A Comparison of Puerto Rican and Anglo Concepts of Appropriate Mental Health Service Utilization

Walter J. Torres (Ph.D., 1980)

Thesis directed by Associate Professor Peter G. Ossorio

Many cultural differences between Puerto Ricans (PRs) and Anglo-Americans (AMs) reflect some of the basic differences between natural societies and industrial/technological societies. In light of this and related considerations it is probable that certain helping practices that instantiate the industrial/technological traditions of AMs will not be appropriate or effective with PRs whose world view corresponds to that of natural societies. This study addresses the particular ways in which psychotherapy, a practice embedded in AM cultural patterns, fails to be as appropriate and/or relevant for PRs, as it is for AMs.

Five hypotheses were drawn concerning differences in PRs' and AMs' concepts of client and therapist role appropriateness. To test these hypotheses, a questionnaire was administered in Spanish to 37 low-income PR residents of Chelsea, Massachusetts, and subsequently administered in English to a matching sample of 37 AM residents of Chelsea. By presenting hypothetical situations and asking subjects to respond in a multiple choice format, the questionnaire delved into subjects' notions of appropriate treatment duration, compliance with medical advice after symptom relief, judgments on the appropriateness of emotional self-disclosure to a therapist and on the appropriateness of several alternatives as potential sources of help for nine mental health problems.

In support of the first hypothesis, it was found that the less Anglo-acculturated of the PR sample were significantly more likely than AMs to view the non-amelioration of a client who has visited a psychiatrist for five weekly sessions, as evidence of psychiatrist failure or ineffectiveness.

It was found that both AMs and PRs show a significant tendency to voice belief in the value of heeding expert medical advice after symptom relief. However, in support of the second hypothesis, PRs showed a significantly greater tendency than AMs toward actually disregarding expert health advice after symptom relief.

In support of the third hypothesis, PRs were found to be significantly more inclined than AMs to view a relationship between a female client and male therapist, in which the client discloses intimate concerns and occasionally expresses emotion toward the therapist, as an unexpected, incorrect, unhelpful and strange use of a therapist. PRs were particularly more inclined than AMs to disapprove specifically of the intimate self-disclosure occurring in the relationship. The PRs' and AMs' appraisals of the appropriateness of this therapy relationship did not vary as a function of the title under which the therapist was presented (i.e., "counselor" or "psychiatrist"), thus giving no support to the fourth hypothesis.

In support of the fifth hypothesis, it was found that PRs tend to view the psychiatrist's role as appropriate only for problems formulated in terms of individual psychopathology, and not for problems formulated in social-interactional terms; whereas AMs tend to see the psychiatrist as appropriate for both sorts of problems.

Whereas PRs saw five of nine mental health problems as more appropriately helped by a counselor than by a psychiatrist, the AMs saw one. Whereas PRs saw all nine problems as either more appropriately helped, or just as appropriately helped by Religion/God than by a psychiatrist, AMs saw all nine problems as more appropriately helped by a psychiatrist than by Religion/God.

These findings offer strong support for this study's conceptualization of PR and AM differences in attitudes toward, and actual relationships with, mental health secular experts. The findings help explain PR underutilization of, and high rates of attrition from, traditional mental health treatment. In so doing, they also yield clues toward developing treatment modalities that are appropriate and helpful for the PR client. [153 pp.]