North Texas firm fills a void as mental health provider for the Hispanic community

For Ana Marcela Rodríguez, an immigrant from Mexico, finding a bilingual therapist in North Texas who understood her culture felt like a near-impossible task.

In Texas, where about 40% of the population is Hispanic, only about 15% of more than 6,000 recently surveyed mental health providers identified as Latino or Hispanic.

“That’s when I thought, ‘I can be that therapist for all those other people like me.’ And that’s how Therapy Works was born,” said Rodríguez, 37, now a licensed family and marriage counselor and founder of a mental health counseling company in North Texas that, through six clinics, provides bilingual and bicultural services for Latinos.

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“This was born from my necessity, but I was sure that a bunch of people were on the same page, looking for the same kind of help,” Rodríguez said.

Seeking mental health therapy has been a taboo topic among Hispanics for generations, with a historic tendency for people to believe there’s no need for counseling or that there is no time for it, Rodríguez said. But the pandemic and the increase in awareness of mental health on social media platforms has led to more Latinos looking for therapy.

The company started by Rodriguez is one small part of an effort to close the gap between their needs and the availability of Hispanic therapists.

A survey by the Texas Behavioral Health Executive Council showed that only 20% of the respondents offered mental health services in a language other than English.

Nationwide, there are about 5,000 Hispanic psychologists, accounting for only 5% of the country’s psychologists, according to census data published by the American Psychological Association. But 19% of the country’s population is Hispanic.

Growth

Rodríguez studied psychology with a specialization in education and development of children and teenagers. She practiced her career in her home country of Mexico until her family moved to the U.S., where her husband had a job opportunity.

In 2012 her family moved to Frisco. The cultural change and being homesick made her look for therapy for herself, and that’s when she couldn’t find a therapist who could speak Spanish and understand her culture shock and her experience as an immigrant.

A year later, she decided to enroll at Southern Methodist University and pursue a master’s degree to obtain her license as a therapist in Texas.

As she was finishing up the program and completing an internship, a new problem arose: She couldn’t find a clinic where she could practice in Spanish and focus her work on the Hispanic community.

Between 2014 and 2019, the proportion of facilities in the U.S. offering mental health treatment in Spanish declined by 17.8% — a loss of 1,163 Spanish-speaking mental health facilities, according to research conducted by the American Psychiatric Association.

After graduating and obtaining her license in 2017, she began seeing her first clients in a room subleased from other mental health care providers.

“I had to knock on many doors. I started my website, talking with community groups, churches and other places to gain the community’s trust,” said Rodríguez. “But most importantly, I had to explain what therapy was and how it works.”

Nury Márquez, 32, a licensed therapist born and raised in Zacatecas, Mexico, migrated with her family when she was a kid. This year, she opened her mental health clinic focused on Hispanics in Oak Cliff after completing her education at The University of Texas at Arlington and working with different local organizations that provide mental health care services to people of color.

Márquez understood when she was in her 20s that there are are thousands of people like her but not enough therapists who could understand their experiences.

Márquez named her clinic Papalotl, which means butterfly in Nahuatl, the language of the Aztecs, to represent her culture and honor her indigenous ancestors.

“Representation of other therapists in the field of mental health is so important because there are certain things that you don’t have to explain to them because they understand that’s part of your culture,” Márquez said. “It’s deeper than the language. It’s very deeply rooted in the identity of individuals, and how much you feel understood just simply by talking to a person who looks like you.”

Rodriguez emphasized educating and helping the Hispanic community from the beginning, but she said it wasn’t until the pandemic hit that she noticed a big uptick in the number of Latinos seeking help.

Over 40% of Latino adults reported symptoms of depression during the pandemic, compared to 25% of white non-Hispanics, according to the Centers for Disease Control and Prevention.

“By the end of 2020 is when it really started to grow because there was a huge necessity from our community to seek help,” Rodríguez said.

As Rodríguez expanded her team, she sought to make sure everyone was fully bilingual and bicultural.

Now her team of 28 Latino therapists — 27 women and one man — are first-, second- and third-generation immigrants with family roots in Mexico, Puerto Rico, Peru, Colombia, Guatemala, Cuba and elsewhere. They serve about 1,500 clients, starting with children as young as 4.

“Their unique experiences and cultural backgrounds have helped us expand and serve our community,” said Diana Beltran, clinical operational director at Therapy Works.

Language and culture

Providing mental health therapy to the Latino community is not only about speaking their language. It is about understanding their culture and respecting their religious beliefs, said Beltran, 29, a licensed social clinical worker in Texas and Arkansas.

Working in non-Hispanic clinics, Beltran experienced how patients were often poorly treated because the therapists couldn’t understand their perspectives or family history.

“Our community has very different beliefs compared to the Anglo community. One example is the machismo culture,” she said. Historically, “we think it is OK for women to respect their husband even if he cheated and stay with him because that’s what we are supposed to do.”

“Another example is the belief of witchcraft to keep a person by their side, so when patients go and tell their therapist about those things, they don’t understand what the person is going through,” Beltran said.

The Therapy Works staff is trained to deal with those issues.

Márquez experienced similar situations when working in places that did not focus on the Latino community.

“Some people had a certain level of understanding of Spanish, but not even necessarily, that they were Latinx. So it’s a very different type of support that you can get from a person who has had similar experiences to you,” Márquez said.

The demand for bilingual therapy is expected to keep growing as the population of second- and third-generation children of Hispanic immigrants does, too. Therapy Works has experienced an increase of about 35% in younger clients: children and teens seeking therapy for anxiety and depression.

In Texas, the second largest increase in emergency department hospitalizations for suicide attempts was seen in the up to age 7 population, with a 29% increase from 70 hospitalizations per 100,000 population in 2016 to 92 hospitalizations in 2020, reported the Statewide Behavioral Health Coordinating Council this year.

Nationwide in 2021, there were about 2,900 suicides in youths ages 10 to 19, and 4,200 in 20- to 24-year-olds, showed a report by the CDC published this month.

When parents bring their kids in for therapy, the clinic explains that sooner rather than later parents will need to attend sessions, too, because having the whole family on the same page can be more effective, Beltran said.

“Commonly, we conduct the therapy in Spanish for the parents, and the sessions for the child or teenager are in English,” she said. “We want them to feel comfortable in the language they want to communicate in so we can help them.”

Beltran said that children and teenagers tend to be more open when the conversation with them is in English and in Spanish for the parents.

Future Latino therapists

Future Latino therapists who want to serve their community and keep promoting mental health awareness need help, too. Therapy Works has opened its doors to students who need to complete their internships before starting their careers and obtaining their licenses.

Texas licensing requires applicants to participate in internships and complete a certain amount of time working with a supervisor before being allowed to see patients on their own.

“Knowing that there are spaces like this, where you see that you can serve your community, the people who look like you, and you can make money, is amazing. You know you are in the right career,” said Pamela Espinoza, 32, who is one of seven people completing internships at Therapy Works.

Espinoza was born and raised in Peru and is graduating from LeTourneau University this fall with a master’s degree in mental health counseling.

She says understanding cultural backgrounds is the most important element when starting out with patients. But for Espinoza, it has been a challenge practicing all her theories in Spanish since her education is in English.

“Sometimes it is tough to make sense of the theories in Spanish, but in this place, everyone wants to help you,” Espinoza said. “Feeling welcome and knowing when I’ll obtain my license and be able to work either here or another place but for your community is priceless.”

Therapy Works also works closely with local organizations, organizing workshops about why therapy is necessary, how it works and how to find the right therapist.

“It’s called self-love. We need to normalize going to therapy and learn about the benefits for ourselves, our families and our community,” Rodríguez said. “We all have a role to play in society, but we must start with ourselves.”