The Therapist
(January/February 2007)

Although the overall employment of counselors is expected to grow faster than average for all occupations¹, today’s job market continues to become increasingly competitive. Having skills above and beyond a Marriage and Family Therapist license, Intern registration or Masters Degree can make you stand out from the rest of the interviewees when applying for mental health positions or starting your own practice.

Within the border-states such as California, having bilingual abilities is increasingly becoming an enormous asset in obtaining a mental health position, as well as expanding your private practice clientele. According to the 2000 US Census Bureau Report, 40 percent of Californians speak a language at home other then English. Moreover, when discussing cities² with the greatest number of non-English speakers, California holds three of the top six. In fact, currently there are over 200 languages spoken and read in California.³ Research indicates that Hispanics will constitute 50 percent of California’s population by the year 2040 and 25 percent of the U.S. population by 2050.⁴ Regardless of opinion as to border issues, the fact is California houses many different cultures and languages. Being able to work with the growing population of non-English speakers opens the door to various jobs, especially in the bigger cities and within the government and social services arena.

Discrepancies in Provider-Patient Communication
As reported by the University of California, California Policy Research Center⁵, many persons with limited English proficiency are unable to access health and mental health services due to language barriers. The report states that the health care field, in particular, has been criticized for failing to provide linguistically proficient care.⁶ Obviously, for mental health services to be effective, providers must be able to communicate with clients in ways that they can understand. Professionals who cannot communicate efficiently with a patient “run the risk of having their advice ignored, incorrectly diagnosing the cause of a problem, or failing to develop an appropriate solution.” It went on to say that “conducting an interview in English, when it is the client’s second language, may result in a more disorganized, withdrawn, or disturbed interview.” Such misunderstanding may lead to misdiagnosis and inappropriate treatment for a mental health problem, which then may lead to a lawsuit and/or a disciplinary action.

The ability for patients and providers to communicate with one another is essential. According to the United States Surgeon General⁷, this is especially true in the area of mental health “because mental disorders affect thoughts, moods, and the highest integrative aspects of behavior” which obviously needs to be communicated verbally. The Surgeon General stated that Hispanic Americans were the largest and fastest growing minority group in the United States and that about 40 percent of Hispanic Americans did not speak English very well. As very few providers identify themselves as Spanish-speaking, the results are that most Hispanic Americans have limited access to linguistically similar providers.

On CAMFT's www.counselingcalifornia.com website, out of the 8,000 therapists listed, only 5 percent speak Spanish or a form of the Eastern Asian languages. With 40 percent of Californians speaking a primary language other then English, and only 5 percent of the California therapists on www.counselingcalifornia.com speaking Spanish or an Asian language, it would seem that there is quite a demand for bilingual therapists. Arguably the majority of therapists on www.counselingcalifornia.com are in private practice and not working in social services, but you can nevertheless see the disparity in the numbers.

Job Opportunities Await Bilingual Therapists
The California Department of Mental Health (“DMH”),⁸ states that the linguistic capacity of the health care workforce will need to keep pace with the changes in ethnic and monolingual populations. The DMH reports that county mental health facilities are experiencing reoccurring challenges in attracting and retaining staff that are bilingual and bicultural, especially Spanish speakers. They also report that Asian, Russian, Armenian, Farsi and Arabic speakers are in short supply in large urban areas and in the Central Valley. Accordingly, many counties are looking for bilingual therapists, and positions remain open, unfilled and available.

According to Don Martinez, founder and managing partner of The Domar Group, a Bilingual Spanish/English Executive Recruiting agency, and a board member of the Latin Business Association, “within the next decade, one in four people in the workforce will be Latino.” In his capacity as a recruiter, he has noticed that the Fortune 500 and 1,000 companies are preparing to penetrate the bilingual market, and thus learning a second language, especially Spanish, “is necessary and a must.” Mr. Martinez further mentioned that “it is a challenge finding bilingual people in the health care field…and that finding bilingual talent is crucial and yet there is a huge shortage.”

Clearly there is a shortage of bilingual therapists in the mental health field, especially in California. The question then becomes, how does one become fluent in a second language if not already? There is a difference between simply educating oneself in a second language and becoming fluent enough to work as a bilingual health professional. There are two major ways one can become fluent in another language, classroom education and/or emersion.

Training Abroad-Emersion
Total emersion in a foreign country, and thus a foreign language, is a great way to become fluent in a second language. There are hundreds of language schools that specialize specifically in teaching professionals a second language for the purpose of expanding their business skills. For instance, www.linguaserviceworldwide.com and www.languageskillsabroad.com. Most programs last from a few weeks to a year, depending on the program and what you hope to accomplish. Clearly if you have taken previous courses in a second language, the time spent abroad will be minimized. Depending on the program one chooses, the cost can be minimal to extreme.

Assuming that an individual does not have the time or money to fly off to Spain for a summer just to learn a second language, there are some exciting new alternatives. Recently, some schools have had the foresight to recognize the changing times in California and have enacted programs to assist their students in becoming bilingual. For example, Alliant University rolled out a program in 2005, giving their students the opportunity to study abroad in Mexico City and to earn a Certificate in Latin American Family Therapy.⁹ When discussing this program with Concepcion J. San Jose, M.A., Graduate Advisor of Marital and Family Therapy Graduate Programs, she indicated that students in their California program can take a semester at the Mexico City campus, and the units would transfer towards their Masters Degrees. Of course the student would need to take transferable classes, but Alliant assists the student in determining such courses. While in Mexico City, Alliant places the student with a Mexican family so that he/she can be immersed in the Mexican culture and language, thus coming home with increased and viable bilingual abilities along with a semester of units.

Learning Spanish in the Classroom
Learning a second language through classroom instruction can be cheap and easy but not necessarily efficient. Assuming, however, that you did not learn a second language during high school and/or do not have the financial means or time to study abroad, with determination and practice, an individual can become bilingual in the classroom.

Most courses available on the market today are rooted in the “grammar translation method” which is helpful if taking the course for academic purposes, but not necessarily helpful in conversation. Therefore, we would suggest conversational language courses, which are offered through CD, the internet, and the classroom. Many community colleges and private classes have conversational language courses for a reasonable price. If you prefer the online and/or CD approach, there are numerous courses available, for instance: www.mylanguageexchange.com and www.pimsleurapproach.com. As mentioned above, simply sitting in a language class will not make you bilingual, however due diligence will.

In Summary
Some of you reading this article are rolling your eyes imagining taking on a second language in addition to running your practice, your social and family obligations, and life in general. However, this article isn’t intended to convince every therapist that he/she needs to learn a second language to succeed. This article is intended to educate trainees entering their careers, interns looking for jobs, and licensees looking to expand their horizon with the hard facts about bilingualism in California. The percentage of second language speakers in California is growing, will continue to grow, and if one is trying to expand job marketability, being bilingual is a sought-after trait. For instance, if a trainee took some Spanish courses in high school and college, now is the time to refocus those latent abilities. If you have the desire to travel or work abroad, utilize your time and learn a second language to expand your practice upon your return. Again, becoming bilingual is not easy, it takes time and dedication. But if you are looking for ways to expand your marketability…being bilingual will make you stand out from the crowd.

Catherine L. Godfrey, J.D., is a Staff Attorney at CAMFT. Cathy is available to answer members’ questions regarding business, legal, and ethical issues.

REFERENCES

¹ United States Labor Department. Occupational Handbook.
² Cities with populations over 100,000.
³ http://en.wikipedia.org/wiki/California#Languages
⁴ California Department of Finance. Race/Ethnic Population Estimates: Components of Change by Race, 1997.
⁵ Overcoming Language Barriers to Public Mental Health Services in California. 2005. Written by Joan R. Bloom, Mary Masland, Crystal Keeler, Neal Wallace, and Lonnie R. Snowden, PhD.
⁶ California Little Hoover Commission Report, 2002.
⁷ Mental Health: Culture, Race and Ethnicity-1999 Executive Summary.
⁸ Workforce Education and Training 5 Year Strategic Plan Draft.
⁹ Universities and programs interested in developing similar opportunities for their students are invited to participate in the annual five week summer program or can arrange individual programs any time during the year. Included is an opportunity for students to participate in Spanish language training designed specifically for mental health workers. For more information, contact Jason Platt, Ph.D. at jplatt@alliant.edu.

This article appeared in the January/February 2007 issue of The Therapist, the publication of the California Association of Marriage and Family Therapists, headquartered in San Diego, California. The information contained in this article is intended to provide guidelines for addressing legal dilemmas. It is not intended to address every situation that could potentially arise, nor is it intended to be a substitute for independent legal advice or consultation. When using such information as a guide, be aware that laws, regulations and technical standards change over time, and thus one should verify and update any references or information contained herein.