Culturally Competent Family Therapy: A General Model

Culturally Competent Family Therapy: A General Model

Shlomo Allel Westport CT: Praeger Press, 1999

Reviewed by Katherine Tyson

SHLOMO ARIEL IS A LICENSED family therapist who directs the Integrative Psychotherapy Center in Ramat Gan, Israel. He also is the Coordinator of Research and Academic Development at the Israeli branch of Lesley College, Boston, MA. In this volume he has used both his practice and research expertise to address two of the more challenging topics in contemporary mental health care:

* developing a model of family therapy that expands contemporary knowledge about understanding and helping families, and

* developing a family therapy model that is applicable to the profound and varying ways that cultural differences affect families and the therapy process.

In order to accomplish his aims, Ariel has reviewed an extraordinary amount of literature about people from diverse cultures and about the treatment process. His book offers an extensive bibliography of family therapy and sociological and anthropological literature about people in different cultures. Ariel also has included clinical examples from diverse sources, including agency-based clinical work, dialogues with students in educational settings, and available clinical literature. The multicultural examples alone make this book edifying. Readers learn about:

* an orthodox Jewish family who attributed their problematic interactions to a flawed mezzuzah;

* a highly educated family from India who interpreted their son's commercial recording success as a threat to their spiritual quest;

* the blurred line between social intimacy and antagonism in African American teenagers' communication via "sounding";

* the Arab concept of honor that led a man to deceive his beloved about his marriage to another woman, and yet also invite her to the wedding; and

* an Irish American family's dismissive, sardonic humor about a child's delinquent behavior.

These examples generate considerable respect for the complexity of Ariel's undertaking. Many examples also illustrate how therapists-unaware of their lack of understanding of the client's cultural values-could misinterpret the meaning of the client's behavior and intentions, to the detriment of the therapeutic process.

Ariel articulately describes some of the core problems in contemporary approaches to teaching crosscultural mental health care. For instance, he comments that cultural sensitivity is too often equated with a knowledge of the histories and common traditions of different cultural and racial groups. When such a definition of cultural sensitivity regulates education or theory development, it has the unfortunate impact of deepening ethnocentric and racial stereotyping rather than remedying it.

Another important issue cited by the author is the increasing difficulty defining distinct ethnic or racial groups. Ariel says, "I am doubtful whether groups such as African Americans, Italian Americans, and so forth, constitute ethnologically or sociologically researchable entities. These groups are far from being homogeneous ..." (p. 6). He emphasizes that social changes and global communications can rapidly shift inter-systemic interactions, thus rendering generalizations about social groups obsolete.

Among the book's strongest points is Ariel's treatment of the therapeutic alliance with families. He notes, for example, that the degree of therapist self-- disclosure that will help a family to form a connection with the therapist varies with the extent to which a family has accepted cultural values about authority figures' remoteness and self-disclosure. Ariel does not tend to conflate socioeconomic status with ethnicity, and throughout the book he recognizes the importance of empowering families who are socioeconomically disadvantaged. His examples tend to focus on client behaviors that would be morally condemned or seriously misunderstood by therapists not familiar with the client's culture, and he shows how, from the client's frame of reference, the client's choices not only make sense; they have an adaptive and even moral motivation. In this way, Ariel's examples communicate the great importance of therapists' learning about a client's culture and how they [clients] perceive their values and intentions in making choices.

Ariel also does not shy away from one of the more problematic areas in cross-cultural therapy-- how to address the conflict of values that can occur (Saleebey, 1994). Ariel does not buy into the common illusion that one can be value-free and should refrain from being judgmental, but instead recognizes that from a vantage point outside a culture, some culturally-sanctioned behaviors will be perceived, justifiably, as inhumane. One example cited by the author is the custom that led some families to burn daughters who dated men of whom they disapproved. He could also have used the custom in the United States of forcing poor parents to abandon their young children to seek employment, which although recently written into law here, is regarded as barbaric by people in many other countries where the problem of parental poverty is handled legislatively by giving parents stipends so they can stay home and care for their young children (Carnegie Commission, 1994). Ariel recognizes that it is not possible, nor is it desirable, for therapists to avoid judgments about whether cultural norms benefit or harm families, and that, in fact, it is necessary for clinicians to be reflective about the fact that their clinical responsibilities require that they make such judgments all the time.

Ariel as a theoretician has more trouble holding onto the complex interplay between cultures and the therapeutic relationship. One way to understand the problem with his model is to consider two of the more important issues that face any theoretician seeking to develop a psychology or treatment theory:

1. The ontology (the definition of the object of study or the "real" to be addressed) and

2. The epistemology (the way of knowing that real) to be used as the foundation for developing the theory (Tyson, 1995).

A clinical theorist's choice of ontology is of the profound importance. Consider that behaviorists study the "real" of observable behavior, cognitive behaviorists focus on a client's conscious thoughts and perceptions, and narrative therapists focus on the client's "stories." These different ontologies significantly regulate a therapist's understanding of and interactions with clients. For instance, therapists who believe their focus needs to be on modifying an overly harsh superego (a psychoanalytic orientation) define client problems and go about treating them differently from therapists who focus on modifying aspects of the client's behavior.

Likewise, the clinical theorist's choice of epistemology also has a profound impact on the clinical data she or he obtains. In the absence of an "aperspectival perspective," or a "view from nowhere," (Daston, 1992) we, like all scientists, are in the position of studying data that we have-by definition-- profoundly influenced in the process of observing and recording it. Because humans are clearly more suggestible than stars or fossils, clinical researchers need to be even more scrupulous in considering how their epistemological processes bias the data they gather. So for instance, the use of audio or video taping, process recordings, or standardized questionnaires all present their own advantages and biases for gathering clinical data (Heineman Pieper, 1994).

For his ontological and epistemological concepts about the mind and the therapy process, Ariel has chosen the model of a computer program. So he emphasizes the content of the family's "program," by which he means the family's values, beliefs, rules, etc. He analogizes the process of assessment of psychopathology and the helping process to "debugging" computer programs that are malfunctioning. Consequently, Ariel's discussions of underlying theory seem very far removed from the intensely and uniquely human, often passionate interactions that commonly occur in family therapy.

There are some other problems that result from conceptualizing family interactions and pathology using a computer program metaphor as a starting point. For instance, in providing clinical examples, Ariel does not address the epistemological issue of the clients' ongoing relationship with the therapist-what has been called from another theoretical standpoint the "process level" of the client's experience of the therapist's caregiving (Pieper & Pieper, 1990). Because of this, clinical examples have an obscurity and a limited helpfulness if one wants to understand the role of the intervention in the development of the treatment relationship. To illustrate, Ariel describes how an Irish American family reacted to the therapist's query about their son's delinquent behavior with humor Knowing the context of the interaction is vital for understanding the meaning of the family's humor. For instance, if the therapist was simply probing further into a problem the family had brought up, it could represent the family's conflict about getting help, taking the form of defensive compensation for the family's deep feelings of shame. On the other hand, if the therapist brought up the subject of the child's delinquency, it could represent the family "circling their wagons" in reaction to what they could experience as the therapist intrusively trying to set the agenda and bring up painful experiences before there was a sufficient alliance to deal with them constructively.

When it comes to cultural diversity and family therapy, ontological and epistemological assumptions are all the more important because one is dealing with both a micro-level of system (the family) and also a meso- and even potentially macro-level of interactions and values (the surrounding culture). For instance, when family members complain about their unhappiness with a daughter's boyfriend, are they voicing a cultural value that they should be able to pick the partner, or are they reenacting abusive relationship patterns from their family of origin, or are they accurately perceiving that the boyfriend is a potential pitfall for the daughter's happiness? Notice that the different possible interpretations use different systems as the frame of reference for understanding the family (Wimsatt, 1986). Accordingly, a reason why the analogy to a computer program flounders is that it is overly reductionistic and insufficiently flexible for capturing the multi-layered, interactive causality of the variables with which one is dealing as a cross-cultural family therapist.

In conclusion, when clinical theorists are addressing the multi-layered systems associated with family therapy and cultural diversity, the issues of how to define the reality with which one is working, and how to know about it, become even more complicated. There is much work yet to be done to advance our understanding of this critical area, and despite the limitations of the theoretical model, overall, Ariel's book contributes to advancing this field.

References

Carnegie Commission. (1994). Starting points: Meeting the needs of our youngest children. New York: Carnegie Corporation.

Daston, L. (1992). Objectivity and the escape from perspective. Social Studies of Science, 22, 597-618.

Pieper, M. H. (1994). Science, not scientism: The robustness of naturalistic clinical research. In E. Sherman and W. J. Reid (Eds.), Qualitative research in social work. New York: Columbia University Press.

Pieper, M. H., & Pieper, W. J. (1990). Intrapsychic humanism: An introduction to a comprehensive psychology and philosophy of mind. Chicago: Falcon II Press.

Saleebey, D. (1994). Culture, theory, and narrative: The intersection of meanings in practice. Social Work, 39(4), 351-359.

Tyson, K. (1995). New foundations for scientific social and behavioral research: The heuristic paradigm. Needham Heights, MA: Allyn & Bacon.

Wimsatt, W. C. (1986). Heuristics and the study of human behavior. In D. W. Fiske and R. A. Shweder (Eds.), Metatheory in social science: Pluralisms and subjectivities (pp. 293-314). Chicago: University of Chicago Press.

Katherine Tyson, Ph.D. Associate Professor Loyola University of Chicago Chicago, IL

Copyright Families in Society Jul/Aug 2001
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