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Article 87

Modismos

Mindfulness and the Importance of Language With Latin American Clients

Peter J. Economou, Marcela Farfan, Ana Maria Idarraga, and Vanessa H. Chafos

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Paper based on a conference presentation at the American Counseling Association Conference, March 12–15, Orlando, FL.

Introduction

For decades now in the West, the concept of mindfulness has been introduced and practiced; however, it has gained tremendous interest in the past 10 years. Mindfulness emphasizes attention and awareness of the present moment experience, purposefully and nonjudgmentally (Kabat-Zinn, 1994). As counselors, it is incumbent upon us to ensure that we are effective with our clients, no matter the theoretical orientation that is employed. One such way is through assessment of interventions. As a way to measure mindfulness, the Philadelphia Mindfulness Scale (PHLMS) has been shown to be a reliable and valid measure (Cardaciotto, Herbert, Forman, & Moitra, 2008). This research, and continued research, aims to bridge the gap between the efficacy of mindfulness interventions, the measurement of mindfulness, and implementing interventions with clients of Latin American descent.

Approximately 53 million Latin Americans (17% of the U.S. population) reside in the United States, making it not only the largest ethnic minority group, but also one of the fastest growing according to the U.S. Census Bureau (2015). While there are many terms to refer to those from Spanish-speaking countries, Latin American includes any person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish Culture or origin, regardless of race. Of the approximately 50.5 million respondents to the 2010 Census (16% of the U.S. population), three-quarters self-reported being of Mexican, Puerto Rican, or Cuban heritage, in that order (Arredondo & Cooper, 2014).

In an attempt to bridge the gap between the efficacy of mindfulness interventions and Latin American clients, Tejedor and her colleagues (2014) examined the use of the PHLMS scale with Spanish-speaking clients. The researchers were interested in assessing mindfulness and its integration into the mainstream of the West. Tejedor and her colleagues (2014) concluded that their Spanish version of the PHLMS was a valid measure of mindfulness with the Spanish-speaking sample (Tejedor et al., 2014). While their research confirmed the validity of their translated measure, we were still unsettled with the dialect of Spanish used in the translated PHLMS due to the difficulty our research team had interpreting the translation (Tejedor, 2014). Specifically, members on our research team are from Chile, Colombia, Cuba, and Peru. Our research team was debating over the use of soy and estoy (i.e., the verb to be).

Furthermore, there has been a gap in the multicultural literature with the use of evidenced-based interventions (Matsumoto, Yoo, & Nakagawa, 2008). This gap is further alarming as research has indicated that ethnic minorities may also be more vulnerable to emotion dysregulation in response to stress-related acculturation (Lee, 2013) and chronic experiences of prejudice and discrimination (Economou, 2011). More collectivistic cultures, such as those in the Latin American population, may be more susceptible to maladaptive stress coping mechanisms (Matsumoto et al., 2008).

Mindfulness and Latin Americans

For the Latin American population, mindfulness can be seen as a threat to their religious beliefs. Some Latin Americans are not completely comfortable speaking in English, and sometimes the values of psychotherapy are antithetical to those of the Latin American client. Latin American cultures tend to value a family's health more than that of its individual family members and may view a clinician’s suggestions for self-care—such as taking a short vacation alone—as selfish (Tejedor et al., 2014). Mindfulness-based approaches vary and include: mindfulness-based cognitive therapy (MBCT; Segal, Teasdale & Williams, 2002), dialectical behavior therapy (DBT; Linehan, 1993), acceptance and commitment therapy (ACT; Hayes, Strosahl, & Houts, 2005), and mindfulness-based stress reduction (MBSR; Kabat-Zinn, 1990; Kabat-Zinn, 2003). There are others, but this paper focuses on MBSR as it was translated into Spanish and utilized with the Latin American population.

Mindfulness Based Stress Reduction (MBSR)

Mindfulness-based stress reduction (MBSR) is a therapy based on Dr. Kabat- Zinn's model, originally developed to treat the chronic pain population (Baer, 2005). The program teaches mindfulness through body awareness exercises, sitting and walking meditation, and gentle hatha yoga. It is conducted in a group format for a period of 8 weeks including two-and-a-half hour sessions; the program also includes a one day session where participants practice all day. Each participant has an individual interview with the program instructor before and after the program. Daily at-home practice is required, and practice CDs are provided for this purpose.

Reducción de Estrés Basado en la Atención Plena (REBAP)

Reducción de Estrés Basados en la Atención Plena (REBAP) was adapted by Fernando A de Torrijos, who is currently the international coordinator for MBSR in Spanish. REBAP maintains the same structure as MBSR with some cultural considerations specific to the Spanish-speaking population such as “body movements” instead of “yoga” (Baer, 2005). Another clear example was how to translate the word “mindfulness” for REBAP. The word mindfulness has been translated to conciencia plena (Vallejo, 2006) and to atención intencional (intentional attention), atención enfocada (focused attention), conciencia del momento (awareness of the moment), presencia mental (mindfulness), atención vigilante (mindfulness), visión cabal (insight), atención consciente (mindfulness), and atención plena (mindfulness; Baer, 2005).This presented as one of the major difficulties in implementing REBAP with the Latin American population. None of these translations, itself, truly captures the full picture of what it means to be mindful. Another major revision that has been highlighted is to translate the word “yoga” to gentle stretching (estiramientos suaves) or body movements (movimientos del cuerpo) in order to prevent any challenges with the culturally Catholic Latin American population. As one can see, language plays a key role in implementing interventions with the Spanish-speaking population.

Modismos

Modismos illustrate the importance of language in the clinical relationship. Modismos can be defined as words, or a phrase (i.e., idioms), in which a meaning cannot be inferred from the words that compose an expression. They are a fixed expression whereby the meaning is not apparent, and these expressions can have a significant impact in the counseling relationship and implementation of interventions. Modismos are linguistic practices that allow individuals to condense an idea and transmit the concept to individuals who share the same dialect of a language (i.e., based on geography, such as the same city or country). Since modismos are not only based on the language, it is essential to consider the relationship between the modismo and its geographic location. With many Spanish-speaking countries in Latin America, the modismos cannot be understood even though the Spanish language is the shared language between many different countries.

The Spanish language is the uniting factor among persons of Latin American origin. Language is an important aspect that counselors should be sensitive about. The language has less to do with competency and more to do with the cultural meaning the Latin American population attaches to the language. For Latin Americans in the United States, Spanish can be a key component of their identity. It is important as counselors to be aware of the different idioms and dialects (e.g., modismos) used among the Latin American population. It is imperative to know and differentiate the words being used by clients. The use of these different words in the Latin American population is very common and, as such, the interpretation of the words and meanings varies between countries, cities, and towns of the same country. See Table 1 for specific examples of modismos.

Table 1

Examples of Modismos

Concientizate: Cultivating Awareness With the Spanish-Speaking Population

The purpose of this study was to validate the translation of the Philadelphia Mindfulness Scale (PHLMS) with the bilingual Spanish-speaking population mainly of Latin American descent by using the PHLMS scale both in English and two versions of Spanish. The previously translated PHLMS by Tejedor and her colleagues (2014) was based on Spanish from Spain, which is often quite different than Spanish from Latin American countries. A professional translator from South America was retained to translate the measure into Spanish more commonly spoken by the Latin American population (Fuentes, 2013).

Results

The sample included 65 bilingual individuals from Latin America. The majority of the participants were females (68%) and from South or Central America (56%). Other countries included other “Spanish-speaking region” (28%), Puerto Rico (8%), Cuba (5%), and Mexico (3%). Only 14% of the sample had been here for less than 10 years, whereas the remainder of the sample had been in the United States for more than 10 years or since birth. These findings would suggest that this sample is likely to be highly assimilated.

While there were some significant differences between the scores on the different PHLMS scales, the researchers determined that the differences were not statistically significant enough to warrant the development and psychometric testing of a new scale. That is, the correlation coefficients indicated that the measures were in fact measuring the same constructs. These correlations are discussed below (See Tables 2 and 3).

Table 2

Awareness

** Correlation is significant at the 0.01 level (2-tailed)

The PHLMS has two main subscales of Awareness and Acceptance. The subscales from the three different measures (i.e., the English version, the Spanish version from Spain, and the Spanish version from Latin America) were significantly correlated indicating that they were likely measuring the same thing.

Table 3

Acceptance

To highlight some of the item differences, the researchers performed an item analysis that found the language differences as follows (where the items were significantly different):

1. Item number 10. Tejedor- Me digo a mi mismo que no deberia tener determinados pensamientos (2.8) whereas Fuentes- Me digo a mi mismo que no deberia tener ciertos pensamientos (2.6). The Cronbach’s alpha was 0.487 and indicates that these items are not correlated.

2. Item number 20. Tejedor - Cuando aparece un mal recuerdo, intento distraerme para que se vaya (2.8) whereas Fuentes- Cuando tengo un mal recuerdo, intento distraerme para que se vaya (3.2). Again, here the Cronbach’s alpha of 0.598 suggests the measurement of different principles.

However, overall the subscales scores were highly correlated suggesting that both measures would suffice in measuring the level of Awareness and Acceptance of Spanish- speaking clients.

Conclusion

The Latin American population in the United States is the largest ethnic minority group (17% of the U.S. population), and it is also one of the fastest growing according to the U.S. Census Bureau (2015). While the Spanish language is the common denominator amongst those identifying as Latin American, there are significant differences in words and expressions used to express feelings and ideas (i.e., modismos). One major issue in implementing mindfulness with the Latin American population resides in the translation of the word mindfulness. There is no exact translation and no researcher has been able to fully capture its essence in the Spanish language even though there have been attempts. In fact, MBSR has been translated and employed with the Spanish-speaking population as REBAP. However, the Latin American population continues to struggle with practicing mindfulness in their daily lives (Matsumoto, Yoo, & Nakagawa, 2008). Findings from this study indicate that the use of the PHLMS would accurately measure the level of mindfulness of Spanish-speaking clients.