The "Comadre" Group Approach: A Wellness-Based Group Model for Monolingual Mexican Women PDF

The Journal for Specialists in Group Work ISSN: 0193-3922 (Print) 1549-6295 (Online) Journal homepage: www.tandfonline.com/journals/usgw20 The “Comadre” Group Approach: A Wellness-Based Group Model for Monolingual Mexican Women Andrea Dixon Rayle, Jennifer K. Sand, Toni Brucato & Jessica Or...

The Journal for Specialists in Group Work ISSN: 0193-3922 (Print) 1549-6295 (Online) Journal homepage: www.tandfonline.com/journals/usgw20 The “Comadre” Group Approach: A Wellness-Based Group Model for Monolingual Mexican Women Andrea Dixon Rayle, Jennifer K. Sand, Toni Brucato & Jessica Ortega To cite this article: Andrea Dixon Rayle, Jennifer K. Sand, Toni Brucato & Jessica Ortega (2006) The “Comadre” Group Approach: A Wellness-Based Group Model for Monolingual Mexican Women, The Journal for Specialists in Group Work, 31:1, 5-24, DOI: 10.1080/01933920500341424 To link to this article: https://doi.org/10.1080/01933920500341424 Published online: 19 Aug 2006. Submit your article to this journal Article views: 442 View related articles Citing articles: 2 View citing articles Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=usgw20 PRACTICE The ‘‘Comadre’’ Group Approach: A Wellness-Based Group Model for Monolingual Mexican Women Andrea Dixon Rayle Jennifer K. Sand Arizona State University Toni Brucato Mesa Public Schools, Mesa Arizona Jessica Ortega Arizona State University The ‘‘comadre’’ approach to group counseling with immigrant Mexican women creates an environment of sisterhood, trust, support, and education. This article describes a wellness-based, comadre pilot group designed to support monolin- gual Spanish-speaking, Mexican-born women who recently immigrated to the United States. The need for the group and group development and process are described. The 10-week pilot group is described illustrating this particular comadre model of group work with immigrant Mexican women. Implications for future group work and research with Mexican female immigrants are discussed, and suggestions are offered for wellness-based group work led by cross-cultural counselors. Keywords: group work; immigrants; Mexican women; wellness The majority of the United States population growth in the last dec- ade was due to increases in minority groups, some of which, such as the Latino population, grew at rates seven times the rate of Euro Americans (U.S. Census Bureau, 2003). Latinos recently became the largest minority group in the country with 13.5 percent of the total Andrea Dixon Rayle, Ph.D., NCC, is an assistant professor in the Counseling and Coun- seling Psychology Department at Arizona State University. Dr. Toni Brucato is a clinical psychologist with Mesa Public Schools in Mesa, AZ. Jennifer K. Sand and Jessica Ortega are doctoral students in the Counseling Psychology Department at Arizona State Uni- versity. This paper was sponsored by the Association for Specialists in Group Work for presentation at the 2004 American Counseling Association annual meeting in Kansas City, MO. Correspondence concerning this article should be addressed to Andrea Dixon Rayle, Division of Psychology in Education, P.O. Box 870611, Arizona State University, Tempe, AZ 85287-0611; phone: (480)965-8057; fax: (480)965-0300; e-mail: andrea [email protected]. THE JOURNAL FOR SPECIALISTS IN GROUP WORK, Vol. 31 No. 1, March 2006, 5–24 DOI: 10.1080/01933920500341424 # 2006 ASGW 5 6 THE JOURNAL FOR SPECIALISTS IN GROUP WORK / March 2006 population. Greater than half of this increase was due to immigration (Cohn, 2003; U.S. Census Bureau, 2003). As Latino immigrants con- tinue to enter the U.S. in great numbers, they face multiple political, legal, cultural, and personal challenges in the process of adapting to a new culture, or acculturation, and these challenges are even more difficult to overcome for those who face language barriers (Garcia & Marotta, 1997; Smith, 2003; Sue & Sue, 2003). Additionally, it is imperative to recognize institutional barriers Latino immigrants face such as high cost of medical care, lack of bilingual or bicultural personnel, low socioeconomic status, racism, discrimination, and immi- gration laws (Smith, 2003; Zambrana, Ell, Dorrington, Wachsman, & Hodge, 1994). Barriers such as these consistently contribute to the underutiliza- tion of medical and mental health services for immigrants as a whole. In particular, Latino individuals do not overtly seek counseling ser- vices, thus leaving this population underserved (Padilla, 1995). For example, Mexican-origin populations are the least likely to have public or private healthcare and show the lowest use of healthcare services (Cornelius, 1993). Among the general Latino immigrant populations, Mexican immigrant women are a cross-section of the population who possess particular risk factors that affect their psychological and physi- cal well-being (Padilla, 1995) but do not have regular access to cultu- rally sensitive, bilingual counseling services (Zambrana et al., 1994). The institutional language obstacles and multiple forms of discrimi- nation that immigrant Mexican women face (based on their being women, women of color, immigrants, and sometimes undocumented immigrants) have tremendous impact on their parenting, personal self-esteem, and emotional and physical well-being. The obstacles may be precursors to their experiencing less overall wellness and lack of group social support (MacLeod & Nelson, 2000; Madriz, 1997). Although Mexican women are between two and three times more likely to suffer from mental disorders such as depression than their male counterparts (Koss-Chioino, 1999), recently immigrated Latinas are an overlooked group in terms of counseling research and practice. Many Mexican immigrants are raising children on their own without the support of family or friendship networks, and existing language, acculturation, and economic barriers may inhibit these women from seeking personal counseling support and interventions for their self- care (Madriz). This is particularly problematic due to the sheer num- ber of Mexican women in need of services, since the traditional roles of these women leave them caring for others and often neglecting themselves (Perez-Strumolo, 2000). The purpose of this article is to describe a unique, culturally grounded, 10-week wellness-based psychoeducational group experience  Rayle et al. / THE ‘‘COMADRE’’ GROUP APPROACH 7 for Mexican female immigrants who were monolingual Spanish speak- ers struggling with acculturation to the U.S., lack of social support, and overall personal wellness. The group experience took the form of an unstructured ‘‘comadre’’ group approach. The Latino=Latina value of compadre=comadre is similar to the idea of extended family; extended family members that are as close as true blood-relation family mem- bers. For Mexican women, the comadre represents an important figure in their culture, another female that is sister-like and considered a close friend, advisor, and confidant (Santiago-Rivera, Arredondo, & Gallardo-Cooper, 2002). Comadres, or sisters, are known to create bonds between one another that help them to survive life’s daily strug- gles; comadres have significant trust in one another, share secrets, celebrate and support one another, and share alliances for a lifetime (Santiago-Rivera et al.). In addition, various group issues such as the need, development, and creation of the group, screening and selection, group co-facilitation, group norms and rules, a written assessment, wellness-based group topics, specific group counseling techniques, and post-group interviews are described. The implemen- tation of a group for Latina immigrants provides a timely example of how the principles for diversity-competent group leaders as described by Association for Specialists in Group Work (ASGW, 1999) can be applied to a wellness-based psychoeducational group for monolingual Spanish-speaking Mexican women. Group Social Support and Mexican Immigrants It is clear that the immigrant Mexican population is an important group for counselors to target for overall wellness development, and the authors believe this may be best accomplished through group work that offers a sense of ‘‘comadre social support’’ as well as wellness- based counseling interventions. Studies have reported that immi- grants tend to have smaller support systems available when compared to their U.S.-born counterparts, thus eliciting or securing the need for emotional support and interdependence of those who share similar immigration experiences (Zuniga, 2002). Social support has been a relevant variable researched in the area of immigrant adaptation and adjustment experiences to a new cultural environment and appears to be a positive life circumstance for Mexican women that offers them comadre support and a forum to feel as if they belong (Madriz, 1997). Research has shown that the role of social support may mediate the stress endured by immigrant women and may lead to their overall feelings of wellness (Vega, Kolody, & Valle, 1986). Group social support has been shown to be a buffer or serve as a 8 THE JOURNAL FOR SPECIALISTS IN GROUP WORK / March 2006 protective function for Mexican women who have recently immigrated to the U.S. (Zuniga, 2002). The role of group social support also serves as a moderator for depressive symptomology. Vega, Kolody, and Valle (1986) expected that comadre support would be important in reducing stress associa- ted with marital status for immigrant women. Comadre support is a type of social support that encompasses two functions: It protects against stressors by modifying their potential effects and provides enhancement of belonging, respect, and affirmation. Vega et al. found that certain immigrant women are at high risk for experiencing trau- matic life events (e.g., disrupted marital status), and coping is enhanced by social support that reaffirms the self-worth and cognitive coherence of the individual. Simply stated, social support networks and groups may allow for a smoother adjustment for Mexican female immigrants, in particular comadre support from other Mexican women. Recent research endea- vors have explored the benefits of group counseling with immigrant populations and illustrate that early access to family support among immigrant women is the key factor for increasing optimization in their adaptation after immigration (Zuniga, 2002). Group work may also be appropriate with Mexican female immigrants because groups can incorporate their important cultural values of comadre support, perso- nalismo, and familismo (Gil & Vazquez, 1996; Madriz, 1997; Santiago- Rivera, Arredondo, & Gallardo-Cooper, 2002). Personalismo is having the ability to be personal; it is the characteristic of being genuinely kind to others and the desire to be treated in the same way. It empha- sizes the quality of personal interactions and is used to relate to and maintain a relationship with other individuals. In other words, it is important for the Mexican culture to be warm and kind and to show some interest in others and for others to return these feelings. In addition, Mexican persons do not respond well to people who have no sense of humor, who are cold, who act superior to them, and who do not make time for them (Santiago-Rivera et al.). Possibly the most significant value of Mexicans (and most Latino cultures) is the value of familismo—family unity, welfare, and honor. The emphasis is on the group, not the individual as in the mainstream U.S. culture, and on family commitment, obligation, and responsibility (Forehand & Kotchisk, 1996; Garcia-Preto, 1996). Familismo represents the impor- tance of family in the Latino household, and that support is generally found in the family. Mexicans have a deep sense of familialism and fam- ily loyalty, are reliant on extended family and social support networks, and emphasize interpersonal relatedness and mutual respect (Forehand & Kotchisk, 1996; Santiago-Rivera et al.). Familismo means family comes first and that the family is the greatest sense of community. Therefore,  Rayle et al. / THE ‘‘COMADRE’’ GROUP APPROACH 9 if a major decision needs to be made, the immediate and extended family are involved in the process. In the most traditional households, the father or oldest male is head of the household and holds ultimate decision-making authority, while mothers hold greater influence over their children throughout their lifespan (Santiago-Rivera et al.). Because small groups provide an avenue in which to build social support networks (Corey & Corey, 2002), there have been develop- ments in the organization of groups that focus on immigrants’ experi- ences. There are group models that seek to address the acculturative process of immigrants (Asner-Self & Feyissa, 2002) and encourage the successful adjustment to prevent risk of emotional and physical ill- ness (Edleson & Roskin, 1985). Asner-Self and Feyissa proposed a psy- choeducational group that sought to work with multicultural and multilingual U.S. immigrants=clients. The goal of this group format was to focus on the acculturation process and implement the use of poetry and bibliotherapy. It was designed to offer immigrants a forum in which to address, explore, share, and resolve some of their accul- turative experiences, allowing for the recognition of universal and unique experiences that clients are likely to interject in group sessions (Asner-Self & Feyissa). Unfortunately, to date there is a paucity of empirical research based on support groups specifically for Latinas. Gloria (1999) detailed the possible positive outcomes of Latina college student support groups: instilling hope, imparting information on area resources, producing altruistic behaviors among group members, and developing socializa- tion techniques. Although research has addressed saliency for group work targeted to the immigrant experience, limited research has examined the unique needs and experiences of Latina immigrants, and group counseling may offer the needed comadre group social support these women need, leading to their overall wellness. Wellness Through Group Work It is evident that group counseling may be one of the prime inter- ventions to utilize in counseling Latina immigrants because groups offer the comadre social support and a sense of community. For Mexican women, who are a part of a culture that values familialism (Santiago-Rivera et al., 2002), sharing with other females is a familiar experience grounded in their lives (Madriz, 1997). Group work can aid immigrant Mexican women to overcome the stigma of receiving coun- seling services that exists in their culture and may provide a forum in which they can talk about and share their personal struggles as well as learn from others and group leaders concerning numerous topics such as personal wellness. 10 THE JOURNAL FOR SPECIALISTS IN GROUP WORK / March 2006 The authors define wellness as the maximization of individuals’ human potential and life satisfaction through integrating body, mind, and spirit in a purposeful and positive manner (Archer, Probert, & Gage, 1987; Sweeney & Witmer, 1991). Wellness is a multifaceted construct that encompasses more than just the absence of illness or disease but is a holistic approach to living life with optimal physical, spiritual, and mental health (Myers, Sweeney, & Witmer, 2000). Challenges to wellness may be especially significant for immigrant Latinas as they attempt to cope with the demands of their own beliefs and culture and the U.S. culture simultaneously (Madriz, 1997). Past research on wellness and ethnic minorities has linked ethnic identity, acculturation, and wellness (Dixon Rayle & Myers, 2004; Garrett, 1999); however, no wellness-based group counseling interventions exist specifically for Mexican immigrant women. A variety of models of wellness have been proposed to explain the interrelationships among factors that enhance human functioning. For example, Hettler (1984) proposed a hexagonal model that incorpo- rates physical, occupational, intellectual, social, emotional, and spiri- tual components as the foundation of wellness. Ryff (1995), writing from the perspective of positive psychology, developed a multidimen- sional model of well-being comprised of six distinct components of positive psychological functioning: self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life, and personal growth. Sweeney and Witmer (1991) and Myers et al. (2000) developed the Wheel of Wellness incorporating 18 factors based on cross-disciplinary research that correlate with longevity, quality of life, and life satisfaction and serve as a foundation for counseling interventions. Six major life tasks are defined in this model based on Adlerian counseling theory: spirituality, self-direction, work=school work, leisure, friendship, and love. Because the authors believe wellness is culturally subjective and may even differ among Mexican female immigrants and U.S.-born Latinas, the authors created this comadre wellness-based group around seven specific areas of importance to overall wellness among Latina immigrants. These seven areas of wellness include physical health, occupation=career wellness, emotional self-wellness, social support=relationships, acculturation experiences, spiritual wellness, and physical safety. Specifically, the authors (two of whom are Mexican, one American Indian, and one Euro American) designed the current wellness-based group for Mexican female immigrants based on their personal experiences as women and women of color in the U.S., their counseling work with immigrant Mexican women, and their experiences with comadre relationships.  Rayle et al. / THE ‘‘COMADRE’’ GROUP APPROACH 11 GROUP PLANNING AND PREPARATION Design of the Group The group was designed to be a psychoeducational group promoting a balanced life of wellness for Mexican women who had recently immi- grated to the U.S. Additionally, the group was meant to be a form of comadre social support for these women, which has been found to be a positive condition for all Latinas (Garcia & Marotta, 1997) facing multiple challenges in their personal and work lives. This group model surfaced as an answer to a need in a Southwestern community that contains a large percentage of Mexican female immigrants struggling with personal, relationship, parenting, and societal pressures and who report a lack of focus on taking care of themselves and their overall personal wellness. Based on previous definitions and models of well- ness, the authors and group participants co-designed a wellness-based psychoeducational, comadre support group model. In other words, this group of 10 Mexican women participated in a group model that was designed, created, and led by Mexican women and was able to co- construct the group so they could receive what they felt they needed as participants as well. Selection/Description of Members The authors teamed with a local agency serving the Latino com- munity through individual and group counseling for Latino=Latina families, children, and adolescents. The agency’s lead counselor had noticed numerous needs among the Mexican mothers. Most of the Mexican mothers were recent immigrants to the U.S. (within the past three years), all were married or cohabitated mothers, either living alone with their children (due to separation from or having incarcer- ated spouses) or residing conjointly with children, and were primarily monolingual Spanish speakers. Selection of members was conducted in conjunction with the lead counselor at the local agency who initially contacted possible women through telephone calls. Each of the interested women was then brought in for pre-group selection interviews with the primary Mexi- can women’s group leader=third author and the secondary group lea- der. The interview process included an initial description of the proposed comadre group, questions for the women pertaining to what they might be looking for in such a group experience as well as their commitment to attending the group regularly. Group goals and group norms were discussed and set during the pre-group interviews (Corey & Corey, 2002), and the willingness and readiness of the possible 12 THE JOURNAL FOR SPECIALISTS IN GROUP WORK / March 2006 participants to engage in the group process was assessed (Yalom, 1995). The leaders discussed with each prospective member how this experience was a pilot group and how each leader would be learning with and from the participants, as well as documenting and reporting the overall experience and results of the comadre group approach. Overall, ten Mexican women willingly admitted their personal need for such a comadre group and voluntarily agreed to take part. The second author and lead agency counselor were in agreement that these particular women would gain from this group experience. The group took place at the local agency every Monday night for 10 consecutive weeks. Childcare was provided by bachelor’s level, Spanish=English speaking child development specialists provided through the agency. The group met for two hours every week and continued as a closed group until its closure, despite interest from other Mexican women who were later informed by their peers about the group’s benefits. The final group consisted of 10 women ranging in ages 25 to 53 (M ¼ 36.7; SD ¼ 7.6), each having between one and three children living at home. Two of the women were married, five were separated from their husbands, and three were recently divorced. In addition, all 10 of the women reported they worked at least part time. When asked to report on their education levels, five reported having elementary-level education, three reported having finished high school, and two reported some college-level training. Four of the 10 women reported being able to speak and write some English, whereas the other six members considered their verbal and written use of English poor. Instrumentation Description Prior to the actual group experience, the authors administered the Latina Wellness Assessment (LWA; Dixon Rayle, Brucato, Sand, & Ortega, 2003), a paper and pencil, self-report wellness evaluation (cre- ated in Spanish) to each participant to assess pre- and post-group experience. The LWA (Dixon Rayle et al.) was created for use with Latina participants in research, group, and individual counseling. The LWA is a 53-item assessment of wellness in seven areas based on previous wellness research and the authors’ knowledge and experi- ence of the Mexican=Latina culture. The wellness areas assessed included: Physical Health, Occupation=Career, Self-Emotional, Social Support, Acculturation Experiences, Spirituality, and Safety. Participants responded to each statement on a 5-point Likert scale ranging from Almost Always to Almost Never. Scoring was based on the sum of the responses in each of the seven wellness categories and then averaged for an overall wellness score. Scores ranged from  Rayle et al. / THE ‘‘COMADRE’’ GROUP APPROACH 13 1 (low wellness) to 5 (high wellness). The Cronbach’s alpha for the LWA in this study was.86 pre-group experience and.88 post-group experience. Group Leaders The comadre group design incorporated the co-leader approach to group work. This was in part due to the overall theme of comadre sup- port for the group and was also selected for observation, planning, and research purposes. Both leaders were middle-aged bilingual Latinas who considered Spanish to be their first language. The primary leader had a Psy.D. in clinical psychology and counseling with over 16 years of experience providing mental health services for the Mexican popu- lation in the U.S.; she also taught graduate-level courses in counseling and psychology and designed and led groups for Latinas in the past. The secondary leader held a master’s degree in counseling, was the lead counselor and the authors’ contact at the local agency serving the Mexican community in this area, and had more than 14 years of experience working specifically with the Mexican community in the Southwest. GROUP SESSIONS Group Sessions 1–4 The group began with structure to the sessions including topics planned for each session. However, due to the nature of this pilot group, it became less and less structured and more process-oriented. The leaders followed the participants in that the participants wanted more of a support network versus structured lessons. Indeed, the comadre approach to group work surfaced as more process-focused rather than a structured, psychoeducational approach, although holis- tic wellness remained a theme throughout. The authors were open to this because this group was a pilot group—the first of its kind. At every stage of group development, sessions were co-constructed to meet the needs of members (Corey & Corey, 2002; Yalom, 1995). The theoretical orientation behind the group incorporated both an existential approach for exploration and support purposes, coupled with a cognitive-behavioral approach for the restructuring of negative self-talk and learning new behaviors for navigating their adaptation to the U.S. culture. The early sessions addressed issues of the comadre nature of the group, goals, rules, and introductions. The participants received their individualized results from the LWA (Dixon Rayle et al., 2003), and the model of Latina wellness was described. All 14 THE JOURNAL FOR SPECIALISTS IN GROUP WORK / March 2006 participants were able to speak of their challenges with each of the seven areas of wellness and how those areas were either healthy or unhealthy in their lives at that time. The entire group experience was conducted in Spanish. Group part- icipants brought up the issue of monolinguality; however, no current actions were being taken to learn English due to their work, monetary, and family responsibilities. Because most participants were single mothers, they simply did not have the money or time to study English at this time. However, six participants believed that it was a major inhibitor to their wellness and to their access to resources. The leaders reminded participants of the culturally grounded nature of the group and invited the participants to aid in co-constructing the wellness group as they needed and saw fit. Members were invited to speak to their cultural traditions, beliefs, values, and relationship and parent- ing experiences. Members and counselors agreed to continue to seek cultural clarification any time it was needed. Early in the sessions, members supported one another and the leaders, demonstrating the beginning of group altruism and universality (Yalom, 1995). Process questions were employed to reinforce the norms for comfort, cohesion, and support for one another (Yalom). Universality continued as the lead facilitator led experiential activi- ties in sessions two–four. One such activity included each of the women receiving a bunch of colored Popsicle sticks joined together with both rubber bands and a single Popsicle stick. Participants were asked to try and break both the bunch of sticks and the lone stick. The activity was used to convey the purpose of the group: to support a lone stick and prevent breakage when stress and pressure was applied. This activity communicated the vision for the group: women would feel less alone, feeling as if they had their ‘‘comadre’’ with them. The part- icipants found they would get support and advice about how to handle the stressful areas in their lives. In addition, the group co-created a list of positive strategies that enabled group members’ wellness: exer- cise, prayer, church attendance, belonging to a community, eating vegetables, taking Herbalife, and putting on make-up and taking care of one’s appearance. The group also co-constructed a list of behaviors that inhibited their wellness: overeating, taking drugs, smoking cigar- ettes, drinking alcohol, and letting one’s physical appearance go. Group cohesion continued to grow as the members discussed the potency of the comadre support they were receiving and as they were learning and processing avenues for enhancing their self-care and wellness. The group brought up a variety of issues that affected differ- ent areas of their lives: parenting concerns in the U.S., racism and stereotypes of African Americans and Latinos, and husbands or partners who were alcoholics and abusive. One participant who  Rayle et al. / THE ‘‘COMADRE’’ GROUP APPROACH 15 recently left her husband asked another what she could do for herself to get over the loss of her relationship. The discussions also included negative acculturation experiences and feelings of isolation. One mem- ber reported that she knew some neighbors but had no friendships after having lived in the U.S. for 14 years. Her feelings prompted members to ask how long each woman had lived in the U.S. The aver- age amount of time lived in the U.S. was four years. Isolation appar- ently can last for many years. Overall, early sessions were spent on introductory issues related to wellness for Latina immigrants, areas where they needed to enhance their personal wellness, their gratefulness for having met other Lati- nas who understood them and could be comadres, and the frustrations of being a monolingual Latina immigrant in a European American society. Each session ended with process questions related to intra- group relations, such as ‘‘What are you noticing about others in here?’’ and ‘‘Who has been most helpful to you in here? How? Share that with them,’’ to reinforce universality and altruism. Finally, the very end of each session was audiotaped, and participants were asked to offer feedback and suggestions for the co-construction of subsequent group meetings. Group Sessions 5–7 Relatively quickly, the group shifted to a model of therapy, self- help, and positive comadre support. Wellness concepts were integrated into the process informally to maintain a natural flow of the parti- cipants’ conversations. The women began to report their progress in the seven areas of wellness. One participant reported that the relationship with her child had become less combative and she had quit smoking, another reported that she got a job as a medical billing assistant and was looking into getting back into school, and other members used the group as a sounding board to discuss their ideas or plans. For example, one woman shared her regret at bringing her daughter to the U.S. only for her to have been physically violated here and her subsequent dilemma about whether she should return to Mexico to live closer to her mother. The leaders planned activities that seemed to resonate with many group members and often provided humorous relief, something wel- come as each group member shared herself emotionally at some point in the group process. The activities illustrated important concepts in a concrete and visual manner. For example, one activity required each member to stand and move a disc tied to a vibrant pink string using her mind and=or thoughts without moving her arms or fingers. The discs moved for all the women. The intent of the activity was to 16 THE JOURNAL FOR SPECIALISTS IN GROUP WORK / March 2006 illustrate the power of suggestion and the women were cautioned to refrain from denigrating or hopeless thoughts. An activity describing projected anger was also introduced in the middle sessions to help the single mothers understand and cope with their children’s anger at their absent fathers. Specifically within the Self-Emotional area of wellness, most of the group members engaged in self-defeating thoughts and language. These thoughts and behaviors led to the lea- der challenging everyone to think of themselves in positive terms and to refrain from putting themselves down. This led to a member suggesting that members who verbally put themselves down during the group process must contribute a quarter to a potluck to be held at the end of the series of sessions. The group collected one dollar and 75 cents over the remaining groups. During the middle sessions of the group, the group leaders received continual affirmation that the group structure and content were reso- nating with the group members. The leaders considered consistent participation, recruitment of more members, encouraging verbaliza- tions, and the need to reinforce the time limit for the group as evidence of participants’ positive experiences. Often in the earlier sessions, most of the women experienced emotion to the extent they cried. They voiced that they felt ‘‘comfortable’’ and that the concepts, models, and directives gave them something to think about in their lives. After each session, the women expressed surprise at how quickly time passed. Relaxation strategies became a customary ingredient in each of the middle sessions of the group. These strategies were new experiences for the women, and the leaders made certain that the women learned how to conduct them for themselves. One example included the women being asked to visualize future goals such as their house, where they would live, the quality of their relationships, their husbands, their work, and how they would serve others. They were then asked to create that vision using magazine and newspaper images, words, markers, crayons, and drawings. They spent the majority of the ses- sion perusing magazines for relevant images, cutting, arranging, and pasting. At the end, each woman expressed her dreams and explained her creation. Many of the women’s career goals had to do with entrepreneurship, and they found that they had overlapping trades=skills to offer. Building upon the early sessions in the group in which participants learned about the seven areas of wellness, explored their weaknesses and strengths of each area of wellness, and spent time getting to know one another and the leaders, the middle sessions were used for con- tinuing comadre group cohesion, teaching strategies for enhancing personal and familial self-care and wellness, and focusing on future  Rayle et al. / THE ‘‘COMADRE’’ GROUP APPROACH 17 wellness goals and plans. The women were encouraged to express themselves and their needs. Therapeutic concepts were presented dur- ing these sessions as well, such as projected anger. Lastly, the middle sessions took on a comadre environment around parenting concerns. Group members offered advice, shared experiences, and acknowledged the challenges of parenting in the U.S. when their children spoke Eng- lish and they did not. The group leaders challenged participants to allow children to have choices within a framework of family rules. Ses- sions continued with process questions related to group experiences and activities. At the end of each session, participants’ responses were audiotaped as they offered feedback and suggestions for co-construct- ing the end of the group experience. Group Sessions 8–10 As the group prepared for termination, the focus was on the con- tinuation of the awareness and practice of self-care and personal well- ness, the future personal and familial goals, the leaders’ instillation of hope (Yalom, 1995), and the translation of the women’s personal insights and restructured thoughts into new behaviors (Corey & Corey, 2002). As the group transitioned into the working stage, the cohesive comadre approach to the group allowed the women to listen, comment, offer opinions and personal experiences related to others’ wellness=self-care issues, and ask for comments from the group lea- ders. Many of the members took significant risks as they fearlessly commented to other participants with honest opinions regardless of whether they thought what they shared would be perceived as unpopular. The participants shared openly about the areas of wellness they believed they had learned the most about and the areas that required continued attention and awareness. The impending termination of the group was discussed, and the participants were resistant to the ending of the comadre=support experience. Many of the women spoke to the joy, optimism, personal self-enhancement, and hope the group experience had brought to their lives. An assessment of progress on the group’s goals was made to instill hope and encourage the members to incorporate their new understandings of the seven areas of wellness and the importance of taking care of each of those in their lives outside of the group. The women were able to share about how the group experience helped them feel more comfortable as immigrants to the U.S. and aided them in learning new ways for acculturating while remaining true to their cultural values and traditions. Most importantly, as the group began moving toward termination, questions were answered, connec- tions were made, and resources were shared. When processing this 18 THE JOURNAL FOR SPECIALISTS IN GROUP WORK / March 2006 experience, the members of the group discussed how important it was to witness Latina immigrants like themselves struggling with self- care, wellness, and acculturation, as well as looking to their group lea- ders as successful female role models. An activity related to the future allowed members to voice goals for their futures in the U.S. or upon return to Mexico. Their goals reflected academic and occupational pursuits, family relationships, parenting-style adaptations, and more time for self-care and personal wellness. Each member identified specific changes they wanted to make in their lives within the next year. Members gave each other feedback and support. Discussion included worries or fears about finances and the future, identification of comadre support systems, personal strengths and comadre support to deal with challenges, and personal reflections on what it would be like to ask for help in the future. In the last session, members offered verbal feedback and evaluation and shared results from their post-group LWA (Dixon Rayle et al., 2003) that assessed the seven areas of wellness upon which the group focused. These activities were designed to allow mem- bers to share what they learned, as well as to express their regard for each other, a process necessary for effective termination of the group (Corey & Corey, 2002). Members were asked to voluntarily participate in audiotaped individual post-group interviews to assess group effi- cacy and to offer feedback for future comadre groups. Altruism and regard were so high that the final session ended with a group party during which tears were shed and group hugs ensued that included the two leaders of the group. EVALUATION Post-Group Interviews Voluntary, post-group interviews were conducted by doctoral-level research assistants who spoke fluent Spanish. All of the participants agreed to participate in the individual interviews that were audio- taped with members’ consent. Questions included: 1) On a scale of 1–5 (with 5 being the highest), how helpful do you believe this group was for you? 2) What area of wellness do you believe you made the most significant changes as a result of your participation in this group? 3) How helpful were the group leaders? 4) What topics do you believe would have been helpful that were not covered in the group meetings? 5) What general feedback do you have about your experi- ence as a group member in this comadre support group? and 6) Would you recommend a group such as this for other Latina immigrants?  Rayle et al. / THE ‘‘COMADRE’’ GROUP APPROACH 19 Overall feedback from the group participants was overwhelmingly positive. All of the women rated the group as a 5 when determining how helpful the group was for them individually. In addition, each woman highly recommended such a comadre group for Latina immi- grants across the U.S. and stated that having two Latina leaders made the comadre approach to the group even more useful. General feed- back included: ‘‘The group helped me to develop, to be better with more people, and to give me more value for myself’’; ‘‘I guess what motivated me was when all of the women were talking and hearing that other women have problems just like I do, and it just made me feel better...’’; and ‘‘So now, I think that’s the most important thing—not being so negative and just kind of believing in myself. Feeling like I don’t have to be dependent on a man.’’ Most of the women suggested that more topics on parenting in the U.S. would have been helpful because they do not speak fluent English and their children do, and many of their cultural values and traditions differ from general U.S. society values and traditions. In conclusion, the majority of participants believed the area of wellness they experienced the most growth in was emotional self-awareness. LWA Results Findings from the pre-group LWA administration resulted in a mean wellness score of 2.82 (SD ¼.56). The post-group administration on the LWA resulted in an overall mean wellness score of 3.87 (SD ¼.62), resulting in a significant increase in overall wellness for these participants after their experience in this particular group. An independent-samples t test was conducted to evaluate whether there was a significant difference in mean scores of overall wellness pre- and post-group. The test was significant, t(9) ¼ 12.89, p
.01. Therefore, the authors assume that with the use of a comadre, well- ness-based group model such as the current project, future group participants would illustrate increased wellness as well. DISCUSSION Responses from the members during the final session and final interviews revealed that the group helped by letting them express their feelings; allowing them to meet other Latina immigrants experi- encing similar challenges; helping them recognize that although they had good ideas and plans, they needed resources to help their plans to be realized; learning how to succeed; allowing them to release stress; and teaching them how to take care of themselves in new ways. They 20 THE JOURNAL FOR SPECIALISTS IN GROUP WORK / March 2006 learned that they can be confident, can handle difficult times, are strong and important, can speak up for their needs=desires, and can find the resources they need to lead a life of wellness. Members most liked the comadre group approach that invited everyone to share their feelings, trust each other, and be honest. Members also liked that they had a chance to really get to know, listen to, receive=give serious advice, and discuss personal wellness with other Latinas like them- selves. This feedback supported Madriz’s (1997) belief that social sup- port is relevant in the area of immigrant adaptation and adjustment and is a positive life circumstance for Latinas to feel as if they belong. The experience of the members also supported the contention stated in the research (Vega et al., 1986) that social support mediates the stress of immigrant women and acts as a protective factor for recently immi- grated Latinas (Santiago-Rivera et al., 2002). In addition, the awareness the women experienced in the group may help them deal with oppression as it continues to occur in their lives. Additional suggestions from the members included making the sessions longer, having the sessions more often, having field trips and guest speakers from the community, inviting their husbands= partners for a session, discussing healthcare more often, and talking about their occupational opportunities in the U.S. Members also reported liking the depth of the conversations, the feedback, sharing feelings, the fun, and the food. If it were not for their ‘‘comadres’’ in the group, several members reported that they would still be holding in their feelings about their transitions to the U.S., not asking for help, and feeling lonely. The authors recognize that although only one pilot group of this type, subjectively judged to be effective, does not allow for definitive conclusions about this type of group experience for all Latina immi- grants, this experience encouraged the leaders to conduct further research with additional comadre groups for Latina immigrants in the Southwest. In addition, the authors recognize that the group experience would differ greatly if led by co-leaders from another race=ethnicity; however, additional comadre group experiences could be offered in English or Spanish by group leaders from diverse race=ethnicities to test the efficacy of such interactions. There is no doubt a need exists for more Spanish-speaking counselors in the Southwest and across the U.S. (Santiago-Rivera et al., 2002). How- ever, with the disproportionate number of European American counse- lors in our field, wellness-based comadre groups for immigrant Latinas can be an integral addition to any clinical setting serving the Latina population regardless of leader race=ethnicity. It is possible that due to the strength of the historical relationship between and among females in the Latino culture, using female  Rayle et al. / THE ‘‘COMADRE’’ GROUP APPROACH 21 counselors with a group of Latina immigrants positively affected the group. A number of authors affirm the importance of other fema- les=comadres in the lives of Latinas (Madriz, 1997; Marin & Marin, 1991; Prieto, McNeill, Walls, & Gomez, 2001; Zuniga, 2002). Research by Prieto et al. found that Latina immigrant clients ranked preference for a same-sex counselor higher than for an opposite-sex counselor. The researchers suggest this preference may be due Latinas’ tendency, inside or outside of the U.S., to prefer women as sources of emotional support. The impact of acculturation experiences among these women may also have affected the success of the group in a positive manner. Mov- ing from having no support from other Latina immigrants who are experiencing similar acculturation experiences was a positive step for these Latinas. Acknowledging the personal impact of racism against immigrants, women, and Latinos heightened the women’s awareness of the significance of having coping resources and techni- ques for personal wellness. Group interaction is an important means of furthering identity development and social support for Latina immi- grants (Zuniga, 2002). Being able to share their similar experiences with others is immensely helpful at the early stages of immigration (Zuniga). IMPLICATIONS FOR FURTHER RESEARCH AND PRACTICE Not mentioned as a topic for discussion by the members, although suggested in multicultural literature, is the addition of a session or two devoted to discussing the negative and positive experiences of being women immigrants in the U.S. (Prieto et al., 2001; Zuniga, 2002). This would allow the Latinas to look at their own identity for- mation, discuss their feelings about being women of color, relate their experiences, and possibly gain insight into the differences in their experiences from Mexico to the U.S. In addition, additional symbols of Latina ethnicity, including more art and music, could be further incorporated into the sessions. The authors hypothesize that further grounding in the Latinas’ culture of origin would contribute to a deeper sense of being able to hold on to their traditions=beliefs while integrating into U.S. culture (Santiago-Rivera et al., 2002). Supporting minority immigrant females is only one of the roles of culturally competent counselors; as with all forms of counseling today, professional counselors must be aware of the limitations of their own beliefs and assumptions about others (American Counseling Associ- ation, 1997; ASGW, 1999). As set forth by the Association for Specia- lists in Group Work’s Principles for Diversity-Competent Group 22 THE JOURNAL FOR SPECIALISTS IN GROUP WORK / March 2006 Workers (ASGW, 1999), the starting point for group workers is to increase their own awareness, knowledge, and skill in facilitating groups whose memberships represent the diversity of our society. Group leaders must continually examine their own prejudices and be open to and genuinely respectful of culturally different attitudes and behaviors (ACA, 1997; ASGW, 1999; Sue & Sue, 2003). Group lea- ders can be greatly enriched by experiences such as leading comadre approaches to group work with Latina immigrants, and Latina mem- bers can gain knowledge from the perceptions and experiences of Latina leaders as well as leaders from other races=ethnicities. As noted by Atkinson, Morton, and Sue (1989), cross-cultural counseling may not only be effective for the resolution of concerns, but may also serve as a forum for unique learning experiences. Moreover, female leaders from other races=ethnicities might act as positive role models for immigrant Latinas desiring guidance in their acculturation experi- ences (Atkinson et al.). Regardless of leader race=ethnicity, the future of Comadre wellness-based group approaches with Latina immigrants is one with great promise and generates a compelling area of group work research and rewarding clinical group practice for all involved. REFERENCES American Counseling Association. (1997). Multicultural competencies. Alexandria, VA: American Counseling Association. Archer, J., Probert, B. S., & Gage, L. (1987). College students’ attitudes toward wellness. Journal of College Student Personnel, 28, 311–323. Asner-Self, K. K. & Feyissa, A. (2002). The use of poetry in psychoeducational groups with multicultural-multilingual clients. Journal for Specialists in Group Work, 27, 136–160. Association for Specialists in Group Work. (1999). Principles for diversity-competent group workers. Journal for Specialists in Group Work, 24, 7–14. Atkinson, D. R., Morton, G., & Sue, D. W. (1989). Minority group counseling. In D. R. Atkinson, G. Morton, & D. W. Sue (Eds.), Counseling American minorities: A cross- cultural perspective (pp. 11–34). Dubuque, IA: William C. Brown. Cohn, D. (2003, June 18). Hispanics declared largest minority: Blacks overtaken in census update. The Washington Post, p. A1. Corey, M. S. & Corey, G. (2002). Groups: Process and practice (6th ed.). Pacific Grove, CA: Brooks=Cole-Thomson Learning. Cornelius, L. (1993). Ethnic minorities and access to medical care: Where do we stand? Journal of the Association for Academic Minority Physicians, 4, 16–25. Dixon Rayle, A., Brucato, T., Sand, J. K., & Ortega, J. (2003). The Latina Wellness Assessment. Unpublished Instrument. Dixon Rayle, A. & Myers, J. E. (2004). Wellness in adolescence: The roles of ethnic ident- ity, acculturation, and mattering. Professional School Counseling, 8, 81–90. Edleson, J. L. & Roskin, M. (1985). Prevention groups: A model for improving immigrant adjustment. Journal for Specialists in Group Work, 10, 217–224.  Rayle et al. / THE ‘‘COMADRE’’ GROUP APPROACH 23 Forehand, R. & Kotchisk, B. A. (1996). Cultural diversity: A wake-up call for parent training. Behavior Therapy, 27, 187–206. Garcia, J. G. & Marotta, S. A. (1997). Characterization of the Latino population. In J. G. Garcia & M. C. Zea (Eds.), Psychological interventions and research with Latino populations (pp. 1–14). Boston: Allyn & Bacon. Garcia-Preto, N. (1996). Latino families: An overview. In M. McGoldrick, J. Giordano, & J. K. Pearce (Eds.), Ethnicity and family therapy (2nd ed., pp. 141–154). New York: Guilford Press. Garrett, M. T. (1999). Soaring on the wings of the eagle: Wellness of Native American high school students. Professional School Counseling, 3, 57–64. Gil, R. M. & Vazquez, C. I. (1996). The Maria paradox: How Latinas can merge old world traditions with new world self-esteem. New York: The Berkeley Publishing Group. Gloria, A. (1999). Apoyando estudiantes Chicanas: Therapeutic factors in Chicana college student support groups. Journal for Specialists in Group Work, 24, 246–259. Hettler, B. (1984). Wellness: Encouraging a lifetime pursuit of excellence. Health Values, 8, 13–17. Koss-Chioino, J. D. (1999). Depression among Puerto Rican women: culture, etiology and diagnosis. Hispanic Journal of Behavioral Sciences, 21, 330–350. MacLeod, J. & Nelson, G. (2000). Programs for the promotion of family wellness and the prevention of child maltreatment: A meta-analytic review. Child Abuse and Neglect, 24, 1127–1149. Madriz, E. (1997). Nothing bad happens to good girls: Fear of crime in women’s lives. San Francisco, CA: University of California Press. Marin, G. & Marin, B. V. (1991). Research with Hispanic populations. Applied Social Research Methods Series, 23. Thousand Oaks, CA: Sage Publications. Myers, J. E., Sweeney, T. J., & Witmer, J. M. (2000). The wheel of wellness counseling for wellness: A holistic model for treatment planning. Journal of Counseling & Development, 78, 251–266. Padilla, A. M. (1995). Hispanic psychology: Critical issues in theory and research. Thousand Oaks: Sage Publications. Perez-Strumolo, L. (2000). Latino gender roles and their relationship to acculturation, self-esteem, and life satisfaction. Unpublished doctoral dissertation, Fairleigh Dickinson University. Prieto, L. R., McNeill, B. W., Walls, R. G., & Gomez, S. P. (2001). Chicanas=os and men- tal health services: An overview of utilization, counselor preference, and assessment issues. Counseling Psychologist, 29, 18–54. Ryff, C. D. (1995). Psychological well-being in adult life. Current Directions in Psycho- logical Science, 4, 99–104. Santiago-Rivera, A. L., Arredondo, P., & Gallardo-Cooper, M. (2002). Counseling Latinas and la familia: A practical guide. Thousand Oaks, CA: Sage Publications. Smith, J. P. (2003). Assimilation across the Latino generations. American Economic Review, 93, 315–319. Sue, D. W. & Sue, D. (2003). Counseling the culturally diverse: Theory and practice. New York: John Wiley & Sons. Sweeney, T. J. & Witmer, J. A. (1991). Beyond social interest: Striving toward optimal health and wellness. Individual Psychology, 47, 527–540. United States Census Bureau. (2003). Population profile of the United States. Washing- ton, DC: U.S. Government Printing Office. Vega, W. A., Kolody, B., & Valle, J. R. (1986). The relationship of marital status, confi- dant support, and depression among Mexican immigrant women. Journal of Marriage and the Family, 48, 597–605. 24 THE JOURNAL FOR SPECIALISTS IN GROUP WORK / March 2006 Yalom, I. D. (1995). The theory and practice of group psychotherapy. New York: Basic Books. Zambrana, R. E., Ell, K., Dorrington, C., Wachsman, L., & Hodge, D. (1994). The relationship between psychosocial status of immigrant Latino mothers and use of emergency pediatric services. Health and Social Work, 19, 93–102. Zuniga, M. E. (2002). Latino immigrants: Patterns of survival. Journal of Human Behavior in the Social Environment, 5, 137–155.