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More than any other classic psychoanalyst, Karen Horney has stressed that psychotherapy requires the understanding of the total person, and that familiarity with the patient's psychological and social worlds is a necessary condition for a therapeutic relationship (Horney, 1937). Because ethnic identity permeates people's lives so pervasibly, clinicians must have a full understanding of the patient's ethnicity if they are to make a valid diagnosis and to work in psychotherapy successfully.
Understanding ethnicity means familiarity with the person's social values and beliefs, religious views and customs. It means understanding the person's culture; that is, the integrated pattern of human behavior that is learned and transmitted to succeeding generations. It also means understanding the person's language, the systematic means of communicating ideas and feelings. Verbal communication is the essence and heart of psychotherapy. But language is more than a means of communicating. As Sapir has said, “people who speak different languages live in different worlds, not in the same world with different labels attached” (see Edgerton and Karno, 1971). For people's behavior is often influenced by the semantic structure of their language, and their ideas and perceptions are shaped by the language they speak (Weinreich, 1953).
The United States is populated by a rapidly growing Hispanic minority. A 1985 population survey shows that 17 million Hispanics live in this country—not counting Puerto Rico and undocumented immigrants. Should the present level of growth continue, Hispanics will soon become the largest minority group in the United States (U.S. Bur. of the Census, 1986). An essential part of Hispanics’ ethnicity is their bilingual condition. Their world involves two languages, and irrespective of how well they speak English or Spanish,