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This is to certify that the

dissertation entitled

MEXICAN AMERICANS' EXPECTATIONS
AND UTILIZATION PATTERNS OF
MARRIAGE AND FAMILY
THERAPY SERVICES

presented by

GLORIA ELENA GONZALEZ-KRUGER

has been accepted towards fulfillment
of the requirements for

Ph.D. Family & Child Ecology

degree in

 

 

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Major professor

Date 12/18/98

 

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MEXICAN AMERICAN'S EXPECTATIONS AND UTILIZATION PATTERNS OF
MARRIAGE AND FAMILY THERAPY SERVICES

BY

Gloria Elena Gonzalez-Kruger

A DISSERTATION
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of
DOCTOR OF PHILOSOPHY
Department of Family and Child Ecology

1998

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ABSTRACT

MEXICAN AMERICAN'S EXPECTATIONS AND UTILIZATION

PATTERNS
OF MARRIAGE AND FAMILY THERAPY SERVICES

BY

Gloria Elena Gonzalez-Kruger

Serveral studies have found that people of Mexican

orirgiri luave the highest drop-out rates and underutilization

of mental health services. This study considers the rela-

ticuiskufp between acculturation (behavioral and cognitive),

expectations for marriage and family therapy (MFT) services,

leveal (of knowledge of various mental health services, open-

ness; tr) learning about mental health services, and utiliza-

tion.<>f counseling, therapy,

and marriage and family therapy

by pmmople of Mexican-origin. The Mexican~origin population,

like idhe Latino, is growing at a faster rate than any other

ethnix: group in the United States and is facing serious

concxarns in their communities, including high rates of

poverflqy, school dropouts, unemployment, and substance abuse.

This gyrowing group will require accessible and effective
mentzfil health services consistent with the expectations and

needs of people in this diverse community. The factors that
influence the utilization of resources, specifically mental
health services, is a critical area of inquiry in need of

extensive study. The majority of studies in this area were
conducted with student and clinical populations and samples

from the southwest that are not generalizable to the

Mexican—origin population in the Midwest.

This research was designed to be culturally sensitive
and ecological in nature. It utilized a cross sectional,
inferential, explanatory, two-stage design. Data was
collected from a sample of Mexican-origin individuals over
age 24 who resided in either one rural or one urban county.

Data collection was completed in bilingual, face-to-face

interviews conducted in non-controlled settings. The 230-

item questionnaire consisted of: (a) demographic questions,

(b) two standardized instruments measuring level of

behavioral and cognitive acculturation, (c) a revised

standardized instrument examining expectations about MFT,

and (d) questions related to their level of knowledge of,

openness to learning about, and utilization of mental health

services, including coun-seling, therapy, and MFT. A second

audiotaped interview was conducted with a subsample of 15

individuals, using open—ended questions to encourage them to

share their ideas and feelings about help-seeking and mental

health issues as people of Mexican-origin.

The results of this study indicate that a very low

percentage of people of Mexican-origin in this population

utilized MFT and that subjects’ responses to the types of

services they utilized were suspect due to lack of under—

standing of the differences between counseling, therapy, and

MFT .

Copyright by
GLORIA ELENA GONZALEZ-KRUGER
1998

DEDICATION

This dissertation is dedicated to loving and supportive
iinnily and friends that have endured with me this long and
earduous process. They have experienced the joys and
excitement that have been part of my journey, but, even more
appreciated, are the times that they have sustained me in
times of great stress and pain. Without their support, I
have no doubt that I would not be writing this dedication.
Each of them have taught me more about children, family, and
systems than I could ever learn from my academic endeavors.
They sustained me and helped me to stay connected to
friends, family, community, and my Mexican roots during this
process of completing the dissertation and my doctoral
program. When they would see me being consumed by academia,
they gave me the love, nurturance, and/or guidance to return
to what I value most in my life, the relationships with them
and the larger community. Each of these unique and special
relationships provide richness to my life and serve to
motivate me in my work to enhance the lives of children,
families, and communities. The life they represent and live
keeps me grounded and enhances my personal life as well as
my professional life as an educator, therapist, and
researcher.

An incredible thank you to my husband, David, and my
son, ChristOpher, who endured this journey alongside me.

Thank you to my parents, Jaime y Elena, who have taught me

to cherish family and our rich Mexican culture. I treasure
you as my parents and the support you gave me, especially
during those times when you did not agree or understand my
choices in life. This dissertation and Ph.D. belongs to us;
with you, my journey has been rewarding.

The decision to attend graduate school and obtain my
doctorate has been a gratifying and painful experience. I
have discovered many worlds that were unknown to me, which
has helped me grow and flourish in many respects. As a
Mexicana, I have been challenged as I have attempted to
learn to live within two cultures that are often in conflict‘
with each other. Blending the beliefs and values of each
culture has been a challenging but rewarding experience. It
has enhanced my life by allowing me to experience and
integrate the richness of my Mexican and Anglo American
cultures. Now, I understand more about the process of

“becoming and being bicultural.”

vi

ACKNOWLEDGEMENTS

There are so many people to acknowledge that have
contributed to the development and writing of this
dissertation. Gracias (Thank you) to mi familia for the
love, support, and tolerance that you gave to me over the
last eight years as I have encountered the challenges of
juggling family, friends, work, and graduate school. To my
husband, Dave, who has given me unconditional love and has
taken more than his share of household chores and stress as
we each battled through the stressors of graduate school and
life. To my son, Christopher, who has challenged me as a
parent, taught me the importance of listening to children,
and kept me rooted in reality. To my parents, who worked
many hours helping me prepare for and conduct this research
study. To my brothers and sisters—David, Rene, Laura, Ruben,
Raul, Irene, and Jaime—who challenged me to find ways to
stay connected to family when I would drift away. I know we
will always find our way back to each other. To all of my
professors, who have supported me and taught me the
importance of looking at life through another lens and
experiencing multiple realities. To my committee members,
who have been patient and understanding while I tried to
find my way through the dissertation. To Dr. Borland-Hunt
and Dr. Villarruel, who invested and trusted in me and my

goals, even when I was unable to invest and trust in myself.

vii

To Ruth and Mary, who have provided many years of friendship
and encouragement. To my supportive and tolerant friends,
Kathy, Julie, and Lynn, who rode the waves of connectedness
and separateness. To my new friend, Rosemary, who provided
wonderful editorial and typing support in finalizing the
dissertation and who went beyond the call of duty by
providing encouragement and friendship. Finally, but most
importantly, I thank and appreciate my dear friend, Dorothy,
who has given me a unique and treasured relationship. She
has provided me the affective and instrumental support that
most contributed to me completing this dissertation. Thank
you for the home away from home, the encouragement, the
input and feedback, the laughter, your willingness to learn
and experience my Mexican culture, and your willingness to

teach me and let me experience your German culture.

viii

TABLE OF CONTENTS

LIST OF TABLES . . . . . . . . . . . . . . . . . . .
LIST OF FIGURES . . . . . . . . . . . . . . . . . . .

CHAPTER 1

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . .
Scope of the Problem . . . . . . . . . . . . . . . .
Statement of the Problem . . . . . . . . . . . . . .
Significance of the Study . . . . . . . . . . . .
Generalizability . . . . . . . . . . . . . . . . . .

CHAPTER 2
REVIEW OF THE LITERATURE AND CONCEPTUAL FRAMEWORKS . . .
Theoretical Frameworks . . . . . . . . . . . . . . .
Ecological Perspective . . . . . . . . . . . .
Multicultural Perspective . . . . . . . . . . .
Acculturation Theory . . . . . . . . . . . . .
Multicultural Family Therapy . . . . . . . . .
Ecology of the Mexican Origin Population . . . . . .
Changing Demographics . . . . . . . . . . . . .
Environmental Influences in Latino Communities
Mental Health Services in the Mexican-Origin
Population . . . . . . . . . . . . . . . . . . . . .
Mental Health Status of Latinos . . . . . . . .
Help-Seeking: Sources, Access, and Utilization
Utilization of Mental Health Services and
Marriage and Family Therapy . . . . . . . . . .
Knowledge of Mental Health Services . . . . . .
Openness to Learning about Mental Health
Services . . . . . . . . . . . . . . . . . . .
Expectations About Counseling (Marriage and Family
Therapy) . . . . . . . . . . . . . . . . . . . . . .
Marriage and Family Therapy: An Alternative
Resource . . . . . . . . . . . . . . . . . . . . . .
Review of the Literature: Summary . . . . . . . .
Definitions . . . . . . . . . . . . . . . . . . . .

Delimitations . . . . . . . . . . . . . . . . . . .
Assumptions . . . . . . . . . . . . . . . . . . . .
CHAPTER 3
METHODOLOGY . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . .

Research Design . . . . . . . . . . . . . . . . . .
Research Questions . . . . . . . . . . . . . .
Variables . . . . . . . . . . . . . . . . . . .
Hypotheses . . . . . . . . . . . . . . . . .
Criteria for Sample . . . . . . . . . . . . . .
Recruiting of Sample . . . . . . . . . . . . .

ix

xii

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73

Data Collection . . . . . . . . . . . . . . . 74
Respondent Characteristics/Demographic Section 80

Interview Number 2 . . . . . . . . . . . . . . 81

CHAPTER 4
RESULTS AND DISCUSSION . . . . . . . . . . . . . . 82
Introduction: Instrument and Sample . . . . . . . . 82
Instrument . . . . . . . . . . . . . . . . . . 82
Sample Description . . . . . . . . . . . . . . 83
Reliability of Measures . . . . . . . . . . . . . . 87

Acculturation Rating Scale for Mexican
Americans- II (ARSMA- II) . . . . . . . . . . . 89
Internal Consistency: ARSMA- II . . . . . . 89
Factor Analysis: ARSMA- II . . . . . . . . 89
Multiphasic Assessment of Cultural Constructs-
Short Form (MACC-SF) . . . . . . . . . . . . . 91
Internal Consistency: MACC-SF . . . . . . 91
Factor Analysis: MACC-SF . . . . . . . . . 93
Reliability of Spanish Version: MACC-SF . 94
Expectations about Counseling—Brief Form (EAC—BF;
(adapted to Expectations about Marriage and Family‘
Therapy-Brief Form (EAMFT-BF) . . . . . . . . 100
Internal Consistency: EAC-BF (EAMFT—BF) 100
Factor Analysis: EAC-BE (EAMFT-BF) . . . 102
Spanish Version: EAC-BF (EAMFT-BF) . . . 103
Measure of Level of Integrated Acculturation . . . 105
Introduction . . . . . . . . . . . . . . . . 105
Development of Measure . . . . . . . . . . . 105
Level of Integrated Acculturation . . . . . . 106
Results of Level of Integrated Acculturation 107
Results of Study by Research Questions and
Hypotheses . . . . . . . . . . . . . . . . . . . . 108
Help Seeking . . . . . . . . . . . . . . . . 110
Utilization of Mental Health Services . . . . 110
Type of Expectations of Marriage and Family

Therapy Services . . . . . . . . . . . . . . 116
Impact of Openness to Learning about MFT on
Expectations . . . . . . . . . . . . . . . . 120

CHAPTER 5
SUMMARY, CONCLUSIONS, LIMITATIONS, DIRECTIONS FOR FUTURE
RESEARCH, AND IMPLICATIONS FOR CLINICAL PRACTICE . . . 125

Summary . . . . . . . . . . . . . . . . . . . . . 125
Conclusions . . . . . . . . . . . . . . . . . . . 132
Limitations . . . . . . . . . . . . . . . . . . . 140
Directions for Future Research and Implications for

Clinical Practice . . . . . . . . . . . . . . . . 142
Personal Reflection . . . . . . . . . . . . . . . 152

‘---\

.0-

APPENDICES .. . .. . . .. . .. . .. . . .. . . . 153
A” Complete Instrument for Research Study . . . 154

13. Acculturation Rating Scale for Mexican Americans-
II (ARSMA-II) . . . . . . . . . . . . . . . . 182
Overview . . . . . . . . . . . . . . . . . . 183
Cut Off Scores . . . . . . . . . . . . . . . 185

C. Multiphasic Assessment of Cultural Constructs—
Short Form (MACC— SF) . . . . . . . . . . . . 191
Overview . . . . . . . . . . . . . . . . . . 192

Survey Instrument Items Representing Five
Scales: Familism, Fatalism, Machismo, Folk
Beliefs, and Personalism . . . . . . . . . 194
D. Expectations About Counseling-Brief Form . . 198
Overview . . . . . . . . . . . . . . . . . . 199
Definition of Expectancy Scales for Expectations
about Counseling (Adapted to MFT) . . . . . . 200
Spanish Version of Expectations about Counseling-

Brief Form . . . . . . . . . . . . . . . . . 202
E. Informational Advertisement: English and

Spanish . . . . . . . . . . . . . . . . . . . 204
F. Informational Sheet for Subjects: Session 1,

English and Spanish Versions . . . . . . . . 207
G. Approval Letter: University Committee on

Research Involving Human Subjects; Consent Form:
Session 1, English and Spanish Versions . . . 210

H. Bilingual Response Cards . . . . . . . . . . 214
I. Informational Sheet for Subjects: Session 2,
English and Spanish Version . . . . . . . . . 219
J. Consent Form: Session 2, English and Spanish
Version . . . . . . . . . . . . . . . . . . . 224
K. Research Instrument-Session 2, English and
Spanish Version . . . . . . . . . . . . . . . 227
L. Copyright Permission Documentation . . . . . 232
M. Results of Study Based on Level of Behavioral and
Cognitive Acculturation . . . . . . . . . . . 238

REFERENCES . . . . . . . . . . . . . . . . . . . . . . 253

xi

Table

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Table

Table

Table

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Table

Table

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Table

Table

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LIST OF TABLES
l--Variable List and Measure . . . . . . . . . . . 56

2--Crosstab in Development of Level of Integrated
Acculturation . . . . . . . . . . . . . . . . . . 64

3--Content of Research Instrument . . . . . . . . . 83

4--Racia1 and Ethnic Characteristics for Respondents
and Their Partners . . . . . . . . . . . . . . . . 85

5--Demographic Characteristics for Respondents: Means
and Percentages . . . . . . . . . . . . . . . . . 86

6--Mean and Percentages: Education and Income of
Respondents . . . . . . . . . . . . . . . . . . . 88

7--Comparing Means and Correlations for ARSMA-II to
Cuéllar’s Study . . . . . . . . . . . . . . . . . 89

8--Rotated Factor Matrix for Anglo Orientation Scale
of ARSMA-II . . . . . . . . . . . . . . . . . . . 90

9--Rotated Factor Matrix for Mexican Orientation Scale
of ARSMA-II . . . . . . . . . . . . . . . . . . . 92

10--Means and Correlations for Scales/Subscales of
MACC-SF . . . . . . . . . . . . . . . . . . . . . 93

11--Rotated Factor Matrix for Machismo Scale of MACC—
SF . . . . . . . . . . . . . . . . . . . . . . . . 95

12--Rotated Factor Matrix for Folk Beliefs Scale of
MACC-SF . . . . . . . . . . . . . . . . . . . . . 96

13--Rotated Factor Matrix for Familism Scale of MACC-
SF . . . . . . . . . . . . . . . . . . . . . . . . 97

14—-Rotated Factor Matrix for Fatalism Scale of MACC-
SF . . . . . . . . . . . . . . . . . . . . . . . . 98

15--Rotated Factor Matrix for Personalismo Scale of
MACC-SF . . . . . . . . . . . . . . . . . . . . . 99

16--Means and Internal Consistency Scores for Scales
of Expectations about Counseling-Brief Form (adapted
to Expectations about Marriage and Family Therapy-
Brief Form) . . . . . . . . . . . . . . . . . . 101

xii

Table

Table

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17--Mean, Standard Deviation, and Internal Consistency
for Factors of the Expectations about Counseling-
Brief Form (Adapted to Marriage and Family Therapy-
Brief Form) . . . . . . . . . . . . . . . . . . 104

18--Use of Counseling Services by Level of Integrated
Acculturation . . . . . . . . . . . . . . . . . 112

19--Use of Marriage and Family Therapy (MFT) Services
by Level of Integrated Acculturation . . . . . . 113

20--Relationship between Type of Expectations and
Level of Utilization of MFT Services . . . . . . 115

21--Comparison of Expectations about MFT by Level of
Integrated Acculturation . . . . . . . . . . . . 118

22--Frequencies for Knowledge of Mental Health
Services . . . . . . . . . . . . . . . . . . . . 120

23-—Openness to Learning about Marriage and Family
Therapy and Expectations of MFT . . . . . . . . 123

Bl-Raw and Mean Scores for ARSMA-II Subscales . . 187

BZ—Reliability Data for ARSMA-II Scales and
Subscales . . . . . . . . . . . . . . . . . . . 188

B3-Acculturative Types Generated by ARSMA-II . . 189

Cl-Internal Consistency Data for Five Cultural
Constructs (MACC-SF) . . . . . . . . . . . . . . 197

C2—Factor Analysis (MACC-SF) . . . . . . . . . . 197
Ml-Acculturative Types Formulated by ARSMA—II . . 240
M2-Cultural Constructs Generated by the MACC-SF . 242

M3-ANOVAs for Cultural Constructs by Acculturation
Levels . . . . . . . . . . . . . . . . . . . . . 243

M4-Means, Standard Deviations, and Significant
Differences of Cultural Constructs by Acculturation
Level . . . . . . . . . . . . . . . . . . . . . 243

M5-Comparison of Expectations about Marriage and

Family Therapy by Level of Behavioral
Acculturation . . . . . . . . . . . . . . . . . 245

xiii

Table M6—Comparison of Expectations about Marriage and
Family Therapy by Level of Cognitive
Acculturation . . . . . . . . . . . . . . . . . 248

Table M7-Use of Counseling Services by Behavior and
Cognitive Acculturation (N=60) . . . . . . . . . 251

Table M8-Use of Marriage and Family Therapy (MFT) Services
by Acculturation Behavior and Cognitive Acculturation
(N=60) . . . . . . . . . . . . . . . . . . . . . 252

LIST OF FIGURES

Figure l--Ecological Model of Constructs: Mexican Americans'
Expectations and Utilization of Marriage and Family
Therapy Services . . . . . . . . . . . . . . . . 17

Figure 2--Theoretical Model of Constructs Related to Mexican

Americans' Expectations and Utilization Patterns of
Marriage and Family Therapy Services . . . . . 109

xiv

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CHAPTER 1

INTRODUCTION

Scope of the Problem

There is an increasing need to study the factors that
influence effectiveness and utilization of therapy services
in ethnic and racial groups to enhance the understanding and
treatment of diverse populations (Aronson Fontes & Thomas,
1996; Goldner, 1985; Leslie, 1995; Saba, Karrer, & Hardy,
1989). Leslie identified three characteristics of marriage
and family therapy (MFT) that are consistently found in
critiques of how this field has been oppressive or
insensitive to ethnicity, gender, and sexual orientation.
First, MFT has not applied a contextual approach in the
study of family dynamics; second, it ignores power
differences within the family and in the larger society;
and, third, it assumes a monolithic family form. The
oppression results from therapy being based on predominantly
Euro-Anglo, paternalistic therapy models conducted by
primarily Euro-Anglo therapists. Criticisms of the MFT
field's insensitivity to and oppression of diverse groups
have motivated the increased attention to research and
changes in clinical treatment in these areas (Doherty &
Baptiste, 1993; Goldner, 1985; Hardy, 1989; Saba, Karrer, &

Hardy, 1989).

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The issue of whether counseling needs to be culture
specific (emic) or universalistic (etic) has generated
controversy (Pike, 1954). Culture specific counseling
stresses the need to use culturally sensitive and relevant
therapy models (Sue & Morishima, 1982; Kagawa-Singer & Chi—
Ying Chung, 1994), while universalistic counseling
underscores the common elements of mental health needs. If
one is approaching this issue from a systems perspective, it
readily becomes apparent that both types of counseling are
equally relevant. The system’s concepts of wholeness and
hierarchy (Whitchurch & Constantine, 1993) supports the
study of therapy using both the emic and etic approaches.
Neither approach should be used in isolation if there is to
be a holistic understanding of how each impacts therapy with
ethnic and racial groups. The hierarchy is composed of
subsystems, systems, and suprasystems. The latter sets the
foundation for the study of families in relation to their
ethnic and racial subcultures and in relation to larger
systems.

Piercy and Sprenkle (1990) summarized trends in theory
and research on MFT over the 19805. They offered suggestions
for research in the 19905 which included increasing
specificity, describing and defining client and therapist
variables, and distinguishing among clinical populations.
Specifically, they suggested (a) documentation of

therapists' adherence in the use of treatment protocols,

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(b) descriptions of the uniqueness of client populations,
(c) consistency in therapist equivalency in treatment
studies, (d) valid and reliable measurement of family
therapy constructs, (e) qualitative research, and (f)
consistency and longevity in conducting research.

The present investigation was undertaken in response to
the call to study the uniqueness of potential client
populations and to develop multiculturally appropriate
research. It was based on the tenet that culture strongly
influences the beliefs, expectations, behaviors, and choices
that people make in their lives. The focus of the
investigation was to take an emic perspective in examining
the relationship between the cognitive and behavioral
constructs of acculturation that influence expectations and
utilization of marriage and family therapy services. People
of Mexican origin live within two cultures, the Anglo and
the Mexican, in varying degrees. The level of acculturation
is impacted by a plethora of factors, including place of
birth, generation, beliefs, cognitions, place of residence,
and family. The interaction of these dynamic factors leads
to an ever changing environment that is continuously being
influenced by outside forces. This investigation was
designed to examine how culture is related to the help-
seeking behaviors, expectations, and utilization of therapy
services by people in this ethnic group with a focus on the

in-group variation.

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The mental health system purports to serve diverse
populations to access and acquire effective resources and
services and, thereby, to achieve an improved quality of
life. The majority of studies conclude that there is an
underutilization of mental health services by people in the
Hispanic or Latino community (Acosta & Sheehan, 1976; Keefe,
1979; Marin, Marin, Padilla, & de la Rocha, 1983; Sue, 1977;
Sue & Zane, 1987) and a high drop-out rate by those who use
the services (Sue). However, there is a lack of prevalence
data available in the literature and from mental health
organizations on the Mexican origin community specifically
(Torres, 1991).1

There is a continuing debate about the explanation for
this underuse of mental health services by the Latino
community. Some researchers claim that counseling or therapy
is not perceived as a viable option by people in the Latino
community who are seeking help. Others contend such services
are not culturally sensitive to the needs of ethnic groups,
and there is a deficiency in research and therapeutic models

that are culturally sensitive and respectful (Martinez,

 

1The term “Hispanic” is generic and refers to all
Spanish-speaking or Spanish-surnamed people who reside in
the United States or Puerto Rico. The term “Latino”
signifies a person of Latin American origin. This paper
will use terms as they are used by original authors when
citing their work. The terms “people of Mexican origin” and
Mexican- origin prople or community are used to specify the
group of people who reside in the United States and whose
ancestors or who themselves came from Mexico.

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1994; Soto-Fulp & DelCampo, 1994; Sue, 1977). Many
researchers believe that an increased understanding of
acculturation patterns, cultural beliefs, and expectations
of counseling/therapy will serve to enhance the
appropriateness of mental health services. The results will
also add useful data to the growing debate related to
utilization of mental health services by this group.

The number of Mexican-origin people has been increasing
at a faster rate than any other ethnic or racial group.
The Latino population was the fastest growing ethnic group
(7.7 million people) between 1980 and 1990, with a rate of
growth that more than doubled that of the African American
population. The Latino population constitutes nine percent
of the population in the United States, with the Mexican
origin group representing 60.4% of the Latino population
(0.8. Bureau of the Census, 1990). This national pattern is
evident in the Midwest, with Mexican-origin people
representing approximately three quarters of the growth and
almost two thirds (65%) of the Hispanic population. The
growth of the Latino population highlights the cultural
variation within and between ethnic groups. Moreover, it
will have a considerable impact on the larger society
through reciprocating interactions between people in the
dominant culture and people who have varying degrees of
culturally bound beliefs, values, expectations, and

behaviors which differ from those of the dominant culture.

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The growing Mexican-origin community is faced with a
multitude of issues that are stressing the relationships and
resources of families. Families are facing powerful
obstacles, such as poverty, unemployment, underemployment,
discrimination, and substance abuse. It must be recognized
also that this community has strengths that are inherent
within individuals, family systems, and the community as a
whole. Mental health providers must understand and
appreciate these issues within the context of three
discrete, but interrelated, environments-- the Natural
Physical-Biological, the Social-Cultural, and the Human
Built--if they are to become an increasingly viable option
for people of Mexican origin.

People select support systems and resources that are
congruous with their beliefs and expectations to assist them
with mental, emotional, and relational problems. Systems
exist within the Mexican-origin community, such as extended

family, compadres,2

and the church, that are accepted as

appropriate sources of support to individuals and families
in times of need. The mental health system has not been a
primary resource utilized by the Mexican-origin community.

Mental health providers must be aware and accepting of

common beliefs and practices of this community as they

 

2Compadre refers to a religious kinship between adults,
in which one person may serve as a support system or a
second parent to a child of the other.

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attempt to become a more recognized and sanctioned option
for people to utilize.

The mental health system must make adaptations in its
delivery of services and assessment and treatment of
clients. Attention to providing culturally competent mental
health services will increase its effectiveness and insure
an increase in the level of utilization by people of Mexican
origin. It will also be necessary to build trust between the
Mexican-origin community and the mental health system.

Trust can be developed among people involved in the mental
health system if providers listen to the voices of people of'
Mexican origin and dialogue with them. In this way
professionals can become educated about the types of changes
that would be necessary to create culturally relevant
services. Studies must take into account the larger outside
environment and its impact on the Mexican-origin community;
research must assist in clarifying the necessary
modifications which the mental health system needs to make
to adequately and effectively respond to the needs of the
Mexican-origin population. This process can also serve as an
opportunity to develop a relationship with this community in
which trust can be cultivated.

Individuals and families in the Mexican-origin
community, and ultimately the community as a whole, will
fail to make use of a potential resource if culturally

competent mental health services that respect the special

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needs of this ethnic population are not made available.
People may suffer in isolation rather than seek professional
help because of the stigma that is associated with choices
inconsistent with their culture. The professionals can be a
safety net to the community in circumstances where systems
closer to the individual or family have not been successful
in alleviating or minimizing the negative impact of the
stressor.
Statement of the Problem

Definition and identification of the Mexican-origin
population is a major issue for researchers due to the
heterogeneity of this people and the historical and
political climate in which they have existed in the United
States. The dominant population group has sought to
categorize people who belong to the Mexican-origin group by
selecting a stratifying variable, such as nativity, that was
consistent with their perception of how to define, identify,
and label persons of Mexican origin. Simultaneously, the
people within this ethnic group have engaged in internal
struggles over the identity issue that has compounded the
difficulty of finding resolutions, which become more
critical as this population grows.

Traditional and accepted modes of the research process
in the academic and professional community have disregarded,
to a great degree, the need to develop methodologies for

studies respectful of the community being studied. Research

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paradigms that are Anglo-oriented and inappropriate to the
study of diverse groups have produced areas of weakness in
the study of cultural groups. This has also decreased the
strength and validity of the studies and their conclusions.
Historically, there has been disagreement or a lack of
information in the study of ethnic or cultural groups in the
following areas: (a) defining and identifying the Latino
population and its cultural subgroups; (b) defining and
operationalizing culturally appropriate constructs; (c)
developing culturally sensitive and valid instruments and
procedures; (d) engaging culturally appropriate
methodologies in recruiting, interacting, and gathering
information; and (e) interpreting data within a cultural
context.

The importance of culture and its influence on human
growth and development has been increasingly acknowledged by
members of the academic, research, and professional
communities. This has prompted an expansion in the funneling
of time and energy to efforts aimed at building a robust
data base related to cultural issues. Researchers have also
become more cognizant of including people of ethnic groups
in their studies of mental health (Aronson Fontes & Thomas,
1996; Comas-Diaz & Greene, 1994; Gregory & Leslie, 1996;
Marin & VanOss Marin, 1991; Odell, Shelling, Scott Young,
Hewitt, & L'Abate, 1994; Sue, Fujino, Hu, Takeuchi, & Zane,

1991). However, the majority of these and other studies

have been conducted "comparing" Hispanic samples with
"normative" Anglo groups, who are primarily white middle-
class populations or student samples.

Therefore, this study was designed to identify: (a) the
characteristics of people of Mexican origin who seek out
help when they need it; (b) their level of knowledge about
various mental health services, specifically MFT; (c) what
the Mexican-origin community expects from helpers; (d) their
openness to learning about MFT; and (e) their utilization of
counseling, therapy, and MFT. This information about
Mexican-origin populations will increase the breadth and
depth of mental health practitioners’ effectiveness.9 The
mental health system can utilize this information to
generate the changes that must be made to increase
utilization and efficacy rates of services within the
Mexican-origin community.

In summary, assuming that expectancies are related to
the utilization of services, this research highlights areas
that mental health providers must address to develop
culturally competent services.

Significance of this Study

The mental health system must respond to the changing
populations it will be serving as the demographics and
characteristics of this country are transformed by the
increasing numbers of people from diverse ethnic and racial

backgrounds. Mental health services and service providers

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must develop culturally competent support systems that
correspond with expectations held by members in this
community. Culture impacts each of the participants'
perspectives of the objectives and process of therapy. In
order to achieve a positive outcome, professionals in the
field must acknowledge the influence of culture and
acculturation on the expectations held by persons of Mexican
origin since this influence has been shown to moderate the
effectiveness of therapy (Tinsley, Bowman, & Westcot Barich,
1993). Providers must have an awareness of important
cultural norms in order to demonstrate credibility and
trustworthiness with Mexican-origin communities. This
research study exemplifies culturally competent research
that considers the ecology, the strengths, and the needs of
the Mexican-origin population.

This investigation was unique in the following ways:
(a) The researcher/interviewer and the participants of the
study were of the same culture; (b) the researcher was
bilingual; (c) the researcher was a marriage and family
therapist; and (d) the researcher utilized a community
sample of people with varying levels of acculturation and
experience with therapy. Thus, the study provided data on
the variations within this ethnic group. The study
functioned as a channel for the people in a midwestern, mid-
sized Mexican-origin community to be heard in a manner that

was respectful, encouraged dialogue, and integrated

11

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important variables into the study of cultural meaning.
Finally, this research contributes information to the field
of MFT, which is increasing the energy devoted to the study
of ethnic and minority families.

The methodology and instruments were designed to be
consistent with the cultural norms of the Mexican origin
group. The subjects participated in bilingual face-to—face
interviews conducted by a person of Mexican origin. Care was
taken throughout the various stages of research, such as
planning, development, collection, and analysis, to engage
in culturally appropriate behaviors that were respectful and'
consistent with conducting research with Hispanic
populations. These steps were taken to assure the completion
of a culturally sensitive investigation that secured
reliable and valid results and, simultaneously, fostered
trust in mental health services among members of the
Mexican-origin community.

The development of a positive relationship between the
researcher and the Mexican-origin community increased the
likelihood that members of this community engage in future
studies that serve to enhance their quality of life.
Participation in this study served to minimize the stigma
or, at best, normalize the option of seeking mental health
services in response to experiencing difficulties in their
lives. Finally, this study increased the visibility of the

MFT field, which this author believes is consistent with

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many of the values and beliefs held by a majority of the
Mexican-origin community.
Generalizability

Conclusions from this investigation are based on a
purposive sample; therefore, they will not be generalizable
to the larger Mexican-origin population. However, the use of
a community sample improves upon studies that have been
conducted primarily with student samples. It will also
provide a basis for future studies to be conducted with

random samples from various geographical areas.

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CHAPTER 2

REVIEW OF THE LITERATURE AND CONCEPTUAL FRAMEWORKS

Over the last ten years, professionals in the field of
marriage and family therapy (MFT) have focused more time and
energy on issues related to ethnicity (Berg & Jaya, 1993;
Cohen, 1993; Goldberg, 1993a, 1993b; McAdoo, 1993;
McGoldrick, Pearce, & Giordano, 1982; McGoldrick, Preto,
Hines, & Lee, 1991; Odell, Shelling, Scott Young, Hewitt, &
L'Abate, 1994; Saba, Karrer, & Hardy, 1989). In a recent
review of family therapy literature, Leslie (1995)
identified specific goals for this field, such as
consideration of the broader social context, acknowledgement
of power differences within and between systems, and more
attentiveness and adeptness at working with diverse family
systems. She provided multiple suggestions for research and
clinical work. Parameters that have been exemplified in this
study include examining racial and ethnic groups more
extensively and looking to organizations as sources for
creating change.

This chapter is organized into four sections: (a)
theoretical frameworks, including human ecological theory,
acculturation theory, and the multicultural perspective; (b)
current status of research related to multicultural family
therapy; (c) the ecology of the Mexican-origin population;

and (d) mental health services with a focus on factors that

14

are related to help-seeking and utilization of services in
this population.
Theoretical Frameworks

A brief summary of each of the theories that are
integrated into this investigation is presented to provide a
structure within which to understand the research being
conducted.
Eeelegieel Perspective

An ecological framework (Bubolz & Sontag, 1993)
supports examination of the interrelationships between the
human ecosystem and its three environments: the Natural
Physical-Biological, the Social-Cultural, and the Human
Built. This perspective is based on a hermeneutic philosophy
that is grounded in values. The ecological perspective draws
attention to groups that experience prejudice and
discrimination and have problems in accessing resources. In
addition, this perspective incorporates systems concepts and
emphasizes the subjectivity of people's experiences.
Finally, the ecological perspective requires that an effort
be made to understand perceptions, interpretations, and
meanings that are created as a result of their
interdependence on and interaction with the three discrete,
but interrelated, environments.

This study of expectations and utilization of MFT took
into account the various climates that people in the

Mexican-origin community are embedded within and how each

15

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influences the other (Figure 1). In this study, the human
environed unit was the individual of Mexican origin, and the
Natural Physical-Biological environment was represented by
an individual's ancestry, birthplace, generation, age,
country of origin, and length of residence in the United
States. The social-cultural environment included the
person's gender, ethnic self-identification, type of
citizenship, primary language, level of acculturation,
education, religion, and level of expectations. Finally,
type of employment, amount of income, socioeconomic status,
and utilization rates of therapeutic services illustrated
the human built environment.

Herrin and Wright (1988) assert that family therapy,
which is based on systems theory, has shown a growing
tendency to use the ecological approach in its studies since
it requires consideration of the interdependence of humans
and their environment in the therapeutic process. This is
illustrated by the manner in which family therapy (a)
addresses or examines issues in relation to age, ethnicity,
race, gender, socioeconomic status, and family type; (b)
recognizes the processes by which systems function and
adapt, internally and as systems interdependent with their
environment; (c) contributes to the betterment of
individuals and families (human or family ecosystem) by
providing a safe place to explore the changes necessary to

achieve goals; (d) assists families in identifying what they

16

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can do to create, manage, or enhance their environments to
improve their quality of life or vice versa; (e) supports
the examination of meaning which structures human behavior;
(f) encourages adaptation within, among, and between
systems; (g) recognizes the need to consider the individual
or family in the context of society and the ecosystem; (h)
establishes a caring relationship in which to conduct
therapy; and (i) focuses on achievement of a "good fit"
between human environed units and their environment.

In summary, family therapy works with the system, which
is conceptualized as being comprised of multiple subsystems
that are dynamic, interdependent, and have a reciprocal
influence. Family therapy deals with across systems problems
by considering the part each subsystem plays in establishing
and maintaining overall patterns and then focusing on
helping each one make change of their own rather than
attempting to change others.

W

The multicultural perspective supports the movement
toward cultural sensitivity by increasing awareness of
culture and its role in people's lives. Within the mental
health field, counseling and psychology have been the
dominant contributors to the study of culture and
counseling. As early as 1940, researchers were developing
psychological and intelligence tests that were designed to

be culture free (Catell, 1940). By the 19705, the awareness

18

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of the importance of culture increased dramatically, and a
foundation was established for the growth of research,
models, and treatment based on the culturally sensitive
approach (Bloom, 1964; Kluckhohn & Strodteck, 1961; Padilla,
1971; Ruiz & Padilla, 1977). During this same period of
time, the family therapists were focused on developing
theories and techniques and affirming their standing in the
academic and professional domains (see Doherty & Baptiste,
1993, for review of MFT history). The bulk of the work from
this period was devoid of ethnicity and race (Aronson Fontes
& Thomas, 1996; Doherty & Baptiste, 1993; Hardy, 1989;
Leslie, 1995) leading to treatment and training based on the
"theoretical myth of sameness" (Hardy).

By the 19808, key figures in the field of psychology
and family therapy began to take a more active role in
studying the value and significance of ethnicity and
developing multicultural counseling models that moved from
pathologizing ethnic and racial groups (Boyd-Franklin, 1989;
Falicov, 1983, 1988; Ho, 1987; Karrer, 1987; Levine &
Padilla, 1980; McGoldrick et al., 1982; Pinderhughes, 1982;
Sue and Zane, 1987). Although controversy continues about
the role and importance of culture in the field of mental
health, the 19905 has seen the emphasis change in the field
of family therapy. The focus has moved from applying
existing models to diverse groups to (a) considering biases

of the models, (b) highlighting the culture of client and

19

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therapist and their therapeutic relationship, (c) increasing
culturally relevant research with diverse populations, (d)
examining the biases in theory and practice and integrating
contextual variables into the work (Aronson Fontes & Thomas,
1996; Breunlin, Schwartz & Mac Kune-Karrer, 1992; Comas-Diaz
& Green, 1994; McGoldrick, Giordano, & Pearce, 1996;
Roberts, 1993; Saba, Karrer, & Hardy, 1989).

The multicultural perspective has stressed the need to
develop culturally appropriate theory, research, and models.
Although family therapists have traditionally conducted
research on White, middle-class populations (Gurman &
Kniskern, 1991; Pinsof, 1991), there has been a call for
"family therapy research into cultural issues" (Aronson
Fontes & Thomas, 1996, p. 273). Aronson Fontes & Thomas
recommend acknowledging the importance of cultural issues in
family therapy and research. They believe this can be
accomplished by (a) conducting research with various groups,
especially non-white convenience samples; (b) including and
controlling for cultural variables; and (c) conducting
research that highlights positive aspects of ethnic/racial
groups. Two of the questions that Aronson Fontes & Thomas
pose are: (a) "How can the cultural awareness and
sensitivity of the therapist be raised, and how can the
increase be evaluated?” and (b) “How can cultural fit
between therapist and client be evaluated, and how does the

fit influence therapy outcome?"

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For research with ethnic groups to be culturally
sensitive necessitates that researchers employ methodology,
procedures, instruments, and variables that are identified
as important to the study of ethnic groups (cf. Fisher,
Jackson, & Villarruel, 1997; Herrera, DelCampo, & Ames,
1993; Marin & Marin, 1991). In response to this need, an
increasing number of family researchers and clinicians have
focused their work on matters associated with diverse
populations (Berg & Jaya, 1993; Boyd-Franklin, 1989;
Braverman, 1990; Comas-Diaz, 1994; Dillworth-Anderson,
Burton, & Turner, 1993; Flores-Ortiz & Bernal, 1989; Gregoryl
& Leslie, 1996; Herrera et al., 1993; Martinez, 1977, 1994;
McAdoo, 1993; Padilla, 1995; Porter, 1994). Included in this
approach (Marin & Marin; Rogler, 1989) is: (a) being
cognizant of similarities and differences within cultural
groups; (b) using theories that encourage a focus on the
interaction between systems and their larger environment;

(c) developing methodologies consistent with the group's
culture; (d) adding sociocultural variables (Martinez,
1994); (e) involving researchers who are from the subject's
culture; (f) conducting research in the language of
participants; (g) developing bilingual instruments for use
in studies; (h) providing opportunities for people to self-
identify their ethnicity; (i) using acculturation measures
as a proxy for ethnic identity; (j) including open-ended,

qualitative questions to allow for participants to talk

21

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about what is important to them; and, finally, (k) measuring
societal factors and cultural characteristics that impact
access and delivery of services to ethnic-racial groups
(Martinez, 1994).

People of Mexican origin must contend with pressures
that result from living in a society that is frequently in
conflict with the needs of their families and communities
(Kaplan & Marks, 1990; Markides & Coreil, 1986; Saenz,
1984). The social, economic, and political ecosystems often
create environments that are inconsistent with or invalidate
the cultural values and beliefs of the Mexican-origin
population. The low percentage of experienced Latino mental
health professionals (.7% to .9% of marriage and family
therapists and 3.3% to 9.9% from other therapeutic fields;
see AAMFT Family Therapy News, April 1997, for details), the
lack of affordable and bilingual services, and the lack of
marketing directed at this community bespeak a disregard for
serving this ethnic group and illustrate that the
application of a culturally sensitive approach is still
deficient in the delivery of services to the Mexican-origin
community. Development of a "good fit" between this
community and larger systems necessitate that culture become
a consistent part of making decisions regarding the access
and delivery of services. Although this deficiency continues
in many areas of the mental health field, this paper will

focus on the MFT profession.

22

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Cross cultural research provides a framework for
studying therapy through an emic (culture specific) and etic
(universalistic) lens (see Ekstrand & Ekstrand, 1986, for a
review of these concepts). An understanding and utilization
of each perspective by therapists would maximize their
ability to conceptualize and respond to the therapeutic
needs of Mexican—origin clients. One manner in which this
can be accomplished is by listening to their expectations,
which may correlate with their level of acculturation.
Professionals must understand that acculturation can also be
a proxy indicator for negative processes and outcomes. For
example, the variations in the environment surrounding the
context of immigration have been changing for people of
Mexican origin, and this has necessitated a reexamination of
the acculturation process and its impact on individual,
family, and community development.

W

Acculturation theory assumes that there is an
intergenerational transfer of culture and that people change
as a result of interactions with people from diverse
cultures (Berry, 1994; Padilla, 1980; Redfield, Linton, &
Herkovitz, 1936). Acculturation theory and models have
developed as definitions and perspectives of the
acculturation process continued to change over time (for
details, see Berry, 1980; Berry & Kim, 1988; Newcomb &

Myers, 1995; Orzoco, Thompson, Kapes, & Montgomery, 1993;

23

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Ponce & Atkinson, 1989; Rogler, Cortes, & Malgady, 1991;
Sabogal, Perez-Stable, Otero-Sabogal, and Hiatt, 1995).
There has been an inconsistent but generally common use of
the term "acculturation." There has been more variability
among researchers regarding how to measure this concept
(Burnam, Telles, Karno, Hough, & Escobar, 1987; Franco,
1983; Marin, Sabogal, VanOss Marin, Otero-Sabogal, & Perez—
Stable, 1987; Montgomery, 1992). This has made the study of
ethnic groups challenging and has contributed to weaknesses
in the research. Historically, acculturation has been
defined and perceived from an assimilationist perspective
(Negy & Woods, 1992a, 1992b; Sena-Rivera, 1976) based on the
European immigrants' experience. In this perspective, the
transfer of culture was always from the dominant group to
the minority group until the latter conformed completely to
the former's culture. Only recently has the dynamic (Padilla
& Lindholm, 1984), systemic (Rueschenberg & Buriel, 1989),
and multidimensional nature (Cuéllar, Harris, & Jasso, 1980;
Marin, 1992, Szapocznik & Kurtines, 1980) of acculturation
been acknowledged and incorporated more fully into the study
of cultural groups.

There is a continuing controversy regarding the
specific characteristics that represent acculturation and
the manner in which it should be measured (Marin, 1993;
Marin & Marin, 1991; Neff & Keir Hoppe, 1993). Measures of

acculturation have been utilized as a proxy for ethnic

24

identity, although some scholars argue that they are related
but unique concepts (Phinney, 1991; Ruiz, 1977). Berry
considers acculturation as the process of change that an
individual encounters when they are in contact and
interaction with a new culture. Berry (1980) proposed a
model that identified six aspects of psychological
functioning that are impacted by acculturation: language
use, attitudes, personality, identity, cognitive style, and
stress. The acculturation process has been described as a
staged process of adaptation by which individuals tend to
assimilate, integrate, or reject the new culture (Marin,
1993; Rogler et al., 1991). Studies have indicated that
people experience higher levels of acculturation as their
interactions with the new culture increase (Padilla, 1980;
Szapocznik & Kurtines, 1980). However, it is increasingly
accepted that peOple are bicultural and can be competent in
more than one culture (Cuéllar, Arnold, & Gonzalez, 1995;
Cuéllar, Arnold, & Maldonado, 1995; LaFramboise, Hardin,
Coleman, & Gerton, 1993; Tropp, Erkut, Alarcon, Garcia Coll
& Vazquez, 1994).

Cuéllar, Arnold, and Maldonado (1995) utilized a
definition of acculturation advanced by Redfield et a1.
(1936) in the development of the ARSMA—II. Acculturation is
defined as changes in the original cultural patterns of
either or both groups (i.e., client and therapist) which

results from individuals from the different cultures having

25

continuous first-hand contact with each other. The process
of acculturation entails change which occurs at the micro
(individual) and macro (social/group) levels. The former is
referred to as psychological acculturation (Graves, 1967),
which comprises changes in attitudes, beliefs, behaviors,
and values in the individual. Contextual factors include
aspects of the social, political, cultural, and economic
climates, such as education level, employment,
underemployment, and prejudice, to name a few. This model
illustrates the interactive, developmental, multifactorial,
multidirectional, and multidimensional process of
acculturation; and it is consistent with ecological theory
(see Cuéllar, Arnold, & Maldonado, 1995).

In spite of the controversies surrounding the study of
acculturation, researchers tend to agree that acculturation
is the process of cultural learning and change that occurs
when individuals come into close proximity to a different
culture. In addition, they agree that acculturation is a
significant moderating variable in studies for understanding
intracultural differences (Cuéllar, Arnold, & Maldonado,
1995; Padilla, 1995). Acculturation was found to be a
significant moderating variable in studies on Hispanics'
mental health status (Szapocznik & Kurtines, 1980) and
levels of social support (Griffith & Villavicencio, 1985).
This finding is leading to greater interest and consensus

among researchers studying ethnic and minority groups.

26

 

 

.. u

H‘

In

The debate on acculturation has resulted in the
development of numerous instruments with primarily Mexican—
origin samples (see Cuéllar, Arnold, & Gonzalez, 1995;
Cuéllar, Arnold, & Maldonado, 1995; Cuéllar et al., 1980;
Marin & Marin, 1991; Marin et al., 1987; Olmedo, Martinez, &
Martinez, 1978; Padilla, 1980). Until recently, many of the
instruments focused on behavioral constructs of
acculturation (e.g., language utilization, food
preferences).

Recent research has underscored the importance of
examining psychological and cognitive referents of
acculturation, such as beliefs, values, and attitudes
(Cuéllar, Arnold, & Gonzalez, 1995; Domino & Acosta, 1987;
Marin, 1993; Tropp et al., 1994). The instruments used vary
in the strength of their psychometric properties, and
additional research is necessary to further validate their
use in the field. Consensus does not exist in the field on
what instruments should be used primarily in this area of
study. Until more studies are conducted that add support to
the use of a specific instrument or set of instruments, it
is essential that researchers select the strongest
instruments that measure behavioral and cognitive
components.

In summary, human ecological theory, cross—cultural
theory, and acculturation theory have provided a framework

for this study that facilitated examination of the factors

27

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that influenced utilization rates of MFT among people of
Mexican origin. Acculturation comprises of behavioral and
cognitive or psychological constructs that are continuously
in the process of influencing or being influenced. Many, if
not all, of the components of these constructs can impact
mental health status, access to services, and service
delivery to varying degrees. For example, individuals of
Mexican origin who hold supernatural beliefs about a
traumatic incident (i.e., malo ojo, susto) might increase
their level of openness to therapy if the therapist was able
to be knowledgeable and respectful of their culture and
beliefs. This encourages dialogue and development of trust
between the therapist and client. Regardless of their level
of acculturation, people of Mexican-origin have strengths
and resources within their culture. A greater understanding
of these systems by the MFT field will provide a broader and
deeper understanding of people of Mexican origin. It will
also serve to provide more effective services and increase
the likelihood that people in the Mexican—origin community
would utilize these services.
Wm

Fine (1993, pp. 235-237) summarized 12 issues related
to family diversity and their implications for multicultural
family therapy (MCFT). These issues included:

(1) "demographic changes increase the extent of family

diversity; (2) definitions of family have important
implications and are inextricably intertwined with

28

values; (3) different types of families are themselves
heterogeneous; (4) understanding family diversity
requires attention to similarities as well as
differences among families; (5) social institutions
experience difficulties in being sensitive to different
type of families; (6) appreciation of diverse types of
families illuminates how families can adapt to
adversity; (7) empirical findings are needed to test
professionals' theories and popular speculation; (8)
understanding of family diversity is enhanced by
attending to multiple generations within families; (9)
teaching individuals to appreciate family diversity is
a challenging endeavor; (10) understanding family
diversity requires attention to processes that occur
within families; (11) concepts and techniques used with
white, English-speaking American families may not be
applicable to other types of families; and (12)
knowledge of diverse families is facilitated by
understanding family members' perceptions of their
experiences" (Odell et al., 1994, p. 146).

There are multiple indicators of a field's commitment
to the study of and service to ethnic communities.
Indicators include amount of time and energy in the area of
research, the quality of the research, the number of
publications on related topics in the field's primary
journals, the number of minority/ethnic people in the field,
the recruitment efforts made to increase the numbers of
minority staff and professionals, the existence of
advertisements in multiple languages, advertising in modes
typically seen or heard by the specific population, and the
number of ethnic/minority people that are served by
professionals in the field. The success of the MFT field
varies depending on the indicator and tends to be a first
order change. Although there has been either an

acknowledgement or an improvement in each of the indicators,

29

more changes in thinking and action are necessary for second
order change to occur.

The field of mental health has spent the last decade
trying to become culturally responsive to increase mental
health access and resources for minority populations by
following Sue's (1977) recommendations to provide culturally
sensitive training of providers, to increase the percentage
of bilingual and bicultural providers, and to develop
services for ethnic populations. According to some
researchers, implementation of these suggestions have
increased utilization and reduced dropout rates (Flaskerud &I
Liu, 1991; O'Sullivan, Peterson, Cox, & Kirkeby, 1989; Sue
et al., 1991;). Nonetheless, aA search of the MFT literature
reveals a scarcity of strong empirical research conducted in
the Latino community by clinicians and researchers in this
field. A 10-year review by Bean and Crane (1996) of the
major MFT-related journals revealed that fewer than 5% of
published articles focused on racial and ethnic minority
populations and issues. The existing studies are conducted
primarily by Anglo Europeans on primarily white populations.
Another investigation conducted by Naden, Rasmussen,
Morrissette, and Johns (1997) reviewed articles from 1980
through 1995 in three major journals in the MFT field:
Jburnal of.Marriage and Family Therapy, Family Process, and
IAMerican JOurnal of Family Therapy. The goals of this study

imCluded extending Gurman's work (1981) and generating a

30

L-II 2‘

 

list of topics that have provoked interest in the field
since the early 19805, as exemplified by the number of
publications in each area. This information clarifies and
increases understanding of the history, current state, and
future needs of the field of MFT. Based on previous
research, these three journals have been identified as most
representative of the field of MFT (Snyder & Rice, 1994).
The journals rank as first, second, and fifth, respectively,
in terms of prominence (Shortz et al., 1994). Eighteen
percent of the articles examined were related to clinical
issues regarding specific populations. From this group,
almost 10% of the articles and 2% of the research articles
focused on ethnic/minority/cross-cultural populations.
However, the percentage of ethnic/minority/ cross-cultural
articles (2%) and research reports (.2%) were extremely low
when the 15 years of publications were examined.

Other studies indicate increasing efforts at studying
clinical approaches that are sensitive to various
populations, including men (Dienhart & Myers Avis, 1994;
Pittman, 1991), people with AIDS (Bograd, 1990; Green &
Bobele, 1994), women (e.g., Bograd, 1984, 1992; Kaufman,
1992), and people of color (Boyd-Franklin, 1989; Flores-
Oritz & Bernal, 1989; Gregory & Leslie, 1996). Much of the
research on ethnic/racial/minority groups examines multiple
racial or ethnic groups, discusses characteristics of

various groups, and examines concepts related to culture and

31

therapy (Leslie, 1995; Odell et al., 1994). There is also
wide use of panethnic labels or inconsistent use of ethnic
labels. These approaches result in confusion and a
minimization of the heterogeneity among and between ethnic
populations and make generalization between studies
challenging (Gimenéz, 1989; Marin & VanOss Marin, 1991;
Trevino, 1987). Although the existing work still provides
important information, it is imperative that professionals
negotiate a common and consistent form of identifying ethnic
groups. Researchers must also engage in culturally
appropriate research designed to produce in depth studies of
issues relevant to serving the Latino population. For
example, in-group and among-group similarities and
differences within the Latino population would help to
clarify the needs of the various ethnic groups and would
increase therapists' understanding of factors that influence
help-seeking and clinical work with various cultural/ethnic
groups.

A study by Killian and Hardy (1998) examined other
indicators of minority representation in the field of MFT.
They assessed how the American Association for Marriage and
Family Therapy (AAMFT), the national organization for MFT,
had progressed in the inclusion of minority people and
issues among its concerns from 1980 to 1996. Results
indicate positive changes and also a need for continued

growth and change in this area. There was an increase in

32

programs related to minority issues; but there was low
representation of ethnic minority members (about 3%), when
compared to the national population, and a lack of minority
members as keynote speakers and in the executive level of
the organization.

A comparison of minority professionals in other mental
health fields was reported by AAMFT with data collected by
the Center for Mental Health Services (Manderscheid &
Sonnenschein, 1996). A summary of data on eight disciplines
in the mental health field-- MFT, psychology, school
psychology, psychiatry, psychiatric nursing, counseling,
social work, and psychosocial rehabilitation--reveals the
status of each discipline in terms of its effectiveness in
increasing minority membership (AAMFT, 1997). According to
the data collected, none of the disciplines in the field of
mental health have a number of minority members comparable
to their ratio in the total U.S. population. The percentages
of minority members reported for social work, psychiatry,
psychosocial rehabilitation, psychology, and school
psychology ranged from .5% to 21%. The percentage of
minority marriage and family therapists is lower than that
in other mental health disciplines, with Hispanic therapists
having an extremely low presence in the MFT discipline (.7
to .9). Females who identified as Asian/Pacific Islander
(Mental Health United States, 1996, cited in AAMFT, 1997)

were the only group that had lower rates (.4) of MFTs.

33

Finally, the first national survey of the clinical
practice patterns of MFTs (Doherty & Simmons, 1996) provided
a profile of the clients served by marriage and family
therapists. It provided critical data, which has contributed
a baseline of information regarding who is accessing MFT
services. Clients were primarily female (58%), the median
age was 38 years, and the majority held at least a high
school diploma (83%). Specifically, 40% had graduated from
high school or had completed some college work, and 43% had
a college degree. A shortcoming of this study was the
omission of ethnic, racial, and/or cultural data for
therapists and clients. This information is critical to
evaluating the progress made over time in increasing
minority recruitment to the professional field and
increasing access and delivery of services to diverse
populations. Sixty-three percent of MFTs reported feeling
competent treating racial and ethnic minorities.

Ecology of the Mexican Origin Population
Wigs

The importance and relevance of conducting research
with the Hispanic population is supported by changing
demographics. The Census Bureau estimates that between 1995
and 2050, the Hispanic-origin population will add the
largest number of people to the population and that by 2010,
the Hispanic-origin population may become the first or

second-largest racial/ethnic group in the United States

34

(U.S. Bureau of the Census, 1996). Sixty percent of the 22
million Hispanics in the United States are of Mexican
origin, making them the largest of the Latino/Hispanic
nationality groups. The state of Michigan ranked twelfth in
the nation in 1990, with over 200,000 Hispanics in the state
(U.S. Bureau of Census, 1990), 69% of whom are of Mexican
origin (Aponte & Siles, 1996). Consequently, there is a need
for research to be conducted in Mexican communities located‘
in Michigan so that practitioners can increase their
understanding of the significance of ethnicity, culture, and
environment to the lives of people in this ethnic group and
to the delivery of mental health services.

Understanding of mental health in the Latino community
cannot occur without contemplating the social, cultural, and
economic factors that have been found to be related to the
mental health problems experienced in Latino communities
(Neff & Keir Hoppe, 1993; Ponterotto, 1987; Rogler et al.,
1991; Sue, 1992; Torres, 1991). These factors are
illustrated by the ecological model (see Figure 1, p. 17)
and consist of alienation resulting from prejudice, cultural
differences, family problems, language barriers, poor-self

image, lack of education, academic underachievement, and

35

unemployment and underemployment. An examination of the
demographic data on the Hispanic origin population reveals a
variability in their educational, economic, and employment
status, with a significant percentage struggling to access
suitable resources. There is a slightly higher rate of males
(51%) to females (49%) in the Hispanic population, with the
median age being 26 years. Fifty-three percent were high
school graduates or had some college, and the majority of
people over 18 years of age were married (51%). Data on
Mexicans indicate that their educational attainment is lower
(47%) than Hispanics, and more than three quarters did not
have any college (77%) (U.S. Bureau of the Census, 1994).
Risk factors for Hispanic people include the highest rate of
dropouts (35%), higher rates of unemployment over the last
ten years (11%) when compared to non-Hispanics, and a high
rate of poverty (28%) (U.S. Bureau of the Census, 1993).
Although there is wide variability in the incomes within the
Hispanic population, 26% of families were identified as
being below poverty level compared to 10% of non-Hispanic
families (Bureau of the Census, 1993).

Mental Health Services in the Mexican-Origin Population
WW

Some studies indicate that people of Mexican origin may

be more susceptible to mental health problems or symptoms
because of environmental factors, such as discrimination,

poverty, language barriers, low academic achievement,

36

 

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unemployment and underemployment (Keefe & Casas, 1980;
Saenz, 1984; Vega, Warheit, & Palacio, 1985; Vega, Warheit,
Auth, & Meinhardt, 1984). The conclusions of these and other
studies must be considered with caution, however, due to
weaknesses in methodology, instruments, and sampling design.
Variation in the definitions of variables, lack of bilingual
instruments, data collected without differentiating among
ethnic groups in the Hispanic or Latino population, and a
lack of sensitivity to contextual and cultural variables
contribute to the weaknesses of the studies (Price-Williams,
1987; Rogler, Malgady, Constantino, & Blumenthal, 1987;
Rogler, Malgady, & Rodriguez, 1989). In addition, the
conclusions of studies related to mental health in the
Latino communities cannot be generalized since the majority
have been conducted with students, clinical populations, and
community participants from the southwest or the east or
west coasts (Wells, Hough, Golding, Burnam, & Karno, 1987).

Increased utilization of mental health services will
require more than the provision of services to this
community (Santiago, Villarruel, & Leahy, 1996). Although
there is a lack of research that specifically addresses
reasons for the underutilization of MFT by Mexican-origin
people, there are related studies that provide insight into
the issue of service utilization. Training multicultural
therapists, developing more bilingual providers,

GStablishing services designed for specific populations

37

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(O'Sullivan et al., 1989; Sue et al., 1991), creating
linkages with respected community organizations (Fischman,
Fraticelli, Newman, & Sampson, 1983; Guiterrez, Ortega, &
Suarez, 1990), and improving location and hours of services
(Sue & Morishima, 1982) have been found to be effective in
improving utilization of mental health services in minority
populations (Santiago et al., 1996). Providers of services
will need to recognize the values and norms of the
particular community that is being served in order to decide
which of the factors are of importance to a potential client
population.

Torres (1991) examined the data on the mental health
status of Latinos in the Midwest and discovered a grave need
for further research on health-related issues. The data
indicated serious risk factors within the Latino community,
including mental illnesses, substance abuse, and AIDS.
Torres called for the development of health programs
tailored to the needs of Latinos in the Midwest. However,
without research that focuses on studying ethnic groups in
depth, it is unlikely that information will be collected
that provides a strong basis on which to develop and deliver
culturally appropriate services. Since the data were
collected from a mixed group of people of Mexican, Puerto
Rican, Cuban, Central American, and South America origin who
resided in the Midwest, it is often difficult to

differentiate between the needs of the various groups. For

38

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example, a study in Michigan conducted by Saenz (1984) to
examine the mental health needs of Latinos revealed
depression, alcoholism, anxiety, lack of identity, drug use,
and adjustment reactions to be the most frequent mental
health problems; but it is impossible to know the rates
within each subgroup. This information is critical to
professionals as they develop services that correspond to
the needs of diverse populations. Studies must be designed
to consider the heterogeneity within each subgroup (e.g.,
Mexicans, Puerto Ricans, Cubans)(Torres).

Help-seeking behavior is determined by pre-disposing
factors (i.e., age, sex, education), enabling factors (i.e.,
knowledge of services, availability of services, existence
of bilingual services), and need for assistance (Starret,
Todd, Decker, & Walters, 1989). Numerous studies have shown
that Hispanics prefer alternative sources of help (see
Rogler et al., 1989; Santiago et al., 1996) that are
indigenous to their culture, such as family (Golding &
Baezconde-Barbanati, 1990), extended family, and church
(Medvene, Mendoza, Lin, Harris, & Miller, 1995). Studies
have shown that families tend to be larger (Golding &
Baezconde-Barbanati), to live in closer proximity, and to be
in more frequent contact with each other in the Mexican-
origin community (Antonucci, 1985) than in Anglo

communities. Family is a primary source of identity, self-

39

worth, and social support (Keefe, Padilla, & Carlos, 1979;
Salgado de Snyder, 1986). The literature reveals that people
of Mexican origin place greater importance on (Raymond,
Rhoads, & Raymond, 1980; Sabogal, Marin, Otero—Sabogal,
Marin, & Perez-Stable, 1987) and have greater satisfaction
with (Sabogal et al.; Schumm et al., 1988) family support
than do non-Hispanic whites. Golding and Burnam (1990)
analyzed data from the largest epidemiologic study of social
support among people of Mexican origin (see Eaton & Kessler,
1985; Regier et al., 1984, for details on Los Angeles
Epidemiologic Catchment Area [LA-ECA] project). Despite
differences in culture, Golding and Burnam found many
similarities among non-Hispanic whites, U.S.-born Mexicans,
and Mexican—born Mexicans in their level of social support.

Medvene et al. (1995) found that parents of children
who were diagnosed with schizophrenia reported family
members as their most frequent source of support. Sixty-nine
percent of the parents received help from their other
children. Non-family support was most frequently accessed
through neighbors (41%), people associated with their
religion, or the parish priest (34%). The results of the
study were limited because the sample was small (N=32) and
the study targeted a group that was coping with a family
member with a severe mental illness, compounded by the
effects of acculturation and SES.

A study conducted by Santiago et al. (1996) provided

40

insight into perceptual barriers to accessing services.
Qualitative responses regarding participants' decision to
not seek formal rehabilitation services for their disability
were reported. The three primary reasons given for not
accessing services were (a) does not want or feel need for
service (26%), (b) family disapproval (22%), and (c)
relative/friends' disapproval (18%). Other reasons cited
were cost of services (9%), limited English proficiency
(5.5%), lack of transportation (5.5%), and lack of knowledge

of services (3%).

Contradictory conclusions may be drawn regarding the
utilization of mental health services by the Mexican-origin
community (see Ponterotto, 1987; Rogler et al., 1989).
Criticisms of Hispanic utilization studies include a lack of
consistency in how utilization is defined, a focus on
descriptive studies, and a lack of differentiation between
and among ethnic groups. Despite the criticisms, it is
important to note that the majority of studies indicate a
higher dropout rate and underutilization of mental health
services by diverse populations (Acosta & Sheehan, 1976;
Keefe, 1979; Keefe & Casas, 1980; Sue, 1977, 1992; Sue et
al., 1991; Sue & Zane, 1987; Torres, 1991). Wells et al.
(1987) documented an underutilization of outpatient mental

health services by people of Mexican origin in the Los

41

Angeles ECA study, which had an extremely large sample of
over 1,200 Mexican-origin subjects. Much of the disagreement
in the literature regards the degree of underutilization and
the reasons for this underutilization (i.e., alternative
theory or barrier theory) (Lin, 1982 Snowden & Lieberman,
1994). Starrett et al. (1989) called for studies that employ
"a sophisticated conceptual framework or multiple analysis
to clarify the process by which Hispanics utilize formal
helping networks when in need of emotional support" (p.
260).

One reason for the underutilization of mental health
services by the Hispanic community has been suggested and is
identified as a form of a barrier. Although there are
limited studies to confirm or negate these ideas, there is
an increasing body of literature examining barriers and
enablers to service. Organizational barriers can be language
that is incompatible with the clientele (Guiterrez et al.,
1990; Rogler et al., 1989), lack of linkage with respected
community institutions (Guiterrez et al.), financial
barriers, and transportation difficulties. Starrett et al.
(1989) identified three additional variables that affected
the utilization of formal support systems by Hispanic
elderly. The Hispanic elderly, who had a higher number of
health problems, greater illness severity (need factors),
and higher church attendance (enabling factor), had higher

utilization rates of formal services. Elderly people of

42

Mexican origin, primarily the females, who attended church
more frequently utilized mental health services more often.
The study found that this population evidenced a need for
mental health services; however, the utilization rates were
still low (13%). The people in this sample chose to seek the
church or a doctor (13%) more frequently than a professional
(4%) to access help.

Some studies indicate that Mexican-origin people are
utilizing mental health services. Hispanics (9%) were found
to utilize self-help groups (peer led) slightly more than
Caucasians (8%) and more than African Americans (2%)
(Snowden & Lieberman, 1994). A mental health center in
Northern California experienced success in increasing the
Spanish-surname patient population by 40.5% over a four-year
period by instituting enablers. This included adding
bilingual staff and linking to community agencies accessed
by the Mexican-origin population (Fischman et al., 1983).
O'Sullivan et al. (1989) repeated Sue's study (1977) in the
Seattle area to investigate the level of utilization of
mental health services by ethnic groups there. The study
concluded that dropout rates had decreased for ethnic groups
and there had been changes that created a more culturally
responsive system. Acculturation level has been shown to
impact utilization rates ( Wells et al., 1987). People of
Mexican origin who had low acculturation levels had a very

low (3.1%) utilization rate of services. Those with high

43

acculturation levels had a moderate (11.3%) utilization rate
compared to non-Hispanic whites (16%). Although the studies
cited are not from the field of MFT, most studies have been
conducted with restricted (limited) populations; and the
inference can be drawn that these services, like MFT, are
highly specialized and, therefore, may be indicative of
patterns of service utilization.
W555

There is a scarcity of literature related to this
variable. More recent studies conclude that knowledge of,
and need for, services are predictive of utilization of
social services (Mindel & Wright, 1982; Starrett et al.,
1989). Knowledge of services increases the awareness about
available resources and services to potential clients who
are experiencing individual, couple, or family problems. No
studies were found in the counseling or therapy literature
that discussed the best method of dispersing service related
knowledge.

E I I . l ! H I J H 1!] S .

Leaf, Livingston, Bruce, Tischler, and Holzer (1987)
examined attitudes and beliefs about mental health which are
closely related to openness to learning about mental health
services. The results indicated that 81% of the sample had
a high receptivity to mental health services. However, 83%
perceived at least one barrier to accessing services. The

results of this study must be considered cautiously in

44

relation to ethnic minority populations. The sample of non-
White participants was small (13%) and did not specify the
ethnic identity of this group.

Expectations About Counseling (MFT)

Scholars and psychologists in the field of counseling,
counseling psychology, and psychology have been studying
client expectations about counseling for over 30 years
(Apfelbaum, 1958; Robinson, 1950; Tinsley, 1982; Tinsley,
Bowman, & Westcot Barich, 1993). A major drawback in the
existing studies is that the majority of information on
expectations has been collected from samples that are
predominantly Anglo-European, students, clinical
populations, or comparison samples that dilute the
information on ethnic groups due to smaller sample size.
Other literature concludes that minority groups often
receive ineffective mental health treatment (Acosta,
Yamamoto, & Evans, 1982) and that therapists may fail to
acknowledge the larger context of clients' goals and
expectations of therapy (Acosta et al.).

There is agreement in the mental health field that
client expectations influence the therapeutic process and
outcome of therapy (Tinsley, Bowman, & Ray, 1988; Tinsley,
Holt, Hinson, & Tinsley, 1991; Varvil-Weld & Fretz, 1983;
Yanico & Hardin, 1985). The counseling literature indicates
that ethnicity is related to counseling expectations

(Cherbosque, 1987; Kunkel, 1990), and expectations are

45

believed to impact the counseling process, outcome, and
termination (Pope, Seigman, Blass, & Cheek, 1972; Tinsley,
Bowman, & Ray, 1988; Tinsley, Bowman, & Westcot Barich,
1993; Tinsley & Harris, 1976). Expectations have also been
found to influence perceptions (Postman, 1951), judgements
(Festinger, 1957), learning (Overmeier, 1988), and behaviors
(Bandura, 1986). More specifically, expectations are
believed to impact people's decisions regarding whether to
enter or terminate therapy, and they have been shown to have
a moderating effect on the therapy itself. Expectations that
are not met in a therapeutic relationship may lead to
negative outcomes in therapy and may be related to the
underutilization of MFT services. Research has also
indicated that expectations are influenced by ethnicity
(Cherbosque; Kunkel; Kunkel, Hector, Gongora Coronado, &
Castillo Vales, 1989), as well as societal, cultural (Yuen &
Tinsley, 1981), and economic (Subich & Hardin, 1985)
factors. The influence of acculturation must be an integral
part of any study that is examining the lives of individuals
who have beliefs, values, and attitudes that vary to some
degree from those of the dominant culture. A study of client
expectations in the Mexican-origin community may serve to
help in understanding the changes the MFT field can make
that will decrease the dropout rates and increase the
effectiveness and utilization rates of therapy.

Professionals in the MFT field must become involved in

46

this area of study in order to serve the needs of groups
that are not now being served by this discipline.
Identifying the understanding and expectations of Mexican-
origin people regarding MFT will benefit the field. This
ethnic group was selected for study due to the complexity of
studying the Hispanic or Latino population and the need to
increase the amount of information on each cultural
subgroup. This study also allowed for an in-depth
examination of the intracultural similarities and
differences within this group, which are related to the
variables under study. In order for the field of MFT to
serve this population more effectively, it is necessary to
examine the knowledge, expectations, and utilization rates
within this community. This information will provide
indicators to the MFT profession that will assist in
developing objectives and goals that will allow for a
stronger relationship to be built between these two systems.

Marriage & Family Therapy: An Alternative Resource

The federal government recognizes the MFT discipline as
one of the five mental health professions. MFT is a
specialized discipline in the field of mental health whose
goal is to provide treatment to individuals, couples, and
families who are experiencing problems in their lives. The
goals are to consider the system the client lives in, to
examine how the system contributes to the maintenance of the

problem, and to consider alternatives to the system that

47

would alleviate or eliminate the problem. In order to
successfully examine the system the client lives in, the MFT
profession must also be willing to examine themselves.

A recent study indicates that MFT services were rated
as good or excellent by 98.1% of all clients surveyed
(Doherty & Simmons, 1996). The clients surveyed included
females (58%) and males (42%), and the majority (82.5%)
reported having a high school degree or higher. A high
percentage (42.5%) had a college degree or higher. Racial
and ethnic data was not reported. The cost of a therapy
session ranged from $0 to $170 per hour, with an average of
$63 and a median of $65. Sessions were conducted primarily
in private practice settings (65%). The results of this
study are consistent with research that concluded that MFT
is not serving populations that tend to have lower levels of
education and income, which are overrepresented among people
of color, based on census data (Green & Bobele, 1994). Yet,
63% of the marriage and family therapists who participated
in the study reported feeling competent in treating racial
and ethnic minorities. Given that the study did not report
the racial or ethnic composition of their participants, it
is unknown what percentage of their clients were from ethnic
or racial groups.

The MFT field can facilitate increased access and
utilization for special populations by developing marketing

strategies, taking actions to create services that are a

48

"good fit“ with ethnic communities, and designing
educational goals and curriculum in professional programs
that will prepare multiculturally sensitive therapists. At
this time, insufficient services are available to the
Mexican—origin community, and therapists fail to
acknowledge problems people of Mexican origin experience as
members of a minority group. For example, acculturation
stress or cultural stress is not identified as a sign of
distress in the American Association for Marriage and Family
Therapy's (AAMFT, 1998) pamphlet, "A Consumer's Guide to
Marriage and Family Therapy." This marketing tool is not
available in Spanish, which makes the information
ineffective to those who are primarily Spanish-speaking or
cannot read English. The reading level also appears to be
directed at individuals with at least a high school
education. An increasing amount of attention is being given
to evaluating and changing MFT curriculum and educating
AAMFT members to become more culturally sensitive. Although
their efforts have had varying degrees of success, their
goal is to integrate the teaching and study of diversity
into MFT programs across the nation. The national
organization, AAMFT, has made great efforts to increase the
number of workshops and audiotapes that focus on topics and
issues related to racial and ethnic minority groups. This
may be the reason why 63% of marriage and family therapists

reported feeling competent in treating racial and ethnic

49

minorities (Doherty & Simmons, 1996). Nonetheless, feeling
competent and being competent are not the same, and the
actual level of competence will only be tested if marriage
and family therapists are treating racial and ethnic
minorities.

Review of the Literature: Summary

In summary, individual, relational, and societal
factors influence the level of acculturation of people of
Mexican origin, which, in turn, influences their knowledge
and expectations of and openness to MFT services. It has
been hypothesized that a combination of some or all of these‘
variables influence the decision to access or not access MFT
services. It was the purpose of this study to examine the
similarities and differences among the various groups on
each of the designated variables in this study.

This study examined client variables in a Mexican-
origin community to increase MFT's cognizance of and
sensitivity to the following: (a) level of acculturation,

(b) level of knowledge of MFT, (c) expectations about MFT,
(d) level of openness to learning about MFT, and (e) manner
in which these three factors influenced the level of
utilization of MFT for people of Mexican origin.
Specifically, this study considered sociocultural variables
such as income, education, employment, and acculturation.
It acknowledged that MFT needs to consider expectations of

Mexican-origin people to address power differences and to

50

become more cognizant of how to more effectively work with
individuals and families from diverse groups. The review of
the literature supported this investigation of the
relationship among and between the variables identified in
this study.

Operational Definitions

Ethnitity: refers to a “shared culture and lifestyles”
(Wilkinson, 1993, p. 19) that can include culture, values,
beliefs, language, religion, color, ancestry, and norms, to
name a few. Ethnicity can be the result of self—
identification (determined by individual) or ascription
(ascribed by larger society) and influences individual and
group identify formation. Ethnicity was measured by asking
people what word they used to describe their ethnicity.
Seven common responses in the Latino community were provided
along with an "other" category.

Cultnte: refers to the shared history, common language,
common religion, and shared memories of the past as they
have unfolded themselves in the arts and literature
and in commonality of customs and traditions.

Hispanig: This is a generic term that refers to all
Spanish-speaking or Spanish-surnamed people who reside in
the United States or Puerto Rico. The major groups among
Hispanics are people of Mexican origin, Chicanos, Cuban
Americans, and Puerto Ricans. The term "Hispanic" is

generally more accepted on the East Coast.

51

Latino: This term signifies that a person is of Latin
American origin. It is the preferred term on the West Coast.
It includes the same ethnic origin terms used to define
Hispanic above.

Mexitan: Residents of the United States who self-
identify as Mexican. This term is often used by people who
were born in Mexico.

Mexitan;gtigin_petsgn: Residents of the U.S. who self—
identify as being of Mexican origin. Frequently used by
those who were born in the United States but have parents or
grandparents who were born in Mexico.

Chitang: This term refers to persons of Mexican origin
or heritage who were born in the United States. It was
initiated in 1960 by blue-collar people of Mexican origin
and college student activists (Melville, 1988). This term is
traditionally preferred on the West Coast.

Mental_flealtn: Loosely defined to include issues of
assessment and treatment of mental disorders, individual,
marital, or family problems as well as social, economic, and
cultural factors that can be directly linked to the etiology
of mental health problems.

Mattiagg_anfi_£amil¥_Ihetapy: This is one of multiple
disciplines in the field of mental health. It is based on
models of therapy and scientific findings that assume that
"individuals and their problems are best seen in context,

and the most important context is the family" (AAMFT

52

pamphlet, 1997, p. l). The goal of MFT is to resolve

problems by creating opportunities for change for the

individual and/or family.

Delimitations
There were several delimitations in this study.
A snowball sample was used to increase the researcher's
contact with the Mexican—origin community.
A self—selected sample was accepted since this was an
exploratory study and the first study of expectations
and utilization of MFT in the Mexican- origin
community.
The principal investigator, a Mexican female trained in
MFT, conducted all the interviews due to the
unavailability of a male of Mexican origin who was
trained in the field of MFT.

Assumptions
Studying one ethnic group would provide more culturally
sensitive research data.
Marriage and family therapy must take an emic (culture-
specific) and etic (universal) perspective when
conducting therapy with persons of Mexican origin.
Marriage and family therapy can be an effective means

of support to Mexican-origin families.

53

CHAPTER 3

METHODOLOGY

Introduction

This investigation was designed to be ecological in
nature and emphasized a multicultural perspective. The study
considered acculturation (natural-physical-biological and
social-cultural environment) and its dynamic relationship to
individuals of Mexican origin (human environed unit) and
mental health services (human—built environment) using an
ecological framework (see Figure 1). The multicultural
framework provided a foundation that recognized and
respected the strengths and diversity of the Mexican
culture.

The study identified (a) the characteristics of people
of Mexican origin who seek out help when they need it,
(b) what the Mexican origin community expects from helpers,
(c) their level of knowledge about various mental health
services, (d) their level of openness to learning about
marriage and family therapy (MFT), and (e) their level of
utilization of counseling, therapy, and MFT.

Research Design

This investigation utilized a cross sectional,
exploratory, inferential, two-stage study using an interview
survey design in non—controlled settings with individuals of

Mexican origin as the unit of analysis.

54

This chapter will give an overview of the following:
(a) research questions, (b) variable definitions, (c)
hypotheses, (d) sample design, (e) data collection, (f)
proposed data analysis, and (g) limitations.
W

Several research questions guided the development of

this study.

1. Whom do people of Mexican origin seek out when they
need help?
2. What factors impact the level of utilization of

marriage and family therapy services by people of

Mexican origin?

3. What do people of Mexican origin expect from "helpers"?

4. How does the openness to learning about MFT in people
of Mexican origin impact their expectations?

Marianas.

The dependent variables in this study were level of
utilization of counseling services, level of utilization of
MFT services, and the type of expectations of MFT services.

The independent variables were level of behavioral
acculturation, level of cognitive acculturation, level of
integrated acculturation, type of expectations of MFT
services, level of knowledge of MFT services, level of
knowledge of mental health services, and level of openness

to learning about MFT services (see Table 1 for variable

list).

55

Table 1

V . l] I' l H

 

Variable Classes

Measures

 

Independent Variables
Level of Behavioral
Acculturation

Level of Cognitive
Acculturation

Level of Integrated
Acculturation

Type of Expectations
About MFT Services

Level of Knowledge of
Mental Health
Services

Level of Openness to
Learning about MFT
Services

Acculturation Rating Scale for
Mexican Americans (ARSMA—II)
(Bilingual)

Multiphasic Assessment of
Cultural Constructs (MACC—SF)
(Bilingual)

Integrated Score from
ARSMA-II and MACC-SF

Expectations About Counseling-
Brief Form (adapted to
Expectations about Marriage and
Family Therapy-BF), English
Version and Spanish Version

How much do you know about the
services provided by
(a)counselors, (b)therapists,
(c)marriage and family
therapists?

I have some written information
about MFT. Would you like me
to leave you a copy?

Interviewer’s observation of
participant’s verbal and non-
verbal response

 

(table W)

56

Table 1 continued

 

Variable Classes

Measures

 

Dependent Variables
Level of Utilization
of Counseling
Services

Level of Utilization
of MFT Services

Type of Expectations
of MFT Services

Control Variables:
Respondent's
Age
Gender
Birthplace
Marital Status

Religious Preference
Level of Education
Ethnicity
Immigration Status

Occupation
Income

Generational Status

Have you ever received services
from a counselor?

Have you ever received services
from a therapist?

Have you ever received services
from a marriage and family
therapist?

Have you ever heard the term
“marriage and family therapy
Or therapist?”

How much do you know about MFT?

Have you ever been to see a
professional MFT?

See above

Self-Report of Age in Years

Interviewer Observation

Self-Report of Country of Birth

Self-Report (Single, Living
with Partner, Married,
separated, widowed,
divorced, or remarried)

Self-Report

Self-Report

Self-Report of Ethnic Label

Self-Report of Citizenship
Status

Self-Report

Self-Report (Individual and
Household)

Self-Report

 

57

The control variables were age, gender, birthplace,
marital status, religious preference, level of education,
ethnicity, immigration status, occupation, income, and
generational status. Data are based on self-reports
collected in the demographic section of the instrument (see
Appendix A, Research Instrument, questions 3-27). The
hypotheses are written in the null form if there is a lack
of information in the literature that would support the
alternate hypotheses.

LeIel_Qf_fltilizatiQn_Qf_CQunselinQ_§er1ices was defined
as the level of services received from counselors. The l
dependent variable was measured by one item that asked the
respondent if they have been to see a professional counselor
(see question 216, Appendix A). A five-point scale was
developed to determine the individual's level of contact
with the counselor. The scores of one to four were collapsed
into ”don't use services" (0) and a score of five was
identified as "used services" (1).

Le1el_9f_fltilizatign_gf_MEI_Serxices was defined as the
level of services received from marriage and family
therapists. The dependent variable was measured by one item
that asked the respondent if they have been to see a
professional marriage and family therapist (see Appendix A,
question 224). A five—point scale was developed to determine

the individual's level of contact with the therapist.

58

Scores of one to four were collapsed into "don't use" (0)
and a score of five was categorized as "used" (1).

Leygl_gt_Attultutatign was defined by Herskovits (1936)
as "those phenomena which result when groups of individuals
having different cultures come into continuous first-hand
contact, with subsequent changes in the original cultural
patterns of either or both groups" (cited in Cuéllar,
Arnold, & Maldonado, 1995, p. 278). Acculturation was
measured by two standardized acculturation instruments. The
two measures of acculturation were utilized to create a
measure of integrated acculturation for use in this study.

The WM (ARSMA-II)
construct refers to behavioral aspects of acculturation,
including “(a) language use and preference, (b) ethnic
identity and classification, (c) cultural heritage and
ethnic behaviors, and (d) ethnic interaction” (Cuellar et
al., 1995, p. 282). This variable was measured by the
bilingual Acculturation Rating Scale for Mexican Americans-
II (ARSMA-II; see Appendix A, questions 29—76; Cuéllar,
Arnold, & Maldonado, 1995). The ARSMA II categorized people
by measuring behavioral constructs of acculturation.

The ARSMA-II, comprised of two scales, measures a
linear acculturation level, a multidimensional acculturation
category, and a level of marginality. The linear
acculturation level is based on Scale 1 which is comprised

of two scales, the Mexican Orientation Scale (MOS) and the

59

Anglo Orientation Scale (AOS). There were 17 items (29, 31,
33, 34, 36, 39, 40, 42, 45, 46, 48, 49, 50, 52, 54, 56, 57)
that comprised the MOS and 13 items (30, 32, 35, 37, 38, 41,
43, 44, 47, 51, 53, 55, 58) in the A08. The choice of
responses ranged from “not at all (1)” to “extremely often
or almost always (5)”.3 Mean scores were calculated for

each scale by summing the responses and dividing by the
number of items in each scale. The behavioral acculturation
level (CATACC), a linear acculturation score, was computed

by subtracting the Mexican Orientation Scale (MOS) mean (M =

3.49, SD .61) from the mean on the Anglo Orientation Scale

(AOS) (M 3.71, SD = .63). Cutting scores (see Appendix B)
determined the five ordinal levels of acculturation, "very
Mexican oriented (1)," "Mexican oriented to approximately
balanced bicultural (2)," "Slightly Anglo oriented
bicultural (3)," "Strongly Anglo oriented (4)," and "very
Assimilated--Anglicized (5)."

The acculturation category was based on a
multidimensional, orthogonal, bicultural classification
frame. The frame had two axes (A08 and MOS) and four
quadrants (l=high integrated bicultural, 2:Mexican oriented

bicultural, 3=low integrated bicultural, and 4=assimilated

bicultural; see Appendix B for definitions). Classification

3Words in italics in this and following sections are
from the instrument used in this study.

60

of biculturalism used the mean scores on the AOS and MOS.
Scores greater than -l/2 standard deviation were considered
to be high and scores ranging from -1.5 standard deviations
below the mean to -.5 standard deviations below the mean
were identified as low. Individuals with high scores on the
AOS and the MOS were classified as high integrated
biculturals (1), those with high scores on the MOS and low
scores on the AOS were identified as Mexican oriented
biculturals (2), respondents with low scores on the AOS and.
MOS were low integrated biculturals (3), and finally, people
with high scores on the AOS and low scores on the MOS were
identified as assimilated biculturals (4).

The marginality scores, derived from Scale 2,
(Marginality scale) is an experimental scale with 18 items.
The responses were based on the same 5-point Likert scale as
the AOS and MOS. This was used to measure separation and
marginality from three cultural groups. Specifically, it
measured the level of difficulty accepting Anglo (M = 16.98,
SD = 4.95), Mexican (M = 14.95, SD = 5.14), or Mexican
American (M = 13.58, SD = 4.21) culture (i.e., customs,
values, beliefs, and ideas). Types or cutting scores “were
based on standard deviations or fractions thereof, which
made intuitive sense based on the likelihood of individuals

falling within a given portion of the normal distribution

61

curve” (p. 287) (see Appendix B for cut off scores).
Individuals fell into more than one typology or subtypology
since the scores were based on multiple criteria.

The W (LEVEL) refers to
cognitive cultural constructs, such as beliefs, ideas, and
attitudes. This variable was measured by the Multiphasic
Assessment of Cultural Constructs-Short Form (MACC-SF; see
Appendix A, questions 77-136; Cuéllar, Arnold, & Gonzalez,
1995. See Appendix C for detailed review of instrument).

The MACC-SF included five scales that were comprised of
60 true-false items. It measured five constructs, using an
interval level of measurement, which were identified as
cognitive referents of acculturation. The scales were: (a)
Familism (12 items: 77, 80, 93, 97, 107, 110, 111, 112,
117, 120, 135, and 136); (b) Fatalism (8 items: 82, 86, 90,
96, 99, 118, 124, 128); (c) Machismo (17 items: 78, 83, 84,
85, 91, 93, 100, 102, 105, 107, 109, 115, 116, 125, 127,
129, 130), (d) Folk Illness Beliefs (14 items: 87, 92, 94,
101, 103, 106, 108, 119, 122, 126, 131, 132, 133, 134), and
(e) Personalismo (11 items: 79, 81, 88, 89, 95, 98, 104,
113, 114, 121, 123). A three step process was used to
calculate the level of cognitive acculturation (LEVEL).
First, the true items were summed (note: item 94 was reverse
scored) and divided by the number of items in each scale to
calculate the mean for each of the cognitive constructs.

Next, scores above the mean were identified as having high

62

(1) levels of the construct and scores below the mean
signified low (0) levels of the cognitive construct.
Finally, the high scores were summed to create a level of
cognitive acculturation score. The scores ranged from zero
(no high scores on any cognitive construct) to five (high
scores on all five constructs).

The Le1el_9f_Integrated_Agculturati2n (INTEGRAT) refers
to the behavioral and cognitive cultural constructs
identified above. It was derived by creating a profile type
that combined the scores of the behavioral acculturation
measure (ARSMA-II) with the five cultural constructs of the
cognitive acculturation measure (MACC-SF) (see Table 2).

The Level of Behavioral Acculturation from the ARSMA-II
and the Level of Cognitive Acculturation from the MACC—SF
were employed to create an integrated acculturation score.
A five-step process was employed to create four ordinal
levels of integrated acculturation. First, the exact scores
from the level of behavioral acculturation were computed.
Secondly, the scores on level of cognitive acculturation
were recoded to identify the number of constructs
respondents scored below the mean. This number indicated
they were more Anglo oriented in their cognitions and
provided a scale consistent with the one used for the level
of behavioral acculturation. This scale measured increasing
levels of acculturation from 1 to 5 with higher numbers

indicating higher levels of acculturation to the Anglo

63

Table 2

O I
0 .0 O .‘ ‘ 0..“‘0 0 ‘ ‘ 0 ,0 ‘0. o. ‘0. 5 . - o. .0

 

Behavioral Acculturation Level (CATACC)

 

 

 

 

 

Low Anglo High Anglo
Orientation Orientation
Cognitive *
Acculturation 1 2 3 4 5 ROW ROW
Level Number of Respondents Total %
Low Anglo 0 2 2 1 0 0 5 8
orientation I (n=15, 25%) II (n=16,27%)
1 3 2 6 0 0 11 18
2 0 6 7 2 0 15 25
3 2 1 6 5 0 14 23
III(n=6,10%) IV (n=23,38%)
4 0 2 4 3 0 9 15
High Anglo
orientation 5 O 1 5 0 0 6 10
Column Totals 7 14 29 10 0 60 99*
Column % 12 23 48 17 0 100

 

64

culture. Third, a crosstab of the Level of Cognitive
Acculturation (0-5) (MACC-SF) by Level of Behavioral
Acculturation (1-4) (ARSMA-II) was constructed in order to
create an acculturation profile (see Table 2). Fourth, the
cognitive and behavioral levels were categorized into low
and high levels of acculturation to the Anglo orientation.
Scores on the vertical axis of zero to two were classified
as low Levels of Cognitive Acculturation and a score of
three to five was considered a high Level of Cognitive
Acculturation (MACC-SF). Next, the Level of Behavioral
Acculturation scores of one and two were classified as a
low Level of Acculturation and scores of three and four were
identified as high Levels of Behavioral Acculturation.
Finally, a four-level classification system was devised
based on the clusters created by the crosstab of Level of
Cognitive Acculturation by Level of Behavioral
Acculturation. The four integrated acculturation categories
were labeled (1) Low Integrated Acculturation, (11) Mixed
Integrated Acculturation: Acculturated Behavior, (III) Mixed
Integrated Acculturation: Acculturated Cognitions, and (IV)
High Integrated Acculturation. Groups I and IV indicated
congruency in behaviors and cognitions. Groups II and III
were incongruent in measurements of their levels of
behavioral and cognitive acculturation.
Wises was defined as
"probability statements regarding the likelihood that an

65

event will occur" (e.g., I expect the therapist will
understand my problem)(Tinsley, Bowman, & Ray, 1988, p.
100). This variable was measured by the Expectations about
Counseling-Brief Form (Tinsley, 1982; adapted to
Expectations about Marriage and Family Therapy-Brief Form;
see Appendix A, questions 137—202; see Appendix D for a
detailed review of instrument) and the translated Spanish
version by Buhrke & Jorge (1992; see Appendix A, questions
137-202; see Appendix D for review of instrument).

The 53-item instrument was comprised of 18 scales
although only 17 scales were used in this study (see
Appendix D for listing and definitions of subscales). The
7-point Likert scale for this ordinal measure ranged from
not true (1) to definitely true (7) with higher numbers
indicating a higher level of expectation for an event to
occur. The scale scores for type of expectations of MFT were
derived by summing the responses and dividing by number of
items in the Subscales. The 17 expectation variables are
level of: responsibility, openness, motivation,
attractiveness, immediacy, concreteness, outcome,
acceptance, confrontation, genuineness, trustworthiness,
tolerance, directiveness, empathy, expertise, self-
disclosure, and nurturance. All were identified in this
study so comparisons could be made between expectations.
Individuals with scores above four indicated higher levels

of expectation on the scales while scores below four were

66

designated as having low expectations for the construct.

A factor analysis of the data found three factors:
Expectation of Personal Commitment, Expectation of Counselor
Expertise, and Expectation of Facilitative Conditions.
Factor scores were obtained by summing the scale scores that
comprised each factor and dividing by the number of scales
in each factor. The higher the mean, the more the
individuals expected to (a) take on the responsibility for
making progress in therapy (Personal Commitment), (b) have
therapists that were directive, empathetic, and expert
(Counselor Expertise), and (c) find the necessary conditions
in therapy that would allow progress to occur (Facilitative
Conditions).

W was defined as
having information or knowledge about the profession of MFT.

The Level of Knowledge of MFT was originally quantified
using a series of three items, a recognition question (have
you ever heard the term marriage and family therapy or
therapist, 0=no, l=yes); a knowledge question (how much do
you know about marriage and family therapy, l=not at all to
5=a lot); and a use question (have you ever been to see a
professional marriage and family therapist, l=no, 2=no, but
tried to get information, 3=no, but made a telephone call,
4=yes, went for initial intake session, and 5=yes, attended

more than 2 sessions).

67

The latter two questions were recoded. The responses
for the amount of knowledge was collapsed into an interval
3-point scale (0=no knowledge [1, 2], 1=a little knowledge
[3], and 2=a lot of knowledge [4,5]). The use of MFT
responses were recoded into a 2-point scale (0=no use [1] to
[4], 1=used services [5]). The three items were summed (0-4)
and categorized into a 3-point interval scale (KNOWMFT) of
0=No Knowledge (0,1), l=Low to Mederate Level of Knowledge
(2), 3=High Level of Knowledge (3,4) (see Appendix A,
questions 218, 222, and 224 in research instrument).

W was
defined as reported knowledge or information about the
profession of counseling, therapy, and/or MFT.

The Level of Knowledge of mental health services was
measured by three items, 220, 221, and 222 (how much do you
know about counseling, how much do you know about therapy,
and how much do you know about marriage and family therapy,
respectively). Responses to the items ranged from 1 (not at
all) to 5 (a lot). The scores were recoded into a 3-point
interval scale (0=no knowledge, 1=a little knowledge, and
2=a lot of knowledge). These scores were used to create a 3
digit number that would measure full knowledge of mental
health services. The digit in the one‘s place was knowledge
of counseling, the digit in the ten's place was knowledge of

therapy, and the digit in the hundred's place was knowledge

68

of marriage and family therapy (i.e, 000=no knowledge of any
service; 012=a lot of knowledge of counseling, a little
knowledge of therapy, and no knowledge of marriage and
family therapy).

WWWmsa
descriptive variable in this study defined as whether a
person appears to be open to learning about the profession
of MFT.

Participants in the study were given a score for two
items: (a) acceptance or refusal of a consumer's pamphlet on
MFT and (b) the interviewer's observation of their attitude
and response to offer of a pamphlet designed for potential
consumers of MFT. The former was a dichotomous scale (no and
yes), and the latter was a 3-point scale (negative, neutral,
and positive, respectively). The respondent's comments,
questions, demeanor, and body language were assessed as part
of the researcher's evaluation of openness.

Specifically, this variable was quantified using two
items: (a) one question asked the respondent if they wanted
the interviewer to leave written information on MFT,
providing a nominal level of measurement (0=no, l=yes) (see
Appendix A, question 225 of research instrument), and (b) a
score ranging from zero to two, based on interviewer's
observation of the participant's negative (0), neutral (1),
or positive (2) responses or reactions (see question 226 of

Research Instrument) to the offer of the pamphlet and the

69

opportunity to initiate a discussion about MFT services.

The summed scores provided an ordinal scale of zero (no

openness to learning about MFT), one (low openness), two

(neutral or moderate openness) and three (high openness)

with higher numbers evidencing a higher level of openness to

learning about MFT services.

8W
Six hypotheses were central to this study:

Hm Among people of Mexican origin, there will be a
significant difference between level of acculturation
and level of utilization of counseling services.

Hm Among people of Mexican origin, there will be a
significant difference between level of acculturation
and level of utilization of MFT services.

Hm Among people of Mexican origin, there will be no
significant differences between type of expectations
about MFT and level of utilization of MFT services.

H14 Among people of Mexican origin, there will be a
significant difference between level of acculturation
and type of expectations about MFT services.

Hm Among people of Mexican origin, those who have a
presence of knowledge of counselors, therapists, or
marriage and family therapists will have significantly
different types of expectations of MFT than those who
do not have a presence of knowledge of counselors,

therapists, or marriage and family therapists.

7O

HM Among people of Mexican origin, there will be no
significant differences between level of openness to
learning about MFT and type of expectations of MFT.

A two—tailed test (p s .05) was required to reject the
null hypotheses and accept the working hypotheses that were
developed for this study.

3 'I . E S J
A purposive sample was obtained using a snowball

sampling technique in two counties in central mid-Michigan;

one county was primarily urban and the other primarily
rural. Hispanics (13,575) constituted 3.7% of the total
population (281,912) for the urban county, with Mexicans
comprising 77.1% of this group (Census of Population and

Housing, Ingham County, 1990). The rural county had a

Hispanic population base of approximately 1.6% of the total

population (92,879) with Mexicans (1,479) being the largest

group (76.9 %) of the Hispanic rural population (Census of

Population and Housing, Eaton County, 1990).

The sample for this study included 60 individuals who
met the following criteria: (a) self-identified as being of
Mexican origin or had parents or grandparents who self-
identified as being of Mexican origin, (b) was a resident of
Eaton or Ingham county, and (c) who was 25 years or older.
Selection of respondents from households with multiple
members was based on the individual who had the next

birthday. This increased the likelihood of accessing males,

71

although the final sample, as in most studies, was primarily
female. The purpose of selecting an urban and a rural county
was to increase the likelihood of a more diverse community
sample. The age requirement was developed to access a sample
who had moved into young adulthood so they were more likely
to be independent and self—sufficient. They had more
opportunity to have experienced challenges in their lives
that could necessitate seeking support from familial and
non-familial sources. The unit of analysis, individuals, was
selected for the sample due to: the lack of data on
individual perspectives; the low response rate of males,
which can negatively affect family participation; and, most
importantly, the response bias that could result due to a
partner's influence. The latter was more likely to occur due
to the cultural values and beliefs that give the husband
more power in the relationship (e.g., machismo, marianisma).
A subset of 15 individuals was selected from the sample
of 60. Qualitative interviews were conducted in order to
provide respondents an opportunity to share their knowledge,
beliefs, and experiences regarding the Mexican origin
community, help seeking, and therapeutic services. At the
end of each completed interview, every respondent with an
even~numbered identification number was asked to participate
in an audiotaped interview until there were 15 completed
interviews. People were assigned the identification numbers

at the initiation of each interview. This gave everyone the

72

opportunity to be assigned an even number, depending on when
they chose to schedule the quantitative interview.
B °!' E S J

Potential respondents were contacted through referral
sources that conveyed verbal and written information about
the research study, the use of advertisements to inform the
Mexican-origin community of the research study, and by
asking potential respondents and participants to inform and
provide contact information to people of Mexican origin in
their familial, social, and occupational systems.
Specifically, the principal investigator provided
informational papers and business cards to key contacts in
the Mexican-origin community. Contact was made with key
people from informal and formal groups, churches, agencies,
and organizations that tend to be connected to or frequented
by people of Mexican origin. The principal investigator
followed up with referral sources on a regular basis.
Information regarding the study was also disseminated
through use of English and Spanish informational
advertisements (Appendix E) placed in newspapers,
newsletters, and flyers that were likely to be seen and read
by people of Mexican origin. The flyers were disbursed by
referral sources and by the principal investigator at key
locations frequented by people of Mexican origin. This

informed people of the existence of the study so they felt

73

more comfortable when approached to participate in the
study.

People were able to refer potential respondents of
Mexican origin directly to the researcher, or they
facilitated contact by providing the researcher's contact
numbers to potential respondents. Potential respondents
called the researcher directly or gave their name and number
to the referral source. Potential participants were given
the opportunity to ask questions during the initial contact
and were asked if they wanted to meet the researcher and
talk before they made a decision. Participants who indicated.
an interest in participating in the study were informed of
the eligibility criteria, the level of commitment necessary
to participate in the study, and of the $5.00 appreciation
gift they would receive at the completion of the interview.
Members from households with multiple members were selected
based on who had the next birthday.

W93

A multifacted, three—stage approach was designed to
respond to the needs of the Mexican origin population. Upon
being notified of a potential respondent, the principal
investigator initiated the first stage of data collection by
contacting the respondent by telephone or in person. The
initial communication was dedicated to engaging in a social
stage with the potential participant. This allowed the

investigator to develop a rapport with the respondent, to

74

address individual questions or concerns regarding the
study, and to verify the respondent's eligibility criteria.
During the initial contact by telephone or in person, the
researcher assessed the respondent's comfort with
participating in the study. Based on their level of comfort,
the researcher engaged in various degrees of "platica"
(talk) until the individual indicated at least a moderate
level of comfort with the researcher. The second stage of
the data collection process was devised for individuals who
sounded guarded. They were invited to meet with the
researcher at a self-selected time and location to enable
them to make a decision regarding their willingness to
participate in the research. Upon meeting the people who
were undecided, some made a decision to participate in the
interview after a 10- to 30-minute social session. The
remainder visited with the researcher for 30 to 60 minutes
before making a decision to participate. The third stage was
to schedule another appointment for people in the latter
group to complete the interview.

Potential respondents who reported that they were (a)
of Mexican origin,(b) a minimum of 25 years of age, and (c)
residents of Eaton or Ingham County were scheduled for a
semi-structured, face—to-face interview conducted by the
principal investigator. Individuals selected the location
for the interview to be conducted from the following

choices: (a) home, (b) school, (c) a local college or

75

university, (d) a community center, (e) church, (f) a
community business, or (g) respondent's place of employment.
The data were collected during face to face interviews that
were predominantly held in the participant’s home (48%) or
place of business (25%). Respondents also selected the
language in which the interview was conducted, English or
Spanish. The amount of time needed to complete the interview
ranged from one hour to four hours, with an average of two
hours.

The interview commenced with an informal social stage
that was designed to increase the respondent's confianza
(confidence or trust) with the interviewer. When the
respondent appeared comfortable, an informational sheet (see
Appendix F) and consent form (see Appendix G for IRB
Approval Letter from UCRIHS) were read to participants.
Respondents were reassured about the confidentiality of the
interview, informed about their right to refuse any
question, and provided an opportunity to asks questions.
Upon securing the respondent's signature, a 45-90 minute
interview was conducted. Respondents were provided response
cards (see Appendix H), in the language of their choice, for
reference. The interviewer read the questionnaire and
recorded the participant's responses. The interview started
with a section of demographic questions (see Appendix A,
questions 3-27 of research instrument), followed by three

standardized Likert-scale instruments (see Appendix B-D for

76

overview of instruments), and concluded with a brief section
of closed-ended questions (see Appendix A, questions 203-225
of research instrument). Responses were hand-recorded on the
227-item questionnaire by the researcher (see Appendix A).
Probes were utilized when respondents indicated a need for
clarity of a question. At the completion of the interview,
participants were presented with a-monetary appreciation
gift of $5.00 and the telephone number of the principal
investigator. In addition, information on potential support
systems and referral sources was also provided at the
participant's request or when it was deemed appropriate by
the principal investigator, based on the information
provided in the interview.

At the end of the interview, respondents who had an
even identification number on their questionnaire were asked
to listen to the interviewer read an informational sheet
regarding a second interview (see Appendix I). The
information sheet indicated the purpose of the second
interview, the level of commitment necessary for
participation, and that no monetary gift would be provided
for participating in the second interview that would be
audio-taped. This process was conducted until a subset of at
least 15 subjects completed the second interview. Most of
the respondents made the choice to complete the second
interview at that time although some scheduled the interview

for a separate time. Before the open-ended interview was

77

started, a second consent form (see Appendix J) was secured
from the respondent. The interview was conducted in the
language preferred by the respondent. Seventy-seven percent
of the interviews were completed in English, and 23% were
conducted in Spanish. The 15-45 minute interview comprised
16 open-ended questions (see Appendix K). Responses were
audiotaped in order to increase the reliability of data
collection. Notes were taken by the interviewer on non-
verbal data that was not able to be documented by the tape
recorder. The use of the audiotapes maintained the
completeness and the reliability of the data, which offset
the risk of getting responses that were not as truthful. In
addition, the established relationship and the nature of the
questions increased the likelihood that honest and truthful
responses were provided. Many of the questions were written
in the third person, and participants chose the depth of
disclosure that was comfortable to them.

The second session utilized a questionnaire that
consisted of 16 open-ended questions (see Appendix K) that
encouraged the respondent to share their cognitions and
emotions about their experiences as a person of Mexican
origin in relation to help seeking and mental health issues.

The standardized instruments were bilingual (English
and Spanish) and have been used with bilingual populations.
(a) The Expectations about Counseling-Spanish Version has

been validated and was developed using the four techniques

78

commonly used in the translation process; back-translation,
bilingual technique, committee approach, and pretest
procedures (see Buhrke & Jorge, 1992, for details; see
Campbell, Brislin, Stewart, and Werner, as cited in Brislin,
1970, for description of four techniques). (b) The original
Acculturation Rating Scale for Mexican Americans (ARSMA) has
been in use since 1980, is considered one of the most
consistently used measures of acculturation, and has been
used with English— and Spanish-speaking Mexican—origin
populations. (c) The Multiphasic Assessment of Cultural
Constructs-Short Form (MACC-SF) was also developed to be a
bilingual instrument when it was developed for use with the
Mexican origin community. (d) The informational sheets,
consent forms, demographic section, and questions related to
openness to and utilization of mental health services were
available in bilingual forms. The back translation or double
translation technique was utilized to make the forms and
instruments culturally equivalent to each other. The
instruments were translated from English to Spanish by two
translators who were Mexican and highly educated in the
English and Spanish language. A computer translation program
(Globalink's Power Translator, 1996) was used as another
method to translate the versions from English to Spanish and
then from Spanish to English. A third translator, who was
from Puerto Rico, conducted a back-translation on one of the

three instruments. The other two instruments were back

79

translated by a Mexican member of the community who had a
high school education and had worked within the Mexican
community with people from the lower and middle SES groups
for 18 years. The various Spanish versions were compared,
and then the original two translators reviewed each
instrument and came to an agreement on the translated
versions. This version was compared to the original English
version and the computer translated English version. The
final version of the instrument was piloted with six people
with varying degrees of bilingualism to eliminate
inconsistencies or misunderstandings in the instrument.

E I I I] I . I. CD I. E I.

This section was adapted from the demographic section
of the Acculturation Rating Scale for Mexican Americans—II
(ARSMA-II; Cuéllar, Arnold, & Maldanado, 1995) and the
Multiphasic Assessment of Cultural Constructs-Short Form
(MACC-SF; see Appendix A, research questions 2-28).
Questions designed to elicit background information on the
participant and their family members were added in order to
examine the influence of contextual factors on the variables
being studied in this research. This information included
gender, age, birth place, self-identification of ethnicity,
perception of skin color, immigration status, residency,
religious preference, level of education, marital status,
occupation, and income. Respondents were asked to provide

the label they used to self-identify their ethnicity and

80

their race. This was conducted to clarify with what groups
people of Mexican origin identify. There were seven possible
responses and an “other” category for the former and an
open-ended question for the latter. Occupation was
categorized using the Michigan Occupational Information
System Index (Michigan Jobs Commission, 1988), and
respondents gave their individual gross income and the
family's total gross income.
Intsrxiew_flumber_2

The instrument for interview number two consisted of 16
open-ended questions (see Appendix K) designed to gather in?
depth data on what people of Mexican origin thought or felt
about the following issues: (a) the role of familial,
social, and professional support systems; (b) their
knowledge base of professional sources of support; (c) their
belief systems and needs related to help-seeking;
(d) utilization of familial, social, and professional
support systems by people of Mexican origin; and (e) their
suggestions to professionals regarding provision of services

to the Mexican-origin community.

81

CHAPTER 4

RESULTS AND DISCUSSION

This investigation examined the expectations and
utilization of marriage and family therapy (MFT) services
using quantitative and qualitative methods. This provided
the researcher a richer and more in-depth understanding of
this area of study. This chapter will focus on the analyses
of the quantitative data. The qualitative data will be
analyzed in the future. However, conclusions from the
results of the empirical data analyses have been influenced.
by the material that was collected in the qualitative
interviews.

The results in this chapter will be divided into four
sections: (a) sample description, (b) reliability of
standardized measures, (c) development and comparison of
integrated acculturation with standardized acculturation
instruments, and (4) hypothesis testing.

Introduction: Instrument and Sample
Instrument

The quantitative portion of the study consisted of a
226-item questionnaire (see Appendix L for copyright
permission for use of standardized instruments) that
contained (a) sociodemographic items, (b) three standardized
instruments, and (c) a section related to help—seeking

behavior and openness to and utilization of mental health

82

services. A breakdown of the instruments and the number of
items in each measure appear in Table 3.
Sample Description

Less than half of the participants reported speaking
Spanish very or extremely often (42%). Almost 90% spoke
English as their primary language, and 7% cited speaking
English very little or with minimal frequency. Seventy—seven
percent of the sample chose to have the interview conducted
in English, and 23% selected Spanish.

There were 60 participants in this study who identified
themselves as being of Mexican origin. However, there was a
wide range of ethnic and racial identity categories provided

by the participants. Thirty-seven percent of the

Table 3

MW

 

 

Instrument Number of Items
Sociodemographic 27
Acculturation Rating Scale-II 48
Multiphasic Assessment of Cultural 60
Constructs

Expectation about Counseling 66
Openness and Utilization of Marriage and 25

Family Therapy

226
Total

 

83

participants self-identified themselves as "Mexican,
Mexicano, or Mejicano." (See Table 4 for a breakdown of
self-defined ethnic identity and racial identity labels for
participants and their partners.) Ninety percent of the
participants were United States citizens through birth or
naturalization. Twenty percent of the total sample was born
in Mexico. Forty-two percent of the sample identified
themselves as being second generation Mexicans with Michigan
(40%) and Texas (37%) being the primary birthplaces of the
participants.(See Table 5 for a breakdown of demographic
characteristics of sample.)

The majority of the sample was female (60%). The ages
of the participants ranged from 24 to 75 with a mean age of
41.9 (SD = 11.4). Over half of the sample was composed of
college-educated individuals (37%) and college graduates
(15%). Twelve percent were educated in Mexico, and another
five percent had one to six years of education in Mexico.
Over half of the sample was married. A little over one third
of the participants (37%) reported having three to five
children (M = 2.58, SD = 2.19), and 20% had no children.

Catholicism was the primary religious affiliation
(63%), with the next largest group identifying themselves as
Christians (17%). Seven percent identified themselves as
having no religion, and one individual self-identified as
agnostic. Thirty nine percent reported being very or

extremely religious or spiritual.

84

Table 4

 

 

is . 9!! on' Io e - i ' o i‘ con-‘1 . d fih-ir
W
Category % Category %
W ' ' = SD=
Mexican, Mexicano, 37% Less than 5 years 3%
Mejicano 6-10 years 3%
Mexican American 27% 24-30 years 15%
Hispanic 25% 31-40 years 37%
Latino 3% 42-50 years 27%
Chicano 3% 52-58 years 14%
Othera 6% Over 60 years 2%
Total 101% Total 101%
Mexican 30% No Partner 20%
Mexicano 17% Mexican Origin 27%
Mexican American 13% Anglo Origin 20%
Hispanic 10% Hispanic or Latino 10%
Caucasian 8% American 10%
White 5% African Amer./Black 3%
Latino 5% Mexican/Anglo Mixed 3%
American 3% Mexican/Black Mixed 2%
Male 3% Black/White Mixed 2%
Meztizo/Mesclada 2% Mixed: Other 2%
Don’t consider race 2% Meztiza/Espafiol 2%
Human 2% Total 100%
Total 100%
E I . E . J I! I'!
W Mexican 7%
$Q=13.8) Mexicano 10%
Less than 5 years 8% Mexican American 7%
7-10 years 7% Hispanic 3%
19-29 years 27% Caucasian 10%
30-39 years 32% White 13%
40-52 years 27% American 3%
Total 101%* Meztizo/Mesclada 2%
Don't consider race 2%
Human 2%
African Amer/Black 7%
No Partner 20%
European 5%

Mixed: Mex & Anglo/Wht 3%
Mixed: Wht/Native Amer 2%
Otherb 5%

Total 101%

 

Mgtet Percentages over 100 are due to rounding up numbers.
AAmerican, Hispanic American, Hispanic, and Mixed

b . ' ~

Chicano, Latino Europea, Espanol

85

Table 5

 

 

I-uoq 291' q.- R- 9c oen .‘ M‘qn one
W
Category % Category %
= = H .I J S! I
24-29 15% Never Married 22%
30-39 28% Married 52%
40-49 35% Separated 2%
50-58 15% Divorced 17%
Over 60 7% Cohabiting 5%
Total 100% Widowed 3%
Total 101%
Gender
Female 60% Religign
Male 40% Catholic 63%
Total 100% Christian 17%
No Religion/Agnostic 8%
Bitthplate Non-Denominational 3%
Michigan 40% Protestant, Baptist, or
Texas 37% Born Again 5%
Mexico 20% Mixed or Believer with
New Mexico 2% No Affiliation 3%
Mississippi 2% Total 99%
Total 101%
E 1' . .I S . .I 1'!
Citizenship_fitatus Not religious/spiritual 2%
U.S. Citizen 90% A little 15%
Mexican citizen 10% Somewhat 45%
Total 100% Very 32%
Extremely 7%
M= = Total 101%
13t generation 20%
2nd generation 42% M: =
3m'generation 12% None 20%
4th generation 15% 1—2 Children 33%
5th generation 10% 3-5 Children 37%
Total 100% 6-8 Children 10%
Total 100%
Language
Primary: English 90% WW3
Primary: Spanish 7% WW
Both 3% 0-4 12%
Total 100% 5-10 33%
11-14 27%
Interview: English 77% 15-19 23%
Interview: Spanish 23% 20 or over 32%
Total 100% Total 100%

 

Motet Percentages below or above 100 are due to rounding up

numbers.

86

A broad range of occupations was represented in the
sample. The most prevalent jobs were related to business and
education (33%). Health and social services positions (17%)
ranked as the second most represented type of employment.
Over one quarter (27%) of the sample was not working outside
the home. There was a major difference in annual income
depending on whether individual or household income was
being cited. Forty-five percent of the sample reported an
annual earned income of less than $20,000 (individual
income). In comparison, only 17% of the sample had annual
earned hensehgld incomes of less than $20,000. A small
percentage of participants had individual annual incomes
over $50,000 (10%), but there was a large increase in the
percentage of households with annual incomes over $50,000
(42%). Less than one third (27%) of the respondents reported
being in unpaid positions, such as being unemployed,
disabled, students, housewives, or in low-paying services
jobs (5%) (See Table 6 for specific information on
occupation and annual income.)

Reliability of Measures

Each standardized instrument was analyzed using
statistical tools (SPSS/PC+). The Cronbach's alpha test was
used on each scale to measure internal consistency. The

results are reported below for each instrument.

87

Table 6

 

 

v-.. .00. ': ‘0 .o- ' 0. - cu «I! _ 01‘ 0. i‘.9090-1
(N=60
Category % Category %
Edueatien Indixidual_lneeme
Less than 12th grade 22% Less than 12,000 32%
High School Grad/GED 27% 12,000-19,999 13%
1-4 years college 37% 20,000-29,999 23%
College grad/higher 15% 30,000-49,999 20%
Total 101% Over 50,000 10%
Don’t know 2%
Country of Egugatign Total 100%
United States 83%
Mexico 12% Heueeheld_lneeme
Most US, 1-3 yrs Mex. 3% Less than 12,000 10%
Most US, 4-6 yrs Mex. 2% 12,000-19,999 7%
Total 100% 20,000-29,999 12%
30,000-49,999 23%
Qeeunatien_er_SES Over 50,000 42%
Category 1a 27% Don’t know 7%
Business & Education 33% Total 101%
Health & Social Svcs 16%
Category 4b 8%
Art, Design, Comm. 7%
Service Occupations 3%
Total 99%

 

Mgtet Percentages below or above 100 are due to rounding up
numbers.

aCategory 1 includes Homemakers, Students, Retired,

Disabled, and Unemployed.

BCategory 4 includes Industrial, Construction, Mechanics,
and Repair.

88

WWI; (ARSMA-II)
NW The reliability or

internal consistency of the ARSMA-II (see Appendix B for
overview and psychometric properties of instrument) was
evaluated using Cronbach's Alpha (SPSS 6.1.3). Alpha
coefficients were calculated for the five subscales (AOS,
MOS, ANGMAR, MEXMAR, and MAMARG) that comprise the two
scales (Acculturation and Marginality; see Table 7). The
results indicated good internal consistency for all of the
scales and subscales (K = .80 to .87).
Eagtgt_Aualy§i§t_A3§MA;llt The varimax rotation method
was used in a factor analysis on the AOS and MOS subscales

to test validity over the group of subjects. In Table 8, the

 

 

 

Table 7
cups ’0 y‘oo -nq o - . oo o 4' 4- 0 ‘ . ’
Study
Instrument Cuéllar Study
M ED K M 52 K
Scale 1:
Acculturation
AOS 3.82 .57 .83 3.71 .63 .82
MOS 3.28 .84 .88 3.49 .61 .80
Scale 2:
Marginality
ANGMAR 14.70 5.28 .90 16.98 4.95 .81
MEXMAR 13.98 5.68 .68 14.95 5.14 .86
MAMARG 12.61 4.73 .91 13.58 4.21 .87

 

89

Table 8

 

 

{o ._ so . o u. o ,‘, o o O - . o. .l- o
Afififlflzll
% of
Commun- Eigen- Variance Correla-
Factor ality value Explained tion
1 1 1 1 1
1)Ethnie_lntereetien .74475 4.463 34.3
Associate w/ Anglos .81
Anglo friends as .79
child
Speak English .71
2)La3euagei_media .6769 1.612 12.4
Enjoy English .86
movies
Enjoy English TV .81
3)Leneuegei_heerine -6189 1-393 10-7
Think in English .78
Enjoy English music .61
4)La393age;_wrifte3 .7668 1.081 8.3
Write letters in .77
English
Enjoy English books .60
Cuéller1;_£eeter;
lAQfil
Language 4.23 32.54
Ethnic Interaction/ 1.47 11.35
Distance

 

90

13-item Anglo Orientation Scale (AOS) generated four factors
with an eigenvalue of 1.08 or higher. These four factors
accounted for 65.7% of the total variance explained by the
factors. The first factor, ethnic interaction, accounted for
34.3% of the total variance explained. Based on their item
composition, the factors for the AOS have been identified as
(1) ethnic interaction, (2) language/media, (3) auditory
language, and (4) written language. The three language
factors combined explained 31.4% of the variance. In Table
9, the l7-item Mexican Orientation Scale (MOS) generated
five factors with an eigenvalue of 1.3 or higher and
accounted for 68.9% of the variance explained by the
factors. The first factor is hard to interpret, but it has
been identified here as "Involvement with Cultural Heritage"
and accounts for 36.1% of the variance. Factor 1 reveals low
to high correlations between items. The correlations of the
items within the factor illustrated that the items are

measuring a common construct or factor.

9. _°oo. ' 4 ‘ u‘n cf r1 Con - 10, _orm:
(MACC-SF)
Inferna1_£en;i;tenexi_MAQQ;;El This instrument consists

of five subscales (see Appendix C for definitions) that
embody characteristics of the Mexican-origin culture. The
subscales and psychometric properties of each construct
appear in Table 10. Internal consistency for the machismo

(Macho; K = .78) and folk illness beliefs (FOLK; K = .75)

91

Table 9

 

 

:0 . ‘0 . o v. a U‘ .0 O ‘0 . co . of
Aflfiflbzll
% of
Commun— Eigen- Variance Correla-
Factor ality value Explained tion
1 1 1 l 1
1)131Q11eme3_t_wi_th
Cultural Heritage .7619 6.492 36.1
Mexican friends as
child .8105
Enjoy Spanish books .7438
Cook Mexican foods .6807
Contact with Mexico .6176
2)Qenfaet_wi_th
Cultutel_teuguege .7079 1.627 9.0
Enjoy Spanish
movies .7889
Enjoy Spanish TV .7174
Enjoy Spanish music .6899
Speak Spanish .6173
MW
Inteteetign .7560 1.558 8.7
Associate w/ Mex/M.
Amer. .7823
Mexican friends .6377
4) Ethnie_lfl;£ethet .5318 1.438 8.0
Father identifies
Mexican .8709
5) Ethuie_1fl;§elt .7439 1.277 7.1
Self Identify as
Mexican .5620
QueIJeLLLEacrer;
lMQfil
Language 6.52 38.36
Ethnic Identity 1.81 10.70
Ethnic Interaction/
Distance .94 5.54
4.23
1.47

 

92

Table 10

II I I I J : . I . HESS-SE E 1 J

 

 

 

Cuéllar (N=379) Study (N=60)

Instrument
M SD K M SD K

Subscales
Machismo 4.66 3.33 .73 5.65 2.98 .78
Folk Beliefs 4.60 3.15 .71 6.15 2.86 .75
Familism 5.71 2.48 .50 6.83 2.02 .65
Fatalism 2.89 1.92 .42 3.80 1.54 .63
Personalismo 5.96 1.94 .42 6.50 1.85 .47

 

subscales were fair. The remaining three scales--Familism
(FAM; K = .65), Fatalism (FATAL; K = .63), and Personalismo |
(PERSON; K = .47) were not acceptable. Cuéllar's results on
internal consistency of these three subscales were low as
well (K = .42 to .50). Overall, the five factors were more
consistent in the current study. The internal consistency
was close to meeting the .80 standard, and the alphas were
higher than the acceptable .60 standard for exploratory
studies.

Eeetet_Anelyeiet_MACC;§E. A confirmatory factor
analysis was conducted using the varimax rotation method on
each of the five constructs. Selection of the factor
solutions for each of the five subscales were determined by
their eigenvalues being above 1.0 and each factor making up
at least 10% of the explained variance.

Machismo: A three-factor solution was selected for the

Machismo Subscales: Traditional Gender Values (21.1), Male

93

Gender Role (12.6), and Male Superiority (9.4). These
factors explained 43% of the variance (See Table 11).

Folk Illness Beliefs: The Folk Illness Beliefs
Subscales yielded a three—factor solution which accounted
for 47% of the variance: Experience (24.1), Folk Practice
Ideologies (12.5), and Belief in Supernatural (10.6)(See
Table 12).

Familism: The 12-item Familism Subscales yielded 5
factors with an eigenvalue above 1.0. The five factors
together explained approximately 55% of the variance:
Parental Roles (19.8), Family Priority (12.7), Dependency on.
Relatives (12.3), Parental Authority (9.9), and Value of
People (9.9) (see Table 13).

Fatalism: A three-factor solution was selected for the
Fatalism Subscales which accounted for 61% of the variance:
Inevitability (27.9), Present Orientation (19.5), and
Mastery (13.6) (See Table 14).

Personalismo: A four-factor solution that accounted
for 55% of the variance was selected for the Personalismo
Subscales; Social Influence (17.8), Supportiveness (14.7),
Friendliness (12.5), and Sociability (10.1) (See Table 15).

W The bilingual
Multiphasic Assessment of Cultural Constructs-Short Form
(MACC-SF) has also been found to be reliable and valid
(Cuéllar, Arnold, and Gonzalez, 1995). The Spanish version

0f the Expectations about Counseling was developed and

94

Table 11

Bgtatgd Eath: Matrix f9: Magbjsmg Scale Q: MEQC_SE

 

% of
Commun- Eigen- Variance Correla-

Factor ality value Explained tion
1 1 1 1 1

 

1) I I.I. J
Cendet_fiele .79507 3.585 21.1

*Better to be man

than woman .75

*Parents stricter

control over

daughters .73

*Boys not play with

girls' toys .64

*Some jobs, women

should not have .61

2) Male_§e3der_Eele .67174 2.138 12.6

*Women like dominant

men .75
*Man not marry

taller woman .69
*Men more

intelligent

than women .62

3) Male.§unerierit¥ ~70204 1-593 9-4

*Father, main say,

family matters .84
*Wife respects man,

head of home .71
*Women learn

housework, not

college .57

Total Factor
Explained 43.1

 

Metet In Tables 11—15, statements have been shortened, but
they retain the meaning of the original. See MACC-SF for
exact statements.

95

Table 12

 

 

{o q ‘0 . o y. o of. l.‘ 3‘ - . - of
MAQ£:§E
% of
Commun- Eigen— Variance Correla-
Factor ality value Explained tion
1 1 1 1 1
l) Etpetienee .73161 3.370 24.1
*Treated for empacho .76
*Used curanderos in
past 1 .55
*Used curandero more
than once .73
*Treated for “Susto”
when young .79
*Treated for “Mal de
Ojo” .72
2) Eelx_£teetiee .74273 1.747 12.5
Ideologies
*Take child to
curandero .77
*Curandero better,
some illnesses .85
3) Belief:
Supernatural .78384 1.488 10.6
*Possible to place
hex .75
*Hexed in past .81

Total Factor
Explained 47.2

 

96

Table 13

E I I I E I H I . E E 'J' S J E HEZZ-EE

 

 

% of
Commun- Eigen- Variance Correla-
Factor ality value Explained tion
1 1 1 1 1
1) Retentel_fielee .609842 2.376 19.8
*Stricter parents,
better child .76
*Father, main say,
family matters .76
*Woman care for
house/family .75

2) Eemily_£tietity .50955 1.518 12.7

*Mother, dearest

person for child .84
*Parents approve
girl’s date .60

*Parents teach
children loyalty to
family .55

3) Dependene¥_en
Reletiyee .63901 1.475 12.3

*Expect relatives'

help .81

*Relatives’ problems

come first .81

4) Eare3t_Autheritx .62234 1-193 9-9

*Children obey, no

question .66
*Family participate,

school activities -.77

5) Value_ef_£eeele ~71986 1.098 9-2

*Relatives more
important than
friends .66
*Respect all adults -.75

Total Factor
Explained 63.9

 

97

Table 14

E I ! I E I H I . E E ! J' S J E “Eli-SE

 

 

% of
Commun- Eigen- Variance Correla-
Factor ality value Explained tion
1 1 1 1 1
1) Inexitebility .74976 2.231 27.9
*People die when it
is their time .84
*Future in the hands
of God .82
*Don’t plan ahead,
just good/bad
fortune .52
2) Eteeent .74311 1.556 19.5
: . ! I.
*Enjoy life now .85
*Live for present,
future unknown .80
3) Meeteu .65270 1.086 13.6
*Someone controls me -.67
*Make plans, they
work .66
*Believe doctor more
than self .63
Total Factor
Explained 61.0

 

98

Table 15

 

 

{o . so . o u. o ’- 0.. go . e o y; -
% of
Commun- Eigen- Variance Correla-
Factor ality value Explained tion
1 1 1 1 1
1) Seeiel_Lnfiluenee .49365 1.960 17.8
*Know people of
power .65
*Start talk: weather .69
2) Suppettiyeneee .47885 1.619 14.7
*Trust people to do
me favors .65
*Don’t mind asking
for favors .64
*Often ask people to
do me favors .59
3) Friendlineee .61778 1.374 12.5
*Try to get to know
everyone I meet .66

*Better to meet

someone if know

their family .69
*Friendly people get

further than cold

people .67
4) Seeiebility .44295 1.116 10.1
*Enjoy being with

people .60
*Greet people in

friendly manner -.64

Total Factor
Explained 55.1

 

99

validated by two studies (Buhrke & Jorge, 1992) that found
it to correspond significantly to the English version for
student and non—student samples. Buhrke and Jorge did find
some items and scales to have lower than desirable
correlations. They explained that concepts do not translate
directly, that there was the potential for different
dialects, and that there were differences in the subjects'

language proficiency (see Buhrke & Jorge for details).

.9‘ 9 '0! «00. 0.. - '19-: '- own A -= ° {94! ‘q o
.c‘ . '00 {you Mo” '.0- - 9 gm'. 0‘ .0 -= ", of“
EAME12BE

13W The internal

consistency for each of the 17 scales was calculated using
Cronbach's alpha (see Table 16). The alphas for the
subscales ranged from .64 to .90 for this study. Almost half
of the correlations in this study (46%) were within .05 of
Tinsley's results, and another 36 percent were within .15.
More specifically, the Immediacy, Motivation, Directiveness,
and Empathy scales were found to be much more reliable, and
Concreteness was slightly more reliable. Unlike Tinsley,
lower reliability was found for the Attractiveness,
Tolerance and Realism subscales. A decision was made not to
use the Realism scale in this study. It is an experimental
scale that lacked meaningfulness in this study due to the

diversity in the sample, and there was no intention to

100

Table 16

 

 

 

 

on the responses of 446 undergraduate students,

V‘q! .go 0 ‘ Co 0! ‘1 0 ‘ . o ‘ 0
o- . o. .Hoo‘ o_g ‘ [go-:7 - o ._q.9 ‘0 o
0‘ . oo .90- U! '29‘ .39 a“: -_.9 -= ‘ 0_u
Scales Study (N=60) Tinsley(N=446)
M SD K K
Motivation 5.12 1.64 .90 .77
Concreteness 5.02 1.49 .85 .79
Confrontation 4.93 1.62 .85 .82
Openness 5.19 1.64 .83 .81
Outcome 5.67 1.25 .82 .81
Directiveness 3.78 1.77 .82 .69
Empathy 3.56 1.61 .82 .71
Trustworthiness 5.88 1.26 .82 .78
Immediacy 5.43 1.34 .81 .69
Nurturance 5.05 1.47 .76 .75
Expertise 4.70 1.61 .75 .75
Genuineness 6.39 0.91 .75 .76
Acceptance 4.46 1.55 .74 .81
Self-disclosure 2.73 1.60 .74 .80
Responsibility 6.00 0.96 .72 .70
Tolerance 4.71 1.52 .68 .71
Attractiveness 4.04 1.46 .64 .76
assess how realistic the individual's expectations were
within this study.
Tinsley's study (Tinsley, Workman, & Kass, 1980), based

consistency reliabilities that ranged between .69 and .82.

In a secondary analyses of data from six studies

Helms, 1980,
Brown,

Workman, 1978;

De St. Aubin,

& Lucek,

Yuen & Tinsley,

as cited in Tinsley,
1984;

1981),

101

Tinsley

Rode, 1979; Tinsley,
Tinsley et al., 1980;
(1982)

had internal

(Biscardi &

correlated the full and brief scale and factor scores and
achieved a correlation less than or equal to .83.
W A factor analysis
supported a three-factor solution that was similar to other
studies (see Hayes & Tinsley, 1989; Kunkel et al., 1989;
Tinsley, Holt, Hinson, & Tinsley, 1991). Three components
satisfied the eigenvalue criterion of being greater than one
(Kaiser criterion). They accounted for 73% of the total
variance explained. When Cattell's Scree test (1940) and the
percentage of total variance explained was examined, the
first two factors accounted for the majority (66%) of the
common variance in scores on the EAC—B. A varimax rotation
indicated that Openness, Immediacy, Responsibility, Outcome,
Motivation, Trustworthiness, and Attractiveness loaded
highest on the first factor, which was identified as the
Expectation of Personal Commitment factor. It is similar to
the Expectation of Personal Commitment factor identified in
the earlier studies, with the exception of trustworthiness
that replaced concreteness in this study. This factor
primarily measured clients' expectations to take on
responsibility for achieving progress in therapy. A varimax
rotation indicated that Empathy, Expertise, Self-Disclosure,
Directiveness, Confrontation, Nurturance, and Concreteness
had the highest loadings on the second factor, Expectation
of Counselor Expertise. Prior research has not included the

latter three in this factor. In past studies, Confrontation,

102

Nurturance, and Concreteness loaded high on the third factor
in this study, Expectation of Facilitative Conditions. The
highest loadings on this Expectation of Facilitative
Conditions factor were Tolerance, Genuineness, and
Acceptance. These have comprised part of the Expectation of
Facilitative Conditions factor identified in other studies.
A decision was made to include the Expectation of
Facilitative Conditions factor in the factor solution in
this study even though the percent of total variance
explained was low (6.6%). In addition, Genuineness and
Tolerance have been identified as being "necessary and
sufficient" (Rogers, Gendlin, Kiesler, & Truax, 1967, in
Tinsley, Workman, & Kass, 1980, p. 565) to facilitate
change, and other studies have indicated that Acceptance is
also a facilitative condition.

Internal consistency coefficient alphas for the three
expectancy factors ranged from .74 to .93 (see Table 17).
The means of the factors ranged from 4.25 to 5.33 (SD, 1.10
to 1.31).

Speni;h_¥er;ieni_EAC:B£_lEAMElzflfill Reliability and
factor analyses were not conducted on the Spanish versions
of the instrument due to the results of an investigation
conducted by Buhrke and Jorge (1992) and the small sample
(n=14) that completed the interview in Spanish in this

study. Buhrke and Jorge found the Spanish version to be a

103

Table 17

 

Factors and Scales

 

I

II

III

Counselor Expertise
Confrontation
Concreteness
Directiveness
Empathy

Expertise
Nurturance
Self-Disclosure

Personal Commitment
Attractiveness
Immediacy
Motivation

Openness

Outcome
Responsibility
Trustworthiness

Facilitative Conditions

Acceptance
Genuineness
Tolerance

4.25

5.19

.15

.10

.92

.93

.74

 

104

"viable and potentially useful tool" (p. 369) for various
Hispanic populations.
v Inte a c l i

Intreduetion

A goal of this study was to calculate a Level of
Integrated Acculturation score that represented a combined
measurement of the behavioral acculturation constructs from
the ARS Qt MA-II and the cognitive acculturation constructs
from the MACC-SF. This section focuses on providing a
description of how the level of integrated acculturation
measure was created by this author. The Level of Integrated“
Acculturation score will be used in analyses conducted for
the hypotheses related to acculturation
Qexelenmemmeaflre

A review of the Level of Behavioral Acculturation
scores and the Level of Cognitive Acculturation scores is
provided to clarify how they were used in the development of
the Level of Integrated Acculturation score.

W The
scores from Scale 1 (Anglo Orientation Scale and Mexican
Orientation scale) were utilized for the “X” axis of the
crosstab used to develop the Level of Integrated
Acculturation score. These included Very Mexican oriented
(1), Mexican oriented to approximately balanced bicultural
(2), Slightly Anglo oriented bicultural (3), Strongly Anglo

oriented (4), and Assimilated/Anglicized (5).

105

LexeLeLSoenitiMeeulfuretienJflACL-SELI The number

of scales below the mean (0-5) were counted to create a
Level of Acculturation score. A decision was made to use the
same labels from the ARSMA-II. Since there were only five
levels in the Level of Behavioral Acculturation, it was
necessary to add a sixth label since the range of scores for
this variable was 0 to 6. The final scale was Very Mexican
oriented (0), Mexican orientation (1), Mexican oriented to
approximately balanced bicultural (2), Slightly Anglo
oriented bicultural (3), Strongly Anglo oriented (4), and
Assimilated/Anglicized (5). For example, respondents with
low scores (below the mean) on all of the five constructs
had a “5" for their cognitive acculturation score.
W

The level of behavioral acculturation score (CATACC)
(level 1-5) from the ARSMA-II and the level of cognitive
acculturation (LEVEL) (level 0-5) from the MACC—SF were
utilized in creating the level of integrated acculturation.

A crosstab of the Cognitive Acculturation Level (0—5)
(MACC-SF) by Level of Behavioral Acculturation (1-5)(ARSMA-
II) was constructed in order to create a Level of Integrated
Acculturation profile. Scores of zero to two on the Level of
Cognitive Acculturation axis and scores of 1-2 on the Level
of Behavioral Acculturation axis measured low levels of
Integrated Acculturation to the Anglo culture. Scores

ranging from three to five on either scale symbolized an

106

increasingly higher level of acculturation to the Anglo
culture. In this study, there were no respondents with
scores that identified them as Assimilated/Anglicized
(level 5) on the behavioral acculturation measure, but this
level was included in the crosstab. A four-level
classification system was devised for this study (see
Table 2, p. 64) based on the clusters created by the
crosstab of the behavioral and cognitive acculturation
levels developed by Cuéllar, Arnold, and Maldonado (1995)
and Cuéllar, Arnold, and Gonzalez (1995). The four levels of
integrated acculturation were labeled: (I) Low Integrated I
Acculturation (low levels of acculturation on beliefs and
behaviors); (II) Mixed Integrated Acculturation:
Acculturated Behaviors (high level of acculturation on
behaviors and low level of acculturated cognitions); (III)
Mixed Integrated Acculturation: Acculturated Cognitions
(high level of acculturation on cognitions and low level of
acculturation in behaviors); and (IV) High Integrated
Acculturation (high levels of acculturation in cognitions
and behaviors). Levels I and IV identified the Very Mexican
and Strongly Anglo or Assimilated/Anglicized groups,
respectively. Levels II and III identified the bicultural
groups.
W

The majority of the respondents (63%; groups I and IV)

evidenced congruency in their level of acculturation on

107

beliefs and behaviors (high-high or low—low). Over one third
(37%) of the respondents had incongruent levels of
behavioral and cognitive acculturation (groups II and III).
Group II had the larger percentage of respondents (27%) with
an incongruent level of integrated acculturation. These
respondents were more acculturated in Anglo behaviors and
held Mexican beliefs. A small percentage of respondents
(10%) were highly acculturated in cognitions but maintained
a Mexican orientation in their behaviors (group III). This
supports the literature which asserts that the rate of
behavioral and cognitive acculturation is varied (Cuéllar,
Arnold, & Gonzalez, 1995; Cuellar, Arnold, & Maldonado,
1995).

Results of Study by Research Questions and Hypotheses

The results of the study indicated that there were more

similarities than differences between the Anglo-oriented and
Mexican-oriented group (see Figure 2). This figure shows the
behavioral and cognitive variables that were considered in
developing the integrated acculturation categories. It also
demonstrates that the demographic variables, such as age,
gender, marital status, and generational status impact the
level of integrated acculturation. Only a few of the
differences between groups were statistically significant
(see 1, 2, and 7 in Figure 2). The majority of differences
were identified as patterns that existed between groups (3,

4, 5, and 6 in Figure 2). These results are discussed below.

108

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109

110135303133

Reseerch Question 6 1: Whom Do People of beican Origin
Seek Out When They need Help? An examination of the help-
seeking data indicate that the majority of people had three
to eight sources of help (70%). Spouses were the most
prevalent initial source of help (40%) for respondents,
followed by sisters (18%) and mothers (13%). Family members
would be the first source of support for 80% of the
respondents. A very small minority (4%) stated they turned
to "God" first. Seeking help from a counselor or therapist
was also an option for another 4% of the respondents. This
sample did not have a mutual agreement on what primary
characteristics were important in their helpers. The two
most common responses were that they were “family” (28%) and
they were “caring” (23%). The majority of the sample found
seeking help from family and friends to be very easy (28%
and 18%) or somewhat easy (28% and 28%). Surprisingly,
social/community services and professional sources were very
easy (18% and 32%) or somewhat easy (12% and 25%) to access
as well. The rate dropped to 17% when subjects were asked
about seeking help from neighbors.
WW

Reseerch Question # 2: What factors impact the level of
utilisetion of marriage snd.£smily therepy services by
people of beicen origin?

Hypothesis Has The first hypothesis predicted that

110

there would be a significant difference between level of
integrated acculturation and level of utilization of
counseling services in the Mexican origin community. The
hypothesis was not confirmed, even though acculturation was
measured in three modes, behavioral, cognitive, and
integrated. (Detailed results for behavioral and cognitive
acculturation measures can be found in Appendix M.)

Due to the confusion of many participants in
differentiating between MFT and counseling during the study,
it was decided to begin the analyses by examining counseling
use. The use of counseling services was a dichotomous
variable; respondents who did not use services were given a
zero, and users of counseling were given a score of one.
Counseling use was found to be independent of any of the
acculturation measures: (a) behavioral (df = 3, A2 = 6.77,

r = .338, p<.05), (b) cognitive (df = 5, A2 = 10.80,

r .056, p<.05), or (c) integrated (A2 = .33801, df = 3,

r = .338, p<.05). Crosstabs and the chi square (A2) were
used to examine the discrepancy of counseling use among the
Level of Integrated Acculturation groups (see Table 18).
Although there was an increased use of counseling services
in the groups that were Anglo-oriented (51%), when compared
to the Mexican-oriented group (29%), the differences were
not significant at the .05 level. For example, almost twice

as many people who were Anglo-oriented reported that they

had utilized counseling services at least two times when

111

Table 18

Use Qf gennseling Seryieee by Level Qf Integrated
. N=

 

Type of Acculturation Counseling (%)

 

Used No Use 19 DF p

 

III) Mixed Integrated 3.37 3 .338

Acculturation:

Acculturated
Cognitions

(Mexbeh/Anglobel) 1.7 8.3
I) Low Integrated

Acculturation

(Mex Congruency) 8.3 16.7
IV) High Integrated

Acculturation

(Anglo Congruency) 20.0 18.3
II) Mixed Integrated

Acculturation:

Acculturated
Behaviors

(Anglobeh/Mexbel) 13.3 13.3

Total 43.3 56.7

 

compared to the Mexican-oriented group. The lack of
significance for the hypotheses may be due to the small
sample size in this study, as well as to the even smaller
sample numbers when the group of 60 respondents was
classified into the four acculturation groups. It may also
demonstrate that there were more similarities than
differences among this community, regardless of level of
acculturation.

Hypothesis Hm. This hypothesis predicted that there

would be a significant difference between Level of

112

Acculturation and Level of Utilization rates of Marriage and
Family Therapy services. A crosstab and chi square analysis
was used for examining the differences in the level of use
of MFT among the three measurements of acculturation (see
Table 19 for results of Integrated Acculturation and Use of
MFT Services and Appendix M for behavioral and cognitive
acculturation and use of MFT services). Consistent with
hypothesis 11, no significant differences were found among
Levels of Integrated Acculturation for Use of MFT services.

However, a pattern was evident of increased usage by

Table 19

 

 

 

Type of Acculturation MFT (%)
Use No Use A2 DF p
I) Low Integrated 1.55 3 .670
Acculturation
(Mex Congruency) 5.0 20.0

II) Mixed Integrated

Acculturation:

Acculturated

Behaviors

(Anglobeh/Mexbel) 5.0 21.7
III) Mixed Integrated

Acculturation:

Acculturated

Cognitions

(Mexbeh/Anglobel) 0.0 10.0
IV) High Integrated

Acculturation

(Anglo Congruency) 8.3 30.0

Total 18.3 81.7

113

participants who were classified as being more Anglo-
oriented, regardless of the acculturation measure that was
used. Based on people's comments during the quantitative and
qualitative interviews, it appeared that people of Mexican
origin did not perceive MFT as an option or necessity. ("We
would never think about telling some stranger about our
problems." "I turn to God, people don't have answers for
me.")

Hypothesis HQ examined whether there were significant
differences among the types of expectations about MFT in the
level of utilization of MFT services. None of the two sample
independent t-tests on the 17 scales were significantly
different when compared across Use of MFT services (see
Table 20). While subjects in the Use MFT group had slightly
higher levels of expectations in 11 of the 17 subscales, the
differentiation was insignificant. However, a review of the
data indicates that a pattern of low expectations (Ms4.0)
was evident with the Used and No Use groups in self-
disclosure, empathy, and directiveness. The Use MFT group
also was low (M = 3.88, §D_= .96) in attractiveness. The
highest expectations (M26.00) were related to responsibility
and genuineness, regardless of the utilization group.
Trustworthiness and attractiveness was slightly higher for
the Used MFT group (M = 6.30, §Q_= .97) than the No Use

group (M = 5.79, £2 = 1.31).

114

Table 20

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Level of Utilization of MFT Services

 

 

 

Type of Don't Use MFT Use MFT

Expectation t ratio p
(df=58) M £2. M ED 1 1
Responsibility 6.00 .92 6.05 1.18 - .16 .88
Openness 5.07 1.68 5.73 1.35 -1.20 .23
Motivation 5.10 1.65 5.21 1.68 — .21 .83
Attractiveness 4.08 1.55 3.88 .96 .41 .68
Immediacy 5.34 1.38 5.82 1.11 -1.08 .29
Concreteness 5.01 1.58 5.09 1.08 - .17 .87
Acceptance 4.51 1.61 4.18 1.31 .64 .52
Confrontation 4.81 1.68 5.48 1.25 -1.26 .21
Genuineness 6.36 .92 6.55 .90 - .61 .55
Tolerance 4.72 1.57 4.64 1.35 .17 .87
Trustworthiness 5.79 1.31 6.30 .97 -1.23 .23
Directiveness 3.82 1.85 3.61 1.42 .35 .73
Empathy 3.57 1.66 3.52 1.47 .10 .82
Expertise 4.65 1.72 4.94 1.01 - .54 .59
Self-Disclosure 2.80 1.66 2.42 1.33 .69 .49
Nurture 4.99 1.51 5.30 1.35 - .63 .53
Outcome 5.61 1.28 5.97 1.09 - .87 .39
Factors***

Personal

Commitment 5.17 1.23 5.39 .96 - .56 .58
Facilitative

Conditions 5.20 1.12 5.37 .75 - .49 .63
Counselor

Expertise 4.01 1.55 4.02 1.11 - .02 .99

 

115

These results must be interpreted with caution due to
the confusion that was apparent in respondents’ difficulty
in differentiating between counseling, therapy, and MFT.
Comments heard frequently in the interviews illustrated that
respondents were unclear about what type of professional
background their “helper” had. (“I’m not sure, they just
helped me with my problems. I think it was a marriage
therapist, and I never asked them what kind of counseling
they did.”) This pattern of response impacted the
utilization percentages of services. Almost half (45%) of
respondents reported that they had used therapy services.

A slightly lower percentage (43%) reported using counseling
services. A dramatic decrease (18%) was evident in the
reported use of MFT services.

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Reseerch Question # 3: What do people ofilexioen origin
expect from helpers?

Hypothesis Hu examined the relationship between the
level of each of the acculturation variables and the 17
scales on type of expectations about MFT services (see
results of Level of Behavioral and Cognitive Acculturation
Variables in Appendix M). Scale scores were calculated for
each respondent by summing the responses to the items
assigned to each scale and dividing by the number of items.
A one-way analysis of variance (ANOVA) was calculated for

each of the 17 expectancy scales by each type of

116

acculturation-behavioral, cognitive, and integrated (see
Appendix M for results related to the first two variables).
.9- , 'on o , ‘1 f ‘ 0 _-V- O m; ‘or- +9
Agenltnretien. Expectancy by integrated acculturation ANOVAs
indicate a significant difference in one scale, tolerance
(F = 5.56, p = .002; see Table 21). The respondents who
scored low on both acculturation measures scored in the low
integrated acculturation group (Group I). They have a
Mexican orientation in cognitions and behaviors. This
Mexican-oriented group had significantly higher expectations
for the therapist to be tolerant (M = 5.69, SD = 1.42)
than the respondents who scored in the Mixed Integrated
Acculturation: Cognitive Acculturation (M = 3.56, SQ = 1.24)
group, who were Anglo—oriented in their cognitions but
Mexican-oriented in their behaviors. The Low Integrated
Acculturation group was also significantly different from
the High Integrated Acculturation group, who were high in
Anglo behaviors and beliefs (M = 4.15, 52 = 1.42).
Hypothesis HQ examined the relationship between the
level of knowledge of counselors, therapists, or marriage
and family therapists and expectations of counselors,
therapists, and MFT services. Knowledge of counseling,
therapy, and MFT were scored initially on a 5-point Likert
scale. First, the responses were grouped into three
categories: None to Very Little (0), Some (1), and Quite a

Bit or A lot (2). The majority of the sample had Some to

117

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118

A Lot of knowledge of counseling (61%), but the percentages
dropped when the respondents were asked about their
knowledge of therapy (45%) and MFT (38%)(see Table 22). The
next step was to create a Respondent's Sum of Knowledge by
creating and then summing a 3-digit number based on their
level of knowledge (0, l, 2). The one's place provided level
of knowledge of counseling, the ten's place provided level
of knowledge of therapy, and the hundred's place provided
level of knowledge of MFT. For example, the number 012
indicated a lot of knowledge of counseling (2), some
knowledge of therapy (1), and none to very little knowledge
of MFT (range = 0-6). Results indicate that over one third
of the sample (37%) did not have any knowledge of any of the
three types of mental health services, and only 15% believed
they had a high level of knowledge in all three areas. The
remaining 48% had a little to a lot of knowledge of at least
one type of mental health services.

T-tests were calculated with level of knowledge of
mental health services as the independent variable and the
17 expectancy scales as the dependent variable. Data
confirmed that there were significant differences between
the two knowledge groups in two of the seventeen scales. The
respondents with no knowledge of mental health services had
stronger expectations that therapists would be tolerant
(M = 5.46, SD = 1.11; F = 5.228, p = .026) when compared to

the group with knowledge of services (M = 6.25, SD = 1.06

119

Table 22

 

 

 

 

‘0 ‘0 ‘ 0 0. ‘Q!‘ 0 V‘ . 1" 0 e ‘

Knowledge of Knowledge of Knowledge of

Level Counseling Therapy MFT

of Use

None 23 38 33 55* ~37 62*

Some 14 23 12 20* *12 20*

A Lot 23 38 15* 25* *11 18*

Total 60 99 60 100 60 100

MeLee Use of services = attending a minimum of two sessions

(unduplicated count of services).

and M = 4.27, SD = 1.57, respectively). The genuineness
expectancy must be highlighted and questioned due to the
extremely close means and the large difference in standard
deviations.

up. 0 09-0.: 0 ‘2 1'1! 290- v 0! 1.9‘ . '09

Research Question #4: How does the openness to learning
about marriage and family therapy in people of liesican
origin impact their expectations?

Hypothesis H%_examined the relationship between
expectations about MFT services and openness to learning
about marriage and family therapy services. First, the
majority of participants were assessed by the researcher to
have a high level of openness to learning. This was

demonstrated by their willingness to take a consumer's

120

pamphlet about MFT and their initiative to continue a
discussion regarding this topic. Respondents were given a
score ranging from zero (no openness to learning) to three
(high openness to learning). The “openness to learning”
score was based on the researcher's evaluation of the
participant's comments, questions, demeanor, and body
language to the offer of the pamphlet. The higher scores (2)
indicated positive and accepting responses, questions, and
comments regarding the offer; lower scores (0) indicated a
negative response and/or an unwillingness to accept the
pamphlet; a neutral response (0) indicated a willingness to
accept the pamphlet, but the observer indicated through
their response and non-verbal behavior that they were
uninterested and accepting the pamphlet to be polite.

The majority of respondents (62%) demonstrated a high
level of openness to learning while slightly less than one
third (27%) were not open to learning about MFT. The
majority of the latter group made it clear in their
responses that they were unwilling to consider MFT and, in
most cases, any type of counseling or therapy as an option.
Most of these participants stated that they would go to
their family, the priest, or a friend if they needed help.
The balance (11%) of the participants who were neutral in
their level of openness to learning did accept the pamphlet,
but their comments and/or behavior indicated to the

researcher that they were accepting the pamphlet out of

121

politeness and did not intend to ask or read about MFT.
Given that the respondents were self-selected to participate
in this study about therapy, it was surprising to find that
38% of the sample was either not open or neutral in their
willingness to learn about MFT. Their openness and
willingness to participate in a one- to two-hour interview
that they knew was about mental health and therapy had
suggested to the researcher that the majority of subjects
would be open to accepting and learning about MFT.

Secondly, one-way expectancies by openness to learning
ANOVAs were computed to determine if there were significant
differences between the groups who were open to learning
about MFT and those who were not receptive to accepting
information about MFT. The null was accepted for the
majority of the expectancy scales due to the lack of
significant differences (see Table 23). The null was
rejected for four expectancy scales and one expectancy
factor due to significant differences found when ANOVAs and
Tukey HSDs were calculated. Respondents with high levels of
openness to learning about MFT had stronger expectations for
immediacy (expectation to talk about the relationship
between client and therapist)(M = 5.62, SD = 1.26; F = 4.66,

5.80,

p = .013) and for therapists to be open (M
SD = 1.05; F = 4.67, p = .013) than the group who was
slightly less open to learning (M = 3.86, SD = 1.91 and

M = 4.50, SD = 1.23, respectively). The group with a high

122

Table 23

Openness to Learning About Marriage and Family Therapy (MFT)
and Expectations of MFT

 

 

Group 0 Group 2 Group 3

Scale M/(SD) M/(SD) M/(SD) F p

Responsibility NS

Openness 4.77 3.86 5.62 4.66 .013
(1.94) (1.91) (1.26)

Motivation 4.23 4.86 5.55 4.09 .022
(1.78) (1.40) (1.49)

Attractiveness 3.25 3.62 4.47 4.79 .012
(1.40) (1.30) (1.37)

Immediacy 4.95 4.50 5.80 4.67 .013
(1.67) (1.23) (1.05)

Concreteness NS

Acceptance NS

Confrontation NS -

Genuineness NS

Tolerance NS

Trustworthiness NS

Directiveness NS

Empathy NS

Expertise NS

Self-Disclosure NS

Nurture NS

Outcome NS

Factors***

Personal Commitment 4.72 4.48 5.56 4.95 .010
(1.38) (1.17) (0.96)

Facilitative NS

Conditions
Counselor Expertise NS

 

 

 

 

 

 

 

 

Mete‘ 0 = None to low level of openness to learning about
MFT; 1 = Neutral in openness to learning about MFT; 2 = High
level of openness to learning about MFT.

123

level of openness to learning also scored significantly
higher than the group that was not open to learning on the
following scales: motivation (M = 5.55, SD = 1.49 and

M = 4.23, SD = 1.78, respectively; F = 4.09, p = .022);
attractiveness (M = 4.47, SD = 1.37 and M = 3.25, SD = 1.40,
respectively; F = 4.79, p = .012); and the Personal
Commitment factor (M = 5.56, SD = .96 and M = 4.72,

SD = 1.38, respectively; F = 4.95, p = .010).

124

CHAPTER 5
SUMMARY, CONCLUSIONS, LIMITATIONS, DIRECTIONS FOR FUTURE
RESEARCH, AND IMPLICATIONS FOR CLINICAL PRACTICE
Summary

The purpose of this study was to investigate how groups
within the Mexican-origin community compared to each other
on the following issues: (a) utilization rates of mental
health services/marriage and family therapy (MFT) services
when the group's level of acculturation and type of
expectations of MFT were examined; and (b) type of
expectations of MFT when level of acculturation, level of
knowledge of MFT, and degree of openness to MFT were
considered.

The results of the study supported the finding that
people of Mexican origin were more similar than different
regardless of their level of acculturation (see Figure 2).
No significant differences between the groups were found on
the following variables: (a) Level of Integrated
Acculturation and Level of Utilization of Counseling
Services, (b) Level of Integrated Acculturation and Level
of Utilization of MFT Services, and (c) Type of Expectations
about MFT and Level of Utilization of MFT.

Significant differences were found between the
following groups:

1. People with low levels of Integrated Acculturation

(Mexican orientation) had an expectation for their therapist

125

to be patient or tolerant. This was inconsistent with people
who were identified as having a bicultural orientation with
a high Cognitive Acculturation. The former group was also
significantly different from people from the highly
Integrated groups on tolerance.

2. The group with a high level of knowledge of mental
health services had a significantly higher expectation for
tolerance and genuineness.

3. People who were highly open to learning about MFT
had significant expectations for openness, motivation,
attractiveness, and personal commitment on the part of the
therapist.

Help-seeking behaviors and utilization of mental health
services were examined with a focus on the in-group
variation. Support was found for literature that shows
family as the chosen support system. Minimal variation was
found in the characteristics and sources of help people of
Mexican origin sought (caring and family). The majority of
people in this sample (62%) did not have any knowledge of
MFT services which influences the low utilization rates of
MFT (18%). Most people's expectations of marriage and family
therapists or therapy were not based on knowledge or
experience. The utilization rates across mental health
services indicated that less than half of the people of
Mexican origin perceived and utilized counseling and therapy

as sources of help, 43% and 45%, respectively. Acculturation

126

was not found to be significant to the utilization rates of
counseling or MFT within the Mexican origin community.
However, patterns were evident that people with high levels
of Integrated Acculturation had a higher use of MFT
services.

Participants were asked what they believed were the
challenges facing the Mexican origin community. They were
not limited in the number of responses they provided.
Although no one issue was consistent among the participants,
the ones most frequently identified by respondents as
problems within the Mexican origin community were related to
(a) forms of abuse (27%) (i.e., alcohol/drugs [20%],
physical [5%], and emotional [2%]), (b) issues related to
teens (10%), (c) marriage/divorce problems (9%), and
(d) family (8%). Although this was not an identified
hypothesis in this study, these contextual issues are
relevant in understanding the mental health needs of this
community. Each has the potential to strongly impact the
functioning of families and communities and is a factor in
identifying appropriate services. For the MFT profession, it
is critical that these issues be understood within the
context in which the Mexican origin population resides. As
the Mexican-origin population continues to grow at a rapid
rate, the importance of knowing, understanding, and
addressing the needs of this community becomes more relevant

to increasing access to and providing culturally relevant

127

services by this helping profession.

The findings also supported the assertion made by
Cuéllar, Arnold, Maldonado (1995) that behavioral
acculturation and cognitive acculturation occur at divergent
rates. The Anglo-oriented group, which included the slightly
Anglo to bicultural and the strongly Anglo subgroups (65%),
was largest when it was based on behavioral acculturation.
Only 48% of the study population were Anglo-oriented (0—2
high scores on cultural constructs) when cognitive
acculturation was measured. This appears to indicate that
behavioral acculturation occurs at a faster rate than
cognitive acculturation. When data was classified into
profile types which were created from behavioral and
cognitive acculturation scores, the total Anglo oriented
group remained the same. However, an examination of the
subgroups demonstrate that the profile type, Anglo
Congruent, which corresponds to the strongly Anglo group,
increased from 17% (behavioral acculturation) and 10%
(cognitive acculturation) to 38% of the respondents,
illustrating that there is an impact on acculturation level
of participants when profile types are used.

Even when the analyses did not indicate statistically
significant differences between the groups, the type of
expectations that were important to this sample was
highlighted. There appeared to be a pattern of low levels of

expectations for the therapist to self-disclose, be

128

directive, or empathetic for Used and No Use groups (see
Figure 2). This can be beneficial in understanding the types
of interactions and conditions that would facilitate the
group’s participation in therapy. Persons with low levels of
Integrated Acculturation (Mexican orientation) had an
expectancy for their therapist to be patient or tolerant.
This was inconsistent with people who were identified as
having a bi-cultural orientation with a high Anglo
orientation in their cognition. The former group was also
significantly different from people identified as having a
highly Anglo orientation in behavior and cognition on their.
expectation that the therapist be tolerant. A high
expectation for tolerance and cognition was also relevant
for the group with a high level of knowledge of mental
health services. In addition, these respondents wanted their
therapist to be genuine. Openness, motivation,
attractiveness, and personal commitment were important to
those who were highly open to learning about MFT. An area of
interest that was intriguing was the lack of consistent
expectations across variables.

A review of the data on utilization of services
indicate that a small percentage of respondents have used
MFT services (18%). This is consistent with the percentage
(18%) that reported having "a lot" of knowledge of MFT.
There was a higher use of counseling (37%) and therapy (42%)

services. The low percentage of people (18%) who indicated

129

knowledge and use of MFT services illustrates the need to
educate and/or market this component of the mental health
field to the Mexican-origin people. These percentages may be
misleading because some respondents were unclear about the
type of therapist or therapy services they had received,
leading to inflated or deflated numbers, with a higher
likelihood of the former. Level of acculturation was not
found to have statistical significance when related to
utilization rates of counseling or MFT. This finding was
consistent with the literature, despite analyses being
conducted using behavioral, cognitive, and integrated
measurements of acculturation.

Unlike with other studies, no support was found for the
notion that acculturation level differentiated people with
respect to expectations. The group with a Mexican
orientation did indicate a significantly higher level of
expectation for tolerance than the strongly Anglo or
cognitively acculturated group. Support was suggested for
the differential rate of behavioral and cognitive growth
that have been suggested by other studies (Cuéllar, Arnold,
and Gonzalez, 1995). The development and use of the Level of
Integrated Acculturation, which combined behavioral and
cognitive acculturation measures, highlight the orthogonal
and multidimensional aspects of the process of
acculturation. The study also suggests that this group of

people of Mexican origin were more similar than different,

130

regardless of their level of acculturation: "Mexican people
are no different than white people in my mind or black
people for that matter or Asian people - we all want for the
most part, I believe, we all want to be the best we can and
we want to feel proud that our life has meant something and
more importantly, those of us with children, want to see the
best for them" (42 year old female).

Although there was a lack of significant differences
between most variables, the patterns of responses did
provide practical information. The study found people of
Mexican origin to have a low level of knowledge of MFT, a
high openness to learning about MFT, and expectations for
the therapist to be tolerant, genuine, and open. They also
expected to talk to the counselor about their problems, to
be motivated to participate in therapy, and to enjoy being
with the therapist. This group also had a low utilization
rate of MFT services and a moderate utilization rate of
counseling and therapy. This information is important in the
process of clarifying the areas that need to be addressed to
increase their level of access and use of MFT services.
Knowledge of their expectations must be understood within
the context of their lives so assessment and treatment can
be consistent with their background, thereby increasing the
prospect of delivering effective, culturally sensitive, and
culturally competent services.

People who had a high level of knowledge of mental

131

health services (counseling, therapy, and MFT) had high
expectations for the therapist to be genuine and tolerant.
The group with a high level of openness to learning about
MFT indicated high expectations for openness, motivation,
attractiveness, immediacy, and personal commitment (see
Figure 2). No pattern was evident when the relationship
between Integrated Acculturation and MFT Use was examined.
At any rate, there was a higher rate of use of mental health
services than expected.

In summary, there were more similarities than
differences among and between the acculturation, knowledge,”
and utilization groups. This study did provide guidance on
expectations held for therapy and the therapist. This
information can be added to the base of knowledge that is
being collected from this ethnic community.

Conclusions

Overall, this study illustrated the importance of
examining within-group variables; it highlighted a few
differences and revealed that there are more commonalities
within the Mexican-origin community. There were two
significant components of this study that were unrelated to
the data that was collected. They were the opportunity the
study provided to develop and implement a culturally
sensitive research design and methodology and the
opportunity for interaction to occur between a

representative of the MFT profession and individuals in the

132

Mexican-origin community. The face-to-face interviews and
the instruments (quantitative and qualitative) provided a
context in which the respondents and researcher could engage
in data collection and dialogue that was conducive to making
a connection, mutual education of researcher and
participants, and identification of needs and goals of each
communicant.

These were small steps to building a relationship and
improving communication between the two groups, and they
illustrated the need for discourse on the transactive nature
of the therapist-client relationship when examining access
and utilization of MFT services. A greater awareness and
depth of understanding occurred throughout the process of
this study for many of the respondents and for the
researcher. Participant's reported their appreciation of
having an opportunity for their voice to be heard as they
had the experience of being valued: "It is so good to be
able to talk about these things - they're important - our
culture and the problems we have and what can help us all be
better in our families - I think about these things - being
Mexicana - and I'm so glad I didn't cancel with you - I
almost did because it wasn't a good day today and I just
didn't want to think about talking to someone - thank you
for coming and letting me talk - this was fun and it was
special to my heart." This respondent also asked for a

referral to a marriage and family therapist to "finally deal

133

with" parent—child conflicts. This is an example of how
dialogue can serve to give people choices so they can access
services that have the potential to enhance or at least
stabilize their lives.

Finally, the letterhead of the national organization,
American Association for Marriage and Family Therapy, states
“AAMFT seeks wisdom and strength of diversity” (Killian &
Hardy, 1998, p. 207). This research is another component in
demonstrating and promoting this position.

The findings of this study suggest a critical need for
marriage and family therapists to: (a) find a way to more
clearly differentiate themselves from other mental health
professions, (b) promote a change in licensing laws that
support the clear identification of marriage and family
therapists, (c) increase understanding of the meaning that
this community places on the expectations that were defined
as significant, and (d) find ways to educate the people of
Mexican origin about the services provided by MFT.

In order to collect accurate data on the utilization
rates and effectiveness of MFT, it is crucial to clarify the
definition of a marriage and family therapy/therapist and
find a reliable and consistent manner with which to identify
MFT. Given that many of the respondents appeared unclear
about the type of therapist they had received services from,
it is unlikely that the data reported in this study on

utilization is accurate. Most of the individuals who

134

reported utilization indicated that they were unclear about
whether their therapist or counselor was or had been a
marriage and family therapist. There was a tendency for
respondents to use the vernacular (i.e., therapist,
counselor) in their responses and in discussion with the
interviewer.

The use of different terms within the same conversation
was another indicator of the confusion. Identification of
the marriage and family therapist was sometimes based on the
type of issues that were discussed in the session rather
than on the education, experience, or licensing of the
therapist. For example, a 48 year old female respondent
reported, "we went to the therapy because my son was having
trouble at school - the therapist talked to both of us - me
and my husband - so yeah, I think she was a marriage and
family therapist." A 43 year old man reported, "it was one
of those family therapists - yeah, a marriage and family
therapist - we were having family troubles - we talked a lot
about our marriage and family." These comments reflect the
remarks of many of the respondents who reported that they
had seen a marriage and family therapist. None of the people
had information about the therapist's education or
credentials. This illustrates the ambiguity in the
participants' understanding regarding the similarities and
differences between the various mental health providers.

Another issue related to the confusion of

135

professional identity was the belief that counselor,
therapist, and marriage and family therapist were
synonymous. The question was asked, "what do the words
‘counselor,’ ‘therapist,’ and ‘marriage and family
therapist' each mean to you?" The response of a 31-year old
male was "I believe they're mostly the same thing. I see it
more as a professional who can work either way - counselor,
counselor is a more positive word than therapist." This
study did not have any way to identify or verify the
counselor/therapist's educational background, type of
profession, or type of license, which are each relevant to
the goal of obtaining precise utilization rates among the
Mexican-origin community.

A related issue is the multiple licenses or
professional identities held by professionals in the mental
health field. There can be incongruence between the
education, training, licensing, and practice of a mental
health practitioner. The laws and regulations are stated in
a manner that allow for therapists to identify themselves as
"doing" MFT although they do not have the education and
training required of a licensed marriage and family
therapist. Even some therapists who are licensed as MFTs are
not educated or trained in a systemic approach to therapy,
due to being "grandfathered" in when new laws were passed
that provided licensing to and required licensing of MFTs.

The professional identity of a therapist is likely to

136

strongly influence the practice of therapy. The laws and
licensing process make it challenging to identify MFTs that
practice using a systemic approach, which is assumed in this
study to be consistent with the values and beliefs of the
people in this community. These issues are bound to
contribute to the ambiguity and confusion surrounding this
community's ability to know the type of services they have
received. The impact on this study was that some to most of
the respondents replied to questions regarding therapeutic
services based on their perception rather than on actual
data or knowledge of the therapist's education, training, or
licensing.

No pattern was evident when the relationship between
Integrated Acculturation and MFT Use was examined, except
that it does indicate that people of Mexican origin are
utilizing mental health services. However, 10% of the sample
that was classified as having Mexican behaviors and Anglo
beliefs did not report any use of MFT services, which was
inconsistent with findings for the other three acculturation
groups.

Overall, there were more similarities than differences
among and between the acculturation, knowledge, and
utilization groups. This study did provide guidance on
expectations held for therapy and the therapist and can
alert the field to increase their efforts to engage and

interact with this group. This information can be added to

137

the base of knowledge that is being collected on this ethnic
community. It can increase the awareness of clinicians and
therapists so that they can continue building their skills
as culturally sensitive therapists.

This study partially responds to the controversy
regarding emic or etic therapy models. The heterogeneity in
this group illustrates the importance of using both
approaches, even when working with people of the same
culture. The study incorporated both approaches to meet the
needs of respondents. Providing the interview and the
instrument in their preferred language illustrated the use.
of an emic approach. The etic approach was exemplified by
using variables that tend to be common across groups in
therapy (i.e., tolerance, trustworthiness). This work
described and defined a potential client population, which
is consistent with suggestions offered within the profession
(Piercy & Sprenkle, 1990).

This investigation has also taken a step in developing
a relationship with the people of Mexican origin. It has
served to inform the community of another resource that they
may find consistent with their values and beliefs about the
family. This information is important as the Mexican-origin
group struggles with the challenges that are universal as
well as unique to our culture. Discourse must continue if
there is to be progress in exploring whether there is a

“good fit” between the needs of this community and the

138

services and skills of professionals in the field of MFT.

An important conclusion of this study comes from the
feedback from respondents that reported a desire and/or need
for their culture or ethnicity to be recognized and
supported (Social Cultural Environment). They reported that
consideration of the cultural aspects of their lives (i.e.,
country of origin, language, prejudice) and their individual
development (ethnic self—identity) (see Figure 1) conveyed
to them an understanding and a sense of respect, as
illustrated by two of many comments related to this topic:
“I don’t really get to talk about how being Mexican affects‘
me—and even how I make decisions. This is good - I mean for
me to be talking about this.” “Even my kids don’t understand
about being Mexican anymore - it’s like we don’t like to
make a big deal of it, we want to fit in - but I know it is,
it is a big deal - it’s great that someone like you - in
your work - understands this.” It was evident that some of
the people experienced a cut-off from a part of themselves
(cultural self) that was nurtured by the opportunity to talk
about their cultural history, beliefs, and cognition. These
exemplify the importance of the ecological model of
constructs (see Figure 1) that were utilized in this study.
The MFT field’s response to this need in a culturally
sensitive and competent manner will serve many people in the

Mexican-origin community, as well as the profession.

139

Limitations

Limitations exist in all studies due to the humanness
of the researcher, subjects, context, and the complexity of
conducting a research study that addresses multiple issues.
Utilization of non-probability sampling limits the
generalizability of the results. Due to the self—selection
of respondents, some groups were over—represented in the
sample, i.e., females, individuals who had moderate to high
levels of acculturation, and people who were young to
middle-aged (Franco, Malloy, & Gonzalez, 1984; LeVine &
Franco, 1981). Individuals who were less acculturated and
those who were older were less willing to participate in an
interview and disclose information regarding services that
they may not see as viable alternatives. Other limitations
included the reliability of the data due to weaknesses in
self-reports, such as inaccurate reporting, various levels
of self-disclosure, and extreme acquiescence, or socially
desirable response sets.

Another limitation found during the study was the lack
of clarity and discreteness in the terms “counseling,”
“therapy,” and “marriage and family therapy.” This resulted
in collecting data on perceptions of utilization of MFT
services rather than on the actual utilization of MFT
services.

Finally, the small sample size decreased the power and

confidence of the statistical analyses. This may be related

140

to the inflated numbers of the utilization rate of MFT
services due to the confusion surrounding participants
identifying the type of mental health services they
received. It was expected that the utilization rate would be
below 5%, which would have increased the power of the
statistics. Walonick (1988), creator/author of the Stat Pac
Gold (Version 3.0,) and manual, states, "...[I]f too small a
sample is chosen, you will not have sufficient confidence
that the sample represents that population and if too large
of sample is chosen, you will have wasted a considerable
amount of effort and money surveying an excessive number of,
people. Obviously, the ideal solution is to choose the
smallest sample possible that still gives confidence that
the sample represents the population" (p. 488). The Stat Pac
Gold was used to assess the adequacy of the sample size
(N=60). This was determined by entering four numbers:

(a) the best estimate of the population size (N=10,500),

(b) the best estimate of the population rate or percentage
of survey characteristics being measured (4%, 5%, 10%, and
15%), (c) the maximum difference between the true population
rate and the rate that could be accepted or tolerated (5%),
and (d) the level of certainty that the difference between
the population rate and the study's sample rate was less
than the difference in number three (95% or alpha = .05).
The size of the sample necessary for the study decreased as

the best estimate of the population rate and percentage of

141

survey characteristics being measured decreased. If 15% of
the sample was expected to utilize MFT services, the sample
would need to be 192 participants. An expectation of 10% of
the sample the sample size decreased to 136 people. A 5%
expectation would necessitate a sample size of 72, and an
expectation that 4% of the sample would utilize MFT
indicated a need for the sample size to be 58 participants.
Given that this was an exploratory study and that it was
expected that a small percentage of the participants (less
than 5%) would have knowledge of or utilize MFT services,
the decision was made to use a sample of 60 respondents.
Since the utilization rate was 18%, the power of the
statistics were decreased.

Directions for Future Research and Clinical Practice

While this study created acculturation profile types
from combining the AOS and MOS of the ARSMA-II with the
cultural constructs of the MACC-SF (Cuéllar, Arnold, &
Golzalez, 1995; Cuéllar, Arnold, & Maldonado, 1995),
additional research needs to be conducted that will validate
the use of the integrated acculturation profile types. The
crosstab that was used to created the Integrated
Acculturation variable had small sample sizes in each of the
four cells (range = 6 to 23). Future studies with larger
samples are needed to replicate the process of creating the
Integrated Acculturation measure.

The need for research designs and studies which take

142

into account multiple variables become more apparent as
there is an increased understanding of the contextual
influence and the complexity of factors that influence
people's decisions to seek therapeutic services. Some
respondents indicated that they were "told" who to go to by
the school, the court, or the church. Some were receiving
services due to a court-mandated order. It is possible that
the referrals from courts, schools, and other community
agencies are to non-MFT providers, which would influence the
use rates in non-MFT therapeutic services. It is critical
that MFTs position and/or align themselves with
organizations that work with the Mexican—origin community.
Educating the social and legal arena about MFT and conveying
the appropriateness of the services to the Mexican-origin
community will be an important step in making a connection
to this community.

One potential goal would be to increase the utilization
of MFT services by the Mexican-origin community and to
increase utilization of the Mexican-origin community by the
MFTs. MFT will need to become more proactive in engaging and
interacting with this community by becoming more sensitive
and competent ("I think they (MFT) need to be more aware of
the culture, the traditions, why religion would be so
important, and those things that are related to religion. I
know that some women are still practicing Novenarios," i.e.,

a ritual in which people participate in saying the rosary

143

for nine days, often after a funeral or before a religious
day). Knowledge and experience of the processes of "being"
of Mexican origin can be instrumental in the development of
a culturally competent therapist and therapeutic process.
In addition, the therapists’ level of acculturation and
expectancies of their racially/ethnically diverse clients
can also be an avenue to enhance cultural sensitivity and
competence. A systemic approach that considers the
transaction between these subsystems (therapist/client)
allows for the study of the dynamic and complex influence of
co—acculturation and co-adaptation that occurs when two
cultures are working together.

Of particular importance is the study of how to inform
and educate diverse populations of the practice of MFT,
especially if there appears to be a good fit between the
values of MFT and the targeted group. Focusing on the
knowledge base and openness of diverse populations to
learning about MFT will provide critical information about
how to effectively educate and market the services to
various groups. In the area of marketing, it is critical
that literature be developed that will be written in the
language of the group and in a manner that is consistent
with the needs of their culture (e.g., ethnic- or culture-
related development issues, parent-child conflict related to
differences in acculturation level and language ability).

Focus groups that review informational and marketing

144

pamphlets is an obvious focus of future research.

Practice and research need to be developed so that MFTs
and people in the Mexican-origin community are mutually
involved in developing relationships and goals. A mutual
devotion of time and energy to creating a context that
allows for learning and positive adaptation to occur between
the groups would serve to increase their access to one
other. MFT’s goal of serving diverse populations and
increased access to support systems for the Mexican-origin
community could result from this work.

Research and practice strategies that find ways for the
people and the MFT professionals to become involved with
each other would encourage the profession-community and/or
therapist/client system to educate one other in methods that
are consistent with the needs and beliefs of the community.
It would also provide opportunities for trust to be
developed and maintained. For example, training key
community people who are of Mexican origin in the
philosophy, theoretical tenets, and skills of MFT would
allow them to serve as links to the people in the community.
The mutual learning, teaching, and experiencing that could
occur in this context would facilitate the process of
building trust and relationships, increasing knowledge, and
enhancing cultural competency for all involved. Trust is an
important component of any therapeutic process. A lack of

trust for therapists was indicated by multiple comments made

145

by this group of respondents:

"I only went because my compadre recommended it to
me" and "they need to drop the paternalistic attitude"
(24 year old female).

"This is a total stranger (therapist) - I, myself,
personally, wouldn't feel comfortable saying certain
things to just anybody;" "oh, it makes me feel like
it's just a money issue for them (therapist) - a fast
way to make a buck. It's not they're so much concerned
about your well being at times" (29 year old female).

"You're just going to be cheated (in therapy)" and
"...especially those that are a little older, I don't
think they're very trusting of agencies" (75 year old
female);

"Mexicans are very stubborn, especially if the
therapist is Anglo-'cause usually for some reason, I
don't know, they just feel-because it's always been the
white culture being more superior and they feel
degraded-Mexicans. It's like, you can't tell me what to
do" (29 year old female).

There are two primary clinical implications from the
present study. First, cultural beliefs, values, experiences,
and behaviors impact the construction of the meaning related
to the expectations of tolerance, genuineness, openness,
personal commitment, immediacy, motivation, and attraction
that were found to be significant in subgroups of the
sample. Therapists who are knowledgeable and attend to the
meaning of the expectations will increase their ability to
join, build trust, and work with the clients. A 48 year old
female made two comments that may suggest her need for
tolerance from a therapist. “I think that having had to live
and survive as a minority you gain strengths, you can get
beat up and still function” and “there’s some reason we
don't melt (melting pot), we're not melting in - we're not

doing a very good job of mixing in.” The respondent went on

146

to talk about her experiences of isolation and intolerance

due to her being “Mexican” and not being able to melt in.

Cultural sensitivity and effectiveness may be enhanced

by being able to understand and analyze the cultural

contexts of each member of the therapeutic system (Breunlin,

Schwartz,

definition

& Mac Kune-Karrer, 1992). The respondent's

of and need for tolerance must be examined within

the cultural map. The experience of minority people has been

one of oppression by people who were not tolerant of the

differences. The high expectation for tolerance may be

related to
do not fit
meaning to

need to be

this history of oppression and feeling as if they
in. A member of a minority group may attach a
tolerance or genuineness that is related to their

accepted as a person of Mexican origin or to have

their Mexican culture acknowledged and accepted. However, it

is not enough to stop with awareness and sensitivity. This

must be followed with cultural competency, which is

indicated by the ability to build or act on the differences

created by being from a diverse culture. This approach to

working with diverse populations may decrease the drop-out

rates that

tend to occur after one or two sessions.

Second, the importance of "family" and the need for

helpers to be "caring" was conveyed by the majority of

respondents

("any time I have a problem, my mother is the

first one that is there by my side every time," 30 year old

female). There is a need for therapists to be sensitive and

147

competent in conveying this sensitivity and knowledge or
curiosity to their clients. A 43—year old male made a
statement that was indicative of comments made by multiple
participants in the sample. He expressed that therapists

“need to learn more about Mexican culture and the

people and their beliefs and their superstitions, their

history and their culture, because it’s different. The
community is not about to just give all of that up,
just to become Americans. They wanna hold on to their
culture, their language, and if you don’t respect all
of that, you’re not gonna be able to understand and
succeed with whatever services you wanna provide until
you understand where we’re coming from and what makes
us Mexican. Mexicans are good Americans, you know, the
ones that are here. And they’re - we’re here to stay.

They’re (Mexicans) proud to be Americans and they’ll

fight and die for this country ‘cause it's a great

country, but our history is too long and it’s too good-

our culture is, it’s a really good culture. There's a

lot of good things about it for us.”

The recruitment phase, the quantitative and qualitative
data collected during the interview, and the feedback about
the study and the interview were consistent in conveying the
importance of "family," "caring," and story-telling to the
respondents. The following comments illustrate the comments
made by the majority of people in the study: "I think they
need to know basically that the family is, that family unity
is a very important factor....if a son or daughter is - has
a problem, everyone is feeling that setback, and has a
responsibility for that person" (42 year old female). "I
guess there's a lot of family oriented things, I mean

Mexican people to me, all the ones I have come in contact

with, me too, family is everything" (30 year old female).

148

The participants suggested that they would be more likely to
seek out services that communicate that they are cared
about. ("I don't think they (therapists) really care about
me or my family - they just are doing their job - I don't
need that," 34 year old female.) Therefore, there must be a
continued effort to design outreach efforts and therapy
models that are inclusive of the people's desire to have
family involved and for caring to be a necessary element in
the therapeutic process in order to provide the opportunity
for people of Mexican origin to take part in the MFT
process. Throughout the qualitative and quantitative
interviews, the consistent ingredient was the story-telling.
Regardless of the structure that had been set up for the
interview, respondents evidenced a desire and need to share
the information through story-telling. It was challenging
for the respondents to respond to closed—ended, true-false,
and Likert scale questions during the quantitative
interviews. Frequently, a respondent would answer the
question with a story; and when the question was repeated
again after the story had been told, they would make
comments such as "you decide where it fits best-I told you
my answer" (67 year old female) or "my answer doesn't fit in
a box - everything I told you is important" (27 year old
male). Involving people of Mexican origin in the development
of a methodology that would quantify the story-telling that

is consistent with their beliefs would be a direction for

149

future research.

The interviews indicated that there are people of
Mexican origin who believe that there have been changes in
the Mexican-origin community and that the people are
changing their perceptions of professional help ("I think
now though, that things might be a little different in that
people are realizing that sometimes their family doesn't
always have the answers and that it's not wrong to go
outside of your little circle asking for help," 42 year old
female; "there would be some that would say ‘well, I'm glad,
I'm glad they're getting help because they need it,’" (25
year old female; "I think the problems that would probably
be easiest, would be like with the children - it would
probably be easier for parents to take their children to go
to counseling, you know, because that's on the outside [of
the parental relationship]," 31 year old male).

Finally, future research must confront the issue of
differentiating between professions so that the data that is
collected is indicative of what is occurring in the MFT
field. This will require that laws and policies be changed
so that professionals from the various mental fields (i.e.,
MFT, clinical social work, psychology, and psychiatry) can
be differentiated clearly. Changes need to occur so that
professionals from the various mental health disciplines can
not assert that they "do" MFT when they do not have the

education or the credentials that are consisent with that of

150

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an AAMFT-licensed marriage and family therapist. This will
contribute to the abatement of the confusion that tends to
occur for clients and potential clients. Simultaneously, the
MFT profession must take more action in finding effective
ways to educate and market to the Mexican—origin community.
This will give the people an opportunity to understand how
the profession can assist in creating the desired changes in
their lives.

The importance of context is exemplified by the
qualitative data that provides insight into why the
respondents were utilizing the various mental health
disciplines. Some of the clients revealed that they went to
therapy because they were "made to go to the counselor" (27
year old male). This information tended to come out in the
quantitative interviews after the respondent indicated that
they had seen a counselor, therapist, and/or marriage and
family therapist. The clients were mandated or referred by
courts, schools, churches, and community agencies.
Historically, these systems have referred to non-MFT
providers. In order for MFTs to get referrals, they will
need to engage and educate these systems that come into
contact and/or work directly with people in the Mexican-
origin community. This will be more successful if MFTs
educate the referral sources of the type of services that
would be consistent with the needs of the Mexican-origin

people as well as the systems.

151

Personal Reflection

This experience has been completely gratifying and has
challenged me to grow as a professional who strives to work
with populations at risk to develop strategies that they
believe would improve their quality of life. The process of
developing and completing this study accentuated the
separation I had made in my cultural self. As a
professional, my Anglo orientation was the major aspect in
my interactions. In my personal or family role, my Mexican
orientation was dominant. In my interactions with people of
Mexican origin, I was challenged to find a way to integrate
the cognitive and behavioral aspects of myself to allow my

bicultural self to interact with the people in the study.

152

APPENDICES

153

Appendix A

Complete Instrument for Research Study

154

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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155

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.HOH

.00H

.00

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30330m 033 3300 3008 033 30m 333 .03H33
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303030030330 0 >3 0030033 3003 0>03 H

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CH «030H003» 0030030330 .0030030330 m0
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H .00H300H0 003 H 0H00 303000 >8 3H

.POH

.mOH

.moH

.VOH

.MOH

.NOH

.HOH

.00H

.00

.mm

.00

.mm

hmuUUdZ

165

NH .00
=03030= 00 000330 H33 C0>0n 008 00

00HQ 00

00308 30 0300 033333 H0 030300 033330
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00338 H00 000H0030 008 0300300

0H 300 0300 03008 0H 03HC C3 0300
30n38 033

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0 30300003 03 0030n38 00H 00 0H30>08 0H

30H00030>300 033 3030080 030H30 003030
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300 0H 03 030 00H 030 00H> 0H 0 008
30000 0H 000030H80 300 030 00300300 003

000H80 00H

030 003C033008H 008 300 00330H300 003
03330030

3H0 00H30000030 30300 000000>H300 30300
003000 030 030 0030 03H3 33 003030 33¢

00nH3 00330033 00 0H03000
0H 300 0000030H0 00000H>H300 00H
30 0H0303003H 300 00H0H3300 0HHH80w HZ

30n38
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0H303 0H 303030030330 33 300 30voflH3
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.0HH

.mHH

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:03030:
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000 m0 0303

033 3H 0H 033333 033 0030003 033333 033
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0003 0H080m 0 3033 0003
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308
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30H30030>300 0 03 33030 0H03 03 0H0000
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0H0o00 0H00 3033 03HH

CH 3033333 3038 300 0H0000 >H030H30

0030H33

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3030HH30
330 303 00H3H>H300 003003000 H00300
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30803 0 3033 308
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.0HH
.mHH
.0HH
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.mHH

.VHH

.MHH
.NHH

.HHH

.OHH
.mOH

.mOH

mmloodz

166

m3 .00
00303000 003H303 0 H030300
300 000030 0H 030HH08 0H 00 00H00 0A
0HHH803 0H 0300
30n08 00H 00 030 0300 03080H0 03000 Hm

30003 H00 0030n 0800 000H308 030 00
30H0H000 0H 30300003 30300 0030m38 00A

0H033300 08 30H30H0 030 0330H0 0000> 4

H03333 00 0030H00 0 003H000H00
0800 00H03 003H3 00 0030303n 300 3003n
3H3H8300 0300 00H 00 03 003H3 00H 4

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0 3H 30n08 00 000000830330 00330H0 0300

033033 300 033803 33 0300 033033008H 03

30H3 3030H00 08 030 00 033030

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30H3300 00030 030 0H 30 03300 03038 >00

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00303300 00 30300
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33 300 3HH00 0300 03 03003038 03:

.HMH

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33033H 0330> >30> 0 03 >H3008 0300003
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08
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303000 0 3033 303303
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0H0000 33H: 03H03 >0n30 H

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.OMH

.mNH

.mNH

.hNH

.oNH

.mNH

.vNH

.MNH

.NNH

.HNH

.ONH

mmloudz

167

03 .00
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00 00003H3003 030 > H0H0300H3300 03308030H3300
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00 30H0033H3300 0 0003300030 0H0000 03 .0HHH800 >
0H308H330z 00 0H0030B 0H 0 30H00H03 30 00>H303000x0
030 300 00H030 0300H03H 00303 0000 0000 33
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168

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169

03 .00

.000H33000303
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170

03 .00 .
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171

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181

Appendix B
Acculturation Rating Scale for Mexican Americans—II (ARSMA-
II): Original Instrument
and Descriptive Information

Questions 29 - 76 on Research Instrument, Appendix A

182

Overview

The Acculturation Rating Scale for Mexican Americans-II
(ARSMA-II) (Cuéllar, Arnold, & Maldonado, 1995) focuses on
categorizing people by generation and measuring behavioral
constructs of acculturation, although it has incorporated a
few affective measures as well. It has been found to have
good internal consistency, strong construct validity, and
strong concurrent validity (Cuéllar, Arnold, & Maldonado).
Generational Status is defined as the number of generations
that someone has lived in the United States, and it is
operationalized by asking the respondent to provide the
place of birth of themselves, their parents, and their
grandparents. It delineates five generational levels, which
are on the demographic section of the instrument. Although
the ARSMA-II is fairly new, it is based on the ARSMA
(Cuéllar et al., 1980), which was shown to be the most
common acculturation measure when thirty publications on
acculturation and mental health were reviewed (Rogler,
Cortes, & Malgady, 1991).

The ARSMA-II comprises two independent scales. The
first scale, Acculturation Levels, is composed of the Anglo
Orientation Subscale and the Mexican Orientation Subscale,
which identify five acculturation levels: Very Mexican (1),
Mexican oriented to approximately balanced bicultural (2),
Slightly Anglo oriented bicultural (3), Strongly Anglo

oriented (4), and Assimilated/Anglicized (5). ARSMA-II

183

scores highly correlate (Pearson's product-moment
correlation coefficient) with the original ARSMA scale (r =
.89, n = 171). The scales measure three of the four
original factors for the Mexican and Anglo culture:

(a) language factor (i.e., “I enjoy speaking Spanish.”);

(b) ethnic identity factor (i.e., “My father identifies [or
identified] himself as 'Mexicano.'”); and (c) ethnic
interaction or ethnic distance (i.e., “I enjoy reading books
in English.”) (Cuéllar, Arnold, & Maldonado, 1995). Scale 1
is a 30-item self-report instrument that uses a 5-point
Likert scale to measure Anglo orientation (AOS, 13 items)
and Mexican Orientation (MOS, 17 items). The internal
consistency scores (coefficient alpha) are .83 and .88,
respectively. Scale 2 (Marginality Scale) is an 18-item
scale that is experimental and needs to be validated. Scale
2 attempts to measure the difficulty experienced in
accepting Anglo, Mexican, and Mexican-American culture.
Scores are obtained by summing the items for each scale and
dividing the sums by total number of items to figure the
mean score for each subscale. Scale 1 measures integration
and assimilation, and Scale 2 measures separation and
marginalization. In order to figure a linear acculturation
score of "1" to "5," from Very Mexican Oriented to Very
Anglo Oriented, the MOS mean must be subtracted from the AOS
mean. Acculturation level can be obtained by using the

cutoff scores and the multidimensional, orthogonal,

184

bicultural classification frame to categorize acculturation
level. Scores greater than -.05 standard deviations (SD)
below the mean on both the AOS and the MOS scales are
categorized as high integrated biculturals, and those scores
between -1.5 standard deviation below the mean and -.5
standard deviation below the mean on either scale are
defined as low integrated biculturals. These quadrants are
consistent with four of Berry's (1980) modes of
acculturation, which include assimilation, integration,
separation, and marginalization. Finally, Scale 2 measures
the marginality among cultures. Although Scale 2 is
currently defined as being experimental, researchers report
that it is appropriate to use it in conjunction with
Scale 1. The authors of the instrument call for more
studies that can serve to validate it for further use.
Cut Off Scores
The acculturation levels and cutoff scores for

determining Acculturation Level are as follows:

Level I Very Mexican Orientation < 1.33

Level II Mexican Orientation to 2 -l.33 and s -.07
Approximately Balanced
Bicultural

Level III Slightly Anglo Oriented > —.07 and < 1.19
Bicultural

Level IV Strongly Anglo Oriented 2 1.19 and < 2.45

Level V Very Assimilated > 2.45

or Anglicized individuals

The raw score means were used to calculate the Acculturation

185

Score. The choices selected for each item were added, and
the sum was divided by the number of items on the MOS and
AOS scales separately to obtain the raw score mean for each
scale. The formula used to calculate the Acculturation
Score is AS = AOS (Mean) — MOS (Mean). (Cuéllar, Arnold, &

Maldanado, 1995).

186

Table Bl

BMW

 

 

 

Raw MEAN NORM
Scale Scores Scores MEANS
Mexican Oriented Scale (MOS) 71 4.18 3.28
Anglo Oriented Scale (AOS) 54 4.15 3.82
Marginality Score (MARG) 44 2.44 41.30
Difficulty Anglo Culture 6 1.00 14.70
(ANGMAR)
Difficulty Mexican Culture 23 3.83 13.98
(MEXMAR)
Difficulty M-A Culture 15 2.50 12.61
(MAMAR)
Note; Acculturation Score = -0.023; Acculturation Level = 3.

From “Acculturation Rating Scale for Mexican Americans-II: A
Revision of the Original ARSMA Scale,” by I. Cuéllar, B.
Arnold, and R. Maldonado, 1995, Hispanic_fiournal_gf
WWW. pp. 275-304. Copyright 1995 by
Cuéllar, Arnold, and Maldonado. Reprinted with permission of
the authors.

187

Table B2

E J' 1.]. E E EEEIE-IE i J I 1 J

 

AOS MOS MARG ANGMAR MEXMAR MAMAR

N=364 N=362 N=367 N=374 N=374 N=375

 

Split-half .77 .84 .82 .87 .60 .90

Spearman- .87 .91 .90 .93 .75 .94
Brown

Guttman .87 .91 .90 .92 .73 .94
(Rulon)

Coefficient .83 .88 .87 .90 .68 .91
alpha (all
items)

Test-retest .94 .96 .78 .72 .80 .81
(1 week

interval,
n=31)

 

Note. AOS = Anglo Orientation Scale; MOS = Mexican
Orientation Scale; MARG = Marginality Scale; ANGMAR = Anglo
Marginality Subscale; MEXMAR = Mexican Marginality Subscale;
MAMAR = Mexican American Marginality Subscale. From
“Acculturation Rating Scale for Mexican Americans—II: A
Revision of the Original ARSMA Scale,” by I. Cuéllar, B.
Arnold, and R. Maldonado, 1995, fiispani§_figurnal_gfi
W0). pp 275- 304- C0pyright 1995 by
Cuéllar, Arnold, and Maldonado. Reprinted with permission of
the authors.

188

Table B3

WWW;

 

Number in Norm

 

 

Typology Sample (N=379) Criteria
Traditional Mexican 40 (10.5%) MOS23.7 and AOSSB.24
Integrated 165 (43.5%) Meets criteria for
Type 2a or Type 2b
Integrated (low) AOS > 2.95 and
bicultural 7 (.02%) MOS > 3.53 and <2.86
Integrated (high) AOS 2 3.53 and
bicultural 158 (42.0%) MOS 2 2.86
Marginal 39 (10.3%) ANGMAR 2 17.34 and
MEXMAR 2 16.82 and
MAMAR 2 14.98
Integrated (low) Meets criteria for
marginal bicult. 1 (.004%) Type 2a and Type 3
Integrated (high)* Meets criteria for
marginal bicult. 18 (.05%) Type 2b and Type 3
Assimilated Meets criteria for
margina1* 5 (.01%) Type 3a or 3b and
Type 5
Separation 61 (16.1%) Meets criteria for
Type 4a
Mexican separation 7 (.02%) MEXMAR 3 11.14 and
ANGMAR 2 14.70 and
MAMAR 2 14.98
Mex-American MAMAR 5 12.61 and
separation 34 (.09%) ANGMAR 2 14.70 and
MEXMAR 2 13 . 98
Anglo separation 20 (.05%) ANGMAR 5 12.06 and
MEXMAR 2 13.98 and
MAMAR 3 14.98
Integrated (low) Meets criteria for
bicult. sep.* 0 Type 2a and Type 4a
Integrated (high) Meets criteria for
bicult. sep.* 27 (.07%) Type 2b and Type 4a
Assimilation Meets criteria for
separation* 0 Type 5 and/or Type
4a
Assimilated MOS s 2.44 and
(all types) 49 (.13%) AOS 2 4.11
Unable to classify 67 (18.0%)
Note. MOS = Mexican Orientation Scale; AOS = Anglo

189

Orientation Scale; ANGMAR = Anglo Marginality Subscale;
MEXMAR = Mexican Marginality Subscale; MAMAR = Mexican
American Marginality Subscale. From “Acculturation Rating
Scale for Mexican Americans-II: A Revision of the Original
ARSMA Scale,” by I. Cuéllar, B. Arnold, and R. Maldonado,
1995, MEWS), pp-
275-304. Copyright 1995 by Cuéllar, Arnold, and Maldonado.
Reprinted with permission of the authors.

*These subtypes must meet multiple typology and subtypology
criteria; therefore, frequencies and percentages do not add
to totals, since not everyone who meets criteria for a major
typology also meets criteria for a subtypology.

190

Appendix C
Multiphasic Assessment of Cultural Constructs-Short Form
(MACC-SF): Original Instrument and Descriptive Information

Questions 77-136 of Research Instrument, Appendix A

191

Overview

The Multiphasic Assessment of Cultural Constructs-Short
Form (MACC-SF; Cuéllar, Arnold, & Gonzalez, 1995) is a 60-
item instrument with a true/false scale that was selected
from a larger scale, Multiphasic Assessment of Cultural
Constructs (MACC), developed by Arnold & Cuéllar (1985). It
is designed to measure five constructs that are hypothesized
to have the potential to influence the experience of illness
and/or help-seeking behaviors. The cognitive referents of
acculturation are: (a) Familism (12 items), (b) Fatalism (8
items), (c) Machismo (17 items), (d) Folk Illness Beliefs
(14 items), and (e) Personalismo (11 items)(see list below).
All of the scales, with the exception of personalismo, were
shown to be significantly related to generational status and
acculturation (Cuéllar, Arnold, & Gonzalez, 1995).
Personalismo was found to be negatively correlated with the
four scales, adding support to the literature that has
indicated that cultural attitudes, ideas, beliefs, and
values are associated with the acculturation process (Domino
& Acosta, 1987; Marin, 1993), that they can be reliably
measured, and that the processes have empirical construct
validity.

Data analysis on the internal consistency of the
subscales reveals that coefficient alphas are fair to good
for folk beliefs and machismo (alpha = .74 to .82), poor for

familism and fatalism (alpha = .59 to .67), and below the

192

accepted levels for Personalismo (alpha = .47 to .53). A
factor analysis using the varimax rotation method was
conducted on each of the five subscales. An ANOVA was
conducted on each of the five acculturation groups for each
of the five constructs. With the exception of personalismo,
each was found to have significant differences between
acculturation and the following: familism, F (4,350) =
6.336, p < .001; fatalism, F (4, 350) = 4.868, p < .001;
folk beliefs, F (4, 350) = 9.057, p < .001); and machismo F
(4, 350) - 4.806, p < .01. Correlations between
acculturation and familism, machismo, folk beliefs, and
fatalism were relatively low (-.19 to -.32) but
statistically significant. Finally, multiple regressions
were conducted for each of the five constructs using
acculturation, SES, grade, age, and generation. All but the
personalismo scale were found to have substantial construct
validity. Acculturation, the strongest of the predictors,
was shown to be correlated in the negative direction, which
supports acculturation theory (i.e., the lower the level of
acculturation, the higher the score on the construct
measured). The amount of variance ranged from 4.5% to 8.8%.
This instrument has been shown to have psychometric
properties that support its use in studying acculturation.
Research has indicated clearly that there is a relationship
between cognitive changes and generational status and

behavioral acculturation (Cuéllar, Arnold, & Gonzalez,l995).

193

Survey Instrument Items Representing Five Scales: Familism,

Fatalism, Machismo, Folk Beliefs, and Personalism

E .1. {12 '! I

1. All adults should be respected.

2. More parents should teach their children to be loyal to
the family.

3. It is more important for a woman to learn how to take
care of the house and the family than it is for her to
get a college education.

4. The stricter the parents the better the child.

5. Some equality in marriage is a good thing, but by and
large, the father ought to have the main say so in
family matters.

6. Even if a child believes that his parents are wrong,
he should obey without question.

7. Relatives are more important than friends.

8. For a child the mother should be the dearest person in
the world.

9. A girl should not date a boy unless her parents
approve.

10. No matter what the cost, dealing with my relatives'
problems comes first.

11. I expect my relatives to help me when I need them.

12. My family frequently participates in school-sponsored
activities for our children.

Fatalism (8 items)

1. It is more important to enjoy life now than to plan
for the future.

2. People die when it is their time and there is not much
that can be done about it.

3. We must live for the present, who knows what the
future may bring.

4. If my doctor said I was disabled, I would believe it
even if I disagreed.

5. It is not always wise to plan too far ahead because
many things turn out to be a matter of good and bad
fortune anyway.

6. It doesn't do any good to try to change the future
because the future is in the hands of God.

7. When I make plans, I am almost certain I can make them
work.

8. I sometimes feel that someone controls me.

194

Betsenaiisme (11 items)

1. Good manners are more important than a formal
education.

2. I often ask people to do favors for me.

3. I like to greet people in a friendly manner when I see
them.

4. I make it a point to know people that hold important
jobs (positions of power).

5. I don't mind calling on people that I know to do
favors for me.

6. I try to get to know everyone I meet.

7. I always feel better about meeting someone if I know
their family.

8. Friendly people get much further in life than cold
people.

9. I like to talk about the weather with people to help
start up a conversation.

10. I enjoy being with people.
11. I can trust many people to do me favors.
Felk Illness Beliefs (14 items)

1. I believe it is possible to place a hex on someone
(embrujar a alguien).

2. I have been hexed (embrujado) in the past. Mental
illness cannot be caused by witchcraft and evil
spirits. *I have been treated for "empacho." My family
and I have used the services of curanderos, curanderas
in the past. I have been treated by a curandero(a)
more than once.

3. I would take my child to a curandero if needed.

4. When I was young, I was treated for "Susto."

5. When I was young, I was treated for "Mal de Ojo."

6. For some illnesses a curandero is better than a
doctor.

7. Caida de.MOllera (fallen fontenelle) happens mostly to
a very young infant.

8. If a person has special powers to do good or evil they
should not be used too much.

9. Physicians should accept gratuities rather than charge
a fee for their services.

10. It is essential to involve the family in healing a

sick relative.

195

H l' [11 'l 1

mm

kOCDQ

10.

11.

12.
13.

14.
15.

16.

17.

A man should not marry a woman who is taller than him.
It is the mother's special responsibility to provide
her children with proper religious training.

Boys should not be allowed to play with dolls, and
other girls' toys.

Parents should maintain stricter control over their
daughters than their sons.

There are some jobs that women simply should not have.
It is more important for a woman to learn how to take
care of the house and the family than it is for her to
get a college education.

A wife should never contradict her husband in public.
Men are more intelligent than women.

No matter what people say, women really like dominant
men.

Some equality in marriage is a good thing, but by and
large, the father ought to have the main say so in
family matters.

For the most part, it is better to be a man than a
woman.

Most women have little respect for weak men.

I would be more comfortable with a male boss than with
a female boss.

It is important for a man to be strong.

Girls should not be allowed to play with boys' toys
such as soldiers and footballs.

Wives should respect the man's position as head of the
household.

The father always knows what is best for the family.

(Cuéllar, Arnold, & Gonzalez, 1995).

196

Table C1

 

 

 

 

 

a ‘21! 0! ‘g D- a ,0. v- 1 . o ,u
inbflfizfiEl
Cultural Construct
Scale Score
Statistic 1 2 3 4 5
Spearman-Brown .67 .59 .77 .82 .53
Guttman (Rulon) .66 .59 .74 .82 .53
Coefficient Alpha--

All Items .65 .63 .78 .75 .47

 

 

 

 

 

 

Hetet 1 = Familism; 2 = Fatalism; 3 = Machismo; 4 = Folk
Beliefs; 5 = Personalismo

 

 

Table C2
Subscale Eigenvalue Variance
Familism
Dependence on Relatives 1.0 or higher 16%
Family Priority 1.0 or higher 16%
Respect for Parental Authority 1.0 or higher 9%
Fatalism
Inevitability 26%
Mastery 17%
Machismo
Male Superiority 15%
Male Gender Role 9%
Female Gender Role 14%
Male Strength 9%
Folk Belief
Experience 23%
Belief in Supernatural 15%
Folk Practice Ideologies 10%
Personalismo
Friendliness 15%
Sociability 14%
Social Influence 12%

 

From “Cognitive Referents of Acculturation: Assessment of
cultural constructs in Mexican Americans,” by I. Cuéllar, B.

Arnold, and G. Gonzalez, October 1995, Qeu;nel_ef_§emmunit¥
Esyeneiegy, 23. pp. 339-356.

197

Appendix D

Expectations about Counseling-Brief Form (EAC-BF): Original

Instrument and Descriptive Information

Questions 137-202 of Research Instrument, Appendix A

198

Overview

The Expectations about Marriage and Family Therapy-
Brief Form (EAMFT-BF) is an adaptation of Tinsley's (1982)
Expectations about Counseling-Brief Form. The terms
"counseling" and "counselor" were replaced with "marriage
and family therapy" and "marriage and family therapist" to
provide some consistency with the terminology utilized in
this study. The EAMFT-BF is a 53-item instrument that
consist of 17 scales (see below) that measure four factors:
(a) Client Attitudes and Behaviors, (b) Counselor Attitudes
and Behaviors, (c) Counselor Characteristics, and (d)
Counseling Process and Outcome. Each sentence starts with
"I expect to..." or "I expect the therapist to...." The
respondents use a 7-point Likert scale with choices ranging
from (1) not true to (7) definitely true. Scale scores are
calculated by summing responses and dividing by number of
items. Factor scores can be obtained by summing the scale
scores that comprise each factor and dividing by the number
of scales in each factor. Six investigations have indicated
that the scales have strong psychometric properties
(Biscardi & Helms, 1980, as cited in Tinsley, 1982; Rode,
1979; Tinsley et al., 1984; Tinsley et al., 1980; Workman,
1978; Yuen, & Tinsley, 1981). The brief form of the
Expectations about Counseling Form has a high internal
consistency (.71 to .89), sufficiently high test-retest

reliabilities (Median = .71), and a high correlation (.85)

199

with the full form of the Expectation for Counseling
(Tinsley, 1982) which make it a good choice to use in
research. Psychometric properties provide inconclusive
information on the Realism scale which is still
experimental.

Four general areas of expectations are measured by 17
subscales: 1) Client Attitudes and Behaviors (Motivation,
Openness, and Responsibility); 2) Counselor Attitudes and
Behaviors (Acceptance, Confrontation, Directiveness,
Empathy, Genuineness, Nurturance, and Self-Disclosure); 3)
Counselor Characteristics (Attractiveness, Expertise,
Tolerance, and Trustworthiness); and 4) Counseling Process
and Outcome (Concreteness, Immediacy, and Outcome).

Correlation of the full scale and brief scale and
factor scores on the Expectations About Counseling
instrument was undertaken in six investigations; these
investigations were reported on in a metastudy by Tinsley
(1982). The six studies include: Biscardi & Helms, 1980 (as
cited in Tinsley, 1982); Rode, 1979; Tinsley et al., 1984;
Tinsley et al., 1980; Workman, 1978; Yuen & Tinsley, 1981.

Definitions of expectancy scales for expectations about
counseling (adapted to MFT)

1. Responsibility: Expect to take responsibility for
making my own decisions.

2. Openness: Expect to speak frankly about my problems.

3. Motivation: Expect to be motivated to work with the
counselor (MFT).

200

10.

11.

12.

13.

14.

15.

16.

17.

Acceptance: Expect the counselor (MFT) to think that I
am worthwhile.

Confrontation: Expect the counselor (MFT) to point out
contradictions in things I say, feel, or do.

Genuineness: Expect the counselor (MFT) to be a
sincere person.

Directiveness: Expect the counselor (MFT) to take the
initiative in bringing up things to talk about.

Empathy: Expect the counselor (MFT) to know how I feel
even when I cannot say quite what I mean.

Self-Disclosure: Expect the counselor (MFT) to discuss
his or her own experiences and to relate them to my
problem.

Nurturance: Expect the counselor (MFT) to give me
support.

Attractiveness: Expect to enjoy being with the
counselor (MFT).

Expertise: Expect the counselor (MFT) to know how to
help me.

Trustworthiness: Expect the counselor (MFT) to be
someone who can be counted on.

Tolerance: Expect the counselor (MFT) to be patient.

Immediacy: Expect to talk about the relationship
between myself and the counselor (MFT).

Concreteness: Expect the counselor (MFT) to talk very
specifically about problems I am having now.

Outcome: Expect to experience a significant change in
my life.

201

Spanish Version of Expectations about Counseling—Brief Form:
Descriptive Information (Questions 137-202 of Research
Instrument, Appendix A)

Recently, Buhrke & Jorge (1992) translated the EAC-BF
into Spanish, using all four translation techniques that are
suggested by Campbell, Brislin, Stewart, & Werner (as cited
in Brislin, 1970) to increase the strength of their
instrument, the Spanish Version of the EAC-BF (Buhrke &
Jorge). This included a combination of back translation
techniques and committee procedures. The authors added
demographic variables to access information on multicultural
experiences, such as length of time in the United States and
place of birth.

Two studies were conducted to develop and test the
Spanish version of the EAC-BF. The study conducted with
students supported the use of this instrument with various
Hispanic populations as it met the criterion (above .60) for
translated instruments (Butcher, 1982). However, the
nonstudent population did not have correlations for items
and scales that were as high as the first group. A brief
discussion included potential reasons for the differences,
i.e., difficulty of making a direct translation for some
words, variations in dialects of Spanish, and varying
degrees of proficiency with the Spanish language. Each of
these factors would impact the correlations between English

and Spanish versions of the instrument. However, even with

202

these problems, overall, the Spanish version of this
instrument fared very well; and it was concluded that it is
a reliable and valid translation for students and

nonstudents.

203

Appendix E

Informational Advertisements: English and Spanish

204

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206

Appendix F
Informational Sheet for Subjects, Session 1, English and

Spanish Versions

207

O I I O O
n 01- 0! o '0 ‘0 e- 'e , 99! ° I - ,:. 0

Hello, my name is Gloria Gonzalez-Kruger and I am a
student at Michigan State University and I am working on my
doctoral degree in Family Studies and specializing in
Marriage and Family Therapy.

I am doing this study to learn what people, who are of
Mexican origin, would expect of marriage and family
therapists. This will help marriage and family therapists
understand what they need to change so that you are more
confident about our services.

Your responses in this intetview will be kept in the
strigtest_eenfidenee. Your name will not appear on any of

the questionnaires or in any of my reports. I will be
talking with other individuals of Mexican origin and when
the interviews are completed, I will be combining the
answers of everyone who has participated and reporting the
results of the group, net of any individual.

The report will be available to you when this study is
completed. Your participation is completely voluntary. If
you choose to do the interview and then change your mind,
you are welcome to stop at any time during the interview.
The interview will take about 45-50 minutes. When you
complete the interview, I would like you to accept a
monetary gift of $5.00 as a way of saying thank you for your
willingness to participate and for giving me the time to
conduct this interview.

' DO YOU HAVE ANY QUESTIONS AT THIS TIME?
0 IF’YES: Respond to questions and then ask: Would
you like to participate in this interview?

9 IE’NO: Would you like to participate in this
interview?

0 IF YES: In order to conduct the interview,
you must sign this consent form that gives me
permission to do the interview and use the
information to complete my report.

9 IF NO: Thank you for your time and if you
know anyone who might be interested in
talking with me, please give them my name and
number.

Again, thank you very much.

208

In ,00- '51 ’e-- '-_ f 1929 ‘ '0 ‘1 i-_' 1 n-V' e N u

Hola, mi nombre es Gloria Gonzalez-Kruger y estudio en
Michigan State University. Estoy trabajando en mi doctorado
en Estudios de Familias y con especializacion en Terapia de
matrimonio y familia.

Realizo este estudio para aprender lo que la gente de
origen Mexicano esperan de los terapeutas en matrimonio y
familia. Tambien ayudara a entender que los terapeutas
necesitan cambiar para que ustedes se sientan mas confiados
de nuestro servicios.

Sus repuestas ea_l2_222rszigfg_2§_egt£istg!egfg
gonfidencial. El nombre de usted no va a parecer en el
cuestionario, ni en mi investigacion. Yo voy a hablar con
otros que son tambien de origen Mexicano, y cuando las
entrevistas estan completas, yo voy a combinar las repuestas
de todos los que han participado. La investigacion va ser

por grupo, ne_indi1iduel. La investigacion va estar
disponible para usted cuando este estudio este terminado.

Su participacion es enteramente voluntaria y puedes
dejar de contestar cualquier pregunta y puede terminar esta
entrevista en cualquier momento. La entrevista toma entré
45-50 minutos. Cuando acabemos la entrevista, me gustaria
que aceptas un regalo de $5.00 como modo de decirte gracias
por su participacién y su tiempo para hacer la entrevista.

Q gTIENES ALGUNA PREGUNTA EN ESTE MOMENTO?

> SI ES SI: Responder a las preguntas y luego
preguntas: Quieres participar en la entrevista?

> SI ES NO: Quieres participar en la entrevista?

> SI ES SI: Para poder hacer la entrevista,
tienes que firmar esta forma de consentir que
me da permiso hacer la entrevista y usar la
informacion para completar mi reportaje.

> SI ES NO: Gracias por su tiempo y si conoces
a algien que podria tener interes en hablar
con migo, por favor dales mi nombre y mi
numero de telefono.

Nuevamente muchas gracias.

209

Appendix G
Approval Letter: University Committee on Research Involving
Human Subjects

Consent Form: Session 1, English and Spanish Version

210

 

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MICHIGAN STATE

LJ hi I V E F! S I 1' Y

April 3. 1997

To: Delores Borland-Hunt
102 Paolucc1 Building

as: ran»: 97.172
TITLE; MEXICAN AMSRICANS' EXPECTATIONS AND UTILZATIONS
parrrnss or MARRIAGE AND FAMILY snip
arvzszon REQUESTED: u/A T" Y SESSI°NS
CATEGORY: 1-c
APPROVAL DATE: 00/02/97

The University Committee on Research Involving Human Subjects'(UCRIHS)
rev1ew of this pronect is complete.' I am pleased to adVise that the
rights and welfare of the human subjects appear to be adequately
rotected and methods to obtain informed consent are appropriate.

herefore. the UCRIHS approved this pr03ect and any rev1sions listed
above .

alllwhh: UCRIHS approval is valid for one calendar ear. b 1
the approval date shown above. Investigatgrs plafigiggxgg w‘th
continue a project be nd one year must use the green renewal
form (enclosed with t e original asproval letter or when a
project is renewed) to seek u date certification. There is a
maximum of four such expedite renewals possible. Investigators

wishin to continue a to ect be d tug: ; m
again or complete revgew? yon ‘ . “"d 5° ‘nb'tt it

RIVISIONB: UCRIHS must review an changes in rocedures involvi human
subjects. rior to in tiation o: tfie c e. :1 thizgll done a:
the time o renewal. please use the green renewal form. To
revise an approved protocol at an other time during the year.
send your written request to the CRIBS Chair. requesting rev1se
approval and referencing the project's IRS O and title. Include
in your request a description of the change and any rewised
instruments. consent forms or advertisements that are applicable

PROILIIS/
CRAIG

Is: Should either or the tollowi arise duri the tour
work. investigators must notgiy UCRIRS prggptly: (1:. 33552:.
(unexpected side ettects. comp aints. etc.) involving uman
subjects or (2) changes in the research environment or new
information indicating greater risk to the human sub ects than
existed when the protocol was previously reviewed aha approved.

I: we can be of an future hel . lease do n * -
at (517)155-2150 0: IA: (517)432-1171. °g h"““' 5° °°““°‘ “4

cerely.

 

Dll:b0d

cc: P anciso A. Villarruel
loria E. Goneales-Krueger

2211.

Signed:

Date:

2 ! E r ! E !° . ! . I !e . H J
This study is being conducted by Gloria Gonzalez-
Kruger, a doctoral student at Michigan State
University. The name of this study is Mexican
American's Expectations and Utilization of Marriage and
Family Therapy Services.

This study is being done to learn what people, who are

of Mexican origin, would expect of marriage and family

therapists. This will help marriage and family
therapists understand what they need to change so that
you are more confident about the services.

The study will be supervised by the following

professors:

9 Dr. Dolores Borland-Hunt, Professor, Michigan
State University, Department of Family & Child
Ecology, Approved Marriage & Family Therapy
Supervisor, and Director, MSU Family & Child
Clinic

9 Dr. Francisco Villarruel, Assistant Professor,
Michigan State University, Department of Family &‘
Child Ecology

As part of this study, you will take part in a 45-50

minute interview that will be held at a location

acceptable to the interviewer and yourself.

Your participation in this study is entirely voluntary.

If you agree to participate, you may refuse to answer

any question and you can stop the interview at any time

and choose to end your participation.

The information you give during the interview is

completely confidential and your name will not appear

on the questionnaires at any time.

The consent forms and questionnaires will be stored in

a locked file cabinet that is available only to the

researcher (Gloria Gonzalez-Kruger). The papers will

be stored in a locked brief case inside a locked car
trunk while traveling to and from the interview.

All of the reports will be based on group information

and your name will not appear on any report. The

report will be available to you when this study is
completed.

For additional information, you can contact me, Gloria

Gonzalez-Kruger, at 694-2937.

 

 

212

,orle 0‘ .9 :1 f 1‘! o '2 . ’-,,i '0- en a ,n -‘Vi t.’

1 Este estudio que conduce Gloria Gonzalez-Kruger,
estudiante de doctorado en Michigan State University.
Yo estoy de acuerdo a participar en
2 El estudio esta intitulado "Mexico-Americano's
Expectaciones, y Utilizaciones de Terapia en el
Matrimonio y la Familia. Realizo este estudio para
aprender lo que la gente de origen Mexicano esperan de
los terapeutas en matrimonio y familia. Tambien
ayudara a entender que los terapeutas necesitan cambiar
para que ustedes se sientan mas confiados de nuestro
servicios.
3 El estudio va estar supervisado por estos profesores:
O Doctora Dolores Borland-Hunt, Profesora,
Michigan State University, Departamento de
Ecologia de Familia y Nifios, Supervisora de
Terapia del matrimonio y la familia, y
directora de la Clinica de Familia y Nifios en
Michigan State University.
9 Doctor Francisco Villarruel, MSU, Asistente
de Profesor, Michigan State University,
Departamento de Ecologia de Familia y Nifios
4 Yo entiendo la intencion de el estudio, porque es
efectuada, y mi participacion en esta entrevista. La
entrevista toma entre 45-50 minutos.

5 Yo entiendo que mi participacién es enteramente
voluntaria y puedo dejar de contestar cualquier
pregunta y puedo terminar esta entrevista en cualquier
momento.

6 Yo entiendo que la informacion que doy en la entrevista
es estrictamente confidencial y que mi nombre no va a
paecer en el cuestionario.

7 Yo entiendo que la forma de consentimiento y los
cuestionarios van a ser depositados en un archivo
segura y que la investigadora nomas va tener
accesibilidad. Los papeles van a estar adrentro de un
maletin segura dentro de la cajuela cerrada con llave
de un carro que maneja a la entrevista.

8 Yo entiendo que la investigacion va a ser de
informacion del grupo y que mi nombre no va parecer en
la investigacion.

9 Tengo el nombre y el numero de teléfono de la
investigadora (Gloria Gonzalez-Kruger) en caso que
tenga preguntas o preocupaciénes despues de participar
en el estudio.

Firma:
Fecha:

 

 

213

Appendix H

Bilingual Response Cards

214

 

 

Question;
1 = Latino(a) 5 = Chicano(a)
2 = Hispanic 6 = Mexican American
3 = Mexicano(a) 7 = American
4 = Mexican 8 = Other
mm
1 = Latino(a) 5 = Chicano(a)
2 = Hispanico/Espanol 6 = Mexicano(a)
3 = Mexicano(a) 7 = Americano(a)
4 = Mexican 8 = Otro
Card No. 2
W
1 = Not Religious or Spiritual at all
2 = A Little Religious or Spiritual
3 = Somewhat Religious or Spiritual
4 = Very Religious or Spiritual
5 = Extremely Religious or Spiritual
W
1 =No Religioso(a) o Espiritual
2 = Un Poco Religioso(a) o Espiritual
3 = Algo Religioso(a) o Espiritual
4 = Muy Religioso(a) o Espiritual
5 = Extremadamente Religioso(a) o Espiritual
252129.}.
222.511.211.25
1 = Less than $ 6,000 7 = 25,000 - 29,999
2 = 6,000 - 8,999 8 = 30,000 - 49,999
3 = 9,000 - 11,999 9 = 50,000 - 69,999
4 = 12,000 - 15,999 10 = 70,000 — 89,999
5 = 16,000 - 19,999 11 = Over $ 90,000
6 = 20,000 — 24,999 12 = Don't Know
mm:
1 = Menos de $ 6,000 7 = 25,000 — 29,999
2 = 6,000 - 8,999 8 = 30,000 - 49,999
3 = 9,000 - 11,999 9 = 50,000 - 69,999
4 = 12,000 - 15,999 10 = 70,000 - 89,999
5 = 16,000 - 19,999 11 = Mas de $ 90,000
6 = 20,000 - 24,999 12 = No se

215

Americano(a)

Qerd Ne. 4

Questign_21z (English/Inglés)

1.

lst generation = You were born in Mexico or other
country [not in the United States (USA)].

2nd generation = You were born in USA; either parent
born in Mexico or other country.

3rd generation = You were born in USA, both parents born
in USA and all grandparents born in Mexico or other
country.

4th generation = You and your parents born in USA and at
least one grandparent born in Mexico or other country
with remainder born in the USA.

5th generation = You and your parents born in the USA
and all grandparents born in the USA.

PrechLa_Zl: (Spanish/Espafiol)

1.

2.

m.otuA>H
ll

la. generacion = Usted nacio en Mexico 0 otro pais [no
en los Estados Unidos (USA)].

2a. generacion = Usted nacio en los Estados Unidos
Americanos (USA), sus padres nacieron en México 0 en
otro pais.

3a. generacion = Usted nacio en los Estados Unidos
Americanos (USA), sus padres tambien nacieron en los
Estados Unidos (USA) y sus abuelos nacieron en México 0
en otro pais.

4a. generacién = Usted nacio en los en los Estados
Unidos Americanos (USA), sus padres nacieron en los
Estados Unidos Americanos (USA) y por lo menos uno de
sus abuelos nacio en México o algun otro pais.

5a. generacion = Usted y sus padres y todos sus abuelos
nacieron en los Estados Unidos (USA).

Card Ne. 5
l t' -76 E r -7
= Not At All 1 = Nada
Very Little/Not Very Often 2 = Un Poquito o A Veces
Moderately 3 = Moderado
Much or Very Often 4 = Mucho o Muy Frecuente
Extremely Often or 5 = Muchismo o Casi todo el
Almost Always tiempo
Cerd Ne. 6
f u tion 77-1 E Pre n 77-1
= True 1 = verdad
- False 2 = Falso

216

gags N9, 7
WWW

 

l = Not True 1 Falso
2 = Slightly True 2 = Ligeramente Cierto
3 = Somewhat True 3 = Algo Cierto
4 = Fairly True 4 = Moderadamente Cierto
5 = Quite True 5 = Bastante Cierto
6 = Very True 6 = Muy Cierto
7 = Definitely True 7 = Definitivamente Cierto
Card.8
Questien_203;2fl8: Who would you turn to for "help" if you
needed it?
1 Mother Figure 8. Uncle(s) 15. Neighbor(s)
2 Father Figure 9. Cousin(s) 16. Clergy
3. Sister(s) 10. Godparent(s) l7. Counselor
4. Brother(s) 11. Spouse/Partner 18. Therapist
5 Grandmother(s) 12. Son(s) 19. Healer _
6 Grandfather(s) 13. Daughter(s) 20. Social Organi-
7 Aunt(s) 14. Friend(s) zations
21. Other:__ ___~
n -20 5A quien vas por "ayuda" si la necesitas?
1. Madre 8. Tio(s) 15. Vecino(s)
2. Padre 9. Primo/a(s) 16. Clero
3. Hermana(s) 10. Padrino/Madrina(s)17. Consejero
4. Hermano(s) 11. Esposo(a)/ 18. Terapéutica
5. Abuelita(s) Compafiero l9. Curandero
6. Abuelito(s) 12. Hijo(s) 20. Organizaciones
7. Tia(s) 13. Hija(s) Social
14. Amigo/a(s) 21. Otro:_____

Compadre(s)

217

Card No. 9

Questign_212;214 Eregunta_212;214
How easy is it for you to look gQue facil es para usted
for, seek or ask for help from... a buscar, solicitar, o

Perdirle ayuda a su...

1. Very Easy 1. Muy Facil

2. Somewhat Easy 2. Algo Facil

3. A Little Hard 3. Un Poquito Dificil

4. Hard 4. Dificil

5. Very Hard 5. Muy Dificil

6. I don't seek or ask for help 6. Yo no busco, solicito,

o pido ayuda

Cerd Ne, 10
i 21 217 Es2ala.2ara_2regunta§_216.
and.ZZA 211..222.22$
1 = No 1 = No
2 = No but tried to get 2 = No pero trate de
information encontrar informacién
3 = No but made telephone call 3 = No pero llame para
to get information obtener informacion
4 = Yes went for an initial 4 = Fui a mi admision/la
intake/lst session Primero sesion
5 = Yes (attended more than 5 = Si (atendi mas de una
1 session) Sesion)

a d N 1
Scale_for_2uestion_222;222 Escala.nara.£regunfa§_2222222
1 = Not at all 1 = Nada
2 = Very little 2 = Un Poquito
3 = Some 3 = Algo
4 = Quite a bit 4 = Bastante
5 = A lot 5 = Mucho

218

Appendix I
Informational Sheet for Subjects, Session 2, English and

Spanish Version

219

c 00 '01 o '0 ‘1 'q- Ia ' 'seo ,0 ,1 - f-w e
I know your time is valuable so I want to thank you
again for taking part in the interview we just completed.
Before I go, would you be willing to give me another 2
minutes to let me read the rest of this informational sheet
that describes what I am doing as another part of my
dissertation?
> If Yes - Continue Reading
> If No - Thank you and if you have any questions or
need to talk about this study, please call me at
this telephone number.

I have some questions that give people of Mexican
origin the chance to talk about how they find help, who they
go to when they need help, and what they think about
counselors and therapists. People can talk about what they
think the Mexican American community needs or wants from
community mental health services, including marriage and
family therapists. This additional information will help
professionals understand how they can be sensitive to the
needs of individuals and families of Mexican origin and
whether their services are needed or wanted.

Again, your responses in this interview will be kept in
the strictest confidence. I would like to tape record this
part of the interview since it will help me make sure I do
not miss anything you say. Your name will not appear on any
questionnaire, audiotape, notes, or any reports and no one
will listen to the tapes but this researcher. The
audiotapes will be kept in a lock box that will be kept in a
locked file cabinet and the tapes will be destroyed after 2
years. I will be talking with 15 individuals of Mexican
origin and when the interviews are completed, I will be
looking for and reporting common points. I will be using
sentences in my report from the interview but it will only
report, for example, a 39 year old female. A summary of the
report will be available to you when this study is
completed.

Your participation is completely voluntary and if you
choose to do the interview and then change your mind, you
can stop the interview at any time. If you do not want part
of what you say to be recorded, I can turn off the recorder
until you give me permission to turn it on again. The
interview will take about 15-25 minutes, depending on how
much you would like to share. We can do the interview now
or we can schedule another day and time. It is not possible
for me to offer you a monetary gift for this part of the
interview. Again, thank you for letting me read you this
informational sheet and you are welcome to accept or refuse
this second interview. Either way, I have enjoyed having
the chance to meet you and talk with you. Do you have any
questions at this time?

0 IF YES: Respond to questions and then ask: Would

220

you like to participate in this interview?

0 IF NO: Would you like to participate in this

interview?

9 IF YES: In order to conduct this interview, you
must sign this consent form that gives me
permission to do the audiotaped interview and
use the information to complete my report.
Again, thank you very much.

9 IF NO: Thank you for your time if you have any
questions about the study, please call me at
this telephone number.

Again, thank you very much.

221

o as. '5 -. e .9 ' '91! 7 '0 ‘1 '4 ’q 1 s ‘V' .
Num, 2

Hemos terminado. Yo se que su tiempo es valioso, asi
que quiero darle las gracias otra vez por participar en la
entrevista que terminamos. Antes de retirarme, consedame 2
minutos mas para leerle e1 resto de este hoja de informacion
que describe lo que yo estoy haciendo para otra parte de mi
disertacion. gMe permite leerlo?

> Si es Si - Continuare leiendo:

' Si es No - Gracias y si usted tiene cualquier
pregunta o necesitas hablar de el estudio, por
favor me hablas en este numero de teléfono.

Yo tengo otras preguntas, que dan a la gente de origen
Mexicano la oportunidad saber como pueden encontrar con
quien ir cuando necesiten ayuda, y lo que ellos piensan de
consejeros y terapeuticas. Usted puede hablar de lo que
piensa de la comunidad de Mexico Americanos y lo que
necesitan o quieren de los servicios en la comunidad para la
salud mental, incluso las terapeuticas de marital y de
familia. Esta informacion adicional va ayudar a los
profesionales a comprender como ellos pueden estar mas
sensitivos a las necesidades de individuos y familias de
origen Mexicano y si necesitan or quieren los servicios.

Otra vez, sus repuestas W
estrictamente confidencial. Me gustaria hacer un grabacion
de esta entrevista para que me ayude y estoy segura que yo
no pierdo algo que usted dices. El nombre de usted no va a
parecer en el cuestionario, grabacion, notas, or reportaje y
nadie va escuchar las cintas, nomas yo. Las grabaciones van
a estar guardadas en un caja cerrada con llave que esta
guardada en un gabinete (archivo) cerrado con llave y las
cintas van a ser destruidas despues de 2 afios. Yo voy a
hablar con 15 individuos de origen Mexicano y cuando las
entervistas esten completas, yo voy a estar buscando y
reportando los puntos comunes. Yo voy a usar sentencias en
mi reportaje de las entrevistas pero nomas para reportaje,
por ejemplo, un masculino o una femenina de 39 afios. Un
resumen del reportaje estara disponible a usted cuando este
estudio se completa.

Su participacion es enteramenta voluntaria y si usted
escoje hacer la entrevista y luego cambia de opinion, usted
puedes parar la entrevista en cualquier tiempo. Si usted no
quiere cualquier parte de lo que dices que esta en la
grabacion, yo puedo apagar la grabacion hasta que me de su
permiso de prenderlo otra vez. La entrevista agarra como
15-25 minutos, dependen en lo que usted tiene o quiere
decir. Podemos hacer la entrevista ahora mismo o nosotros
podemos hacer una cita para otro dia y tiempo. No es
posible que yo pueda ofrecer otro regalo de dinero por esta
parte de la entrevista. Gracias por dejar me leer la hoja
de informacion y usted puede aceptar or rehusar la

222

entrevista. De cualquier modo, yo ha tenido mucho gusto de

tener ocasién de conocerle/lo y hablar con usted. aTienes
alguna pregunta en este momento?
> SI ES SI: Responder a las preguntas y luego
preguntas: gQuieres participar en la entrevista?
> SI ES NO: aQuieres participar en la entrevista?
> SI ES SI: Para poder hacer la entrevista,
tienes que firmar esta forma de consentimento que
me da permiso de hacer la entrevista y usar la
informacién para completar mi reporte. Otra vez,
muchas gracias.
> SI ES NO: Gracias por su tiempo y si tienes
preguntas de el estudio, por favor hablame por
telefono en este numero.
Nuevamente muchas gracias.

223

Appendix J

Consent Form: Session 2, English and Spanish Version

224

2 ! E I E I. . ! . I ! v. H 2

1 This study is being conducted by Gloria Gonzalez-
Kruger, a doctoral student at Michigan State
University. The name of this study is entitled Mexican
Americans' Expectations and Utilization of Marriage and
Family Therapy Services.

2 This part of the study will give you, as a person of
Mexican origin, the chance to talk about how people of
Mexican origin find help, who they go to when they need
help, what they think about counselors and therapists,
and what the Mexican American community needs or wants
from mental health services.

3 The study will be supervised by the following
professors:

0 Dr. Dolores Borland-Hunt, Professor, Michigan State
University, Department of Family & Child Ecology,
Approved Marriage & Family Therapy Supervisor, and.
Director, MSU Family & Child Clinic

9 Dr. Francisco Villarruel, Assistant Professor,
Michigan State University, Department of Family &
Child Ecology

4 As part of this study, you will take part in a 15-25
minute interview that will be tape recorded.

5 Your participation in this study is entirely voluntary.
If you agree to participate, you may refuse to answer
any question, you may ask that the tape recorder be
turned off at any time, and you may stop the interview
at any time and choose to end your participation.

6 The information you give during the interview is
completely confidential and your name will not appear
on the questionnaire, audiotape, notes, or reports at
any time. The consent forms and questionnaires will be
stored in a lock box that will be in a locked file
cabinet that is available only to the researcher
(Gloria Gonzalez-Kruger). The papers and audiotapes
will be stored in a locked brief case inside a locked
car trunk while traveling to and from the interview.

7 All of the reports will be based on group information
and your name will not appear on any report. The report
will be available to you when this study is completed.

8 For additional information, you may contact me, Gloria
Gonzalez-Kruger, at 694-2937.
Signed: Date:

 

 

225

o 12 a: 0. -n fit: to '. - 'ar ' ioar -n En _fV: a Nu . 2
1 Yo estoy de acuerdo en participar en la segundo
entrevista que va hacer usada en el estudio que conduce
Gloria Gonzalez-Kruger, estudiante de doctorado en
Michigan State University.

2 El estudio tiene intitular "Mexico-Americano's
Expectaciones, y Uso de Terapia de Matrimonio y
Familia.

3 El estudio va estar supervisado por estos profesores:

O Doctora Dolores Borland-Hunt, Profesora, Michigan
State University, Departamento de Ecologia de
Familia y Nifios, Supervisora de Terapia de
Matrimonio y Familia, y director de la Clinica de
Familia y Nifios en Michigan State University.

0 Doctor Francisco Villarruel, Profesor Asistante,
Michigan State University, Departamento de Ecologia
de Familia y Nifios

4 Yo entiendo la intencion de el estudio, porque es
conducida, y que mi participacion en la entrevista que
va a ser grabada.

5 Yo entiendo que mi participacion es enteramente
voluntaria y puedo parar la grabacion, dejar de
contestar cualquier pregunta, o puedo terminar mi
participacion en esta entrevista en cualquier momento.

6 Yo entiendo que la informacién que doy en la entrevista
es estrictamente confidencial y que mi nombre no va a
paecer en el cuestionario, cinta de grabacion, notas,
or reportajes.

7 Yo entiendo que la forma de consentir y los
cuestionarios van a estar depositados en una caja que
va estar cerrada con llave que esta guardada en un
gabinete (archivo) y que la investigadora (Gloria
Gonzalez-Kruger) nomas va a tener accesibilidad. Los
papeles y los cintas de grabacion van a estar adrentro
de un maletin segura que esta en la cajuela cerrada con
llave de un carro que maneja a la entrevista.

8 Yo entiendo que el investigacion (las reportajes) van a
ser de informacién del grupo y que mi nombre no va a
parecer en el investigacion.

9 Tengo el nombre y el numero de teléfono de la
investigadora (Gloria Gonzalez-Kruger) en caso que
tenga preguntas or preocupaciones despues de participar
en el estudio.

Firma: Fecha:

 

226

Appendix K
Research Instrument for Session 2, English and

Spanish Versions

227

Openness and Utilization of Marriage and Family Therapy
Qualitative Questions

ID Number:__ __M-n___ Date:__ _ __ ____

1. How does your family help or support you when you are
having problems in your life?

2. What do you want from your family when you go to them
for help?

3. Who do people in the Mexican community go to when they
need help or support and their family is not able to
help?

4. What are the similarities and differences between

counselors and therapists giving support?

5. What are the similarities and differences between
professional therapists and non-professionals (e.g.,
family members, friends) giving support?

6. Do you believe that people of Mexican origin go to
therapy to get help or support when they have problems?

7. What makes you believe this?

8. Do you believe it would help people and families in the
Mexican community to get therapy?

9. Can you tell me why you believe this?

10. What would other members of your community, who are of
Mexican origin, think or feel if they knew a family
member or friend was receiving services from a
counselor (i.e., for personal problems, for mental
health issues, for family problems)?

11. What would other members of your community, who are of
Mexican origin, think or feel if they knew a family
member or friend was receiving services from a marriage
and family therapist?

12. What kind of problems cannot be handled inside the
family or with friend?

13. Give me a few examples of when a person or family of

Mexican origin would consider going to a counselor or
therapist.

228

 

—_——— “2%.._ _. . -___ .- - 5

14. What do professional therapists need to know about
families of Mexican origin and the type of problem(s)
they experience?

15. What do professional therapists need to know about
families of Mexican origin and the way they handle the
difficulties in life?

16. What type of changes need to be made by “professional
therapists and organizations” to improve services to
people of Mexican origin?

Miscellaneous Notes:

 

 

 

 

 

 

 

229

Aprendizaje y Uso de Terapia de Matrimonio y Familia
Preguntas Cuantitativo

ID Numero:w__fl Fecha:

 

l. gCémo le ayuda su familia a resolver problemas en su
vida cuando vas con ellos?

2. aQué quiere de su familia cuando vas a ellos por ayuda?

3. aCon quién van la gente en la comunidad Mexicana cuando
necesitan ayuda y la familia no puede ayudarlos?

4. aCuales son las similaridades y diferencias entre
consejeros y terapeutas dando soporte/apoyo?

5. aCuales son las similaridades y diferencias entre
terapeutas profesionales y no—profesionales (por
ejemplo, familia y amigos) dando soporte o apoyo?

6. aUsted cree que las personas de origen Mexicano van a‘
terapia a obtener ayuda cuando tienen problemas?

7. gPorqué cree usted eso?

8. gCree usted que ayuda a la gente y familias en la
comunidad Mexicana ir a terapia?

9. gMe puede decir usted porqué cree esto?

10. aComo piensa 0 se siente la gente que son de origen
Mexicano si saben que algien en la familia 0 un amigo
estan recibiendo servicios de un consejero (por
ejemplo, de asuntos personales, de salud mental, por
problemas de la familia)?

11. aCémo piensa 0 se siente la gente que son de origen
Mexicano si saben que algien en la familia 0 un amigo
estan recibiendo servicios de un terapeuta de
Matrimonio y Familia?

12. gQué tipo de problemas no pueden manejarse entre la
familia 0 con amigo(a)s?

13. Déme unos ejemplos de cuando una persona o familia de
origen Mexicano considerarian yendo a consejero o
terapeuta.

l4. gQué necesitan saber los terapeutas profesionales de

las familias de origen Mexicano y las problemas que
experiencian?

230

15. gQué necesitan saber los terapeutas profesionales de
las familias de origen Mexicano y los modos en que
ellos arreglan las dificultades en la vida?

16. ‘Cuales ti o de cambios necesitan hacer los “tera eutas
C
profesionales y organizaciones” para mejorar servicios

para la gente de origen Mexicano?

Apuntes Diverso:

 

 

 

 

 

 

 

231

Appendix L
Copyright Permission for Research Instruments
Acculturation Rating Scale for Mexican Americans (ARSMA II)
Multiphasic Assessment of Cultural Constructs-Short Form
(MACC-SF)
Expectations about Counseling-Brief Form (EAC-BF)
Expectations about Counseling-Brief Form, Spanish Version

(EAC-BF, SV)

232

 

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Date: ”1996
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Fax Number : 517 4321445

Requestor‘rnIe; DlasottaflonUse

1524 Jacqueline Dr.
Hoe Ml 43342

 

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Type of Excerpt : selection

momentum: ARSMA-II Scale

Sage Author : CW

3... no. ; HISPANIC JOURNAL OF BEHAVIORAL SCIENCES Volslleeuelz 17(3)
Pages : 275-305

Language : 509M

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234

DEPARTMENT OF PSYCHOLOGY AND ANTHROPOLOGY
THE UNIVERSITY OF TEXAS — PAN AMERICAN

 

1201 West University Drive 0 Edinburg, Texas 78539-2999 0 (210) 381-3329 Office

 

March 31, 1997

Gloria Gonmlez-Krugcr
1624 Jacqueline Drive
Holt, Michigan 48842

Dear Gloria:

Thank you for your interest in using the Multicultural Assessment of Cuhural Constructs- Short -
Form (MACC- SF) and/or subscales from the MACC- SF In your research. As you know the
psychometrics of the MACC SF subscales are reported In the WWW,
Vol 23. Oct. 1995, in the article entitled “Cognitive referents of acculturation: Assessment of
cultural constructs in Mexican Americans.” As copyright holder of the scale itself, you have my
permission to make copies as needed for your research purposes. Best of luck in your research
and if possrble could you remember to send me an abstract of your findings?

8‘ ccrely Yo

Israel Cuellar, Ph.D.
Associate Professor
Department of Psychology & Anthropology

235

meaningful results. For example. clients routinely take psychological tests
(item 1) and see practicum students and interns for counseling (item 6) in some
counseling centers. The reverse is true in other counseling centers.
Consequently, the 'realism' of the client's expectancies must be juoged against
local practices. Needless to say, the validity of this scale is uncertain.
Only future research will reveal whether the realism scale provides information
of scientific and/or practical value.

legulating §cale chres
a e scores on the EAC are calculated by summing the responses to the

items assigned to each scale (see pages 12-14) and dividing by the number of
items. The scale score for motivation. for example. can be obtained by summing
the responses to items 14, 15 and 18 and dividing by 3; the scale score for
responsibility is the sum of the responses to items, 8, 9, 29 and 30. divide by

gglgulating Approximate Factgr §cores

Once scale scores are calculated, scores on the factors reported by
Tinsley. Hartman and Kass (1980) can be obtained by adding the gcale scores
indicated below and dividing by the number of scale scores indicated.

Personal Facilitative Counselor

1tment Conditions gxpgrtise Nurturance
Responsibility Acceptance Directiveness Acceptance
Openness Confrontation Empathy Self-Disclosure
Motivation Genuineness Expertise Nurturance
Attractiveness Trustworthiness Attractiveness
Immediacy lolerance
Concreteness Concreteness
Outcome
Divide by 7 Divide by 6 Divide by 3 Divide by 4

Peggiggton tg gge :55

Penatssion to use the full or brief EAC in your research. or to use

selected scales from the EAC is hereby granted. In return. i ask only that you
'gtve appropriate credit for the development of the instruments in reports of
your research and that you provide me with a copy of your data or a summary of
your results. i am currently evaluating the validity of the EAO and I plan to
develop normative data in the future. Your help in providing me with this
information will make it much easier for me to keep Ip-to-date on the research
bearing on the EAC.

2236

Duke University

DURHAM
NORTH CAROLINA
27708-0955
ROBIN A. BUHHKE. PHD TELEPHONE: (919) 5504000
COUNSELING AND PSYCHOLOGICAL SERVICES FACSIMILE: (919) 660-102a
30" 9095-" EMAIL. rounreracpuo.duxa.aau

SUITE 21‘ PAGE BUILDING

6.19.96

Gloria Gonzales Kruger
Michigan State University
101 Morrill Hall

East Lansing, MI 48823
Ms. Kruger.

Enclosed please find a copy of the Spanish version of the EAC-B. Feel free to use it as you
wish, with, of course, appropriate citation. Good luck in your research.

Thank you for your interest.
Sincerely,

%%M

Robin A. Buhrke, Ph.D.

PSYCHOLOGY INTERNSHIP FULLY ACCREDITED BY AMERICAN PSYCHOLOGICAL ASSOCIATION

237

 

Appendix M
Results of Study based on Level of Behavioral and Cognitive

Acculturation

238

 

Level of Acculturation of Sample

WWW

Level of Acculturation (Scale 1), Almost half (48%) of
the sample was Slightly Anglo oriented Bicultural (M=2.7,
SD=.89). When Slightly Anglo to Bicultural and Strongly
Anglo oriented acculturation levels were combined, the rate
increased to 65% of the sample. The remaining 35% had
scores consistent with a Mexican orientation.

Marginality Scale (Scale 2), Approximately two thirds
of the sample were typified as Integrated Biculturals (62%).
The majority of respondents maintained themselves within the
Mexican and Anglo cultures. Less than one quarter were
Marginal (23%); they scored one half standard deviation
above the mean on each of the marginality subscales.
Fifteen percent scored as Traditional Mexicans, indicating
strong involvement in the Mexican culture (23.7; M=3.28,
§Q=.84) and less than average involvement in the Anglo
culture ($3.24; M=3.82, §Q=.57). With the Separation
typology, the percentage of people found to be separated
from the Mexican (3%), Mexican American (7%), and Anglo (2%)
culture was small. The percentages for the subtypology did
not add up to 100 percent, since they must meet multiple
typology and subtypology criteria. As a result, only a
small percentage of the sample meet criteria for a

subtypology (see Appendix B).

239

Table M1

WW

 

Number in
Study Sample % of Total

 

Type (N=60) Sample

Acculturation Level (Scale 1)
1.Very Mexican Orientation 7 12
2.Mexican Oriented to approxi—

mately Balanced Bicultural 14 23
3.Slightly Anglo Oriented

Bicultural 29 48
4.Strongly Anglo Oriented 10 17
5.Very Assimilated/Anglicized _Q _Q

60 100

Acculturative Types (Scales 1,2)

1.Traditional Mexican 9 15
2.Integrated 37 62
3.Marginal 14 23
4.8eparation 7 12
a.Mexican 2 3
b.Mexican American 4 7
c.Anglo 1 2
5.Assimilated (all types) 1 2

 

Note. Frequency and percentage numbers in acculturative
types do not add to 100%, because not everyone who meets
criteria for a major typology also meets criteria for a
subtypology.

240

In summary, behaviorally, this sample was primarily
Anglo-oriented (65%) and was integrated (62%) into both
cultures (see Table Ml). However, over one third of the
sample had a Mexican orientation (35%), with only 12%
identified as being Very Mexican oriented. When the AOS and
MOS scores were combined, 62% of the respondents were
Integrated Biculturals and 15% identified as Traditional
Mexican. Although the rate was low (7%), there was a
greater separation from Mexican American culture when
compared to Mexican (3%) and Anglo culture (2%).

v 1 n' iv R f r n f A l ' A - F

Individuals with scores below the mean of a cultural
construct (Familism, Fatalism, Folk Beliefs, Machismo, and
Personalismo) were identified as having a high level of
cognitive acculturation (Anglo oriented) on the subscales,
and scores above the mean were rated as having a low level
of acculturation on the construct (Mexican oriented).

An examination of the frequency distributions of the
subscales indicated that over half of the participants had
scores above the mean on the fatalism (62%) and familism
(53%)(see Table M2), indicating a Mexican orientation in
their beliefs or cognitions or a low level of acculturation
on these constructs. Less than half of the sample scored
high in Machismo (47%), Folk Beliefs (45%), and Personalismo
(45%). Overall, the percentages indicate that a large group

of participants still hold Mexican oriented beliefs.

241

Table M2

W

 

 

 

Cultural M of

Construct raw % above
(N=60) score SQ Range n mean
*Familism 6.83 2.02 0-12 32 53
*Personalismo 6.50 1.85 0-11 27 45
Folk Beliefs 6.15 2.86 0-14 27 45
Machismo 5.65 2.98 0-17 28 47
*Fatalism 3.80 1.54 0-8 37 62
R ° v l vior l A c l ura i n Lev

: 'l' E J! r l'

A one-way ANOVA was conducted using the four behavioral
acculturation groups as the independent or group variable
for each of the five cultural constructs on the MACC—SF, the
dependent variable. Significant differences were found for
familism (FAM; F=3.52, p=.02), Personalism (PERSON; F-3.34,
p=.03), and Folk Beliefs (FOLK; F-3.06, p=.04)(see
Table M3). A post hoc Tukey HSD test (p<.05) confirmed that
the differences were significant. The very Mexican Oriented
group had significantlyt higher means than the Strongly
Anglo Bicultural in the three cultural constructs (see
Table M4). The former group also differed significantly from

the Slightly Anglo Bicultural in Familism.

242

 

 

 

 

 

 

 

at. s O . ee e ; , .’ - -
Mean
Construct df Square E
Between groups
Familism 3 12.70 3.52*
Folk Beliefs 3 22.63 3.06*
Personalismo 3 10.26 3.34*
Within groups
Familism 56 3.61
Folk Beliefs 56 7.39
Personalismo 56 3.08
*p<.05
Table M4
U‘e. Q.Q2,. I- a '0 -ae lee',f a! ll - ‘9 ‘. 0
1t r n A l r i v 1
Cultural Acculturation Level
Construct
1 2 3 4
*Familism
M 60 7 14 29 10
M 6.83 *8.71* 7.29 *6.41 6.10*
SQ 2.01 1.60 2.55 1.59 1.85
Fatalism
M 60 7 14 29 10
M 5.65 4.71 3.79 3.55 3.90
SQ 1.54 1.60 1.48 1.50 1.66
Machismo
M 60 7 14 29 10
M 5.65 6.29 6.21 5.48 4.90
SQ 2.98 3.15 3.17 3.10 2.38
*Folk Beliefs
M 60 7 14 29 10
M 6.15 7.86* 7.07 5.93 4.30*
SQ 2.86 2.04 3.41 2.48 2.71
*Personalismo
M 60 7 14 29 10
M 6.50 7.71* 6.71 6.59 5.10*
SD

 

M_Q_i;,_e__L 1=Very Mexican; 2=Mexican oriented to balanced bicul-
tural; 3=Slightly Anglo to Balanced Bicultural; 4=Strongly
Anglo; 5=Assimilated/Anglicized

243

W

W Examination of the
behavioral acculturation by expectation ANOVAs reveals that
the four behavioral acculturation groups had lowexpectations
for the therapist to engage in self-disclosure (see
Table M5). A post hoc analysis using Tukey's honestly
significant difference (MSQ) procedure was performed on the
self-disclosure scale. Group 1, the very Mexican (M=3.91,
SQ;.85), and group 3, the slightly Anglo orientation to
balanced bicultural (M=2.11, SQ=1.28), were found to be
significantly different in the self-disclosure scale.
Although the results were not significant, the four
acculturation groups scored high on genuineness (M26.0),
indicating that they expected a therapist to be genuine and
sincere. The means ranged from 6.33 to 6.62 with group 1,
the very Mexican group (M=6.62, SQ=.73), having the highest
scores. Group 2, the Mexican oriented to approximately
balanced bicultural (M=6.45, SQ=1.15), had scores between
the other three groups; and groups 3 and 4, slightly Anglo
oriented bicultural and strongly Anglo oriented,
respectively, shared the lowest mean (M=6.33, SQ=1.17) for
genuineness.

The very Mexican (M=6.04, SQ=.60) and the slightly
Anglo oriented bicultural (M=6.13, SQ=.85) respondents had
the highest expectancy scores in the responsibility scale

(making their own decisions). The Mexican oriented to

244

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245

approximately balanced bicultural expected the therapist to
be trustworthy (M=6.05, SQ=1.35). The slightly Anglo
oriented bicultural participants scored highest in
responsibility (M=6.13, SQ=.85), with the very Mexican group
having scores that were slightly lower (M=6.04, SQ=.60). Low
expectancy scale scores (<4.0) indicated weak expectations
for attractiveness (M=3.63, SQ=1.18), acceptance (M=3.97,
SQ=1.20), and tolerance (M=3.97, SQ=1.15) by the strongly
Anglo oriented respondents. Respondents in the slightly
Anglo oriented bicultural had a low expectation that the
therapist would be directive (M=3.21, SQ=1.44). With the
exception of the very Mexican group, respondents had low
expectations that the therapist would have empathy (M ranged
from 3.15 to 3.83, SQ ranged from 1.32 to 1.81).

Examination of the ANOVAs on the three factors
(Expectations of Personal Commitment, Expectations of
Facilitative Conditions, and Expectations of Counselor
Expertise) revealed no significant differences among the
behavioral acculturation groups. The slightly Anglo oriented
bicultural group revealed a low mean (<4.0) for the
Counselor Expertise (M=3.67, SQ=1.12) factor. There were no
high expectancy scores (26.0) for any of the expectancy
factors.

W... A one way ANOVA was
also calculated using the acculturation groups derived from

the MACC-SF. A post hoc analysis using Tukey’s honestly

246

significant difference procedure was performed whenever a
statistically significant interaction was discovered. The
groups were defined by the number of high scores (above the
mean) respondents had in the five cultural constructs,
ranging from no high scores on any scale (0) to high scores
in all of the scales (5). Higher scores indicated a Mexican
orientation in beliefs or cognitions. Significant
differences were found for 3 of the 17 expectancy scales
(see Table M6). Respondents with low scores on all of the
five constructs (group 0, Assimilated/Anglicized; M=3.17,
(SQ=1.56) were significantly different from individuals
scoring low on none of the constructs (group 5, Very Mexican
oriented; M=5.52, SQ=1.06) in acceptance (F=2.40, df=5.59,
p=.049). The Mexican oriented group had higher expectations
for the therapist to think of them as worthwhile. The
expectations for tolerance (F=3.67, p=.006) were found to be
significantly different between group 0 (Assimilated/
Anglicized; M=3.50, SQ=1.94) and group 5 (Mexican oriented;
M=5.73, SQ=1.12) and between group 3 (Slightly Anglo
oriented bicultural; M=3.83, SQ=1.11) and group 1. The
scores reveal that expectancy for tolerance from the
therapist was stronger for groups that held low scores in
one or two of the cultural constructs, indicating a more
Anglo oriented belief system. Although the empathy scores
were low, Group 1, the Mexican oriented group (M=4.64,

SQ=1.59) had significantly higher scores in the empathy

247

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248

Table M6 continued

M931L Groups are: 0=Very Mexican oriented (low scores on
none of the cultural constructs (Familism, Fatalism,
Personalismo, Machismo, and Folk Illness/Beliefs; 1=Mexican
oriented (low scores on 1:5 cultural constructs); 2=Mexican
oriented to approximately balanced bicultural (low scores on
2:5 cultural constructs); 3=Slightly Anglo oriented
bicultural (low scores on 3:5 cultural constructs);
4=Strongly Anglo (low scores on 4:5 cultural constructs);
5=Assimilated/Anglicized (low scores on all five cultural
constructs). ***Factors: None were significant--Personal

Commitment, Facilitative Conditions, and Counselor
Expertise.

scale (F=3.04, p=.017) when compared to group 5, the
Assimilated/Anglicized respondents (M=1.78, SQ=.40).
E E i E NET 5 .

W The predicted
positive relationship between acculturation level and
expectations about MFT services was partially supported. The
measure of acculturation (behavioral, cognitive, and
integrated) did make a difference in the number and the type
of expectations that were found to be significantly related.
The respondents in the sample had low expectations for the
therapist to engage in self-disclosure and high expectations
for the therapist to be genuine when it was based on
behavioral acculturation. When the cognitive acculturation
measure was examined, the only consensus across
acculturation groups was the low expectation for the

therapist to be empathetic.

249

We. Although

expectations for self-disclosure were low across grouops, a
significant difference was found between the “very Mexican”
group and the “slightly Anglo to balanced bicultural” group,
with the former having higher expectations than the latter
group. Significant differences were not found, but the
expectancy mean for the therapist to be genuine increased as
respondents became increasingly Mexican oriented. Two other
expectations that had means over 6.0 but were not
significantly different from other behavioral acculturation
groups were (a) responsibility in the very Mexican and
slightly Anglo to balanced bicultural groups and (b) trust—
worthiness in the Mexican oriented group. Another
interesting finding that did not reveal any significant
differences was the high number of low expectations in the
Strongly Anglo group that included attractiveness,

acceptance, tolerance, empathy, and the nurturance factor.

250

Table M7

 

 

 

- e e" -,ge_ f, r e :- .eV' . . e een V‘
Warm
Counseling
Type of Acculturation (%)
A2 DF P
Used NoUse
Behavioral:ARSMA—II 6.77 3 .079
Very Mexican oriented 0 11.7
Mexican oriented to
approx. bal. bicult. 10.0 13.3
81. Anglo to bicult. 23.3 25.0
Strongly Anglo 10.0 6.7
Assimilated/Anglicized 0 0
Total 43.3 57.7
Cognitive:MACC-SF 10.80 5 .056
Very Mexican oriented 0 10.0 '
Mexican oriented 10.0 5.0
Mexican oriented to
approx. bal. bicult. 11.7 11.7
$1. Anglo oriented 10.0
bicultural 15.0
Strongly Anglo orient. 5.0 13.3
Very Assim./Anglicized 1.7 6.7
Total 43 3 56.7

 

Mote. Behavioral Acculturation scores from the ARSMA-II and
Cognitive Acculturation scores from the MACC-SF.

251

Table M8

 

 

 

‘ o u. oo- .10 on or .9 u - v - e
h v n A r n N:
Counseling
Type of Acculturation (%)
A2 DF P
Used NoUse
Behavioral:ARSMA-II 2.59 3 .459
Very Mexican oriented 0 11.7

Mexican oriented to

 

approx. bal. bicult. 5.0 18.3
$1. Anglo to bicult. 8.3 40.0
Strongly Anglo 5.0 11.7
Assimilated/Anglicized 0 0
Total 18.3 81.7
Cognitive:MACC-SF 0.293 5 .998
Very Mexican oriented 1 7 8.3 -
Mexican oriented 3.3 11 7
Mexican oriented to
approx. bal. bicult. 3.3 20.0
81. Anglo oriented
bicultural 5.0 20.0
Strongly Anglo orient. 3.3 15.0
Very Assim./Ang1icized 1.7 6.7
Total 18.3 81.7
Note. Behavioral Acculturation scores from the ARSMA-II and

Cognitive Acculturation scores from the MACC-SF.

252

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253

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