Immigrants are the fastest growing population in the United States (U.S.), with more than half of the 44 million foreign-born residents and 11 million undocumented immigrants being from Latin America (Passel & Cohn, 2019; Radford & Noe-Bustamante, 2019). Thus, increased access to culturally responsive mental health services in Spanish for marginalized Latinx communities is paramount. In pursuit of this work, we have collaborated to develop and facilitate Hablar Es Sanar (Talking is Healing), a community-based and trauma-focused mental health and wellbeing support group for Latina women. This group derives from a critical, increased need for quality services that are not only in Spanish, but are also tailored to meet the unique needs of Latina immigrant women.
Many Latinx immigrants have lived through war-related trauma, political and gendered violence, and life-threatening situations during the migration journey to the U.S. (Martínez, 2014; Vogt, 2013). Once in the U.S., Latina refugee and immigrant women commonly report loneliness, isolation, and difficulty creating trustworthy and supportive relationships (Hurtado de Mendoza et al., 2014). For these women, interpersonal relationships and social networks are imperative for enhancing resilience (Goodman et al., 2017), protecting against depression (Hovey, 2000), and reducing the negative effects of economic and social stressors on health outcomes (Ornelas et al., 2009). Further, social support has been shown to buffer against the impact of trauma on mental health (Charuvastra & Cloitre, 2008). Hablar Es Sanar was designed to help foster a strong sense of community and serve as a source of social support, while also providing an inclusive space for Latina women to feel comfortable discussing shared life experiences, learning from one another, and healing together in community.
Group Format, Topics, and Structure
To provide context, Hablar es Sanar is housed within a local non-profit organization that provides trauma-informed healing and wellness services. The group, which we have facilitated for two years, consists of weekly, two-hour long sessions in 10-week cycles. To facilitate accessibility, Hablar Es Sanar remains “open,” such that new members can join at any point in a cycle, with an average of 5-7 attendees each week. The group structure was adapted from the “Manual de Salud Emocional” (García et al., 2009), a curriculum designed by the Jesuit Migrant Services in Mexico and the Universidad Iberoamericana Puebla to enhance cognitive tools for women whose family members had immigrated, which includes an adapted version specifically for immigrant women in the U.S. (Lundy et al., 2017). Building upon these resources, Hablar Es Sanar covers a range of topics based on group members’ requests, including emotion regulation, trauma healing, immigration-related stress, intersecting identities, interpersonal violence, self-care, and self-compassion.
Regarding group structure, each session begins with a “check in,” consisting of a one-word description of their emotional state and one question related to the previous week’s topic. Then, after an interactive activity that encourages movement and/or creative expression, we introduce a new topic, which we discuss and reflect on as a larger group or in pairs. Last, to close the group, we have a “check out,” which includes another single-word description of the group members’ current mood or emotional state, as well as a short reflection of that day’s group or goal for the upcoming week.
Community Ties and Logistic Foundation
In addition to creating structure, we have realized that the success and sustainability of our work depends heavily upon our consideration of context. In forming the group, it was essential for us to consult with community stakeholders, such as providers with intimate knowledge of and access to the local Latinx community (Goodman et al., 2017), in order to understand and meet existing needs. Further, we collaborated with treatment coordinators and providers who were aware of ongoing services and treatment gaps. These consultations not only allowed us to ensure the relevance of the services we provide (i.e., avoiding scheduling conflicts with other services, integrating trauma-focused concerns), but also facilitated continued dialogue and built trust with providers and community members. Of particular importance was receiving endorsements from trusted providers in the community to increase the likelihood of members attending their first group. From there, we have continued to integrate input from both group members and professionals in order to adapt services to better meet group members’ needs, increase accessibility, and remain sustainable long-term. For instance, in response to feedback, we have incorporated new content, altered the type of food provided, and, more recently, transitioned to a more accessible online platform during the COVID-19 crisis.
A mentor once gave us the helpful insight that, from an equity standpoint, services for under-resourced communities will require additional resources and support for successful engagement. We have found this approach to be crucial for the group, given that many participants are working, financially under-resourced, mothers, and providers for their families. In order for these women to attend our evening sessions, it has been vital for us to provide food and childcare at every group. Providing dinner aims to reduce barriers and allow participants the time needed to attend the group by removing the need to cook or take care of their children that evening. Breaking bread together at the start of each group has also encouraged community building and a welcoming transition into the session. Additionally, we have found that the children’s enthusiasm to attend childcare, as well as group members’ ability to take a break from caregiving to focus inward have served as powerful motivators for group attendance. Thus, rather than being additional perks of the group, food and childcare are viewed as indispensable components of the intervention itself. Contextual factors such as these are critical considerations when designing and implementing accessible, supportive services for community members.
Interventions: Mind-Body Connection and Healing through Interactive Activities
The consideration of cultural and contextual factors is also crucial for understanding human suffering and supporting psychological healing. Our intention is to make the group as contextually informed as possible to align with group members’ life experiences, while also incorporating relevant research to shape group interventions and activities. For instance, research suggests that stressful and traumatic life experiences not only impact mental health, but can also have significant physical consequences on the body (Pascoe & Richman, 2009; Silver et al., 2018). Further, the expression or manifestation of psychological or emotional distress in one’s body is culturally normed and more commonly reported among Latinx groups as compared to other racial/ethnic groups (Canino, 2004; Sirin et al., 2015). This is highly relevant to our work, given that many of the women in Hablar Es Sanar are significantly impacted by immigration- and acculturation-related stress, varying forms of trauma, and ongoing, everyday stress.
With these factors in mind, we are more cognizant of the ways in which traumatic and stressful life experiences can disrupt group members’ experiences of and relationships with their bodies. For instance, a common stress response is for individuals to feel less grounded in the present moment and more disconnected from their physical being. Therefore, we have incorporated an interactive element in the group aimed at encouraging physical movement, creative expression, and healthy mind-body connections. Interactive activities include mindful breathing exercises, intentional stretching, yoga movement, and “ice-breakers” involving dance or creative expression. Further, group members are asked to identify physical sensations (e.g., muscle tension, temperature, pressure/contact, feelings of ease or discomfort) before and after engaging in these movement activities. By checking in and noticing any physical changes, group members can develop useful grounding strategies, greater present-moment awareness, and stronger mind-body connections. Not only has physical movement been shown to facilitate trauma healing (Dieterich-Hartwell, 2017), but the strategies gained through these practices could also be applied to everyday coping (e.g., emotion-regulation, stress-management, increased comfortability with being present in one’s physical body).
Reflections on Identities and Cultural Humility
Through the process of co-facilitating the group, it has been imperative for us to critically reflect on our own identities and the intersections between our identities and those of group members. For instance, while our gender identities as females align with those of group members, our racial/ethnic backgrounds and much of our lived experiences differ from participants’, given that we neither identify as Latina nor immigrants. Further, while all facilitators are fluent in Spanish and have spent time working in Latin America, we are second-language Spanish-speakers. In acknowledging these differences, we are aware of the unique challenges that group members face, including navigating cultural and language barriers in the U.S., coping with xenophobic prejudice and discrimination, and managing fear and uncertainty related to legal status.
Our ongoing, critical reflection of shared and distinct identities and life experiences has required humility and cultural responsiveness through every step of the design, coordination, and facilitation of the group. This work also calls for an openness and willingness to recognize and take ownership of our mistakes along the way, as well as a continued commitment to educating ourselves, examining the influence of our power and privilege on group interactions, and holding one another accountable in the process. We have also strived to honor the Latinx values of personalismo (i.e., an inclination for warm yet formal relationships), confianza (trust), and respeto (respect) to create a safe and nonjudgmental space for group members to share in community (Sue & Sue, 2015). To deepen reflection and increase accountability, we check in with one another following each group to highlight successes and identify challenges and areas for improvement. Additionally, we receive weekly bilingual group supervision, engage in consultation with a Latina immigrant psychologist, conduct periodic check-ins with group participants, and provide opportunities for anonymous feedback after the completion of each 10-week cycle.
Concluding Thoughts
In reflecting on the impact of Hablar Es Sanar, group members have shared, “Sé que merezco estar bien y feliz” (“I know that I deserve to be well and happy”), “[Tengo] confianza para compartir cosas que no puedo compartir afuera” (“I have the confidence/trust to share things that I can’t share outside”), “Mi alma y mi mente están más estable” (“My soul and my mind are more stable”) and many other similar experiences. As multiculturally-trained clinicians and soon-to-be counseling psychologists, we are profoundly grateful for the opportunity to work with, learn alongside, and strive to enhance culturally responsive services to this highly resilient and underserved group of Latina women. The purpose of this article is not to provide a blueprint for designing and implementing a trauma healing group in Spanish, but rather to engage in the collaborative, ongoing process of sharing ideas, critically reflecting, and learning from our experiences as part of a larger community of providers, educators, and society members.
Through our applied work, we have learned the importance of (a) integrating evidence-based practices and cultural adaptations to inform interventions and better meet group members’ needs, (b) conducting outreach to strengthen community ties, enhance recruitment, and establish positive, ongoing relations with community stakeholders to ensure the sustainability of services, and (c) engaging in ongoing, critical reflection and examination of the intersecting identities, life experiences, and cultural and contextual factors. We hope that, as a collective, mental health practitioners can continue to reflect on the strengths of our existing services and areas in need of improvement in order to provide equitable and culturally salient, trauma-informed care to communities of Latina women that continue to face marginalization, trauma, and mental health disparities.
References
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Alyssa Kennedy, M.S. is a rising fifth-year Counseling Psychology doctoral candidate at the University of Oregon. Her primary clinical focus is the treatment and assessment of trauma among ethnically and culturally diverse communities including immigrant families as well as juvenile-justice involved youth. Her research focuses on ethnicity and ethnic identity as related to family functioning and health behaviors.
Kelsey Kuperman, M.S. was born and raised in Atlanta. She is a sixth-year Counseling Psychology doctoral candidate specializing in Spanish Language, Psychological Services, and Research at the University of Oregon. Kelsey has gained local and international training and experience providing therapy and community-based mental health services to adults, particularly Latinx and Spanish-speaking individuals. Her dissertation research examines the impact of discrimination on cognitive and mental health outcomes and aims to identify potential protective factors such as social support for a group of Latinx immigrant youth living in Oregon.
Darien Combs, M.S., M.Ed. is a fifth-year doctoral candidate in Counseling Psychology with a specialization in Spanish Language Psychological Service and Research at the University of Oregon. Her research and clinical work focus on integrated trauma healing with immigrants and refugees, mental health impacts of immigration policy and legislation, and critical consciousness, academic and vocational outcomes with Latinx high school students. Her dissertation explores the meaning Latina immigrant women place on their experiences in mental health and social support groups.
