Indigenous Treatments: Cuento Therapy

Cuento therapy is a group treatment modality that uses Spanish-language folktales (cuentos). Historically, storytelling has played an important role in the education of children by relaying social morals, values, rules, and customs, as well as by providing a functional means of coping. Storytelling, which has theoretical underpinnings in social learning theory, is used in cuento therapy to enhance emotional and behavioral outcomes by modeling appropriate thoughts, beliefs, and behaviors.

Giuseppe Costantino and his colleagues developed cuento therapy for use with Puerto Rican youth and conducted several studies to document its efficacy. In cuento therapy, the selected stories have ethnic themes and characters with whom children can identify. Because the children's difficulties are viewed as the result of acculturation stress, weak traditional cultural values, and loss of ethnic pride, a goal of the therapy is the transmission and reinforcement of traditional Puerto Rican culture.

In the first study of cuento therapy, participants included 208 kindergarten to third-grade students who were second-generation Puerto Rican children in New York City. The children were selected for inclusion based on a behavioral screening and were randomly assigned to one of four groups: original cuento therapy, adapted cuento therapy, art/play therapy, and a control group. The adapted cuento therapy group experienced modifications in the treatment protocol, particularly the adaptation of the original Spanish-language cuentos to the life experiences and coping skills needed by Puerto Rican children in New York City.

Bilingual therapists and the children's mothers were involved in the therapy, which included (1) reading Puerto Rican folktales (in English and Spanish) to groups of four to five children; (2) discussing the meaning of the tales; (3) role-playing the characters in the stories; and (4) discussing the relationship of the roleplay to the children's personal lives. The therapy comprised 20 two-hour sessions over a six-month period. The results indicated that the adapted cuento group experienced a greater reduction in anxiety than the other three groups, and the original cuento therapy group experienced a greater reduction in anxiety than the control group only. Additionally, social judgment (measured by the Comprehension Subtest of the Wechsler Intelligence Scale for Children–Revised) increased to a greater degree for the two cuento therapy groups than for the other groups. After one year, the anxiety treatment effects remained stable, but the social judgment treatment effects were not maintained.

Cuento therapy has been adapted for use with Puerto Rican adolescents who face acculturation, ethnic identity, and other adjustment issues that are common to their group. In the therapy, termed “hero/heroine modeling,” the adolescents are exposed to the biographies of adult Puerto Rican role models (in sports, politics, arts, and education) who have successfully coped with adversity, such as poverty or discrimination. In a study of hero/heroine modeling, treatment and control groups comprised 90 Englishdominant Puerto Rican eighth- and ninth-grade adolescents who had been identified as at risk for behavioral problems. The therapy sessions were similar to cuento therapy. Compared with the control group, the hero/heroine therapy group had a significantly [Page 249]higher level of Puerto Rican ethnic identity, and a lower level of anxiety among eighth graders.

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