3. Multiple Couples Assessments - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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All Relationships and Therapy are Multi-Cultural- Family and Cross-Cultural Complications
Chapter 3: MULTIPLE COUPLES ASSESSMENTS
by Ronald Mah





Cross-cultural and multi-cultural principles and theories with multiple relationship assessments are necessary to clarify complexities in client presentations that will lead to more effective treatments.  Simple or singular theoretical perspectives are often inadequate as illustrated in the following example of a heterosexual couple.  Helena came to America when she was eight years old from Ukraine when her professional parents sought greater opportunities for the family shortly after the fall of the Soviet bloc.  Wealthy and privileged in their country of origin, they were working-class in the United States throughout her childhood.  Helena's mother because of her music background found well-paying work as a music teacher relatively easily.  Her father turned to alcohol to deal with his depression from having to do menial work instead of continuing in his previous profession.  Raised casually Catholic, Helena converted to Islam a few years after marrying her Saudi-born husband, Adit who is a casually practicing Moslem.  He drank frequently and could be controlling.  He had a temper. His family was affluent in Saudi Arabia and he came in his thirties to the United States to do business.  They live with his parents.  Her mother-in-law is very subservient to her husband and to Adit.  Adit has been emotionally and occasionally physically abusive throughout the 15-year relationship.  Helena has just discovered he had an affair with a mutual friend of theirs.  He does not want to talk about the affair.  It was a mistake and he wants to move on.  He doesn't understand why she is so emotional.

Preliminary assessment of Helena and Adit find as potentially relevant issues, race, ethnicity, class, religion, loss, emotional abuse, domestic violence, possible depression, alcoholism, personality disorders, and who knows what else!  Some issues may co-exist while others may be completely intertwined.  Baltas, et al notes that "individual differences in psychological well-being were associated with perceptions of marital conflict due to cultural differences" (page 178).  He continues, "Whether the cultural conflict within marriages leads to deterioration of psychological well-being, or psychological distress gives rise to cultural tensions, can only be determined with longitudinal investigation," (page 179).  It becomes difficult to ascertain what caused or created what for a couple like Helena and Adit.  There are many indications that culture and cross-cultural issues are relevant.  By the same token, emotional abuse, domestic violence, possible depression, alcoholism, and personality disorders also seem relevant.  Some therapists may want to ignore cultural issues and focus on communication or apply some favored theoretical strategies and interventions.  Others may choose to prioritize which areas to work on.  They may conveniently prioritize the areas they are familiar with and minimize or ignore other areas of professional ignorance.  This would not only be therapeutically improper but also ethically reprehensible.  Therapeutically, this would constitute an existential annihilation of major aspects of one's formative experiences.  To dismiss how growing up African-American in a white dominated and racist society, or to ignore how immigration and language and cultural deficits during early childhood, or bumping into or slamming against a gender glass ceiling from toy selection to sports to academic and vocation options so that the therapist does not have to incorporate unfamiliar life experiences into his or her clinical process invalidates individuals, and inherently and fundamentally harms therapy.  

Fortunately, all these potential issues can be included in an overall canopy of cultural, cross-cultural, and multi-cultural theories.  Since the couple previously mentioned is Moslem (especially, since Helena is a convert), addressing religious issues among the cultural issues may be relevant as one of several relevant strategies.  Duba and Watts in "Therapy With Religious Couples" (2009) make the following recommendations, "In our experience, clinicians working with religious couples are advised to (a) systematically assess the couples' religious faith, preferences, and potential conflicts; (b) demonstrate respect for and strive to use the couple's religious beliefs to establish a therapeutic relationship; (c) collaboratively investigate with the partners the potential strengths, supports, and opportunities of their religious beliefs that might advance their marriage; (d) operate flexibly and integratively in using their preferred therapy and thus be able to incorporate the couple's faith language in the therapy process; and (e) be open to consulting with religious leaders who can bring greater understanding about the needs and belief system of the couple" (page 221).

Consideration of Duba and Watts' advice reveals that every recommendation for clinicians mirror advice for working with anyone, couple, or family with significant cultural perspectives and anyone, couple, or family conceptualized as inherently cross-cultural.  While their advice was specific to religious couples and applicable to a couple such as Helena and Adit, every recommendation is appropriate when more broadly applied to other cultural considerations in addition to religion: assessment of individuals' belief systems, preferences, and potential conflicts; respect for and using cultural beliefs to establish rapport; investigating strengths, supports, and opportunities for supporting the relationship; flexibly integrating therapy with the communication style of the relationship; and consulting if necessary with other professionals knowledgeable with the culture of the individuals in the relationship.  Joanides, et al in "Investigating Inter-Christian and Intercultural Couples Associated with the Greek Orthodox Archdiocese of America: A Qualitative Research Project" (2002) identify areas to examine in couples that are relevant to many individuals and therapy: negative view of intermarriage, individuals' view of religion, individual challenges, couple challenges, parenting challenges, extended family challenges, faith community directives, and gender-specific differences.  The areas that appear to be specific to religion have comparable cultural issues.  Negative view of intermarriage is comparable to negative views of crossing class lines (working class vs. middle-class) or political beliefs (conservative vs. liberal).  Individuals' view of religion is comparable to their view on class, ethnicity, education, or politics.  Faith community directives are comparable to social or cultural messages from the mainstream including media influences.

To do appropriate therapy in our diverse and multi-cultural society, therapists must be able to make appropriate assessment including assessment of multiple cross-cultural and multi-cultural issues in therapy.

Any relationship is

made up of two different (diverse) people who have learned how to survive (and possibly, to flourish) in different contexts (families), who are now coupled in a cross-cultural situation;

who now need to reconcile what can be transferred, what cannot be transferred, and what shouldn't be transferred from the old culture into the new relationship;

and to negotiate a new functional culture (attitudes, beliefs, values, and behaviors) for the new context (the partnership as a couple, marriage, and family) that is respectful, effective, and fulfilling with individual and group integrity (multiculturalism).

Each attitude, belief, value and behavior may have lesser or greater emotional or psychological charge or symbolism that may or may not still be relevant in the new context.  

Each aspect needs to be honored for its cultural relevance, functionality, and role in the family-of-origin (and community of origin and life experience) before it can be appropriately examined for its like relevance, functionality and role in the couple or family.  

This honoring amounts to a cross-cultural respect that is the foundation to healthy multiculturalism and healthy relationship dynamics.  

This careful examination enables the therapist and individuals to get past the two traps of cultural determinism and cultural relativism that curtail multicultural unity and relationship cohesion.  The potential for change and the process of challenge are intrinsic to any therapeutic processes which is why cultural determinism ("that's how it is" "it's a black… or female… or Smith family… thing!") and cultural relativism ("you can't understand because you're not Latino… a man… didn't grow up poor!) must be addressed.
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Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
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