By Valeria Chavez, Paula Ogalde-Carmona, Sabrina Rosario Santana, and Anne Lutz

Latinx community mental healthThe Institute for Solution-Focused Therapy was born from the need to spread the solution-focused approach to as broad a public as possible. From the very beginning, our compass has been on finding new ways to enable people around the world to have access to the evidence-based tools and resources associated with the approach. The idea to translate our courses and related material to Spanish was born from a conversation in early 2020 between Dr. Lutz and Ms. Chavez. The question was how can we broaden the population that has access to the resources we offer? At the time, the COVID-19 pandemic had effectively taken over the world and exposed the structural racial and social inequities inherent to the American healthcare system (CDC 2022). As the pandemic spread, so did a much less talked about mental health crisis. As an organization dedicated to the spread of mental health resources and wellness, we felt it was our responsibility to do our part to address these inequities. After discussions with our team, we concluded that the most effective way to make an impact would be to challenge one of the main barriers preventing ethnic groups from accessing mental health resources: language.

In the latter half of 2020, the Institute of Solution-Focused Therapy set out on an ambitious project: translate all its material into Spanish. Considering the incredible diversity of the Latinx community within the United States – not to mention the world – this was no small feat. With this in mind, the Institute put together a team of diverse native Spanish speakers to begin our translation efforts. The goal for the project went beyond the textual translation of our material but rather the natural adaptation and interpretation of an approach originally designed around the English language. After several months of work, the Institute of Solution-focused Therapy is proud to announce the release of the Spanish translation of its introductory course – Terapia Breve Centrada en Soluciones: Introducción a la Práctica Clínica – is set to happen in May 2022. Below, you can learn more about the importance of increasing the accessibility of mental health resources to the Spanish-speaking community in the United States as well as our unique translation process.

In the context of the mental health crisis caused by the COVID-19 pandemic, the need for mental health resources available for ethnic and racial minorities in the United States could not be overstated. According to the National Alliance on Mental Health, “approximately 34% of Hispanic/Latinx adults with mental illness receive treatment each year compared to the U.S. average of 45%” (NAMI 2022). This is due to a number of reasons including access to healthcare, concerns related to deportation, stigma related to mental health, language barriers, reliance on traditional healing, religious and cultural beliefs, etc. Reviews of the literature and research point to the need for services that focus on the unique context of the Latinx community in the United States (Lawton and Gerdes 2014) as well as the increased availability of culturally competent mental health resources (Martinez 2020). A systemic review of solution-focused therapy with Latinos suggests SFBT is applicable among Latino populations and that there is an increasing interest in its use in Latin America (Gonzalez et at., 2016).

Why We Translated Our Solution-Focused Course into Spanish?

The solution-focused approach recognizes that successful therapeutic outcomes depend on the quality of the therapeutic alliance. One of our main goals in translating our materials to Spanish is in providing our students with tools to enhance the therapeutic alliance in a solution-focused way. Our translation efforts are focused on increasing awareness of the need for culturally-competent mental health resources in Spanish as well as on spreading the solution-focused approach across the Latinx/Hispanic community.

The Latin American region has a history of social and political instability which has forced people to migrate and flee from poverty, political violence, and social injustice. Throughout the process of relocation and migration, people face intense stressors that make them susceptible to developing psychological distress such as depression, anxiety, and PTSD (Blackwell and Ford, 2009). Stressors such as racism and other forms of discrimination, unemployment, poverty, family separation, language barriers, among others, are all risk factors associated with long-term trauma, depression, suicidal ideation, and substance abuse for Latinx immigrants and second-generation Latinx people living in the United States (Idem). The Latinx community is the fastest-growing ethnic group in the United States and is predicted to represent 28.6% of the population in the United States by 2060 (Colby and Ortman, 2015). Over 16% of Latinx/Hispanic people in the U.S. have expressed experiencing mental illness (MHA 2022) yet, only about only 34% receive treatment each year compared to the U.S. average of 45% (NAMI 2022).

The Prevalence of Mental Health Issues in the Latinx/Hispanic Community

Despite the alarming prevalence of mental health issues in the Latinx/Hispanic community, most people do not have access to mental health services or do not receive quality mental health care as a result of social and systemic inequities among people of color (Toro Garcia, 2021). Despite the decrease in poverty rates in the United States, 15.7% of the Hispanic/Latinx community live in poverty which is more than twice as much as non-Hispanic whites (7.3%) (Creamer, 2020). Prior research implies that there is a connection between poverty and mental illness, suggesting that either poverty is linked to a higher risk of mental illness or people experiencing mental illness are more vulnerable to living in poverty (NAMI, 2022). Both of these possibilities suggest there is an urgent need to increase mental health resource accessibility to the Hispanic/Latinx population in the US. In addition, approximately 19% of Hispanic/Latinx people do not have health insurance (NAMI, 2022), which further prevents people from seeking professional help. These statistics largely exclude undocumented immigrants as there is very limited information about healthcare utilization for mental health among this population (Bucai-Harari et al 2020).

Another factor is the notably strong stigma in the Latinx/Hispanic community associated with seeking support from mental health professionals (NAMI, 2022). People from Latin America highly value strong family bonds and tend to be reserved when it comes to personal and familial problems. Depending on the family context, the strong sense of family connections can be either a protective or a risk factor for Latinx youth’s mental health. Family can be a very effective support system that helps people cope with challenges, but they can also contribute to the cultural stigma surrounding mental health (Lawton & Gerdes, 2014). It is a commonly held belief that personal problems or struggles should remain inside the household and not be shared with others due to fear of bringing shame to the family (MHA 2022). Similarly, mental illnesses can be perceived by strongly devout households as a result of the lack of faith by the individual or as a punishment for sinful behavior. By working with religious or spiritual leaders in the community alongside parents and other family members, Hispanic/Latinx people can be more informed about mental health and make faster progress in their treatment. Through the use of VIPs – or the client’s important relationships -, the solution-focused approach is a great option for this population as the community and the unique context of the client are incorporated in the formulation of solutions.

The Shortage of Bilingual and Culturally Competent Mental Health Professionals

The shortage of bilingual and culturally-competent mental health professionals is also a factor contributing to the access disparities in the Latinx/Hispanic community (LULAC 2022). Hispanics are significantly more likely than non-Hispanic Whites to report poor communication with their health care provider (Alegría et al 2013; AHRQ 2010). The literature on the subject suggests that policies centered on assisting Latinx patients overcome linguistic and cultural barriers to health care directly contribute to the improvement of access to care by the Latinx population (Oh et al. 2020). In particular, programs centered around increased workforce diversity can help reduce communication barriers and improve provider-client relationships. According to the 2021 NHDR, Hispanic people represent 18% of the U.S. population but only 8% of therapists and 10% of psychologists; no data is available on the percentage of Latinx mental health professionals with solution-focused training. Many Latinx people are hesitant to seek mental health services because the field lacks culturally competent professionals who can reflect the intersecting identities of their clients (Martinez 2020). Whether it involves racial and socio-economic barriers, stigma, or cultural competency, there are many factors standing in the way of equitable access to mental health resources by the Latinx/Hispanic community.

How We Translated our Solution-Focused Course into Spanish?

According to a 2013 study by the PEW research center a record 36.7 million persons ages, 5 and older speak Spanish at home (PEW 2013). This makes Spanish the most spoken non-English language in the United States. When we realized that translating our material to Spanish would increase access to solution-focused resources to millions of people, not only in the US but around the world, our team got to work. In order to create a product that would be accessible to the incredibly diverse Hispanic/Latinx community, we had to build an equally diverse translation team. After several months of recruiting, we put together a team made up of Central and South American native speakers as well as second-generation Latinx people from Spanish-speaking households in the US. Using automated translation software in combination with our native language skills and hours of research on existing Spanish-language mental health resources, we crafted a neutral solution-focused vocabulary in Spanish that allowed us to communicate the soul of the approach across regional differences within the language.

Due to the linguistic nature of the solution-focused approach, our team spent hours debating the best ways to translate specific words and phrases. Should we use “tu” or “usted”? How do we use gender-neutral language? How do we say “hope-friendly” and “best hopes”? What about the word “manage”? Does it make sense to say “maravillarse mentalmente” for “mind-wander”? Do we keep the word “haboob”? We learned that beyond translation our job was to interpret and adapt our material to communicate the same message, even if textually our words did not reflect the original writing. We marveled at Dr. Lutz’s ability to lecture on video without laughing at the sound of her own voice and to enjoy the “bloopers” as learning opportunities. Above all, we realized how compatible the solution-focused approach is with the values of the Hispanic/Latinx community as a compassionate and collaborative approach to therapy that maximizes the potential of community, family, and faith-based resources. Our team is thrilled to be in the beta-testing stages of Terapia Breve-Centrada en Soluciones: Introducción a la Práctica Clínica and we look forward to sharing our work with the world.

What Makes This Translation of Solution-Focused Therapy Different?

A common theme in Spanish-language mental health resources out there is the blind reliance on Google Translate or similar automated translation software. While the overall message is there, due to the grammatical complexity of the Spanish language, the final products read like they had been written by cavemen. Our team carefully combined the outputs provided by automated translation software with our native language skills and hours of research on existing Spanish-language mental health resources to craft a neutral solution-focused vocabulary in Spanish that allowed us to communicate the soul of the approach across dialectic differences within the language. Our consistent use of subject pronouns and prepositions, as well as our language interpretation beyond textual translations, makes the Institute’s Spanish-language material remarkable in comparison to existing Spanish-language mental health resources.

One of the easiest ways to note if something has been carefully translated from English to Spanish or simply plugged into an automated translation software is to look at the consistency (or inconsistency) of the use of the formal and informal “you.” As any Spanish speaker will tell you, the difference between “usted” (or formal “you”) and “tu” (or informal “you”) is very important and it varies depending on who you are addressing. This detail, however, is often overlooked by automated translation software which will pivot back and forth from formal to informal “you” within a single sentence; for example: “Sí un 10 significa que usted está muy seguro de que puede llegar a su meta, ¿qué nota te pondrías a ti mismo?” Note the use of the formal “you” in the form of “usted está” (underlined) at the beginning and then the careless transition to the informal “you” in the form of “te pondrías a ti” (bold) at the end. Our translation team spent hours fixing and reformulating these discrepancies for a product that respected the correct use of subject pronouns and corresponding verb conjugations.

Another important aspect of English to Spanish translations is the interpretation of the message rather than the direct textual translation of the language used. In comparison to Spanish, English is a “reductive” language as it takes fewer words to say the same thing. This results in translations that require more words within a single sentence to communicate the same message. However, this is where interpretation becomes really important as it is rather easy to fall into the trap posed by repetitive language – something that most automated translation software are not aware of; for example: “¿Qué se necesita para que usted pueda alcanzar un puntaje que es 1 punto más alto?” This sentence directly translates to “What is needed for you to reach a score that’s one point higher?” In English, there is no issue with this sentence. However, the Spanish translation uses the words “puntaje” and “punto” which have the same etymological root and the result reads closer to “What is needed for you to reach a score that’s one score higher?” Our translation team worked really closely on these details to provide an accurate interpretation of the material in a way that could be read more naturally.

Our team’s attention to detail is evident in the quality of our final output. As a therapeutic approach that is linguistic by nature, the solution-focused language was translated and interpreted deliberately and carefully. This course is different from other solution-focused and mental health resources in Spanish out there because it was created to be more than just a translation. Terapia Breve-Centrada en Soluciones: Introducción a la Práctica Clínica goes beyond a textual translation of an approach designed for the English language; instead, it is a natural adaptation of the soul of the approach across language barriers.