Mejorando Matrimonios

Abstract

Researchers have indicated that Hispanic couples and families experience high rates of mental health issues; however, they tend to underutilize mental health services due to cultural and structural barriers. One potential vehicle to overcoming barriers to mental health treatment for Hispanic couples is through engaging in marriage and relationship education (MRE). MRE, an empirically supported educational intervention, has been found to be effective for Hispanic couples. However, proper application of MRE warrants cultural sensitivity. To this extent, the purpose of this article is to provide an overview of barriers to mental health treatment and suggest several cultural considerations when facilitating MRE for Hispanic couples.

Keywords

marriage and relationship education Hispanics couples

Hispanic families are the largest ethnic minority in the United States; estimates project that by 2050, Hispanic families will make up 29% of the U.S. population (Ennis, Rios-Vargas, & Albert, 2011; Passel & Cohn, 2008). As the number of Hispanic families increase, the underutilization of mental health services continues to be a growing concern (Gonzalez, 2002; Kouyoumdjian, Zamboanga, & Hansen, 2003). Specifically, several socioeconomic and cultural barriers such as poverty, literacy, and acculturation increase the risk of mental health problems for Hispanic families. Noteworthy disparities between need for services and utilization of services indicate the need to better serve the mental health needs of this growing population (Aguilar-Gaxiola et al., 2012). One potential vehicle to overcoming the utilization disparities is through marriage and relationship education (MRE), a skill-based group program designed to teach couples to build and maintain healthy relationships (Hawkins, Blanchard, Baldwin, & Fawcett, 2008). The purpose of this article is to (a) highlight the multitude of barriers Hispanic families experience; (b) provide an overview of MRE programs; and (c) discuss cultural considerations and recommendations when facilitating MRE programs with Hispanic couples. A case illustration is provided.

Barriers for Hispanic Families

Rapid growth in the Hispanic population has highlighted the discrepancies between mental health needs and utilization of services by Hispanic families. A number of factors contribute to underutilization, premature termination, and heightened attrition of mental health services by Hispanics (Kouyoumdjian et al., 2003). For example, Hispanics experience acculturative stress, or stress related to the process of adapting to a new living environment, due to their desires to maintain strong cultural identities, traditional values, and beliefs from home cultures while also attempting to acculturate to the host culture’s values and beliefs (Gomez, Miranda, &Polanco, 2011; Marin, Otero-Sabogal, & Perez-Stable, 1987). Researchers have indicated direct relationships between acculturative stress and psychological maladjustment, with higher acculturation to the host culture being associated with less psychological distress (Wu & Mak, 2012). Consequently, researchers have found that acculturative stress influences various mental health issues such as depression, anxiety, intimate partner violence, psychosomatic symptoms, suicidal ideation, martial distress, and occupational functioning (Caetano, Ramisetty-Mikler, Vaeth, & Harris, 2007; Kouyoumdjian et al., 2003; Smart & Smart, 1991). Despite the impact of acculturative stress and subsequent mental health concerns, researchers have found that many Hispanics avoid treatment stating that they do not feel that mainstream mental health services adequately address their specific needs (Aguilar-Gaxiola et al., 2012). Furthermore, those who do utilize services report being dissatisfied and often terminate treatment after the first session (Kouyoumdjian et al., 2003). Factors that contribute to dissatisfaction with mental health treatment may be due to various cultural and structural barriers that impede Hispanic families from receiving services.

In a study conducted by Uebelacker and colleagues (2012), minority participants reported stigma associated with mental health, fearing discrimination, public exposure of their personal information, and a general mistrust of others as reasons for being hesitant to utilize counseling services. Many Hispanic clients eschew mental health services due to these same cultural barriers including cultural stigma and negative perceptions of mental health services (Aguilar-Gaxiola et al., 2012; Anglin, Alberti, Link, & Phelan, 2008). Gender and age may also contribute to an increased sense of perceived barriers, especially from elderly Hispanic clients and Hispanic clients who are more likely to identify with traditional values, which imply that seeking help is for the weak (Barrio et al., 2008; Uebelacker et al., 2012).

Besides cultural barriers, Hispanic families seeking treatment must also overcome external or structural challenges such as accessibility to services and language proficiency. For example, from 2009 to 2010, the number of Hispanics in poverty increased from 12.4 million to 13.2 million (DeNavas-Walt, Proctor,&Smith, 2011). In addition, there is a widely held belief within the Hispanic population that the economic downturn has had a greater effect on them than on other American groups (Taylor, Lopez, Velasco, & Motel, 2012). Therefore, it is not surprising that Hispanics often cite financial concerns as reasoning for not seeking individual or family counseling (Barrio et al., 2007; Uebelacker et al., 2012). Furthermore, challenges facing Hispanic couples are not limited to insurance fees and health care costs; challenges may also include the need to find affordable childcare, arrange for transportation by planning bus route schedules, and arranging work schedules. Kouyoumdjian, Zamboanga, and Hansen (2003) stress the existing relationship between socioeconomic disadvantages facing Hispanics and higher levels of stress and depression. Therefore, financial stressors not only impede motivation for treatment, but they also highlight the increased need for treatment.

Another structural barrier facing Hispanic couples are language differences coupled with the lack of Spanish-speaking helping professionals. Hispanics with limited English proficiency are less likely to seek treatment than non-Hispanics or their English-speaking counterparts (Fiscella, Frankls, Doescher, & Saver, 2002; Sentell, Shumway, & Snowden, 2007). Kim and colleagues (2011) note that due to the importance on communication in counseling, language barriers have significantly contributed to the disparity in mental health treatment. Likewise, researchers (e.g., Cardemil et al., 2007; Dingfelder, 2005) indicate that Hispanics tend to feel more comfortable with Spanish-speaking helping professionals; highlighting that even when English language is fluent, Hispanics often express themselves with more clarity and detail when speaking Spanish.

In sum, the growing Hispanic population coupled with the underutilization and high attrition rates for Hispanic clients in mental health services highlight the importance of tailoring mental health interventions to meet the needs of this population (Cardona &Softas-Nall, 2010; Garza & Watts, 2010; Yamada & Barrio, 2010). Understanding the previously mentioned structural and cultural barriers to treatment (e.g., language barriers and acculturative stress) will assist helping professionals in providing effective services. Additionally, developing an understanding of core cultural Hispanic values would further strengthen a helping professional’s effectiveness. The following section provides an overview of salient cultural values to consider when working with Hispanic families.

Hispanic Family Values

Although there is considerable diversity within the Hispanic culture, a few key values tend to be universal for Hispanic families including familismo, respeto, and personalismo. An understanding of these terms may be beneficial in conceptualizing traditional gender roles and acculturation issues that may influence relationship dynamics in Hispanic couples. Furthermore, an understanding of these values can aid relationship educators in adopting a culturally sensitive approach in their work with Hispanic couples.

Familismo

Family represents a fundamental value for Hispanics. Much of the Hispanic family literature describes familismo, the belief that family and family unity are of the utmost importance, and a central component of Hispanic life (Ayón, Marsiglia, & Bermudez-Parsai, 2010; Castro et al., 2007; Davila, Reifsnider, & Pecina, 2011; Sue & Sue, 2008). Hispanics tend to place high emphasis on family loyalty, relationships, collectivism, and interdependence. Furthermore, it is common for Hispanics to live with extended family (Sarkisian, Gerena, & Gerstel, 2006). Scholars have suggested that familismo in counseling may be beneficial for couples in distress by strengthening social support, providing a motive to seek treatment, and by serving as a protective factor against significant marital distress (Ayón et al., 2010; Castro et al., 2007; Chen, Gance-Cleveland, Kopak, Haas, &Gillmore, 2010; Davila et al., 2011; Garza & Watts, 2010). On the other hand, familismo may contribute to a sense of obligation and responsibility to extended family, which can contribute to increased amounts of stress for couples (Sarkisian et al., 2006). Either way, familismo significantly affects the health and stability of a Hispanic relationship.

Respeto

Like familismo, respeto (translated respect) is another Hispanic family value that affects relationship health. Respeto denotes the traditional perception of hierarchal authority among Hispanics (Garza & Watts, 2010). For example, traditionally, fathers are seen as the primary authority figure in a family, gender roles are more restrictive for women than men, obedience among children is highly emphasized, and the authority of a health care provider is rarely challenged (Gurman& Becker, 2008; Sue & Sue, 2008). Relationship educators and counselors are encouraged to understand these deeply embedded cultural values as one may unknowingly violate cultural norms when working with Hispanic couples. More specifically, if a couple perceives that a counselor is showing una falta de respeto (lack of respect) conflict may arise in session. An example may be if a male figure perceives that an agency or helping professional is replacing him as el hombre de la casa (the man of the house) or believes that expressing emotions in an open setting would be a threat to his manhood (machismo). Therefore, it is critical for counselors to be aware of the importance of respeto, to decrease the likelihood of resistance and increase client rapport and trust.

Personalismo

In addition to familismo and respeto, it is important to know that Hispanics place a higher emphasis on personal relationships as opposed to impersonal or formal relationships (Añez, Paris, Bedregal, Davidson, & Grilo, 2005). Personalismo refers to an emphasis placed on social caring and congeniality for others and strongly affects Hispanics perception of others (Añez et al., 2005). According to Gloria and Peregoy (1996), Hispanics tend to perceive persons who honor, support, and care for their family as being more valued than persons who possess wealth or other material goods. Given that personalismo is a central component to Hispanic social interactions, it is likely that Hispanic clients would inquire about the helping professional’s personal life, which may result in feelings of discomfort for the professional. Helping professionals are encouraged to consider the deeply held value of personalismo, especially when facilitating MRE groups and working with Hispanic couples.

Confianza

By understanding and acknowledging cultural values such as familismo, respeto, and personalismo, relationship educators have increased propensity to establish confianza (trust), which is a necessary component to establishing an effective working alliance with Hispanic clients (Gloria & Peregoy, 1996; Gloria & Rodriguez, 2000). Moreover, the literature suggests that establishing confianza helps participants and clients feel more at ease and comfortable with discussing sensitive issues such as marital stress or depression (Uebelacker et al., 2012). In sum, consideration of cultural values is imperative to successfully engage Hispanic couples in services. However, barriers to seeking traditional mental health counseling remain. We believe that engaging Hispanic couples in marriage and relationship education, as a vehicle to strengthen their relationships, helps to establish confianza and aids helping professionals in overcoming the remaining barriers to treatment. Therefore, the next sections of this article include an overview of MRE and its application with Hispanic couples.

MRE: Tools for Overcoming Barriers

Given the barriers to traditional mental health services coupled with the strong family values of many Hispanics, we believe that MRE is a vehicle to overcome barriers and better serve the needs of Hispanic couples. MRE is a psychoeducational intervention designed to help couples strengthen their relationships and avoid potential relationship dangers (Hawkins et al., 2008; Markman & Rhoades, 2012). Specifically, MRE focuses on teaching prevention and remediation tools to couples to decrease marital distress and increase effective communication and conflict management skills (Hawkins et al., 2008; Markman & Rhoades, 2012). In comparison to traditional couples counseling which often addresses concerns that are more intimate with an individual couple, MRE is typically offered to groups of couples and is guided by a structured curriculum. Although the group format of MRE is not comparable to couples counseling, researchers (e.g., Blanchard, Hawkins, Baldwin, & Fawcett, 2009; Hawkins et al., 2008; Hawkins, Stanley, Blanchard, & Albright, 2012; Markman & Rhoades, 2012) support MRE as an effective intervention in improving outcomes such as communication and martial satisfaction when compared to control groups.

While cultural values may be barriers in traditional treatment, they may be less so in MRE. For example, MRE is a preventative and educational intervention compared to couples’ counseling, which is perceived as a more personal remedial intervention. Given that a primary barrier to seeking mental health services is lack of confianza and negative stigma, MRE’s nonclinical presentation may make it an attractive alternative to traditional care as it coincides more readily with Hispanic family and cultural values. While formal couples counseling is done on an individual basis, MRE is typically conducted like a class, in group settings with multiple couples and a few relationship educators, giving participants a greater sense of personalismo and familismo. Furthermore, clergy often facilitates groups in community churches; given the rich religious traditions of many Hispanics, church locations may strengthen Hispanic couples’ trust and comfort in the group. Additionally, group settings of MRE workshops may offer couples a sense of universality, normalizing their struggles and experiences, decreasing stigma, and increasing personalismo and confianza in the relationship educators and other group participants.

Additionally, the workshop-style format of MRE may alleviate some of the financial burden for Hispanic couples. MRE educators typically provide services at lower costs than individual counseling sessions due to their ability to work with a number of couples in a single session. In addition, federal and state policy makers have allocated funds for the use of MRE with low-income couples, which enables many institutions to offer services for free (Hawkins et al., 2008). Participants in the MRE may also receive incentives, such as gift cards, meals, and childcare services to keep them motivated, engaged, and provide them with practical solutions to potential obstacles (e.g., child care). Moreover, researchers (e.g., Markman & Rhoades, 2012) have argued that for every dollar invested into helping couples attend MRE programs, participants will save many more dollars in health care costs, fees from divorce, child behavioral concerns, and work loss. In addition to high costs of couple’s therapy, language barriers have commonly impeded Hispanic couples from seeking mental health services. To address language barriers, many of the major MRE programs are available in both English and Spanish. For example, variations of the popular Preventative Relationship and Enrichment Programs curriculum have been translated into Spanish, helping Hispanic participants to express themselves, communicate, and share with more ease.

Although empirical research has not been widely conducted to determine the effects of MRE for Hispanic couples, preliminary empirical support has been promising. Daire and colleagues (2012) conducted a qualitative study to increase understanding on the effectiveness of MRE with Hispanic couples. Results indicated that participants felt increased levels of calmness and communication within their households after the completion of an MRE course (Daire et al., 2012). Additionally, Hawkins, Blanchard, Baldwin, and Fawcett (2008) suggest that there is evidence that MRE is effective with diverse and Spanish-speaking populations, and further research should be conducted to increase the validity of these findings. In sum, initial research on the use of MRE with Hispanic couples coupled with translated Spanish curricula, cost-effectiveness, and safety in group settings highlights the potential for MRE to overcome traditional barriers for Hispanics seeking mental health treatment. However, our experiences using the MRE curricula with the Hispanic population have revealed several cultural considerations not noted elsewhere in the literature. Therefore, the remainder of this article aims to discuss cultural considerations in order to maximize effectiveness when facilitating MRE workshops with Hispanic couples.

Cultural Recommendations for MRE

Adapting any curriculum for use with another culture is complex; therefore, challenges in cross-cultural adaptation of MRE are expected. Although the following is not an exhaustive list of cultural recommendations for facilitating MRE workshops with Hispanic clients, we have identified four areas we believe are crucial in the successful implementation of MRE: (a) language translation; (b) literacy; (c) acculturation; and (d) domestic violence screening. A description of each cultural recommendation follows.

Language

Several linguistic and semantic challenges exist when translating relationship education materials from English to Spanish; therefore, it is imperative for MRE facilitators to be sensitive to differences and trustworthiness of translation of values and meanings across languages. For example, translating the name for a concrete object such as the word “pencil” from English into Spanish may be done with ease; however, translating abstract concepts such as power, respect, or trust are not as simple (Altarriba, 2003). Other language considerations include understanding that Spanish words that label emotions have more contextual considerations than English words (Altarriba, 2003; Altarriba & Basnight-Brown, 2011). Specifically, Spanish speakers describe mental health symptoms in more physiological terms than do non-Spanish speakers (Edgerton & Karno, 1971; Unützer, Schoenbaum, Druss, & Katon, 2006). Therefore, a Hispanic client may be more apt to describe depression by stating its physiological symptoms such as feeling lethargic, experiencing body aches, hypersomnia, or loss of appetite. According to Santiago-Rivera (1995), these contextual and semantic nuances in language have led to misunderstandings and misdiagnoses between helping professionals and Hispanic clients, such as solely treating physical symptoms and failing to understand cultural differences in how clients are describing mental health issues. In MRE curricula, the wrong choice of words could evoke unwarranted emotional reactions from participants or misunderstandings. For instance, one curriculum translates the word compromiso to mean relational commitment. However, depending on cultural dialect, compromiso can also mean an appointment, a compromise, or an engagement to get married. Therefore, relationship educators are encouraged to carefully select an accurately translated curriculum and allow participants to speak in the language and dialect that is most familiar to them.

One strategy for addressing the dilemma of language translation is by coconstructing a shared language within each MRE session. For example, when starting a new section in the relationship curricula, relationship educators could begin by asking the participants to define specific terms. More specifically, before starting the section of the relationship curricula about commitment, relationship educators could begin by asking participants to share their meanings and definitions of the word compromiso. Successively, relationship educators could use visual aides to represent the participants’ interpretations while contributing their own thoughts with the intention of moving the definition of compromiso toward the meaning held in the curriculum. This discussion allows participants to deepen their understanding of common words and have shared meaning with other group members, help educators avoid misunderstandings due to language, and involve participants in attaching personal meaning to the relationship curricula.

Literacy

In addition to language proficiency, education and reading literacy is another consideration when working with Hispanic couples. MRE often engages participants with workbooks and power point slides. However, researchers have reported that Hispanics have lower literacy scores, higher high school drop-out rates, and are less likely to complete a college degree when compared to their White and Black counterparts (National Center for Education Statistics, 2003). Therefore, for many Hispanics, reading from a workbook or viewing power point presentations may provoke feelings of shame or discomfort. Due to a lack of self-efficacy in literacy skills, MRE participants may appear to be disengaged or distracted in the group, when in reality they may not be able to fully understand and follow the presentation. Relationship educators are encouraged to assess for reading literacy through asking participants to complete short confidential surveys on their comfort and confidence in reading. Furthermore, during presentations, relationship educators should invite volunteers from the group to read workbook material rather than calling on participants individually.

Sociocultural Considerations

In addition to literacy, relationship educators are encouraged to consider acculturation and sociocultural differences between Hispanic cultures. Acculturation, defined as the transfer of culture from one group to another (Negy & Woods, 1992), influences language preferences, well-being, and increases risks of psychological distress (Santiago-Rivera, 1995; Wu & Mak, 2012). As noted by Negy and Woods (1992), acculturation influences traditional beliefs on several personally held values such as child rearing, marital interactions, and social support networks. Therefore, assuming universalism through statements on gender roles, social perceptions, or other curriculum values, without considering participants’ level of acculturation and subscription to behaviors and norms that are prevalent in the United States, may create unnecessary acculturative stress or confusion. Consequently, relationship educators are encouraged to consider values that seem normative from their worldview and reflect on how others may or may not uphold the same views suggested by them in the curricula.

Relationship educators are encouraged to address the topics of cohabitation, domestic violence, and literacy within the cultural contexts of the participants. Recently, leaders of MRE training have suggested that MRE curriculums should address cohabitation more directly in the curriculum (Markman & Rhoades, 2012; Rhoades, Stanley, & Markman, 2009), which is a reasonable request, considering the increasing trend of cohabitation. However, Hispanic couples’ perceptions on cohabitation vary between different Hispanic cultural groups as well as between majority groups in the United States. For example, for many Cubans, the concept of cohabitation has historical significance and is a common feature of relationships (Arias, 2001); likewise, many Puerto Ricans are typically more accepting of cohabitation than other Hispanics (Oropesa, 1996). Furthermore, for some Hispanic immigrants, cohabitation may have been the most reasonable option given the financial, political, and social implications of marriage in their native lands (Oropesa & Landale, 2004). Thus, given the complexity and diversity on topics of cohabitation, it is imperative for relationship educators to discuss these topics with respect and cultural awareness and through recognizing that the research cited in the relationship curriculum may not be applicable to all Hispanic or other minority couples.

In addition to cohabitation, the topic of domestic violence should also be approached within the cultural context of participants. Domestic violence is a complex and serious topic for all couples, with increased challenges for Hispanic couples. Vidales (2010) described the following barriers facing Hispanic couples experiencing domestic violence: (a) Hispanic victims may face language barriers, increasing stress and difficulty in seeking help, and understanding available resources; (b) Hispanic victims may struggle with leaving abusive relationships due to cultural beliefs such as familismo and respeto; and (c) Hispanic victims may be deterred from seeking services due to structural barriers, such as legal immigrant status, educational level, income level, and poverty level. Additionally, researchers (e.g., Kulkarni, Racine, & Ramos, 2012; Lewis, West, Bautista, Greenberg, & Done-Perez, 2005) noted that Hispanic victims of abuse tend to be young, struggle financially, have children in the home, use a narrow definition of domestic violence, and generally perceive domestic violence as a family concern rather than a social concern. Therefore, relationship educators are encouraged to take special care in describing the nature of domestic violence to participants, provide culturally sensitive examples, and keep a list of community resources that offer aid to Hispanic domestic violence victims.

In summary, relationship educators working with Hispanic clients face numerous challenges. Specifically, these challenges include working with social, cultural, and acculturative constraints. For many participants, the concepts presented in the MRE curriculum are novel and necessitate effort to understand appropriately. Given that most MRE curricula were originally created for the majority population in the United States, concepts and curricula need to be adapted to be culturally sensitive to aid in participant learning. Relationship educators must take into account cultural challenges inherent in translating a curriculum into Spanish and increase understanding of cultural relevance when discussing specific constructs or concepts. In order to illustrate how the specific cultural recommendations provided in this article may be applied in practice, a brief case illustration of a Hispanic woman who attended an MRE course is provided.

Case Illustration

Yolanda, a 24-year-old Mexican immigrant, learned about our MRE workshops from a visit to the health department. Yolanda and her two children have lived in the United States for the last 4 years. In the last few years, Yolanda has become increasingly concerned about her relationship with her boyfriend, José. Although Yolanda has felt a desire to pursue relationship counseling, she has never attempted to due to feelings of anxiety regarding her undocumented immigration status, a fear of what others might think, and confusion regarding how to initiate such services. Additionally, when Yolanda mentioned the MRE workshop to José, he became aggressive and lectured her about the importance of not “spreading their business” and he refused to attend the initial intake session. José’s aggressive demeanor raised concerns for the relationship educator; therefore, during her initial intake interview, the relationship educator conducted a brief domestic violence screening. Although no current domestic violence was reported, Yolanda did describe a childhood of abuse. However, she minimized these traumatic experience by choosing not to call it abuse, rather, that her parents were of “strong character,” particularly her father who was physically and verbally aggressive with Yolanda's mother, Yolanda, and her siblings. As part of committing to the MRE workshop, all participants were assigned to a Family Services Counselor (FSC) who offered case management services and brief counseling. In Yolanda’s case, the FSC also conducted routine inquiries regarding violence in the home. After the initial interview, Yolanda was assigned to a class specifically designed for individuals who would like to learn how to cultivate, protect, and stabilize their relationship. Although, José’ attended the FSC sessions, he agreed to only attend the MRE courses after he witnessed Yolanda’s experience.

Initially, Yolanda was very quiet and shy. However, as classes progressed, participants shared experiences and the relationship educators disclosed personal examples of their relationships; Yolanda increased her confianza. Other methods used to increase confiazna included having relationship educators and group members introduce themselves, having participants address the relationship educators by their first names, using open questions, and reminding participants that they too were still working on their own relationships and that no one has a perfect relationship. Yolanda also expressed relief when she was handed a Spanish workbook. However, at times, she had difficulty understanding some of the concepts and exercises. In order to ameliorate anxiety related to the workbook, relationship educators made it common practice to give participants more time than allotted in the curriculum to complete written exercises. During this time, the educators walked around room, noticing participants who were having difficulty writing things down or appearing to be disengaged and they offered personal assistance when needed. In addition, relationship educators made intentional efforts to dialogue with participants on their perspective of certain key terms in the curriculum to ensure that key concepts were understood within participants’ cultural contexts.

As Yolanda learned concepts regarding healthy boundaries in relationships and importance of safety in all relationships, she began questioning her parents’ relationship and expressing discomfort in realizing that theirs was not a healthy relationship to learn from. During one discussion, Yolanda realized that she had been a victim of childhood abuse and that quite often she did not feel emotionally safe in her current relationship. Resources were given to all participants as to avoid singling out anyone, and particular focus was given on information that would aid immigrants who were experiencing domestic violence. Moreover, Yolanda was moved by the discussion regarding the impact that relationship conflict may have on children. She committed to attempting to increase safety within her relationship and became motivated to engage in communication techniques with children as well as with her partner as to model this in her family.

By the last MRE class, Yolanda appeared especially empowered by the concept that she could make positive changes in her relationship. She stated that much of the stigma and concerns she had about engaging in psychological services had been alleviated by her experiences in the workshop. Additionally, she reported a desire to pursue further services, especially family counseling. Yolanda shared her gratitude openly with all participants and exchanged contact information. She stated that by using the strategies and tools taught in the course, conflict had decreased and positive communication had increased in her relationship with her partner. During this closing session, relationship educators allotted extra time for a graduation ceremony where participants requested to bring in additional food, desserts, and to take pictures as each received a certificate of completion. According to Yolanda, her partner appreciated the changes he witnessed in her, felt the tools taught in the course were helpful, and was enjoying their deeper conversations and quality time together as a couple. Furthermore, he agreed to attend the following workshop with Yolanda.

Discussion and Conclusion

Fortunately, such as in the case of Yolanda, many of the Hispanic participants of MRE report feelings of satisfaction and improvements in their relationships (Daire et al., 2012). However, oftentimes the barriers facing Hispanics prevent them from attending or truly engaging in MRE workshops. Therefore, it is important that relationship educators make considerable effort to help Hispanic participants overcome potential barriers. Through using an evidence-based Spanish curriculum and a personal nonstigmatizing workshop setting, Hispanics may have increased access to receive culturally sensitive education on healthy relationships.

In conclusion, in order to increase effectiveness and safety when facilitating MRE workshops for Hispanic couples, it is imperative to understand cultural considerations. Specifically, MRE facilitators are encouraged to (a) understand language barriers through increased sensitivity to semantics and accuracy of translating certain words and phrases; (b) demonstrate considerable efforts toward establishing confianza with group participants; (c) understand the role of family and key values such as familismo, respeto, and personalismo; and (d) recognize sociocultural concerns, such as immigration status, literacy, and perceptions of cohabitation and marriage. In sum, we hope that this article will serve as a resource and will better equip relationship educators to help Hispanic participants overcome the many challenges that may impede them from seeking appropriate treatment.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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