Storytelling Through Pictures: Culturally Sensitive Psychotherapy for Hispanic Children and Adolescents. Lauren Marchant Touro College

Transcription

1 STORYTELLING THERAPY 1 Storytelling Through Pictures: Culturally Sensitive Psychotherapy for Hispanic Children and Adolescents Lauren Marchant Touro College

2 STORYTELLING THERAPY 2 Summary This study was conducted to support the effectiveness of culturally sensitive psychotherapy intervention, specifically applicable to Hispanic children and adolescents. When compared to Caucasian children, Hispanic children face a number of adversities that may lead to increased psychopathological symptomatology (Costantino, Earley, & Rogler, 1988) due to acculturation and lingual obstacles. Hispanic adolescents also have higher dropout rates (New York City Board of Education, 1990; Rogler Malgady, & Rodriguez 1989) and go on to experience higher rates of depression in adulthood (Mosicicki et al., 1987). This article discussed treatment effects using the Tell-Me-A-Story (TEMAS) thematic apperception test (Costantino, 1988). The TEMAS utilizes picture cards that depict traditional scenarios across different settings (neighborhood, school and familial) specific to the Hispanic culture. These cards are used to evoke certain emotions in an individual. After presentation of a card, the examinee tells a story about what he/she sees in the specific card shown. It was stressed that Hispanics relate better to scenes in accordance to their cultural context. Therapeutic intervention using the TEMAS with Hispanic teens has been effective in treating symptoms of anxiety as well as conduct problems (Costantino, Malgady, Rogler, 1988). In this study, two groups of different age groups were involved. One group of Hispanic children (five to eight years old), were presented Puerto Rican folktales. The

3 STORYTELLING THERAPY 3 second group was presented with historical idols in the Puerto Rican culture. All were chosen from a low socioeconomic status. Therapeutic interventions were used in this study and conducted amongst three phases. The first phase required participants to formulate a story that described the setting as well as the plot and provided a description of what was happening on the picture card. The therapist then made an effort to gather the common elements of each individual story in order to formulate one story that included one common theme. The second phase of this study required the participants to tell a personal narrative based on the composite story. This allowed participants to reveal their own personal feelings and experiences. In this phase, the therapist compared each personal narrative to the theme of the composite story and reinforced any response that was in line with the theme of the composite story. When maladaptive themes arose, they were brought up in discussion by the therapist to bring to the participant s attention, more adaptive techniques of coping. According to Costantino, Malgady and Rogler (1988), this phase allowed participants to verbalize their personal conflicts and reflect on their coping style. It also allowed them to symbolically internalize adaptive techniques when they encounter a stressful situation. The third phase of this study was videotaped. Participants acted out roles of the characters on the card based on the composite story. Adequate coping techniques were portrayed by the therapist. The video was used to play back for the participants viewing for them to critique; again, for reinforcement of appropriate symbolic coping techniques.

4 STORYTELLING THERAPY 4 Critique This study has been very well formulated with valid execution. But like all studies, there are some downfalls. There were 90 participants (N=90) in this study from low socioeconomic backgrounds from Brooklyn, New York, 60% being Puerto Rican (n=55) 25% Dominican (n=22) and 15% were other of other Hispanic descent (n=13) (Costantino, Malgady, Rogler, 1994). This not the only place where Hispanics reside, and this is only a handful of the Brooklyn population. If some participants of Puerto Rican descent were taken from a higher socioeconomic background with the same symptomatology, would intervention prove to be as effective? Also, including equal parts of different kinds of Hispanic descent included in the sample size may have produced different results. If further studied it would be helpful to include other Hispanic descents from different parts of New York. If one wanted to take it further, they may want to stay consistent with Puerto Rican descent but may want to increase the sample size. Larger sample sizes increase reliability. With such a small sample size, it leaves the study to be less reliable. The control group in this study viewed four children s movies across a couple of weeks. After viewing a movie, the next week they were asked to recall what they saw. The participants related to the movie and were asked to draw the things involved in the movie that they necessarily enjoyed. Participants then discussed and acted out the theme or actions of their favorite characters in the movie. The dramatizations were played back to the control group to view. This was structured much like the experimental group, fostered participants cognitive functioning. Other than the fact that these movies are a part of the

5 STORYTELLING THERAPY 5 American culture and does not provide any Hispanic cultural framework, the fostering of cognitive functioning denounces the participant s ability to apply their own experiences or own thoughts to this activity. Value of Results for Therapeutic Intervention This study produced multiple outcome measures. Treatment outcomes were measured using a number of tests. Focusing on solely the Symptom Check List (SCL-90) and the Center for Epidemiological Studies-Depression Scale (CES-D) self- reports, it was mentioned that they both were developed for use with adult populations (Costantino, Malgady, Rogler, 1994). It was also noted that the reliability decreased by grade level (Grade 6=.84 Grade 5=.79 and Grade 4=.69) and this may be because higher grade levels are closer in age with adults. To further support this claim, it was reported that storytelling therapy refined sixth graders conduct but no significant outcome measures regarding grades 4 and 5. This also may have to do with cognition. Possessing the ability to comprehend, distinguish and recognize when one is anxious or depressed can be a factor that played into using these self-reports as a measure for such young kids. As this article discussed, storytelling intervention proved itself to be more useful with older aged kids. It would be interesting to test children in higher age groups to see the effect of overall reliability as well as treatment outcomes and whether or not they are consistent with the findings of this article. It is known that intelligent kids respond better to psychotherapy because of their emotional intelligence. Therefore, it may be fair to hypothesize that higher emotional intelligence may have a positive correlation with storytelling therapy. To see if cognition and intelligence is certainly a factor, one may

6 STORYTELLING THERAPY 6 want to take it further and administer IQ tests to see if it correlates at all with storytelling treatment outcomes. There were no significant differences between treatment group with depression, but for the anxiety and phobic symptom group. According to participant s teacher reports, sixth graders conduct improved posttest. There were no significant treatment group differences among fourth and fifth graders. The results of this study suggest that sixth graders respond better to storytelling therapy as intervention than fourth and fifth graders. Another finding of this study suggests that storytelling therapy is an effective intervention for children who portray anxiety or phobic symptoms but not depressive symptoms. According to this study, storytelling therapy may also improve conduct or behavior in school. Acculturation and language barriers produce high levels of stress, which is why it is important to have culturally sensitive therapeutic interventions available. There are so many different cultures within the United States. Children may not all respond the same if they have not yet acculturated or mastered the English Language. The TEMAS proves itself to be an effective, reliable and valid therapeutic technique to facilitate intervention among children and adolescents of the Hispanic culture.

7 STORYTELLING THERAPY 7 References Costantino, G., (1988). TEMAS (Tell-Me-A-Story) test. Los Angeles: Western Psychological Services. Costantino, G., Malgady, R.G., & Rogler, L.H. (1988). Technical manual: the TEMAS test. Los Angeles: Western Psychological Services. Costantino, G., Malgady, R., & Rogler, L. (1994). Storytelling Through Pictures: Culturally Sensitive Psyhotherapy for Hispanic Children and Adolescents. Journal of Clinical Child Psychology, 23, Moscicki, E. K., Rae, D. S., Reigier, D. A., & Locke, B. Z. (1987). The Hispanic health and nutrition examination survey: Depression among Mexican Americans, Cuban Americans, and Puerto Ricans. In M. Gaviria & J. D. Arana (Eds.), Health and behavior: Research agenda for Hispanics (pp ). Chicago: University of Illinois. New York City Board of Education. Office of Resources, Education, and Assessment (1990). The cohort report: Four-year results for class The annual dropout rate. New York: Author. Rogler, L.H., Malgady R.G., & Rodriguez, O. (1989). Hispanics and mental health: A

8 STORYTELLING THERAPY 8 framework for research. Malabar, FL: Krieger.