CHAPTER 5: Working with Culturally Diverse Families Family Therapy: History, Theory, and Practice 6th Edition Samuel T. Gladding Developed by Nathaniel N. Ivers, Wake Forest University © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved

Overview Differences in culture and ethnicity regarding family Working with gay and lesbian families Working with culturally diverse families Working with specific cultural family groups African American Families Asian American Families Hispanic/Latino Families Native American Families Arab American Families European American Families

Terms related to Culture Multicultural Intercultural couples Integration Coexistence Lack of resolution Worldview Cultural competency

Dynamics of Culturally Diverse Families Overt and covert criticism of patterns of family interaction Appearance Access to mental health services Economics

Issues in Working with Culturally Diverse Families Sensitivity Experience Acceptance Ingenuity Specificity Intervention

Working with Gay and Lesbian Families Four percent of Americans identify themselves as gay or lesbian (Centers for Disease Control and Prevention, 2013) Approximately 1 in 10 cases in marriage and family therapy are involves gays or lesbians

Gay and Lesbian Families Gay and lesbian families are intergenerational A cycle to gay and lesbian family life Gay and lesbian families are varied Gay and lesbians couples have mixed levels of satisfaction in their relationships

Therapists Working with Gay and Lesbian Families Work with self to sort out feelings regarding gay and lesbian families Address both external and internal issues associated with being a gay or lesbian couple or family Work with society at large and its institutions to deal with matters of prejudice and discrimination Recognize that gay and lesbian families deal with matters besides their sexual orientation

African American Families Second largest minority group in the U.S., comprising 13% of the population African American families are diverse regarding background and traditions Commonalities Many have ancestors who were brought to Americas as slaves Dark skin color differentiates them from the majority of people in the United States May face racism and discrimination, resulting in socioeconomic disadvantage and stress

Strengths of African American Families Kinship bonds Religious orientation and spirituality Cooperation Motivation to achieve Role adaptability Caring parenting Family structure Strong work orientation

Factors Affecting African American Families The following negative factors may affect African American families: Surveillance by mental health and social work professionals regarding strict parenting practices Tension with male-female relationships Outside pressures such as racism, prejudice, poverty, and discrimination

Family Therapists Working with African American Families Provide psychoeducation when appropriate Be attuned to African American experiences and perceptions Understand multigenerational family systems Be sensitive to the importance of respect for elderly family members Assure families that through the therapeutic process they can learn how to handle many of their problems

Working with African American Families Address social and institutional issues adversely affecting African Americans Address concerns bout having a non-African American therapist, if applicable Do not assume familiarity with the family in first sessions Join with family before gathering sensitive information Conduct home visits, if needed Acknowledge strengths, successes, and resources Use appropriate metaphors and scriptural references when appropriate

Asian American Families Constituted about 5% of U.S. population in 2011 Projected to number 20 million by 2020 Trace cultural heritage to a variety of countries, such as Japan, Philippians, Pacific Islands, etc. Differ in regards to language, history, and socioeconomic factors Share many cultural values, such as respect for elderly, extended family support, family loyalty, and high value on education, as well as values associated with self-discipline, order, social etiquette, and hierarchy.

Working with Asian American Families Take acculturation into account Be aware of the effect of racism on Asian American families Recognize the potential importance of being knowledgeable of Asian philosopher Create a safe and nurturing environment that mirrors a supportive and caring family

Working with Asian American Families Assess support available to the family Assess past history of immigration Establish professional credibility Be problem focused/present focused Be directive in guiding the therapy process Provide reframing that encourages the family

Hispanic/Latino American Families Comprises one in every six residents of the United States Nations largest minority Most Hispanic/Latino families trace their ancestry to Mexico, Cuba, or Puerto Rico. Considerable diversity exists among Hispanics/Latinos and their families Tend to be family-oriented

Common Hispanic/Latino Cultural Values Collectivistic Dignidad (dignity) Orgullo (pride and self-reliance) Confianza (trust and intimacy) Respeto (respect) Simpatía (smooth, pleasant relationships) Personalismo (Individualized self-worth) Familismo (family connectedness) Marianismo (female self-sacrifice) Machismo (male self-respect and responsibility) (Carlson et al., 2004)

Working with Hispanic/Latino Families Develop a basic knowledge about cultural traditions before attempting to employ treatment modalities Take into account personalismo Be aware of socioeconomic factors affecting Hispanic/Latino families Assess for acculturation level as well as acculturative stress Utilize outside resources to facilitate treatment, such as the Catholic church Be aware of potential family hierarchy and roles

American Indians and Alaska Native Families Approximately 3.6 million American Indians and Alaska Natives live in the United States Extremely diverse group Belong to 557 federally recognized and state-recognized nations Traditionally, their lives built around harmony, acceptance, cooperation, sharing, and respect for family and nature Importance of extended family

Challenges for American Indian / Alaska Native Families Break up or dysfunctionality of families Geography and culture (biculturalism) Joblessness, poverty, gangs, and substance abuse

Working with American Indian and Alaska Native Families No one size fits all model Cultural knowledge, sensitivity, and innovation Build relationships with local leaders and communities Recognize culturally sensitive techniques Recognize interconnectedness between physical and psychological distress Consider the use of home-based therapy Consider therapeutic techniques that are directive

Arab American Families Fast growing, mosaic group that is more than three-fourths immigrant Large percentage are Christians; however, they make up the largest cohort of Muslims in U.S. Tend to be high context rather than low context Family is the most significant element in most Arab American subcultures Traditionally, a patriarchal, hierarchical structure exists in the family

Working with Arab American Families May be reluctant to seek family therapy Be aware of the potential emphasis on honor and shame Be aware of cultural context in which the family operates Be mindful of the issue of leadership and importance of authority figures in family

Working with Arab American Families Be attentive to the role of the extended family in decision-making Be aware of the influence of culture on therapy Consider a strengths-based approach Balance activity so as not to be seen as a rescuer or a threat Consider exploring identity issues Concentrate on couple dynamics When appropriate, focus on religious and other group support

European American Families Majority of people in the U.S. It is assumed that European Americans embrace WASP values such as individualism, mastery over nature, competitiveness, and Christianity, that is not necessarily the case Diverse group of people

Working with European Americans Consider using an existential approach, as it focuses on uniqueness Consider incorporating universal techniques, such as genuineness, empathic understanding, and structuring

Guidelines for Selecting Treatment Approaches with Culturally Diverse Families Two main approaches Culture-specific model Universal perspective model

Roles of the Therapist Be aware of own cultural heritage and respect cultural differences Be comfortable with differences that exist between themselves and the clients with regard to cultural backgrounds and beliefs Be sensitive to circumstances that may dictate referral of a family Be knowledgeable of own racist attitudes, beliefs, and feelings

ESCAPE Four major investments Engagement with families and process Sensitivity to culture Awareness of family potential Knowledge of environment