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Given the many facets of a human being, it is appropriate to approach family work with “cultural”, “ecological,” and “contextual” sensitivity. It would seem an implausible task to try to understand a client, let alone help them if their environment and context are not taken into account.
In Bronfenbrenner’s article on the ecology of the family (1986), he discusses how many of the different interactions between mesosytems of the identified patient affect the clients in question by the use of his Ecological Model. He points out different dynamics between the Microsystems within the mesosystems and one of the points he made was in regards to the existence of a “support system” outside the home; he pointed to the fact that when the church is included in this support system, there is a lower occurrence of neglect in the home. Also, with regard to father’s job, an exosystemic influence, he showed how the father’s type of work skills are mirrored in the types of skills he uses to parent his children.
In McGoldrick’s (1995) article on family trees, she explains how the microsystem of the immediate family affects the outcome of the identified patient. Using Ben Franklin’s life as a template for this theory, she shows how the attention of an uncle can influence the importance the identified patient places on family. Ben Franklin formed an alliance with his granddaughter in much the same was as his son formed an alliance with his own granddaughter. Furthermore, the father-child relationships were strained in much the same way between Franklin and his son William and William and his daughter Temple. Family inheritances involve much more than just money and genes and a pattern of behavior can be easily traced back through generations. One must consider the context of the family as it pertains to current behavior in the identified patient in order to understand all the influences that are working upon the dynamics between the identified patient and others in his/her life.
When working with diverse families, it is important to adjust our theoretical orientation to encompass the needs of the client, not simply our understanding of the client at that time. It takes time to truly get to know the inner workings of a client and the environmental influences that affect the client in unique ways. Traditional family therapy concentrates on the “nuclear family” that only exists in 6% of U.S. homes (McGoldrick & Hardy, 2008). We fail to address the true needs of our clients if we fail to take into account the individual differences between our clients and their families. In consideration of family hierarchies in individualistic versus collectivist cultures, it is important to note that individualistic cultures have a much more egalitarian marital couple unit and that deference to those higher on the family hierarchy is stressed in collectivist cultures (Falicov, 1998). It can be challenging to treat a client or clients who have different worldviews than our own; trying to get a couple to reach a compromise may be appropriate for a Western family unit, but may be inappropriate and even harmful to an Eastern-influenced couple. Therapeutic interventions must be adjusted in accordance with the values of the family being treated. There is no cookie-cutter approach to therapy; the unique inner workings of the family must be accounted for when deciding what therapeutic intervention will be most suitable.
Another point-of-view difference between traditional Western families (individualistic) and Eastern or collectivist cultures is the existence of family triangles. It may be challenging to watch what we deem to be a pathological interaction between our clients without attempting to change it. Triangulation is seen as pathology in families of Western descent (Falicov, 1998), however it may be a functional mode of conflict resolution for more collectivist cultures. In families of German descent, it is common for the children to take precedence privately with the mother, whereas she pays deference to the father only when he is around (Falicov, 1998). This may be seen as “keeping secrets” or being dishonest or disloyal by Western standards. It is important not to pathologize interactions between family members if the family is functioning well in spite of the existence of what we may term pathology – it may be a knee-jerk reaction to try to get our clients to interact with each other on a seemingly more “honest” level, but we may do more damage than good if we make the decision for them. Exploring the ways in which a family’s system is working for them first, is important in determining what needs to change.
According to McGoldrick and Hardy (2008), the disorders of our society seem to be heavily influenced by sociopolitical forces at play. Slavery, as an example, gave rise to distinct disorders named in the DSM – disorders that no longer exist because of society’s views on slavery changing (McGoldrick & Hardy, 2008). In much the same way, family therapy has neglected to take into account race and other demographic factors because they were not deemed as important to family therapy specifically (McGoldrick & Hardy, 2008). It is of paramount importance for family therapists to place emphasis on the historical background of their clients in order to properly treat the issues the client is having. Family therapists should have training experience that includes perspectives taught from a non-European-American viewpoint in order to include other race/ethnicity’s viewpoints (McGoldrick & Hardy, 2008). It seems imperative at this point to open our minds up to what’s working, regardless of the origin.
It is important to not impress our worldview upon our clients. We must take into account the society in which we live as well as the historical background of the client. In our money-driven society (Laszloffy, 2008), we tend to focus on luxury issues instead of the living problems our clients may have. Not all of our clients are going to be as affluent or as poor as we are. It is important to take into account the client’s socioeconomic status as well as the cultural background to integrate appropriate and feasible interventions with our clients; it is inappropriate and unhelpful to expect a client to attend three-times-weekly meetings if transportation is an issue for them. It is of vital importance to assist the client in helping themselves and we cannot do this if we fail to take into account their resources. Social class is a barrier to therapy, but it can be overcome with creativity and ingenuity.
If we, as therapists can open our minds up to other cultures and their teachings, we open the door to exploring a multitude of other influences such as spirituality and indigenous healing practices (McGoldrick & Hardy, 2008). It seems that as long as we don’t decide that we are the final authority over our clients and that we develop a working alliance with them, we will help the client overcome difficulties and that our interventions will be pertinent to their lives.
REFERENCES
Bronfenbrenner, U. (1986). Ecology of the family as a context for human development: Research perspectives. Developmental Psychology, Vol. 22 (No. 6), 723-742.
Falicov, C.J. (1998). The cultural meaning of family triangles. In McGoldrick, M. (Ed.), Re-Visioning family therapy (pp. 37-49). New York: Guilford.
Laszloffy, T.A. (2008). Social class: Implications for family therapy. In McGoldrick, M. & Hardy, K.V. (Eds.), Re-Visioning family therapy (pp. 48-60). New York: Guilford.
McGoldrick, M. (Ed.). (1995). You can go home again: Reconnecting with your family. New York: W.W. Norton & Co.
McGoldrick, M. & Hardy, K.V. (2008). Re-Visioning family therapy from a multicultural perspective. In McGoldrick, M. & Hardy, K.V. (Eds.), Re-Visioning family therapy (2nd ed.) (pp. 3-24). New York: Guilford.
