living rooms, she explains, and clients are offered chamomile tea and Mexican pastries soon after they arrive to further put them at ease.

The clinic’s new facility adds to the family-friendly environment with an intimate courtyard just outside the entrance. “People really like to sit in the courtyard so their kids can run around,” Yznaga says.

The community clinic also utilizes these family bonds in treating clients. Because Hispanic families are more familiar with medical models than wellness models, Yznaga says, “they want to bring their kids to us and say, ‘Fix them.’” Instead, the clinic takes an approach that educates and helps both parent and child. Parents who bring their children to the clinic for mental health services are asked to enroll with one of the counselors as well. “We tell the parents that we want to teach them how to be counselors with their kids for the rest of the week,” Yznaga says. “They really warm up to that.”

A whole different culture

Roughly 86 percent of the population of Cameron County, where Brownsville is located, is Latino in origin. But both Yznaga and Zamarripa are quick to point out that “border culture” differs greatly from typical Hispanic culture in the United States. “We overwhelmingly serve a first-generation immigrant population,” Zamarripa says. “This population is further marginalized and may not trust the counseling process as much. Part of the cultural fabric here is undocumented workers and people spending time across both borders. The cultural identities are very fluid.”

“A lot of husbands will keep their wives or kids from seeking counseling by saying that we’re going to deport them,” Yznaga adds. “Part of our outreach is going into the community and saying, ‘No, we don’t report or have anything to do with INS (the Immigration and Naturalization Service).” Convincing them takes time, especially since the clinic parking lot is bound by the levee of the Rio Grande, which is patrolled by mounted Border Patrol agents.

Another major difference, Yznaga says, is that the newly arrived immigrants “are at the beginning of the continuum. They have a much lower rate of acculturation and, because this is their first stop, there is a lot of poverty.” According to Yznaga, Cameron County is second in the nation in terms of poverty for all counties with populations of 250,000 or more. Zamarripa points out that one of the Counseling and Guidance Program’s major motivations in opening the community clinic was the lack of available and affordable mental health services in the area.

Depression/anxiety and marriage and family problems are the most prevalent issues among the clients who come to the clinic, according to Yznaga. “Part of the depression comes from realizing that the milk and honey don’t flow freely here,” she says.

“The majority of the problems we see are related to living in poverty — a lack of medical care, a lack of resources, poor living conditions, a lack of education,” she continues. “The poverty permeates everything. Most of these clients don’t understand that a lot of their problems arise from their circumstances and not from an inability to resolve their own problems. It’s a big relief to most of them when we explain that.”

Many of the presenting problems are related to the stress of immigration, Yznaga says, adding that post-traumatic stress disorder is not uncommon among members of this population. “A lot of people have very traumatic stories,” she says. “Many of the stories involve rape and robbery and loss along the way.” That loss also extends to social support systems, she points out, especially among women, who in many cases are simply honoring their husbands’ decisions to cross into the United States.

Despite facing incredible hardship, many newly arrived immigrants don’t feel justified in seeking counseling or other help, Yznaga says. “Initially, they feel really, really lucky to be here in the United States,” she explains. “So complaining about their current situation seems wrong to them. Because these people are fleeing terrible conditions, they are more willing to accept substandard conditions or services here or to wait in a line forever.”

“Another theme with our population is isolation,” Yznaga continues. “They don’t know where to go (for services), and they don’t know who to ask. They don’t know who to trust.” To address that need, the clinic is publishing a Spanish-language social services directory that will describe available services (including counseling, clothing, rent assistance, etc.) and where to obtain them. Another part of the directory will include narratives from former immigrants describing the struggles they faced after crossing the border and what role counseling played in helping them attain a better quality of life. “It will show (new arrivals) that there is a continuum of immigration,” Yznaga says. “It will show them that it is difficult, but it can be done.”

Hands-on training

According to Zamarripa, approximately 93 percent of the master’s counseling students training at the community clinic are Hispanic, while 97 percent of the clientele are Hispanic. A full 50 percent are monolingual Spanish speakers. The counseling students are encouraged to share their own families’ stories of immigration with the clients. “That helps these clients to see the positive consequences of their efforts to immigrate,” Yznaga says.

Zamarripa and his colleagues have yet to isolate reasons for the Community Counseling Clinic’s success in serving members of both the “border culture” and the more traditional Hispanic community. He does have some hunches, however, which include a high ethnic match between counselors and clients and the fact that most of the counseling students are bilingual.

At the same time, he says, it would be wrong to think that “ethnic match” precludes counselors-in-training from harboring cultural misconceptions about their clients. “We teach students to follow multicultural competencies,” he says, “because there’s still great variety in how they see their own culture. We really do pay attention to our students checking their assumptions about the culture of the clients, and we teach them to value the clients’ autonomy and individuality. I think that really hits home here, even if they (the counselors and the clients) come from the same background. We get clients who give you very different ideas about immigration. It’s a great training ground for the counselors.”

The counseling students are first trained to examine their own values and to find their place on the immigration continuum, Yznaga says. “We have to remind them that we all have immigration stories,” she says. “It’s really eye-opening for the students.”

Re-engaging with their family’s immigration experience provides the counselors-in-training with some cultural empathy for their clients, Yznaga says. “It also helps them become aware of their biases,” she says. “The mentality of, ‘Hey, pull yourself up by the bootstraps! We did it!’ But the other reaction is that they identify too much and can’t separate themselves enough from the client to help.”

Students are also taught to pay attention to the cultural and social resources brought to the table by their clients and to solicit each client’s coping skills, strengths and personal stories. For example, Zamarripa says, many people view the risks that immigrants take in coming to American in a negative light. “The part of that risk-taking that’s an asset is usually overlooked,” he says. “There is an extreme willingness to do what they have to do for the well-being of their families. So we might tie that in by commenting to the client that coming to counseling is an important and brave step.”

The community counseling clinic  stresses a strength-based approach. “This is a community of significant personal resources, which includes being grateful for what they have here because it’s so much more than what they had in Mexico, their belief in family and their faith that they can and will succeed, even if it might take a few generations,” Zamarripa points out. “The spirit of perseverance is demonstrated in their ability to cope with a multitude of hardships while they continue to attempt to be accepted and successful.”

Clients are made to feel safe by speaking to them in the language they want to use, Zamarripa says, while also respecting their cultural language, including coping mechanisms. For example, many immigrant clients cope with life’s difficulties by relying on some type of faith system, which often incorporates folk elements or remedies such as lighting candles. “They feel comfortable with that and they draw strength from that,” Zamarripa says. “We just ask them, ‘How does that help?’ and accept it, even if it’s not mainstream. … Our clients are relieved that they’re not going to be placed into some type of category and pathologized.”

In fact, an element of the counseling program that Yznaga takes particular pride in is its training of students to recognize folk remedies in the assessment phase. For example, some clients believe their problems are the result of ill will being wished on them by someone who is envious. Yznaga says this is a relatively common belief in poor communities; members of the community come to think they don’t deserve anything good, and even if they receive something, it will ultimately be taken away.

Another common mindset among the clients who visit the community clinic is that “this is their lot,” Yznaga says, “and if they try to change it, that is going against the will of God.” For instance, a female client might say that if God put an abusive husband in her life, she can do nothing to change it. “We have to be very careful and respectful of not taking that away from them,” Yznaga says. “Instead, we would talk to them about their personal strengths, some of the resources God has given them, including anger, to help them get out of the situation and the people God has put in their path to help them feel less pain. We want to help them reframe the problem without demeaning their approach.”

While the community counseling clinic still receives a significant number of referrals from area schools and social service agencies, more and more individuals are coming because of referrals from former clients. “They’re saying, ‘You can go to this place, and they’ll take care of you,” Zamarripa comments.

“Based on our referrals and the outcome data, we’re doing something right,” Yznaga adds. “Trust is such a huge part of this community, and it’s so fragile.”

The Community Counseling Clinic is now open four nights a week. The goal is eventually to be open eight hours a day, five days a week, Yznaga says. Identifying grants and external funding to increase services is a top priority. An additional challenge at the moment is finding enough graduate counseling students whose schedules aren’t already tied up to staff the clinic. Getting enough clients to come to the clinic is no longer a problem.