Generalist Practice: Real Women Have Curves

Family Assessment

Roles, Norms, Balance of Power, and Communication

Both Raul and Carmen believe that each family member’s role should be defined according to Latino tradition. Raul “appear[s] somewhat aloof from the family” (Kirst-Ashman and Hull, 2012, p. 454), only involving himself in family affairs as a last resort: e.g., finally saying “That’s enough” when Carmen and Ana’s fight starts to get out of hand (Brown, LaVoo, & Cardoso, 2002, 2:22). As the head of the family, Raul ultimately has the final say, and others are expected to defer to him: e.g., although Carmen does not want to invite Mr. Guzman into the house, Raul opens the door for him, and Carmen submits to his decision (58:05). Carmen is more involved in her daughters’ lives and, like many Latino mothers, expects them to defer to parental authority and put their family’s needs above their own (Fischer, Harvey, & Driscoll, 2009, p. 296): e.g., she insists that Ana miss her last day of high school to care for her, even though she knows how badly this request upsets Ana (2:00).

Like many Latino families, the Garcias communicate a great deal through nonverbals (Kirst-Ashman and Hull, 2012, p. 454). In the film’s opening scene, for example, Ana asks her mother what is wrong, a question that would convey empathy if were not accompanied by a big eye roll (Brown, LaVoo, & Cardoso, 2002, 1:55). Carmen’s avenue of communication (Kirst-Ashman and Hull, 2012, p. 333) is often one of condemnation, especially when talking to Ana. When an attempt at manipulation fails, for example, she calls Ana “ungrateful” (2:08). Moreover, Carmen often makes fun of Ana’s weight (7:07, 19:06). Estella feels obligated to conform to her family’s norms and at times encourages Ana to submit to their mother’s demands (:50). Although Ana expresses her own wishes (7:40), she also has the tendency to submit to her parents. For example, she does not want to work at her sister’s factory but, in obedience to Carmen, ends up doing so (7:30-13:00). A second example is that Ana initially decides to turn down her scholarship in order to appease her family (1:00:15). She needs to summon an extraordinary amount of courage before changing her mind, and it is possible that she would not have had the courage to actually leave had she not procured her father’s blessing (1:15:00).

Problems and Strengths

The Garcia family faces the following problems: (1) Some of Ana’s wishes conflict with the wishes of her parents, (2) Carmen continually belittles Ana, and (3) Ana often communicates to her mother in a disrespectful manner. The Garcia family possesses the following strengths: (1) They are willing to help one another financially, (2) Raul often helps make peace between others, and (3) Carmen and Ana do not hesitate communicating honestly with one another.

Immigration, Acculturation, and Assimilation

Ana

Ana’s ongoing conflict with her mother is likely harming her. Smokowski, Rose, and Bacallao (2010) found that Latino parent-adolescent conflict is a risk factor for adolescent internalizing symptoms and lowered self-esteem (p. 152). Ana and Carmen’s conflict can be classified as parent-adolescent acculturation conflict, as it is primarily conflict between Carmen’s “more traditional values” and Ana’s “more individualistic American values,” values she learned “through school and the media” (Dennis, Basanez, & Farahmand, 2010, p. 199). Dennis et al. found that this type of acculturation conflict is a risk factor for adolescent depression (p. 126) and lowered self-esteem (p. 128), possibly because acculturation conflict often leads to reduced family cohesion and greater attempts by parents to control their children (p. 126).

Carmen

Ana’s relatively advanced level of acculturation is likely placing great stress on Carmen. Piedra, Byoun, Guardini, and Cintron (2012) write that Latino parents often feel a sense of powerlessness when their children acculturate faster than they do (p. 127). These authors emphasize that this disparity “can create emotional disconnection between immigrants and their children,” which might in turn be one reason why immigrants who stay in American experience “worsening mental health outcomes” over time (p. 127).

Estella

Estella is being economically exploited: e.g., her business gets paid $18 for each dress they produce, while these dresses are in turn sold for $600 at Bloomingdale’s (Brown, LaVoo, & Cardoso, 2002, 17:08-17:19). Such exploitation can to a large degree be traced back to the decline of unionization. Mishel, Schmitt, and Shierholz (2014) point to numerous studies showing that the stagnation in median American wages over the last 40 years has primarily resulted from the decline in labor unions (p. 28). Gabriel (2008) writes that union organizers have been reluctant to organize immigrant workers, believing they are “unorganizable,” “vulnerable, docile persons, intensely fearful of confronting authority, and willing to accept substandard wages and poor working conditions” (p. 68).

Raul

Raul plays a minor role in the film, and we know very little about him. Nonetheless, it seems profitable to note some difficulties often experienced by Latino immigrant men, as these difficulties might also beset him. Documet et al. (2015) write that Latino immigrant men often suffer from loneliness and social isolation, something to be expected since they left their friends and families when emigrating to America; this loneliness and social isolation might be putting these men at risk for depression and making it more difficult for them to keep a “positive identity” (pp. 244-245). These authors further note that such men are at a greater risk of drinking excessively and less likely to take the actions they deem necessary for their physical health (pp. 242, 245).

CBT Interventions

As I will describe in more detail below, Carmen’s derogating parenting style is likely having an adverse effect on Ana and perhaps the family as a whole. To combat this, I would employ using social reinforcement to encourage Carmen to speak to her daughter more respectfully. Specifically, I would want to observe Carmen and Ana interact with one another, and then, perhaps while talking individually with Carmen afterwards, praise Carmen for the times she spoke to Ana in a positive manner. I would be sure to label my praise, that is, describe in some detail what she did to merit the praise (Corcoran, 2006, p. 44).

Ana regularly reacts angrily to Carmen’s words. Using the ABC model of cognitive restructuring, we can see that when certain activating events occur (e.g., when Carmen insults Ana), Ana in turn feels certain emotions (e.g., anger) (Corcoran, 2006, p. 88). I would like to talk to Ana and discover which of her beliefs might be causing her to feel these strong emotions. Ana might believe that Carmen dislikes her or that Carmen is making these comments out of spite. I would want to help Ana see that these comments might instead by motivated by fear, fear that Carmen is losing her daughter, perhaps fear that she is despised by her daughter.

Evidence-Based Intervention

Carmen and Ana would benefit from an intervention that reduced the acculturation conflict between them. One such intervention is Entre Dos Mundos/Between Two Worlds, a two-and-a-half hour, eight-session psychoeducational group. During each session a social worker leads parents and adolescents from as many as 10 families in discussing “acculturation stressors and challenges” (Smokowski and Bacallao, 2009, p. 168). Each session focuses on “a theme that has been empirically linked to acculturation stress” (p. 168). The first session, for example, raises the following issues: “How are we as a family changing as we adapt to life in the United States? How do we as a family balance demands from two different cultures (our culture of origin and the U.S. host culture)?” (p. 168).

The social worker plays an active role in the sessions, not just facilitating discussions, but also using “psychodrama techniques such as scene-setting, role-reversal, doubling, mirroring, and soliloquy” (Smokowski and Bacallao, 2009, p. 166). The social worker also incorporates specific situations from the lives of participants “to create a dynamic environment for exploring weekly acculturation themes” (p. 166). The social worker additionally helps participants clarify their conflicts and explore new strategies for resolving them (p. 166).

Smokowski, Rose, and Bacallao (2008) found that parents who participated in this program “reported significantly less conflict with their adolescents than did parents who participated in [a less “action-oriented”] support group” (p. 306). Parents from this group also reported that their children displayed “significantly less oppositional defiant behavior, anxious depression, and fewer total problems” (p. 306).

Carmen and Ana would likely benefit from attending the entire eight-session class. If this were not possible they might still benefit from more individualized training: that is, training involving just the two of them and a social worker. This more individualized training would require the social worker to first become familiar with Entre Dos Mundos/Between Two Worlds curriculum and then impart these principles to Carmen and Ana. The worker would also lead the women in the program’s “psychodrama techniques” and help them better understand and work through their conflicts.

Along with leading them through this program, the social worker should also consider having individual counseling sessions with each woman. Carmen in particular could benefit from learning to engage in more positive parenting practices. When deciding how to best impart these parenting practices, the social worker would do well to consult Parent Management Training (PMTO), a program that teaches such positive parenting practices as making compromises and providing positive reinforcement. Cardona et al. (2012) write that the program has been shown to reduce internalizing and externalizing problems for the children of participating parents (p. 59). Cardona et al. argue that this program should be especially effective with Latino parents because it affirms the Latino belief that “parents are the best teachers of their children” (p.59).

Termination

Research has shown that clients often react negatively, often feeling hurt or betrayed, upon the termination of a therapeutic relationship (Gelman et al., 2007, p. 88). In hopes of preempting this type of reaction, I would let them family know as soon as possible how long I thought our relationship would last, thus making it more likely that they would “have positive feelings of achievement, growth, and a sense of mastery and control over the ending of the relationship” (Gelman et al., 2007, p. 88). Towards the end of the relationship I would review our time together, inviting the family’s feedback and emphasizing progress that they had made (Chang, Scott, and Decker, 2013, p. 288). I would emphasize that the clients themselves were responsible for their progress, that my role was just a subsidiary one, and that I have confidence they will continue progressing in the future. To provide thwart any potential anxiety, however, I would make it clear that they could contact me at any point in the future.


References

Brown, E., & LaVoo, G. (Producers), Cardoso, P. (Director). (2002). Real Women Have Curves [motion picture]. United States: HBO Films.

Cardona, J.R.P., Domenech-Rodriguez, M., Forgatch, M. Sullivan, C., Bybee, D., Holtrop, K.,…Bernal, G. Culturally adapting an evidence-based parenting intervention for Latino immigrants: The need to integrate fidelity and cultural relevance. (2012). Family Process, 51(1), 56-72.

Chang, V.N., Scott, S.T., & Decker, C.L. (2013). Developing helping skills: A step-by-step approach (2nd ed.). Belmont, CA: Brooks/Cole.

Corcoran, J. (2006). Cognitive-behavioral methods for social workers: A workbook. New York: Pearson.

Dennis, J., Basanez, T., & Farahmand, A. (2010). Intergenerational conflicts among Latinos in early adulthood: Separating value conflicts with parents from acculturation conflicts. Hispanic Journal of Behavioral Sciences, 32(1), 118-135.

Documet, P.I., Kamouyerou, A., Pesantes, A., Macia, L., Maldonado, H. Fox., A.,…Guadamuz, T. (2015). Participatory assessment of the health of Latino immigrant men in a community with a growing Latino population. Journal of Immigrant and Minority Health, 17(1), 239-247.

Fischer, C., Harvey, E., & Driscoll, P. (2009). Parent-centered parenting values among Latino immigrant mothers. Journal of Family Studies, 15(3), 296-308.

Gabriel, J. (2008). Si, se puede: Organizing Latino immigrant workers in South Omaha’s meatpacking industry. Journal of Labor Research, 29(1), 68-87.

Gelman, C.R., Fernandez, P., Hausman, N., Miller, S., & Weiner, M. (2007). Challenging endings: First year MSW interns’ experiences with forced termination and discussion points for supervisory guidance. Clinical Social Work Journal, 35(2), 79-90.

Kirst-Ashman, K.K. and Hull, G.H. (2012). Understanding generalist practice (6th ed.). Belmont, CA: Brooks/Cole.

Kuhlberg, J.A., Pena, J.B., & Zayas, L.H. (2010). Familism, parent-adolescent conflict, self-esteem, internalizing behaviors, and suicide attempts among adolescent Latinas. Child Psychiatry & Human Development, 41(4), 425-440.

Mishel, L., Schmitt, J., & Shierholz, H. (2014). Wage inequality: A story of policy choices. New Labor Forum, 23(3), 26-31.

Piedra, L.M., Byoun, S.J., Guardini, L., & Cintron, V. (2012). Improving the parental self-agency of depressed Latino immigrant mothers: Piloted intervention results. Children and Youth Services Review, 34(1), 126-135.

Smokowski, P.R., & Bacallao, M. (2009). Entre Dos Mundos/Between Two Worlds: Youth violence prevention for acculturating Latino families. Research on Social Work Practice, 19(2), 165-178.

Smokowski, P.R., Rose, R., & Bacallao, M.L. (2008). Acculturation and Latino family processes: How cultural involvement, biculturalism, and acculturation gaps influence family dynamics. Family Relations, 57(3), 295-308.

Smokowski, P.R., Rose, R.A., & Bacallao, M. (2010). Influence of risk factors and cultural assets on Latino adolescents’ trajectories of self-esteem and internalizing symptoms. Child Psychiatry & Human Development, 41(2), 133-155.