Terapia Filial: Filial Therapy With Hispanic and Latinx Clients

Abstract

Filial therapy (FT) has often been stated as an approach that can address the multicultural considerations of a variety of populations, in which parents are given the tools to strengthen their bonds with their child. This article describes counselors using FT as it applies to Hispanic and Latinx clients in the United States. Common cultural considerations are essential to consider when using FT with Hispanic and Latinx clients. The purpose of this article is to inform counselors about common values in the Hispanic and Latinx culture; application of FT with Hispanic and Latinx clients; and ethical, legal, and multicultural considerations when working with these populations.

Keywords

filial therapy cultural values multicultural counseling Hispanic and Latinx values

Hispanics and Latinxs are the largest and fastest-growing minority group in the United States. According to the American Community Survey in 2018, there were almost 60 million individuals who identified as Hispanic and Latinx in the United States. With the rapid growth of the Hispanic and Latinx population, there is an increased need for access to mental health services for this population in the United States. Only since the 1980 census, there was no term with which to speak of this combination of individuals we now call Latinas/os/xs, with Hispanic being the first term incorporated in the census to encompass Mexican American, Puerto Rican, Cuban, Central American, and South American origin (Vidal-Ortiz & Martínez, 2018). Latinx is a more recent and commonly used term for the same population, intentionally including the “x” as a variant among the gendered/genderless categories (Vidal-Ortiz & Martínez, 2018). Currently, both terms are used since individuals from this large and diverse community use the words interchangeably and are identified differently depending on the geographic location in the United States. For this article, we use “Hispanic and Latinx” to identify all individuals or descendants from predominantly Spanish-speaking countries, and the terms will be used interchangeably throughout the article. The centrality of family to Hispanic and Latinx cultures reflects a shared collectivist emphasis on the paramount role of family as a valued in-group and potential source of social support (Chang et al., 2013; Triandis et al., 1988). Filial therapy (FT) represents an opportunity to provide cultural humility with adaptability and considerations for culture, gender, family system, and children.

FT was described as ahead of its time when Bernard and Louise first developed the therapy in the late 1950s and early 1960s. Through the utilization of FT, the Guerneys sought to empower parents by focusing on rebuilding/affirming relational ties of the family system and providing therapeutic tools in order to better strengthen the caregiver––child relationship through nondirective play (Topham & VanFleet, 2011). Through FT, mental health therapists are able to provide parents or caregivers with tools that promote the child’s ability to grow and play (Garza & Watts, 2010). This was a revolutionary idea, because a predominant attitude in the mental health field in the l950s and early l960s was that children’s problems were usually a product of the pathology of the parents (Landreth & Bratton, 2020). This shift from the parents as pathological perception to being the primary therapeutic agent of change in their child’s life was a radical departure for the time (Landreth & Bratton, 2020).

FT is both a “therapeutic intervention and a preventative approach” (Garza & Watts, 2010, p. 108) for all types of families. FT is considered to be most effective when used with children between the ages of 2 and 12 years and when parents hold nondirective play sessions with their child each week. This expands upon the relationships parents or guardians typically have, leading to “more emotional significance to children than does the therapist” (Garza & Watts, 2010, p. 108).

As parents learn to conduct play therapy sessions, there is a “focus on utilizing four skills in an effort to provide empathy and validation to their child; those skills are structuring, empathetic listening, child-centered imaginary play, and limit setting” (Topham & VanFleet, 2011, p. 146). Providing a structure involves parents opening and closing play sessions in a manner that the child understands therapeutic play is different from their regular playtime. Parents are also asked to monitor their own motives, biases, and preconceived notions and track their child’s behaviors, thoughts, and feelings utilizing empathetic listening throughout the nondirective play session. When parents engage in child-centered play, they may be invited to play by the child and assigned a role to play according to the child’s desire, learning to follow the child’s lead. Lastly, parents learn to set and maintain boundaries and safety during the play therapy session through limit-setting (Topham & VanFleet, 2011). Together, these four skills can aid parents in balancing their acceptance and/or hindrance of necessary boundaries, which “help parents improve their skills and awareness of their child’s feelings and needs, and understanding what might prevent them from being fully attentive and available to their child” (Topham & VanFleet, 2011, p. 147).

Due to the level of integrated care and inclusion of the parent and, in some cases, the family subsystem, the Hispanic and Latinx population may benefit from positive family interventions that can have a great impact on the success on the social and cultural competency of the child through FT (Garza et al., 2009). Serving as an effective intervention with Hispanic and Latinx families while utilizing a values-based approach in conjunction with the values of FT, the intervention seeks to support and strengthen the parent–child relationship (Garza & Watts, 2010).

Hispanic and Latinx Values and FT

In order to successfully implement FT, one must both understand the general concepts of FT and also be able to effectively apply the interventions in different cultural groups. There are various cultural considerations that need to be implicated with FT and the Hispanic and Latinx community in the United States. The word Latinx is a modern term in the U.S. society. Latinx foregrounds tensions among self-naming practices and terms that encompass all members of a diverse and complex ethnoracial group: Latinx acts as a new frame of inclusion, while also posing a challenge for those used to having androcentric terms serve as collective representational proxies (Vidal-Ortiz & Martinez, 2018). According to Garza and Watts (2010), they proposed four Hispanic and Latinx values with FT that help facilitate effective culturally responsive treatment: (a) the importance of familismo (family), (b) respeto (respect), (c) personalismo (personal relationships), and (d) confianza (trust). Two articles mention familismo as a primary cultural value within various Hispanic and Latinx groups (Ceballos & Bratton, 2010; Garza & Watts, 2010).

These concepts have been explained similarly throughout literature in FT and Hispanic and Latinx communities. In the Hispanic and Latinx community, familismo includes the nuclear and extended family. It is common to see aunts, uncles, and grandparents at family therapy sessions, usually the people who take care of the child or children. In general, FT and familismo share common ground in that filial training strengthens the relationship between child and parent, fostering a more cohesive family climate (Garza & Watts, 200). It aligns with FT since it focuses on strengthening the children–parent relationship. The “parent” can also be a caregiver as well. The more caregivers who practice FT, the more consistency the child or children will receive, which leads to the ultimate goal of FT, changing the child’s behavior.

Since the family unit is important in the Hispanic and Latinx community, respeto is important within the family dynamic and in the counseling setting. Hispanic communities follow a hierarchical, systemic understanding with differential behaviors toward others based on age, gender, social position, economic status, and authority (Garza & Watts, 2010). It is important to incorporate respect to authorities when using FT with Hispanic and Latinx clients. Garza and Watts (2010) also stated cooperated behavior and deference by children to parental authority are expected and any deviation from that norm is not tolerated. That being said, this brings some uniqueness in the typical child-centered influence in Latinx FT sessions.

Personalismo (personal relationships) is described as a cultural value referring to behaviors and actions that demonstrate a direct interest in and concern for others (Garza & Watts, 2010) and also identified as an important concept for therapists to understand and respect (e.g., Andrés-Hyman et al., 2006; Ishikawa et al., 2010). Sangganjanavanich et al. (2010) mentioned their participants valued personal over professional relationships and invited the researchers to become involved in their personal lives, such as visiting their homes and joining family meals. They also stated that their requests seemed to represent the importance the participants placed on relationships and seemed consistent with their cultural values. Also, Flores et al. (2000) mentioned personalismo examples such as using the terms señor and señora, facial expressions of attentiveness and concern, and increased proximity such as a hand on the shoulder to demonstrate concern as well as included content in conversations about family that did not involve health care questions (Garza & Watts, 2010).

Confianza (trust) is heavily weighted in mental health and Hispanic and Latinx communities. Across the United States, Hispanic and Latinx community is still being introduced to the idea of counseling, and some individuals in the Hispanic and Latinx community do not understand what a counselor is or does. Confianza is also important in the counseling process to build with the Hispanic and Latinx clients (Garza, & Watts, 2010). Most Hispanic and Latinx families, like many other cultures, like to keep situations private within their own homes. It can also be a sign of disrespect to speak of family matters to someone else. It is already enough that the Hispanic and Latinx community is still seen as “other” and then add mental health situations that can be perceived as justified labels that are given to the Latinx community from the U.S. society. According to Ceballos and Bratton (2010), the National Task Force on Early Childhood Education for Hispanics (2007) reported that Latino children are at higher risk for academic failure, delinquency, and violence compared to non-Latino youth. For mental health services to reach out to the Hispanic and Latinx community, there need to be people who are open and patient enough to build trust and incorporate cultural values.

FT Background

Foundationally built on child-centered play therapy, FT is designed to nurture and develop the relationship between the child and their parent/caregiver, a task that is consistently supported by a mental health professional, who assists in the training of parents to conduct nondirective play and become partners in the therapeutic process (Chau & Landreth, 1997; VanFleet, 2011). In essence, parents and caregivers are taught basic child-centered play therapy techniques (i.e., limit-setting, tracking, reflecting) in order to respond to their child’s behavior. Typically, taking place over the course of 10 sessions, parents and caregivers are able to practice relationship building skills during weekly play sessions with their child in collaboration with the mental health professional. Sanganjanavanich et al. (2010) describe this as “didactic instruction, demonstration of play sessions, required play sessions at home and supportive supervision” (p. 195). As a therapeutic intervention, FT highlights the importance of the relationship between the parent/caregiver and the child, empathy as a conduit for growth, acceptance, and empowerment for all parties involved (Ginsberg, 2012; VanFleet, 2011). The mental health professional serves as a guide by providing training for parents/caregivers, while observing and processing their interactions with the child by keeping track of themes, perceptions of meaning behind the child’s behavior during play, skill utilization, and discussing ways for the parent/caregiver to improve during the next session that are free of judgment. At its heart, FT is about the collaborative process between the parent and the therapist for the betterment of the child’s wellness.

Theoretical Fit

Research has shown that Hispanic and Latinx clients are more willing to comply with counseling services when they feel like they and their family’s culture are understood and respected by the counselor (Garza & Watts, 2010), in which considerations to competencies regarding the family’s culture can enhance positive outcomes in the therapeutic relationship because it allows the family to feel heard as opposed to judge for its cultural norms (Ceballos & Bratton, 2010; Garza et al., 2009; Garza & Watts, 2010; Sangganjanavanich et al., 2010). Garza & Watts (2010) suggest that Hispanics are not likely to use community health services and prefer addressing problems within their family construct. The addition of FT’s possible inclusion of the immediate and extended family can create a connectedness that is family focused, in which family and community networks are supportive throughout the process. Additionally, due to nuclear and extended family members being supportive influences regarding health care decisions, families who participate in FT may return to the community with stories of positive experiences that may lessen the stigma of counseling (Garza & Watts, 2010).

Including immediate family members and extended familial relationships in the therapeutic relationship are sharing attributes between core Hispanic and Latinx cultural values, key principles, and skills of FT (Garza & Watts, 2010). The relationship between the therapist and Hispanic and Latinx families encourages “trust and strengthening of relationships through a more personal approach that can be fostered by providing culturally responsive mental health services” (Garza et al., 2009, p. 218). Along with the use of culturally responsive toys and materials, FT can allow Hispanic and Latinx children the freedom to express themselves comfortably and freely, additionally, the therapist’s cultural responsiveness can allow the clients to express their customs, values, and beliefs “demonstrating the counselor’s openness to the client’s world” (Garza & Bratton, 2005, p. 55).

Application of FT With Hispanic and Latinx Clients

We decided to use Topham and VanFleet’s (2011) outlined phases of FT to highlight the sequence of five phases when using FT:

Assessment. Assessment includes the therapist first meets with the parents to discuss their concerns and the presenting problems, listens empathetically, and obtains further information about the family and the situation. Without children present parents can talk freely about their challenges and frustrations including any problems in the co-parenting relationship. The second session typically involves a family play observation followed by further discussion and final recommendations for therapy.

Training. Training typically takes 3-4 one hour sessions. The therapist demonstrates short nondirective play sessions with each of the children in the family while parents observe. The therapist then trains the parents in four play session skills, culminating in mock play sessions in which the therapist plays the child’s role while parents practise the skills. The therapist provides immediate and encouraging feedback to facilitate the parents learning to conduct the play sessions.

Supervised play sessions. Supervised play sessions entail parents taking turns conducting filial play sessions with each of their children while the other parent and therapist observe. Without the child present the therapist discusses the experience with the parent(s), offers positive feedback and suggests one or two improvements for next time. This helps parents to make continual progress without feeling overwhelmed. Therapists typically observe each parent conducting four to six play sessions, after which most parents become quite skilled.

Home play sessions. Home play sessions are when parents hold weekly half-hour play sessions with each of their children at home and meet with the therapist to discuss the home sessions, the children’s play themes and questions that arise. Parents often observe each other’s home sessions as well. Home play sessions can continue as long as children and parents wish.

Generalisation. Generalization is near the end of therapy, when therapists help parents begin to use their newly mastered skills outside the play sessions in everyday life. This is accomplished in a deliberate way to ensure that parents become competent and confident in applying what they have learned. (p. 152–153)

Ethical, Legal, and Multicultural Considerations

It is vital to consider the ethical, legal, and multicultural considerations related to the applications of FT with the Hispanic and Latinx population, it would be remiss to leave out the importance of ensuring participants have access to their native language throughout the FT approach. Additionally, in an effort to mimic familismo, parents participating in the program should be given the opportunity to build their own supportive community of parents who are going through the same or similar situations as well as the opportunity to address the stigma of counseling within the Hispanic community (Sangganjanavanich et al., 2010).

Due to the close nature of the relationship parents form with the therapist, considerations regarding boundaries must be addressed in order to protect both the therapist and client. It is possible that participants may desire to include the therapist in their family structure, and while consistent with Hispanic and Latinx family values, those requests must be declined in an effort to maintain professional boundaries (Sangganjanavanich et al., 2010). At the same time, it is important to consider the findings in the research of both Ceballos & Bratton (2010) and Sangganjanavanich et al. (2010) which found that the results of their studies should not be used to generalize the Hispanic and Latinx population, as the Hispanic and Latinx community is diverse and varied based on region, class, cultural backgrounds, race, and countries to give a few examples.

Implications for Children and Adolescents and Family Counselors

Due to predominantly positive experiences with FT in the Hispanic and Latinx community, this leads to discussion on implications on findings from the literature. Like mentioned earlier, it appears that FT works with the Hispanic and Latinx community due to the emphasis on strengthening the family unit, which can include caregivers (extended family or family friends). The FT approach is inclusive in its focus on the dynamics of the parent, the child, the parent–child relationship, and the family as a whole (Cornett, 2012). FT benefits the Hispanic and Latinx population due to many cultural considerations since the focus is child-centered, it can bring out particular values within the Hispanic and Latinx customs.

Also, language is important in counseling. If providing counseling services in the predominant language, counselors can create an understanding in knowing how to better educate Spanish-speaking clients in FT. Lastly, FT can lead to positive experiences for the Latinx population when implementing the cultural values, which can lead to reducing stigma by sharing their stories with relatives, extended family, and their community.

Clinical Considerations

Although finding valuable information for FT with the Hispanic and Latinx populations, there are some important limitations addressed throughout the literature. A familiar limitation is the lack of diversity, small sample, and generalization to the Hispanic and Latinx community. The Sangganjanavanich et al. (2010) study, titled “Filial Therapy With Monolingual Spanish-Speaking Mothers: A Phenomenological Study,” consisted of four women, three from Mexico and one from Peru. In Ceballos and Bratton (2010), the majority of participants were of Mexican descent. The small sample size, along with participants being from a narrow geographic region, limits the generalizability of the results to the Hispanic and Latinx population. Generalizing a small sample or a particular group can lead to stereotypes and loss of identity in other Hispanic and Latinx cultures. In addition, there were a few more limitations considered in Ceballos and Bratton (2010). The use of one source of measurement impedes a thorough understanding of the impact of child–parent relationship therapy (CPRT) on children’s behavior. The most significant limitation was the parents who participated in the training as the source of data on child behavior outcomes. It is possible that the findings reflected parents’ changed perception toward their children and not true behavioral change.

Moreover, it appears there is still a common limitation on how the therapy is being translated correctly. For example, in Sangganjanavanich et al.’s (2010) study, the facilitator was English-speaking, and the third author served as a translator. In the same study, the Results section stated frustration from some participants who felt the use of FT terminology was complicated because it could not be translated into Spanish. For example, Spanish words connote gender whereas English words do not (Sangganjanavanich et al., 2010). The limitation could then possibly not receive the exact result and/or experience from the participant. Also, during the study, researchers’ bias could have been a possible limitation since two of the researchers were also cofacilitators of the FT training.

Future Research

Considering possible options for future research, there are multiple avenues that can be explored in regard to sample population, diversity within the Hispanic and Latinx population, program structure, language barriers, and gendered terminology. Despite FT being around since the early 1960s, there is still a lack of ethnic diversity in empirical research regarding the technique and its impact on the therapeutic relationship of play therapy in the lives of children and their families. Therefore, there is a need for more research on FT as it relates to Hispanic and Latinx families because there is a dearth of literature that describes the FT and Hispanic and Latinx dynamic.

Future researchers could explore the role of Hispanic and Latinx fathers, garnering their experiences and or perceptions of FT as often the parent or caretaker in recent research focuses on the relationship between the mother and the child (Ceballos & Bratton, 2010; Sangganjanavanich et al., 2010). The research that addresses FT in Latinx populations reports small sample sizes, with limited population sampling. It may be furtive to explore FT and it’s benefits within a more ethnically and culturally diverse Latinx populations, with a large sample size in hopes of increasing generalizability to the population. Exploring the impact of Latinxs valued interdependence and family/peer relationships/dynamics and the roles those relationships play both in and outside of filial therapeutic practice.

Researchers have frequently highlighted the importance of the inclusion and utilization of Spanish-speaking counselors throughout FT versus non-Spanish speaker’s role or impact on the therapeutic process to see how cultural responsiveness is possible or not. It may also be beneficial to compare FT to other therapeutic interventions to see if there are statistically significant results regarding the positive or negative effects of the intervention. It may also be beneficial to compare FT to other therapeutic interventions to see if there are statistically significant results regarding the positive or negative effects of the intervention. There may also be room to investigate the duration of the FT sessions, as traditionally, FT runs on a 10-week model, and Sangganjanavanich et al. (2010) utilized a 5-week model, comparing the effectiveness of a 5-week model; therefore, a 10-week model may yield information regarding the timeliness of FT. Lastly, Spanish is a gendered language; as such it may impact the child’s ability to gender themselves and causes the parent to assert their perceived notions in what is typically a nondirective play therapy approach.

Conclusion

The benefit of FT is that it allows the family to retain their own Hispanic and Latinx cultural beliefs, giving the client the unique opportunity to experience ownership and contribution to play therapy sessions, and provide counselors with the opportunity to understand the core values of Hispanic cultures allowing for prevention and intervention with both parents and children (Garza & Watts, 2010). FT gives voice to the identification of cultural considerations and interventions that can strengthen Latinx families in an effort to support the child’s wellness through the universal language of integrative play (Wickstrom & Falke, 2013). It is important for counselors to be informed about common values in the Hispanic and Latinx culture and application of FT with those particular clients and ethical, legal, and multicultural considerations when working with these populations.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Chanel Shahnami Rodriguez

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