5 - (IOP 10) Ethical and Language Considerations for Therapy with Families with Limited English Proficiency: A Bilingual Spanish-language Case

Background. Hispanic and Latinx/e families in the U.S. often encounter multiple barriers (e.g., linguistic, structural) to accessing behavioral health services (Bridges et al., 2012; Roller et al., 2023). Due to limited availability of Spanish-proficient providers and interpreters, clients with limited English proficiency (LEP) or who prefer a language other than English (PLOE) often face significant obstacles in obtaining language-congruent and culturally responsive services (Zuckerman et al., 2014). To improve access to evidence-based assessment and treatment for predominantly Spanish-speaking families, it is essential to expand the workforce’s capacity to deliver services in Spanish.

Aims. In this paper presentation, we discuss challenges Latinx/e clients with LEP and who PLOE encounter in accessing language appropriate services. We share our insights providing services at a university-based outpatient behavioral health center in a southern state with a historical shortage of Spanish-proficient providers. Notably, we highlight the experience of a non-Latinx/e graduate clinician, a second-language Spanish learner, providing trauma-informed services to a predominantly Spanish-speaking family. Our discussion focuses on the ethical, language, and cultural considerations relevant to rural and training clinics providing care to Spanish-speaking families.

Case. Before accepting the case, the clinician informally assessed the family's English proficiency (adolescent fluent in English, caregivers with LEP). Services could be provided in English with teen, but all contact with caregivers, including intake and therapy, needed to be in Spanish. Notably, services included trauma-focused cognitive behavioral therapy (TF-CBT; de Arellano et al., 2014), conjoint sessions with teen and caregiver, and a trauma narrative in both English and Spanish. Yet, our training clinic—like many nationwide (Villalobos et al., 2021)—lacks formal interpreter services. Bilingual therapists without formal Spanish training can feel compelled to serve as language brokers, often driven by internal pressure (e.g., feelings of guilt or inauthenticity, awareness of gaps; Delgado-Romero et al., 2018). This ethical concern and clinician’s own Spanish proficiency were carefully considered before rendering services to family.

To ensure quality care, the clinician consulted regularly with supervisor and sought extra consultation from a fully bilingual Latinx/e licensed clinical psychologist. We discuss lessons learned in navigating consultation with supervisors with distinct cultural and linguistic lenses and in collaborating with clinic director to provide inclusive evidence-based practices. Like many, our clinic’s resources in Spanish were limited; we also discuss our process and efforts (e.g., translating, seeking) to expand our repository of language-congruent materials (e.g., forms, measures, handouts).

Summary. We aim to discuss the process of a bilingual second-language student clinician serving a predominantly Spanish-speaking family. This paper highlights the importance of providing linguistically appropriate care and training and discusses ethical considerations for trainees, supervisors, and clinics.