CHAPTER 5 Working with Culturally Diverse Families Family

CHAPTER 5: Working with Culturally Diverse Families Family Therapy: History, Theory, and Practice 6 th 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 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -2

Terms related to Culture • Culture • Multicultural • Intercultural couples • Integration • Coexistence • Lack of resolution • Worldview • Cultural competency Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -3

Dynamics of Culturally Diverse Families • Overt and covert criticism of patterns of family interaction • Appearance • Access to mental health services • Economics Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -4

Issues in Working with Culturally Diverse Families • Sensitivity • Experience • Acceptance • Ingenuity • Specificity • Intervention Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -5

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 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -6

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 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -7

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 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -8

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 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -9

Strengths of African American Families • Kinship bonds • Religious orientation and spirituality • Cooperation • Motivation to achieve • Role adaptability • Caring parenting • Family structure • Strong work orientation Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -10

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 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -11

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 therapeutic process they can learn how to handle many of their problems Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -12

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 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -13

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. Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -14

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 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -15

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 therapy process • Provide reframing that encourages the family Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -16

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 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -17

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) Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -18

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 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -19

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 staterecognized nations • Traditionally, their lives built around harmony, acceptance, cooperation, sharing, and respect for family and nature • Importance of extended family Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -20

Challenges for American Indian / Alaska Native Families • Break up or dysfunctionality of families • Geography and culture (biculturalism) • Joblessness, poverty, gangs, and substance abuse Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -21

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 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -22

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 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -23

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 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -24

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 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -25

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 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -26

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 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -27

Guidelines for Selecting Treatment Approaches with Culturally Diverse Families Two main approaches • • Culture-specific model • Universal perspective model Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -28

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 Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -29

ESCAPE Four major investments 1. Engagement with families and process 2. Sensitivity to culture 3. Awareness of family potential 4. Knowledge of environment Gladding, Family Therapy: History, Theory, and Practice, 6 th Ed. © (2015, 2011, 2007) by Pearson Education, Inc. All Rights Reserved 5 -30