Developing interventions that are congruent with the values of communities that have been marginalized or have had limited access to mental health care is an important but sometimes overlooked aspect of intervention development (Park et al., 2023). The goal of achieving cultural congruence, for which there is no standard approach, may best be conceptualized within a flexible framework that guides the entire process of developing, testing, and delivering therapies, one that centers the perspectives and preferences of marginalized communities at key decision points. Here, we share the story of one intervention program – a brief, relationship-based intervention rooted in principles of attachment theory and positive psychology called relational savoring (RS) – in its ongoing quest to become more culturally congruent.

Deeply immersing oneself in one’s positive experiences can provide immense psychological benefits. Bryant and Veroff (2007) refer to the tendency to attend to, appreciate, and even enhance one’s positive experiences as savoring. People who naturally engage in savoring report greater well-being and are less likely to have mental health problems (Hurley & Kwon, 2013; Smith & Hollinger-Smith, 2015). Although savoring is a trait-like emotion regulation tendency, it can also be taught as an intervention, yielding lower depression and greater happiness (Bryant et al., 2005; Hurley & Kwon, 2013; McMakin et al., 2011).

Bryant’s original conceptualization of savoring is general in its focus (i.e., people savor many different aspects of their experiences). However, given the centrality and importance of attachment relationships in people’s lives, as well as the potential for relationships to impact health and well-being (Mertika et al., 2020; Slatcher & Selcuk, 2017), attachment relationships may be a particularly important target of savoring interventions. Indeed, Fredrickson (2013) conceptualized love as consisting of micro-moments of positivity that resonate in every relationship. Noticing and preserving brief instances of connection and positivity through savoring helps make them less fleeting. Thus, RS interventions were developed to help people savor specific attachment-based experiences occurring within relationships (Borelli, 2024; Borelli, Smiley, et al., 2020).

RS is a brief, strengths-based program that can be used for prevention or intervention. It can be used as a stand-alone program or integrated into existing intervention programs to augment clients’ focus on positive connectedness. RS can be used as a prevention tool for populations who might benefit from enhancing their closeness or positive emotion within a targeted relationship (e.g., new parents, who may be at risk for relationship difficulties within the co-parenting relationship, the partner relationship, or the parent–child relationship). In research contexts, RS has typically been delivered in an individual therapy format by trained paraprofessionals (e.g., college-level students in psychology without clinical experience, lay community health workers),¹ although it has also been delivered as part of group therapy (Borelli, Yates, et al., 2020), over the internet (Borelli, Rasmussen, et al., 2014; Burkhart et al., 2015), over the phone (Borelli, Sbarra, et al., 2014), and via telehealth (Nguyen et al., n.d.). RS can also be delivered by therapists in clinical practice as a stand-alone intervention or integrated into other intervention modalities, including individual therapy (e.g., as a complement to cognitive behavior therapy or emotion-focused therapy) and couples therapy (e.g., as a complement to Emotionally Focused Therapy, Greenberg & Johnson, 1988; for a review, see Borelli, 2024). RS may be particularly compatible with certain therapeutic modalities, including Acceptance and Commitment Therapy, which often incorporates mindfulness and savoring techniques as part of its values-based approach (Hayes et al., 1999), and with Emotion-Focused Therapy (Greenberg, 2004), which shares a strong focus on the importance of emotional expression. A therapist may wish to use RS as an intervention approach when either the client or the therapist identifies that the client would benefit from growth in the areas that RS targets – attachment security, closeness to others, reflective functioning, relationship satisfaction, and the expression of vulnerable emotions in the context of interpersonal relationship experiences. For instance, a therapist may wish to use RS when clients feel disconnected within a relationship, when there is a high level of conflict within a relationship, when a client has experienced a relational loss (e.g., death) or separation (e.g., work-related), or when a client feels rejected or unappreciated in a relationship. The RS therapeutic approach involves helping clients tune into their moments of positive connectedness with others, particularly during moments when they provided or received sensitive care to/from another person.

When delivered in person in a one-on-one format, RS follows three steps. RS commences with a brief mindfulness exercise (step one) to reduce anxiety and stress, preparing the client for deeper reflection. In recent intervention trials (Borelli et al., 2019; Borelli, Hong, et al., 2022; Borelli, Kerr, et al., 2022; Borelli, Russo, et al., 2022), this exercise has taken the form of 1 min of paced breathing that the client and the intervener do together. Then, the intervener leads the client through memory selection (step two) and memory reflection (step three). In the memory selection phase (step two), the intervener helps the client recall two to three recent positive memories occurring with their relationship partner.² The purpose of this phase is to identify the most optimal memory to savor. Once the client has shared a specific memory, the intervener asks questions to better understand the degree of specificity, positive emotionality, and emotional connectedness of the memory. The intervener also assesses the degree to which the memory contains difficult content or negative emotions that might intrude on savoring (which we refer to as “spoiling” in the manual;³ see Borelli, 2024). The treatment manual contains detailed instructions for how interveners can work with clients productively in the presence of negative emotion (see Borelli, 2024, for more details),⁴ but in brief, the approach involves validating the client’s negative emotion, creating space for the client’s negative emotion, and encouraging the client to explore positive emotions during the savoring session. Finding ways to simultaneously consider problems and difficulties while exploring positive emotional experiences and focusing on resources is a strategy shared by many intervention approaches (e.g., Boszormenyi-Nagy & Krasner, 1986). In the RS approach, if the intervener perceives strong negative emotions when the client recounts the memory, the intervener will help the client select a different memory. After memory selection (step two), the intervener and client move on to memory reflection (step three).

The memory reflection phase (step three) is a 5-step process in which the client sequentially focuses on different aspects of the memory. The five steps include: (1) Sensory reflection (i.e., client describes sensory details of the event), (2) Emotion reflection (i.e., client describes and re-experiences the emotions associated with the event), (3) Meaning making (i.e., client describes the thoughts associated with the event), (4) Future focus (i.e., client describes what the memory means about the relationship with their partner in the future), and (5) Mind wandering (i.e., client shares anything that comes to mind related to the memory). At each step of the process, the intervener draws the client’s attention to the precise moment when the client felt most connected to the other person. For instance, when reflecting on a loved one’s departure, the intervener might draw attention to the moment when the client’s partner pulled her back to give her one last embrace.

RS is a strengths-based program; throughout the interaction, interveners praise clients for the positive relationship behavior they exhibit, and at the same time, intentionally avoid commenting on undesirable behaviors. In this way, interveners selectively and positively reinforce the behaviors and emotions they want clients to re-experience; such comments also create a warm and supportive environment in which clients can explore their relational and emotional experiences.

RS is guided by two overarching theories, attachment theory and the broaden-and-build theory from positive psychology. Attachment theory (Bowlby, 1973) holds that experiences in early relationships lay the foundation for socioemotional wellness throughout the lifespan. Through early experiences with attachment figures, people internalize important messages about the self, relationships, and the world. If a caregiver provides a child with consistently sensitive care, the child develops secure attachment, learning that their needs will be responded to and that they deserve to be cared for. On the contrary, if a caregiver is inconsistently responsive to a child’s needs or becomes overwhelmed by their own emotions when responding to the child’s needs, the child becomes insecurely attached, perceiving that their needs are unimportant or dangerous and that the world is a frightening place where people cannot be counted on. Early relationship experiences set in motion a cascading series of internal processes – children build up a mental model of the self and the world that then causes them to interpret future relationship experiences in particular ways. Secure individuals are more likely to perceive experiences of loving care and concern as highly relevant and consistent with their worldview. For insecure people, these same experiences may be discounted as being irrelevant or the exception to the rule. Although internal working models (IWMs) of attachment (Bowlby, 1969, 1973) are thought to be adaptive in the context in which they develop, helping the individual acclimate to their particular relational environment, some IWMs may prevent people from getting possible benefits from positive aspects of their relationships. As with other interventions (e.g., security priming, Gillath et al., 2008), RS seeks to help correct this bias.

RS is premised on the belief that almost all individuals have moments of felt security in their daily lives, fleeting though they may be. For example, a person may catch their partner’s eye, even from across a room, and with one look, feel understood. Often, these moments pass by unnoticed, but moments of felt security – times when one feels safe, accepted, or deeply appreciated – are important to revisit for the positive emotion and feelings of connectedness they contain. Although many people have a threat bias (Mulckhuyse, 2018), those with attachment insecurity may be even more strongly predisposed to lean this way and thus may stand to benefit the most from the RS intervention. Notably, the experience and attribution of threat are affected by multiple internal and external factors. For example, minoritized populations may be more likely to experience collective threats that target their social groups (Cohen & Garcia, 2005). When interventions are developed with cultural congruence in mind, attention to specific threats and specific sources of strength can be incorporated. Further, individuals residing in unsafe environments, such as those characterized by live threats (e.g., abuse, domestic violence) must be vigilant to threat in order to be safe. They may not be suitable for this approach, a limitation that will be discussed in depth below.

The second theoretical framework underlying RS is the broaden-and-build theory (Fredrickson, 1998) within positive psychology (Seligman et al., 2005). This perspective holds that positive emotional states have a beneficial impact on psychological functioning. Specifically, being in a positive emotional state opens people up to considering new perspectives, approaching problems from new angles, and being more creative (Fredrickson, 2001). Positive emotions can also help people recover from negative emotions more quickly and effectively (Fredrickson, 2005). For instance, practicing gratitude (e.g., writing and then sending a letter of gratitude to a person who has been kind) has the power to increase happiness, decrease depressive symptoms, and produce positive changes (Seligman et al., 2005). In contrast, being in a negative emotional state can constrict these same psychological capacities, making people more inflexible or rigid (Fredrickson, 2004).

These principles are similar to those that underlie mindfulness-based programs; that is, being in a euthymic state can help relax one’s cognitive processing and open one up to a more reflective space (Kabat-Zinn, 2003). These ideas have been supported by recent neuroscientific developments (e.g., Hanson, 2016) showing that, to preserve the species, the human brain is oriented toward negative psychological experiences (e.g., threats) to keep physical danger at bay. Noticing and savoring positive experiences and emotions does not appear to be a biologically inscribed behavior in human beings, but rather a learned ability that nevertheless has enormous benefits (Hanson et al., 2021). Based on these findings, RS begins with a brief mindfulness exercise to reduce physiological reactivity and promote expansive reflection before proceeding with the intervention. Further, by focusing on positive relational experiences (as opposed to negative ones), we seek to enhance openness to psychological growth (new emotions, new perspectives on the self and other).

The efficacy of RS has been examined in several studies with a variety of populations. The findings reveal that RS is effective in improving emotional states (Borelli, Kerr, et al., 2022; Burkhart et al., 2015), relationship satisfaction (Borelli, Rasmussen, et al., 2014), parenting sensitivity (Borelli, Hong, et al., 2022; Borelli, Kerr, et al., 2022; Borelli, Russo, et al., 2022), and cardiovascular reactivity (Borelli et al., 2019), and when delivered in the context of an attachment-based group intervention, in reducing mental health symptoms (Borelli, Yates, et al., 2020). RS has been evaluated among parents (majority female) of toddlers (Borelli et al., 2023; Borelli, Kerr, et al., 2022; Burkhart et al., 2015; Doan et al., 2023; Smiley et al., 2024), incarcerated parents (Kerr et al., 2022), adult romantic partners in long-distance relationships (Borelli, Rasmussen, et al., 2014), partnered couples (Wang et al., 2023), female non-deploying partners of military personnel (Borelli, Sbarra, et al., 2014; Froidevaux et al., 2023), older adults aged 60 to 90 (Borelli et al., 2019), adolescent males in residential treatment (Wang, Bouche, et al., 2020; Wang, Huang, et al., 2020), and low-income Latine⁵ mothers and adolescents (Borelli, Yates, et al., 2020). The intervention has also been evaluated among parents of children with autism spectrum disorder (Gaskin, 2021; Pereira et al., 2021) in the United States and Singapore. In addition, several of these studies have examined moderators of response to the intervention or predictors of engagement with the intervention. On the one hand, clients with greater risk (e.g., higher attachment avoidance, higher depressive symptoms) show greater response (Borelli, Hong, et al., 2022; Burkhart et al., 2015), perhaps because their RS is lower quality to begin with (Bond & Borelli, 2017; Borelli, Hong, et al., 2022). On the other hand, adults who begin an intervention trial with higher relationship satisfaction or lower attachment avoidance (Borelli, Rasmussen, et al., 2014; Borelli, Sbarra, et al., 2014) also benefit more from RS. In sum, these preliminary findings suggest the short- and medium-term efficacy of this intervention/prevention approach.

In constructing RS, several goals were at the forefront. First, the developers sought to construct an intervention that was not only grounded in psychological principles but also scalable. That is, designing a protocol that could be easily delivered by interveners without advanced training (e.g., lay community health workers, paraprofessionals) would enhance its potential for dissemination. Second, it was important that the intervention be acceptable to underserved populations. Early findings suggested that it might be particularly appealing to a specific subpopulation in southern California. Goldstein et al. (2019) conducted a re-analysis of data from Burkhart et al. (2015) and found that Latine parents high in attachment avoidance increased parental reflective functioning (a measure of mentalizing) following RS, whereas non-Latine parents did not. We reasoned that for high avoidance Latine parents, the fact that the intervention was culturally matched with values that are strongly held within many Latine families might have contributed to the intervention’s impact. For instance, RS is consistent with values of familismo, the prioritization of family relationships (Corona et al., 2017), and simpatía, an emphasis on harmonious social interactions characterized by positive emotional expression (Acevedo et al., 2020). The focus of RS on close relationships and positive emotions may naturally resonate with these values, perhaps making RS more relevant to Latine parents. In other words, even though the intervention approach may have been at odds with their avoidant attachment style, the fact that it fit with their cultural values may have made it more likely for them to benefit from it. Although not initially developed with Latine families in mind, this exciting finding encouraged us to examine the efficacy of RS for Latina mothers as an a priori goal in a subsequent trial of RS and to begin developing a culturally congruent intervention/prevention program in earnest. When embarking upon this goal, we felt that it was important to note that Latine individuals vary in terms of the extent to which they would benefit from cultural modifications of an intervention; some Latine individuals who are highly U.S. acculturated may not need or benefit significantly from a highly adapted intervention, whereas Latine individuals who are less U.S. acculturated may benefit from an intervention approach that has been more extensively adapted. In our work, we have partnered with communities that vary in the extent to which they are likely to benefit from adaptation of the intervention. Below we present a guiding framework for working toward cultural congruence, illustrated via several case studies.

Culturally congruent care, as defined by the American Nurses Association standards of practice, is “in agreement with the preferred values, beliefs, worldview, and practices of the healthcare consumer” (Marion et al., 2016). For a client to receive culturally congruent therapy, the therapy itself must be both acceptable and accessible. In the following section, we outline lessons learned and active steps taken to enhance the cultural congruence of the RS intervention for Latine families. Although we refer to a broad “Latine community” in our discussion, we also acknowledge the remarkable heterogeneity within groups that may be labeled with this term, and the importance of tailoring interventions to individuals or groups as needed. We have conducted RS with a diverse composition of samples, but we focus on Latine families as this is the underrepresented minoritized group with whom we have had the most in-depth experience. Further, it is the largest racial-ethnically minoritized group in the geographic region where we work.

In the sections that follow, we present three studies that illustrate the path we have taken in adapting RS to be culturally congruent for Latine families. In making modifications to the intervention, we have focused on two types of adjustments. First, we have attempted to adapt RS so that it more fully embraces the values of the community being served (i.e., broader cultural values, inclusion of local metaphors). We refer to this as a cultural adaptation. This type of adaptation is more likely to be specific to the cultural group targeted (in this case, to members of the Latine community). Second, we have worked to increase the accessibility of the intervention, which removes barriers to dissemination – this type of adaptation can be advantageous for many different cultural groups (i.e., not just members of the Latine community). We refer to this as an accessibility adaptation. Below we present a brief description of each study and its findings, followed by the concrete steps we took to culturally adapt RS, as well as the outcomes of the adaptation process. Table 1 presents a summary of the modifications for each study.

Our initial efforts in adapting RS have resulted in improvements in intervention acceptability and accessibility for the cultural group already included in current RS work (i.e., Latine families and health workers). With each study, we have progressively taken steps to increase the cultural congruence of the intervention for specific groups via increased levels of community input. The protocol used in the most recent iteration of the RS studies (El Corazón de la Comunidad) was developed in direct response to community input – and reflects the wisdom of the promotores and CHWs. Yet even with these modifications, there are several aspects of RS that could be targeted for future adaptations, as we discuss below. It is also worth mentioning that we have not evaluated whether the culturally adapted versions of the RS protocols are better received or more effective than the original version. We assume that because we adapted the intervention based on community feedback, the resultant product would be more acceptable and more effective, but we have not formally tested this assumption. Additionally, in considering cultural congruence, it has also become clear that it is important to consider generational or acculturative status, age, and other factors that may influence the degree to which Latine cultural values may resonate with clients.

Looking forward, from a theoretical perspective, we believe the three key areas related to RS interventions that could be more finely crafted to enhance intervention acceptability and cultural congruence are emotion regulation, savoring focus, and targets of RS. One important area that is relevant to RS is how emotions are regulated (i.e., experienced, recognized, and expressed) across cultural groups. Emotions are experienced differently across cultures (Immordino-Yang et al., 2016). For example, Western groups (Eid & Diener, 2001), African and African American samples (Kim-Prieto & Eid, 2004), as well as people of Latine heritage (Senft et al., 2021) have been found to emphasize positive emotional states while suppressing or avoiding negative ones. However, in individualistic cultures, suppressing negative emotion does not reduce the experiential or physiological effects of negative emotion (Gross, 2002). On the contrary, in East Asian collectivist societies, suppression of negative emotion is practiced in order to maintain the social order, but without negative effects on adjustment (Matsumoto et al., 2008). Still, other studies have shown that in East Asian societies, people emphasize harmony between positive and negative emotional experiences, valuing both as crucial parts of human perception (Sundararajan & Averill, 2007). The ways emotion is expressed in language can also heighten cultural differences (Goddard, 2002). Taking these differences into account, Smith and colleagues (2019) suggested that instead of seeking to amplify positive emotions, savoring interventions implemented with individuals from East Asian backgrounds may wish to emphasize dampening negative emotions. Alongside this argument, we wonder whether using terms that connote low arousal positive emotion (such as “calm” or “peaceful”) rather than terms that connote high arousal positive emotion (such as “excited” or “energizing”) would resonate more with people from East Asian backgrounds (Senft et al., 2021).

To address differences in emotional experience and expression, RS interveners could also use culturally congruent terms that better reflect how positive relational dynamics are encoded by individuals from certain cultures. For instance, Smith and colleagues (2019) noted that compared to other forms of savoring, RS may be particularly well-suited for people from East Asian backgrounds given its emphasis on social connectedness. Additionally, some linguistic modifications could enhance its appeal. For example, “honored” may be more congruent with filial piety values (Wong & Chau, 2006) than terms like “connected,”; changing terms to match cultural values will likely increase uptake of intervention. More generally, because impaired emotion regulation is a core process that has been implicated in various psychological disorders, and improvement in emotion regulation is a common focus and byproduct of many psychological therapies (Gratz et al., 2015), a comprehensive understanding of how emotion regulation processes unfold in different contexts for members of different cultural groups is essential to developing efficacious treatments.

Yet another aspect of RS that may be influenced by cultural experiences is the individual’s focus while savoring. Culture shapes one’s sense of self (e.g., degree of interdependence or independence) and how the self is experienced (Markus & Kitayama, 2014; Oyserman & Lee, 2008), which could influence the most appropriate focus of savoring. For selves that are interdependent with close others (e.g., family members), a relational form of savoring may be most appropriate and relevant (Smith et al., 2019). However, in cultural contexts that value interdependent value systems, family and community -- entities beyond the dyad -- are prioritized (Campos et al., 2007), suggesting that savoring experiences that focus on community-level interactions (e.g., such as the form of RS included in the El Corazón de la Comunidad study) would be appropriate. On the contrary, cultures that emphasize an independent sense of self may find self-focused savoring (i.e., personal savoring) to be more acceptable and beneficial. Indeed, several of our studies have documented the beneficial effects of personal savoring (e.g., Borelli, Kerr, et al., 2022; Pereira et al., 2021). Thus, future implementations of RS should take into consideration the kinds of relationships that are most salient or relevant to the target community.

Finally, diversifying the specific groups who receive RS (i.e., the targets of the intervention) will increase our knowledge of how modifications to RS achieve cultural congruence. To date, the majority of the studies conducted with RS have involved female participants (e.g., mothers or majority female samples). Female-identified people tend to feel more comfortable both giving and receiving care than male-identified participants, who may experience more difficulty in participating in this intervention due to differences in gender socialization (Chodorow, 1979; Gerson, 1985; Medved et al., 2006). It is noteworthy, however, that some relationship-based cultural values associated with Latine groups may also play a protective role. The culturally-rooted masculine norm of machismo consists of two components: machismo (i.e., the cultural values that emphasize attributes such as aggression, control, strength, and domination) and caballerismo (i.e., acting in a “gentlemanly” manner or displaying virtues like charity, honesty, honor, and politeness, especially toward women). This second component has been associated with affiliation and supportive co-parenting, processes likely linked to attachment-building and positivity in family relationships (Arciniega et al., 2008). Although we have not studied this in the context of RS, we wonder whether we could achieve greater cultural congruence with the values of Latine men by emphasizing a male role in protection, affiliation, and co-parenting (Arciniega et al., 2008). Despite this theorizing, our data on men’s response to the intervention are limited. Anecdotal evidence and pilot data from male participants who have completed RS interventions suggest that RS is acceptable for male-identifying participants (e.g., Wang, Bouche, et al., 2020; Wang, Huang, et al., 2020). Nevertheless, future research should investigate if modifications in language or approach would make RS more accessible and acceptable to a wider swath of the population.

It is important to consider that the process of making RS more adapted to Latine communities may have rendered the intervention less congruent with the values of other communities. Importantly, this assumption has not been tested. We are currently in the planning stages of projects that involve working with Black/African American families, Asian/Asian American families, as well as male clients. When beginning these projects, we are faced with the question of whether we start with the original version of RS (nonadapted version), with the version that was adapted for Latine families, or whether the projects should begin by seeking input on the intervention from the community through a process of co-development, as was done with the Confía en Mi, Confío en Ti project. In making these decisions, we consider the cultural values of the groups, their similarity with Latine cultural values, and the potential benefits and costs of each different approach.

Although the goal of cultural adaptation is to modify protocols so that they are suitable for people with different backgrounds and needs, it is worth considering that RS may be a poor fit for certain clients. For instance, people who experience significant adverse life events may struggle with this approach. For individuals with past or current relationship challenges, reflecting on moments of positive connectedness that seem more inconsequential (e.g., a positive interaction with a medical provider) when they are dealing with ongoing interpersonal struggles may ignore the emotional reality of their experiences. Imagine clients who are involved in relationships with a high level of conflict, coercion, hostility, or abuse. RS may be contraindicated for this type of client – assisting them in focusing on moments of perceived safety when the relationship is unsafe would be a disservice to them. In these cases, assisting clients in developing accurate appraisals of the threat in the relationship and engaging in safety planning may be more helpful; that is, ensuring a client’s safety ought to be the primary treatment goal.

Further, RS may be difficult for clients who struggle to accept care – the double gaze of giving and receiving can pose a significant challenge for clients with this profile (e.g., Plys et al., 2020). In this circumstance, the intervener will need to assess whether RS leads the client in a direction that is beneficial for them, even if challenging. In other words, if being able to accept care is a treatment goal, increasing the client’s comfort with the thought of being cared for may be pursued through RS. However, the process of engaging with RS may need to be achieved more gradually, perhaps breaking down the steps more slowly, beginning by having the client savor moments of positive connectedness and gradually moving into savoring moments of being cared for in more and more vulnerable situations.

These considerations underscore a broader point – the need for the intervener to use clinical judgment about the appropriateness of the goals of RS for any individual client: to strengthen their mental representation of a relationship as loving, safe, and secure (care-receiving RS), or of the self as sensitive and responsive (care-giving RS). RS should be selected as an intervention when the therapeutic goal is to increase feelings of felt security within a given relational context, but first, the intervener must ask themselves whether that is a worthy goal. Interveners should assess for aspects of a client’s current or past experiences that could be relevant to their suitability to benefit from RS prior to administering the intervention. They can do so using self-report questionnaires (e.g., Traumatic Life Events Checklist-Revised; Kubany et al., 2000; Domestic Conflict Inventory; Margolin et al., 1998) or, in the case of an ongoing therapeutic relationship, their knowledge of the client. In these circumstances, interveners may wish to make one of several clinical decisions: (1) choose a different intervention approach, (2) administer RS but check in more frequently with the client regarding their reaction to the intervention, or (3) consider modifying RS in such a way as to preserve the intervention’s intention – helping the client connect with the experience of felt security, however that may be achieved. For instance, some clients may benefit more from examining relationship interactions from the past or hypothetical, imagined relationships (for an example of this type of modification, see the Confía en Mi, Confío en Ti Study description above).

RS has shown promise not only in terms of its initial outcomes but also in terms of its accessibility and acceptability for members of Latine communities that have been marginalized and poorly served by health care systems. Other marginalized communities who are underserved by mental health interventions will be our next focus. Given its brief format and flexible structure, RS is also positioned for frictionless uptake by interveners and lends itself toward a culturally humble stance. Our hope is that our collaborative process of enhancing the cultural congruence of RS for members of the Latine community will inform similar efforts with other therapies that draw on the existing strengths of underserved populations. By listening to the communities we serve, we strengthen not only the collaborative process but also the interventions themselves.