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O R I G I N A L P A P E R

Ethnoracial Gap in Clinical Practice with Latinos

Frank F. Montalvo

Published online: 8 November 2009

� Springer Science+Business Media, LLC 2009

Abstract People of color drop out of mental health

treatment after the first session significantly more often

than others. Social workers unfamiliar with the importance

of race and ethnicity in the lives of Latinos can contribute

to an ethnoracial gap in clinical practice. Implicit racial

bias is presented as a key element contributing to the gap.

The origin of phenotypes in Mexico and Puerto Rico pre-

pared Latinos to cope with discrimination and colorism in

United States. The influence of skin color on life chances,

the acculturation–assimilation process, and psychological

well-being are analyzed to identify problems in social

adaptation and integration into American society. The

critical incident interview is introduced to aid clinicians to

assess key events in client’s experience with race and

ethnicity. Examples of critical incidents are provided. The

author offers training goals to reduce practitioners’ implicit

racial bias and improve their estimates of phenotype. Five

recommendation are made to improve practice with Lati-

nos concerning psychosocial problems related to

phenotype.

Keywords Latinos � Phenotype discrimination � Implicit skin color bias � Colorism in family � Psychosocial adjustment � Acculturation–assimilation � Clinical practice � Training � Research

Introduction

Over 30 years ago practitioners in the United States

learned that in a large state sample, 50% of minority

patients, including Latinos, withdrew from mental health

treatment after the first interview (Sue and Sue 1977).

Ethnicity was a stronger predictor of termination than

education, income, language, and variety of services

received. A number of suspicious factors were offered to

account for the discrepancy, to include different beliefs

about what constituted mental illness, treatment, and

recovery. The prime suspect at the time remained con-

trasting lifestyles due to poor cultural fit between profes-

sionals and patients that were unique to each and emerged

during initial face-to-face contact. Cultural awareness

training began to address the gap in social work practice,

for example Montalvo et al. (1981), Green (1982), Ho

(1991), Aponte (1995), Kelley (1995), and Thornton and

Garrett (1995). Much of the training focused on Latinos’

traditional values, such as respect, dignity, interdepen-

dency, interactive style, and centrality of family and reli-

gion. Yet, some empirical evidence questioned whether

cultural match between therapist and client improved

treatment outcomes (Sue 1988). More recently, half of the

Latino clients still failed to return after the first session

(Fraga et al. 2004) (Comparison among studies is only

suggested, because research protocols differed).

I begin this review with some definitions of terms. I then

examine the impact of the ethnoracial gap on practice and

the source of implicit racial bias that affect the treatment of

Latino clients. My goal is to lay the groundwork for

improving the knowledge base, practice, and training of

non-Latino clinicians. Toward that end, the article: (a)

traces the role played by social and historical events in

creating skin color preference and shaping attitudes and

F. F. Montalvo

Professor Emeritus, Worden School of Social Service, Our Lady

of the Lake University of San Antonio, San Antonio, TX, USA

F. F. Montalvo (&) 3523 Green Springs Drive, San Antonio, TX 78247, USA

e-mail: ffmont@yahoo.com

123

Clin Soc Work J (2009) 37:277–286

DOI 10.1007/s10615-009-0241-1

relationships in Latino communities; (b) describes the

influence of phenotype on life chances, acculturation, and

psychological well-being to provide deeper understanding

of Latinos’ ethnic and racial reality; (c) presents an inter-

viewing technique to help practitioners identify key events

in the development of the client’s unique cultural and

ethnoracial identity; and (d) outlines two important training

goals for reducing clinicians’ implicit racial bias and

improving accuracy in estimating skin tone. Examples

from real-world events and experiences are cited through-

out. I conclude with five recommendations that will result

in more effective practice with Latinos.

Latino Clients, Phenotyping, and Colorism:

Some Definitions

This presentation drew primarily from research on the

Mexican–American and Puerto Rican experiences in the

United States. Mexican–Americans are the only indigenous

Latino population of some 20 groups from Latin America.

Puerto Ricans are second in size and share the native dis-

tinction by extension of their initial colonial and current

commonwealth status that grants them citizenship at birth.

The former emigrated from Mexico and the latter migrated

from Puerto Rico to this country. Both have similar His-

panic cultural roots and lineage, but their colonial history

and racial-cultural mix differed. Mexicans drew heavily

from Amerindian heritage in Mexico and American

southwest and Puerto Ricans tapped into African ancestry

in the Spanish-speaking Caribbean and urban experience in

United States. Terms like Chicano, Mexican–American,

Latino, and Hispanic, as with African American, black, and

Negro, reflect their time and use by the authors cited in this

article.

Skin color and phenotype are used interchangeably,

although the former is more common in the literature and

defines race as a social category. Phenotype includes other

physical features, such as hair color and texture, nose shape

and breadth, and shape and fullness of lips that encompass

both saliency of skin color and complex notions of race

held by the public, including Latinos. Case in point: The

five-by-five scale employed by Arce et al. (1987) used

degree of Indian and European appearance as well as

Chicanos’ skin tones from very light to very dark. Their

distribution of observed phenotypes was 26% Light Euro-

pean, 45% Intermediate, and 28% Dark Indian. Phenotype

distributions, however, vary by ethnoracial group.

I refer to phenotyping as the act of implementing social

policies that favored European features and light skin as

standards for judging physical appearance, and actions that

marked people for favorable or unfavorable treatment

based on skin color. The phenomenon is old; labeling it is

new. In response, minority groups used phenotype

standards in family socialization as a survival tool where

children were socialized to acknowledge skin color pref-

erence as a reality in their lives. The term colorism is

limited to this internalized form of bias, which developed a

life of its own and acted without the need for external,

institutional prompting. Colorism was familiar to African

American discourse, but was cited infrequently in the lit-

erature about Latinos. A distinction is made between

phenotyping and colorism to clarify their relationship and

focus on the practitioner’s role. For example, some reacted

to phenotyping in daily life as victims who may need help,

but as agents of colorism they became complicit in dis-

criminating against other Latinos and family members that

can call for more direct intervention.

The Impact of the Ethnoracial Gap on Practice

Making the case for the need to improve the relationship

between Latino clients and social workers, Longres (1991)

believed that much of the misunderstanding was related to

different world views that were complicated by status

inequalities and vestiges of prejudice and systematic dis-

crimination. Pizarro and Vera (2001) and Arredondo and

Toporek (2006) concluded that mental health counselors

were usually unfamiliar with Latinos’ concern over their

racial admixture. Abreu (1999) found race to be a signifi-

cant source of stereotyping and estrangement that occurred

during the first session with African Americans about

which white clinicians seemed oblivious. Latinos dropped

out of treatment when they sensed psychiatrists ignored

‘‘the implications of skin color on life experiences and

therefore cannot enter into patient’s frame of reference’’

(Atdjian and Vega 2005, p. 1602). Worker-client alienation

was apparent in countries with deep ethnic and sociopo-

litical divisions that transcend culture. For example, social

work training on cultural differences was insufficient to

overcome Israeli students’ admitted fear and antipathy

toward Palestinians during internships (Baum 2007). Fac-

ulty recognized that political history created social distance

that required specific address in training.

Preparing for cross-cultural practice is essential, but

bridging the gap between professional and client improves

when practitioners also see the world from the client’s

ethnoracial point of view. Skin color discrimination and its

manifestation in the ethnic family and community as col-

orism distinguished the life experiences of Latinos from

other Americans. Phenotype has been a constant in their

lives and a source of ambiguity and ambivalence (Mont-

alvo 1987). It was seldom considered in training and field

instruction nor reported in studies of acculturation (Berry

2005). Consequently, most clinicians have but passing

knowledge of Latinos’ experience with race and ethnicity,

278 Clin Soc Work J (2009) 37:277–286

123

which may have been much less forgiving in treatment

relationships than missing cultural cues.

The source of intergroup tensions was embedded in the

culture and social fabric and took shape in members’

socialization. Membership in white, middle-class, English-

speaking groups tended to be voluntary, exclusive, and

played a positive and symbolic role in their lives at little

social cost (Waters 1990). White, European immigrants

pointed with pride to having suffered prejudice, success-

fully assimilated, and played honored roles in ‘‘the

American immigration story.’’ Yet, they failed to notice

how easily they could shed (or trace) their ethnic origins.

Whiteness was a cherished attribute in the national culture

and tended to be seen as normative. As an assumed stan-

dard, it shielded many from being conscious of their race

and from an awareness of the role skin color played in their

lives. It allowed them to profess the virtues of being ‘‘color

blind’’ as they overlooked skin color as an issue that could

have adverse effects on others. On an interpersonal level,

evidence pointed to those who tried hardest to be color

blind seemed most uncomfortable during interracial con-

tacts and appeared to be the least friendly (Kawakami et al.

2009).

Growing up in an environment that valued one’s group

over others buttressed self-esteem with a sense of entitle-

ment. Attitudes and beliefs toward visible minority groups

were formed before children could rationally understand.

They became deeply held biases, which were intuitive and

impervious to challenge and change in everyday life.

Ingrained in ongoing perceptions, they often contradicted

the person’s own beliefs and egalitarian convictions and

festered as unrecognized, unresolved stress. The influence

of bias was minimized: Slips of the tongue, stereotypes,

ethnic jokes, racially tinged cartoons, profiling, and

arresting citizens who ‘‘look illegal’’ were declared to be

innocent, inadvertent, or justifiable acts. The disdain was

arrogant, the effects racist. Insults were felt deeply among

those who were uncertain about their ethnic group’s status

and agonized over whether slights were due to bigotry or

ignorance. By contrast, not being bothered every day with

consequences of ethnic and racial affiliation was a psychic

benefit derived from privilege.

The disparity between groups created misunderstanding

about racial matters each group regarded as salient: White

members in society focused on monitoring sometime fla-

grant acts of discrimination that threatened violence, and

less so on everyday taunts and ambiguous cues that

diminished self-worth (Salvatore and Shelton 2007). Even

racial epithets aimed to provoke them had little effect.

Trivializing slights that concern Latinos became with time

polarized opinions that widened the gap concerning social

justice (racial profiling and capital punishment) and public

policies (affirmative action and immigration).

Society’s dilemmas were also played out in the thera-

peutic setting. Practitioners have been taken aback by the

depth and intensity of Latino reaction to discrimination and

public’s insensitivity when they are unfamiliar with the

ethnoracial experience. They often attributed minority

protestations to hypersensitivity rather than to pent-up

frustration fixed in life histories. Some clinicians stub-

bornly held that race is peripheral to personality theories

and irrelevant to presenting problems. They were unaware

of changes in their demeanor when working with light and

dark-skinned clients and tended not to notice when feelings

that entered the relationship had racial overtones. They

insisted good practice is in itself culture-free and race

neutral, and said they were unconcerned about the color of

the client’s skin. The color-blind approach to practice led

clinicians to misjudge race as unimportant in the devel-

opment of client problems (Ridley 1995). In contrast, other

practitioners regarded race as too sensitive a subject to be

raised before a working relationship was well established

(Cardemil and Battle 2003). As a consequence, they talked

past clients who sought help with painful concerns over

how they looked. Partial skill, collective guilt, or over-

identification also undermined treatment of Latino clients

when practitioners were quick to attribute race as the

source of the problem and minimized the client’s contri-

bution to complaints and symptom etiology.

The Role of Social and Historical Events

Latino phenotypes did not originate in the United States.

The caste system in colonial Mexico was the subject of

paintings that depicted families’ social status in dress,

occupations, lifestyles, personal habits, and character

traits (Gárcia Saiz 1989). Las castas paintings were

shipped to Europe to provide a first glimpse of inhabitants

from the Americas. Indians were stereotyped as uncivi-

lized and passive, Africans as violent and lazy. Indians

could join members of the white caste through union with

Spaniards within three generations through a process that

prized European bloodline and was referred to as blan-

queamiento (whitening). Offspring of Spanish–African

unions could only revert to another African caste; even

after five generations some castes were labeled ‘‘throw

backs’’ (torna atras). Castes were a prominent feature of

colonial life and so widespread that they indicate

exploitation and conflict were due not to personal distaste

or natural antipathy, but to gaining economic advantage

and imposing social control over indigenous populations.

Slavery and castes were abolished in Mexico at the turn

of the nineteenth century. Mixed feelings linger as afro-

mexicanos are alternately obscured and celebrated as

Mexico’s third root.

Clin Soc Work J (2009) 37:277–286 279

123

A legacy of colonial preference for Spanish culture,

physical appearance, and language over Indian and African

heritage are layered within culture and semantic tradition

throughout Latin America. Colorism is at work when the

colonial myth of Spanish (white) superiority continues to

undermine Latinos’ self-regard, as when whitening results

in ‘‘improving the race’’ (mejorando la raza); when teasing

a fair-skinned Mexican–American with the label, huero/a,

is tinged with envy; when a misbehaving daughter is

admonished, ‘‘Stop acting like a black woman’’; and con-

tinues with the demeaning catch phrase, pelo malo (bad

hair), a Caribbean Latino reference to African hair texture

being coarse and unattractive. In defense, those who boast

having only Spanish blood are accused of hiding dark-

skinned relatives when they are asked, rhetorically, ‘‘And

your grandmother, where is she?’’

The remarks reflect the colonial past. Yet, pejorative

reference to race and skin color conflict with Latinos’ deep

respect for the dignity and worth of the individual

regardless of social status or bloodline. Sereno (1946)

referred to ‘‘cryptomelanism’’ as the self-deception among

Puerto Ricans involved in ‘‘hiding the color problem within

the self’’ (p. 265). He contended that as an outgrowth of

slavery, it was precisely the intensity of adhering to the

value of respeto that barred remnants of racial inequality

from public dialog and avoided racial polarization. This

accommodation, however, was undermined by persistent

deference to light-skinned Latinos in daily life and ideal-

ized claims of social harmony that resulted in ‘‘the pre-

judice of having no prejudice in Puerto Rico’’ (Betances

1972). Draining affect from disparagements allowed values

in conflict to be compartmentalized: By forcing the term

pelo malo out from its comfortable niche in the Spanish

language into English, the latent contradiction is exposed

in the ironic apology, ‘‘I didn’t mean it the way it soun-

ded.’’ It is important, then, for practitioners to understand

the customs and folklore about Indian ancestry, African

origin, and Spanish–European heritage as they take shape

in families and as ground for mainstream ethnocentric

attitudes to take hold in the United States.

The Influence of Phenotype

Life Chances

Skin color prejudice is more explicit in the United States.

Hunter (2007), and Montalvo and Codina (2001) for Lati-

nos, reviewed the extensive literature on phenotype’s effect

on life-chance goals related to class and status, such as

income, education, health, and prestige. An example of

early, groundbreaking studies includes relating skin color

to social class in a study of patients with diabetes

(Relethford et al. 1983). It revealed that Mexican Ameri-

cans’ skin tone became progressively lighter in San

Antonio, Texas, as they moved from low-income barrios

through transitional neighborhoods to affluent suburbs.

Incidence of diabetes decreases with rise in social class and

was associated with family history, diet, and lifestyle.

Massey and Mullen (1984) reported skin color was related

to residential segregation among Hispanics, which limits

contacts and shared experiences in the community. Arce

et al. (1987) found dark Chicanos had less education and

income and cited more incidents of discrimination than

lighter cohorts. Moreover, skin color discrimination in the

United States is more pervasive than previously thought:

Hersch’s (2007) survey of immigrants from foreign coun-

tries found those with light skin earned 15% more income

than darker newcomers.

Acculturation, Assimilation, and Skin Color

Skin color difference is a pivotal factor in Latinos’ accul-

turation and assimilation into American society. The

melting pot was a turn-of-the-century metaphor for the way

homogeneous societies develop by melding the cultures of

Europeans and Americans into a new national identity.

Instead, standard practice had immigrants learning the

American way as their foreign manners and languages

melted away. The process was called Anglo conformity by

Gordon (1964) in his classic work, Assimilation in Amer-

ican Life: The Role of Race, Religion and National Origin.

The melting pot metaphor seems dated, but Anglo con-

formity retains its mythic power to influence nativistic

attitudes and immigration policy.

Individual acculturation is a complex cognitive, psy-

chological, and sociocultural process when asymmetrical

relationships exist between groups in society (Anderson

1991). Race and ethnicity intersect in Latino neighbor-

hoods and emerge as construct ethnoracial realities that

resulted from society’s attitude towards skin color and

minority status. The communities usually functioned

within a numerically larger collective with distinct resi-

dential boundaries and ethnic markers that protected as

well as isolated members. Ideal bicultural integration

depended largely on one’s ability to learn the language,

profess loyalty, and internalize values of the prevailing

culture while retaining local support, native language,

religion, values, and ethnic persona as the core cultural

identity. It defined the elusive requirements for cultural

pluralism. Children formed nascent Latino-American

identities as they learned interdependence and placed the

needs of the tightly knit family ahead of their own while in

the process they negotiated values of independence and

rugged individualism with mainstream members. Latinos

adhered foremost to their cultural identity, and rejected

280 Clin Soc Work J (2009) 37:277–286

123

race as a threat to their ethnic-group consciousness and

capacity to determine their own destiny. They spurned skin

color distinctions in families.

Latinos strove to participate in mainstream society to

gain needed occupational skills even as the host culture

seemed unfamiliar and contacts inhospitable. Time in

country did not necessarily improve integration. Mental

disorder was linked to longer lengths of stay for Latinos in

the stark conclusion in the summary of a 2001 report on

Mental Health: Race, Culture, and Ethnicity by the US

Surgeon General:

The most striking findings from the set of adult epi-

demiological studies using diagnostic measures is

that Mexican immigrants, Mexican immigrants with

less than 13 years in the United States, or Puerto

Ricans who resided on the island of Puerto Rico had

lower prevalence rates of depression and other dis-

orders than [immigrants with more than 13 years in

the United States and Puerto Ricans living there].

This consistent result across independent investiga-

tors, different sites, and two Latino subgroups… suggests that factors associated with living in the

United States are related to increased risk for mental

disorders [Emphasis added].

Assimilation, as in people’s merging or fitting in, is

usually equated with acculturation, but is limited here to

Gordon’s (1964) sense of structural, marital, and ‘‘recep-

tional’’ assimilation. It resulted from their acceptance by

society’s primary groups and inclusion in institutions based

on incorporating of values and beliefs of the dominant

culture. It completed the paradigm: Accultura-

tion ? Assimilation = Integration. Assimilation was vig-

orously defended as an ideal goal and a one-way process

that was within the dominant group’s locus of control. The

premise can have dire consequences: Morandi and Risco

(2006) found lack of personal control over perceived dis-

crimination and social exclusion, society’s gate-keeping

functions, resulted in serious self-esteem loss and accul-

turative stress in a sample of mostly Cuban Americans.

Part of Latinos’ acculturation involved evaluating the

extent that society stigmatized their group as a gauge of

collective self-esteem. It tended to vary by generation and

phenotype. In the wake of their parents’ experience, second

generation dark Latinos tied self-regard to country of origin

and ethnic group as a ‘‘self-protective strategy for dealing

with stigma’’ (p. 395), and less to public opinion (Wiley

et al. 2008). Light skin subjects were more receptive to

selective external evaluations. Society’s evaluation was not

abandoned by those with dark skin. It became one side of a

dual consciousness (Du Bois 1903), which included ste-

reotypes, exclusion, and psychological conflict as they

viewed themselves through the eyes of the other, as it

occurred under Spanish rule and characteristic of the

colonial mentality (Memmi 1991). This uneven duality was

different from the selective melding of cultures in bicul-

turalism. Also, is worth noting that skin color was not part

of the generational study cited, but was introduced post hoc

to explain inconsistent patterns in Latinos’ use of collective

self-esteem.

The racial stereotypes that divided society were not lost

on ‘‘dark Europeans’’ who emigrated from Eastern and

Southern Europe at the turn of the twentieth century

(Roediger 2005). Their acculturation included avoiding

association and contact with people of color to demonstrate

they had compatible mainstream attitudes about race that

made them assimilable. The social distance between them

contributed to an ethnoracial gap expressed in sometimes

violent reactions to social policies that compensated visible

minority groups seen as being at their expense. For

example, ‘‘Busing’’ to racially integrate schools to improve

educational opportunities for some was a threat to the

lifestyle and legacy to others. The controversy was not lost

on minority groups’ efforts to acculturate.

Allen (1994, 1997) in The Invention of the White Race

saw oppression of Irish people by the English since the

fourteenth century as precursor of African American

exclusion, and argued that skin color was devised as an

ideal instrument for social control by dividing the poor into

competing groups. Irish immigrants continued to face

discrimination and hostility upon arrival in United States.

They first sided with Negroes and joined abolitionists, but

soon disengaged under intense pressure to gain popular

support for Irish resistance back home. They underwent a

remarkable and telling transformation in How the Irish

Became White (Ignatiev 1995). Offers of help have tradi-

tionally been suspect by people of color given their col-

lective history of neglect and disappointment. Mental

health service providers need to be alert to such lingering

sentiments in response to their outreach efforts.

Dark skin defined nonwhite people and limited their

economic and political participation in society. Latinos

were labeled members of a minority group mainly because

of skin color, which was in keeping with the ‘‘one-drop

rule’’ that segregated people suspected of having any trace

of nonwhite kinship. It was the opposite of whitening,

which was a process of inclusion in Latin America. It is

important to stress that assimilation can segregate and

exclude people as well as include them: Mexican Ameri-

cans with dark skin had lower levels of acculturation than

those with light skin (Vázquez et al. 1997). Mason (2004)

saw phenotype as a salient issue for dark Puerto Ricans

who actively sought to acculturate by abandoning Spanish

language and Hispanic identification and learned English,

but felt excluded because they were unable to shed the

stigma associated with being Afro-Latino. Moreover, skin

Clin Soc Work J (2009) 37:277–286 281

123

color directly challenged assimilation’s prime objective

when Latinos were asked, ‘‘How strongly do you think of

yourself as an American?’’ (Jones-Correa et al. 2006):

Some 44% of light Latinos ‘‘strongly’’ believed they were

Americans, but only 14% of those who were dark did.

Psychological Well Being

The psychological effect of phenotype discrimination and

acculturation was examined directly by Codina and

Montalvo (1994), using the same data base to study life

chances employed by Arce et al. (1987). Darker skin tone

and Indian appearance among Chicanos were related to

having more frequent episodes of reactive depression.

Using birth origin as proxy for acculturation, dark-skinned

males who were born and raised in United States felt

depressed more often than dark men who were born in

Mexico. This finding was similar to the previously cited US

Surgeon General report in 2001 on the higher rates for

mental disorders among Latinos who lived at length in the

United States. As in most gender studies, women were

overall more depressed than men and fit the phenotype-

acculturation pattern with one difference. A small subgroup

of light-skinned, Mexican-born women felt depressed more

often than darker US and Mexican-born cohorts. Informal,

post-study inquiry indicated that as immigrants they felt

discriminated against for the first time, which contrasted

sharply with their social status in Mexico. They did not

tend to live in communities with high ethnic density, which

was consistent with studies of Latino residential segrega-

tion (Massey and Mullen 1984) and distribution of skin

color reported by Relethford et al. (1983) in San Antonio,

Texas.

Latinos publicly denied that phenotype matters to keep

families and communities together (Arce 1981). Skin color

preference, however, has been a poorly kept secret in fam-

ilies: Relatives are relieved when newborn’s skin color is

light, and not if dark, and when they alienate siblings with

the taunt that they ‘‘must have been adopted’’ because of

their skin tone. Use of dark skin as an epithet and distorted

perceptions of skin color were common in Latino life. Berne

(1959) described in 1950 the case of a ‘‘Spanish’’ woman

with severe depression and distorted self-image that were

caused by an undercurrent of sly innuendoes about her

supposed dark skin. The irony was that her skin tone was as

light as her three children’s, whom the family adored.

They know society prefers light skin, although possess-

ing it is not without problems in and out of the ethnic

community. Some could be too light. A light-skinned

Mexican American strove to overcome being scoffed at by

peers as a heuro, a remark meant to embarrass him. More

than one fair Latina has been confronted with faint praise,

‘‘But you’re not like them.’’ One resisted being cajoled into

rejecting ethnic peers and denying her Hispanic heritage,

because she did not fit the public’s image of an authentic

Latin. Many were not light enough despite their efforts. A

Puerto Rican executive admitted he was dimly aware while

growing up that his preferred skin shade (trigueño, the color

of wheat) was politely accepted by friends as lighter than it

really was. Later, he was concerned that his skin color might

interfere with business. Phenotype preferences were evident

in a study by Darity and Boza (2004), who compared racial

self-identification by Latino subjects with researchers’

observation of skin color in a northeast and midwest sam-

ple. Almost 62% of the sample self-identified as white, yet

47% were observed to have light skin by researchers, a

difference of 15%. A scant 2% self-identified as black,

while some 17% were observed to have dark skin. No light-

skinned subject chose black as a racial identification.

An Interview Technique to Improve Assessments

Social workers should consider the phenotype patterns and

trends reviewed in this article, but also guard against pre-

conceptions that hamper discovering specific profiles of

acculturation and ethnoracial identity clients create for

themselves, and are still evolving. Accordingly, practice

competencies should include extensive knowledge of eth-

noracial socialization and institutional factors affecting it,

and the ability to assess the client’s acculturation experi-

ence as it affected current psychosocial functioning.

Effective casework begins with training practitioners to

explore with empathy and skill significant events occurring

in client lives regarding skin color. In this vein, the critical

incident interview was developed to elicit such information

(Montalvo 1999). The technique enables practitioners to

help clients recall specific incidents and affect-laden

interpersonal events in their lives, both positive and neg-

ative, that made them aware of being culturally, ethnically,

or racially unique. Note is made of the lasting effect on

ethnoracial identity development. Therapeutic intervention

was not its purpose, although life narratives sometimes

generated unanticipated connections between emotionally

charged events that respondents found moving. They also

spoke of incidents experienced vicariously that were life

changing. For example, an elderly Latina became critically

conscious of her ethnicity, rampant discrimination, and

empowerment as a child when she heard that the Anglo

mayor of her town publicly apologized to a Chicano

member of a nearby city council who loudly protested

being barred from a local fairground because he was

‘‘Mexican.’’

Some 500 interviews were collected over a 10-year

period between 1991 and 2001 from two interviews con-

ducted by every student during courses on practice with

282 Clin Soc Work J (2009) 37:277–286

123

minority clients and psychology of bicultural environ-

ments. The training interviews varied in quality and con-

tent: some used guides, others were open ended; some

shared phenotype scales with participants, others kept them

in mind as they conducted interviews. The purposes were

to improve observational and interpretative skills of verbal

and nonverbal behaviors and test social theory and practice

concepts that prepared them to probe clients’ interests and

concerns. Trainees noted the specific social context in

which critical events took place with the familiar who,

what, when, where, and why. Informants readily recalled

events surrounding family, religion, language, festivals,

neighborhoods, peer-groups, and special cuisine as positive

cultural touchstones in their lives. The technique also

facilitated entry into sensitive areas that informants dis-

closed, usually with intense interest, often with concerns.

Skin color was cited as a salient issue by a third of the

Latino participants in ongoing qualitative reviews con-

ducted by the author and students. Incidents involving

violent actions taken by or against Latinos were rare. The

following are brief examples of approaches to practice

involving skin color that are illustrated with excerpts from

critical incident interviews.

Colorism is a symptom of family dysfunction. It is a

difficult but appropriate subject to raise in family group

discussions as it can reveal secrets about the origins of

phenotype bias among its members that resulted in favor-

itism and in real or imagined family coalitions. In one

interview, a father spoke of being more attentive to one of

his two daughters when she grew lighter in appearance as

she matured and no longer shared his dark skin shade.

Treatment goals would include releasing members from

diffused family boundaries held together by colorism and

helping parents renew and fulfill their nurturing role.

Versed in the ethnoracial experience, clinicians can

mitigate destructive forces by helping patients place the

stigma of dark skin in its proper historical and institutional

context as due to phenotyping. The battering of life expe-

riences can sink children into their own world of fantasy

and shame that keeps them from self-approval by invidi-

ously comparing themselves to others. In one interview, an

8-year-old girl with dark skin and hair was drawing a

portrait of her family as she talked about visiting relatives

that day. There was no hint of concern until she colored

herself with blond hair to look like her favorite cousin, who

was fair complexioned and whom she drew floating angel-

like at top of the sketch because she was admired by all the

relatives. Children can be helped to navigate racial markers

and competing identities and rid themselves of stereotypes’

magic power over them when feelings about self-image are

recognized and accepted.

Clinicians should be prepared to analyze their level of

comfort discussing issues of race. Hurdling assimilation

barriers is a problem Latinos often face when they cross

ethnoracial boundaries. For example, a Latina spoke easily

of her family’s initial reluctance to accept her Anglo

spouse, yet hesitated to discuss the source of his parents’

objection to the marriage. Her narrative covered her

uniqueness as a Latina, but did not include what was

reported as her dark skin, which could be a matter of

personal concern and a source of in-laws’ disapproval. In

the end, the informant felt good about the session, but

needed time to think about the feelings that were stirred

about ‘‘things’’ she had long forgotten. The question of skin

color was not raised by the student, even though it often

underlies contentious family disputes over interethnic

unions. Others are social class and religion, which also

require scrutiny. The trainee considered the participant’s

feelings and judged that she was not ready to continue

along that line of inquiry. If clinicians are comfortable

enough discussing closely guarded secrets about race, they

suggest to the client that the subject is not taboo and can be

examined in a safe, therapeutic environment.

Two Training Goals for Effective Practice with Latinos

Racial attitudes are subtly communicated and readily

sensed by clients. Therefore, social workers should first be

mindful of their own affective response to people of color

and demonstrate a capacity to assess and change their own

normative expectations, biases, and stereotypes that distort

the clinical process. Two ways are offered here for

reducing racial bias. Second, they should be trained to

improve the objectivity and accuracy in estimating phe-

notypes with the help of scales designed for that purpose.

Reducing Racial Bias

There is an assortment of training seminars offered

throughout the country for mitigating prejudice and cor-

recting unintended consequences. To start reducing bias in

practice, a simple and widely used procedure, the implicit

association test (IAT), identifies subtle bias in people

(Greenwald et al. 1998). It found hidden judgments and

behavior to be linked to stereotyping and prejudice better

than attitudes people expressed openly. The procedure

weakened automatic preference for white Americans and

reduced subtle prejudices, including skin color, toward

stigmatized groups. The self-administered test is available

at Project Implicit website (http://implicit.harvard.edu/

implicit/). Over a million people have taken the test.

Another and more extensive training method held promise

for dispelling what is referred to as the ‘‘other-race effect,’’

that is, believing that all members of another group look

alike (Libretto et al. 2009). Also, stereotypes can be

Clin Soc Work J (2009) 37:277–286 283

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http://implicit.harvard.edu/implicit/

reduced directly by training subjects to increase their

ability to delineate faces among photographs of other races,

which made it difficult to typecast other races and their

behaviors. Training covered five, 45-min sessions over a 2-

week period. Trainees learned to associate faces with

descriptions that contradicted common racial misconcep-

tions associated with the group.

Both these training methods were demonstrated to be

effective in reducing implicit bias and stereotyping, but

they are essentially diagnostic and should be supplemented

with case reviews, seminars, and supervision of clinical

practice with Latinos.

Improving Estimates of Phenotypes

What is light, intermediate, and dark skin? Skin color is a

subjective construct based on self-reports that often depend

on the social context and observations, which could differ

among clinicians. Hill (2002) found that trained researchers

tended to exaggerate the other race’s skin tone significantly

more than when they were matched with members of their

own race. Also, familiarity and frequent contact could lead

to practitioners’ assessments of in-group skin tone and

features to be more accurate and fine-tuned than of out-

group members. Besides correcting for implicit bias and

stereotypes, workers should also be trained to use and

apply phenotype scales. Objectivity, accuracy, and equiv-

alent measurements in estimating phenotype would

improve significantly with development of an ethnic-spe-

cific, photo-anchored phenotype scale that employs pho-

tographs (or face drawings) as benchmarks for assessing

skin color. The Chicano scale used by Arce et al. (1987)

provides an accessible template for use in designing them

for different ethnoracial groups. Research protocols and

recording phenotype in case records would improve.

Summary and Recommendations

Latinos are conscious every day of their skin tones,

although non-Latinos, black and white, are generally una-

ware, if not skeptical, that race is a problem for them. For

clinicians, the issue has been largely one of out of mind out

of sight. Phenotyping and colorism, as external and inter-

nalized forms of racism, and acculturation and assimila-

tion, as individual and intergroup dimensions of

integration, created a society at variance with cultural

pluralism, under constant tension, and at the core of the

Latino American experience. The process created disparate

world views about ethnicity and race that shaped rela-

tionships and social discourse. As a result, Latino and

mainstream groups grew isolated from each other, dis-

trustful, and vigilant. Latinos’ collective memory of the

colonial experience left them susceptible and poised to deal

with phenotype discrimination in the United States, which

diminished their life chances and social integration and

contributed to their inflicting wounds on themselves and

their families. Growing up, white clinicians learned as well

as anyone about their prominent role and status as domi-

nant members of society. They were likely to live in de

facto segregated neighborhoods and to develop racial atti-

tudes, stereotypes, and implicit biases, of which they were

unaware, that required self-analysis and specific training to

rectify. The theoretical framework presented here to

explain the disparity between many practitioners and

Latino clients was strengthened by results from focused

field interviews used to assess the ethnoracial experience.

Institutional factors were only touched upon, but I am

mindful of the social work maxim that every case is a

failure in social policy. The consequences of making

inaccurate estimates of Latino health and welfare that guide

social policy and service delivery are severe when differ-

ences in Latino skin color are ignored. A study on self-

esteem was cited wherein results were obscured until the

subjects’ phenotypes were known.

The following recommendations are offered to achieve

the goals of improving training and practice and increasing

our understanding of Latinos’ experience with race and

ethnicity:

1. Train clinicians to conduct critical incident interviews

to assess problems and ethnoracial development.

2. Reduce practitioners’ implicit racial bias and stereo-

types and their influence on practice.

3. Conduct qualitative and empirical research to identify

psychosocial effects of phenotyping and colorism.

4. Design photo-anchored phenotype scales to improve

accuracy and consistency in estimating skin color.

5. Assess whether training in ethnoracial factors reduces

early withdrawal of Latinos from treatment.

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