6. Problematic Approaches - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
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6. Problematic Approaches

Therapist Resources > Therapy Books > All Relationships MultiCult

All Relationships and Therapy are Multi-Cultural- Family and Cross-Cultural Complications
by Ronald Mah

The therapist needs to have more than good intentions when confronted with client diversity.  Holding egalitarian and respectful attitudes about cultural differences is foundational to good clinical work.  However, a foundation does not a house make.  A beginning strategy would be to learn about differences among various cultural groups.  Read the following excerpt from "Ethnicity and Family Therapy."  How much cultural information about different cultural groups are presented with the intention of providing benefit for therapists?

"…physically ill patients of Jewish, Italian, Irish, and White Anglo-Saxon Protestant (WASP), the Jewish and Italian patients tended to complain about their pain, while the Irish and the WASPs did not.  When it came to describing their pain experience, the WASPs and Jews were accurate, while the Irish and Italians were conspicuously inaccurate.  The Italian patients dramatized their pain, and the Irish block denied theirs. When the researchers looked at the patients' expected solutions, the results again showed striking differences.  The Italians worried about the effects of the pain on their immediate situation (work, finances, family), but once the pain was relieved, they easily forgot their suffering.  While they wanted an immediate remedy to stop the pain, the Jewish patients found this unacceptable.  They feared anything, such as a pill, to stop the pain, because they felt it would not deal with the real source of the problem… the Irish patients did not expect a cure for the ailments at all.  They were fatalistic and usually did not complain of or even mention the pain.  Rather, they tended to view the pain is the result of their own sinfulness and help themselves responsible for it.  The WASP patients, on the other hand were optimistic, future oriented, and confident in the ability of technology and science to cure disease.  Operating on the "work ethic," sought control over the pain by their own efforts. (Zborowski 1969)

Emotional expressiveness can lead to problems since the dominant culture tends to value emotional expressiveness less than many minority groups within it.  The 'Americanized' medical personnel in Zborowski's study (1969) distrusted the uninhibited display of suffering exhibited by Jewish and Italian patients and saw their reactions as exaggerated.  Another researcher found that doctors frequently labeled their Italian patients as having 'psychiatric problems,' although there is no evidence that psychosocial problems were more frequent among them (Zola, 1969).  We would suppose that Jewish and Italian medical staffs would have also have difficulty understanding the silence of the Irish and WASP patients…

The dominant American (WASP) definition (a family) focuses on the intact nuclear family.  Black families focus on a wide network of kin and community.  For Italians there is no such thing as the 'nuclear' family.  To them family means a strong, tightly knit three-or four-generational family, which also includes godparents and old friends.  The Chinese go beyond this and include in their definition of family all their ancestors and all their descendants [their conception of time is very different, and death does not create the same distinction as it does for Westerners (Shon & Ja, Chap. 10)]

The family life cycle faces also vary for different groups.  For example, Mexican-Americans have a longer courtship.  And see early and middle childhood as extending longer than the dominant American pattern (Falicov & Karrer, 1980).  Adolescence is shorter and moves more quickly into adulthood than in the dominant American structure, while middle age extends longer going to what Americans generally think of as older age.

Cultural groups vary also in the emphasis they place on different transitions.  The Irish have always placed most emphasis on the wake, viewing death as the most important life cycle transition.  Italians in contrast, emphasize the wedding, while Jews often give particular attention to the Bar Mitzvah, a transition most groups hardly mark at all.  As Greeley has noted, the Irish tend to celebrate wedding (and every other occasion) by drinking, the Poles by dancing, Italians by eating, and the Jews by eating and talking (Greeley, 1969)....

The occupations that groups choose also to reflect their values, as well as necessity.  The Irish are over represented in politics and police work; Jews in small businesses, medicine, and, above all, in mental-health specialties; Germans, in engineering; Greeks in the restaurant business; and so on.

Every culture generates characteristic problems for itself. These problems are often consequences of cultural traits that are conspicuous strengths in other contexts.  For example, WASP optimism leads to confidence and flexibility in taking initiative, an obvious strength when there are opportunities to do so.  But the one-sided preference for cheerfulness also leads to the inability to cope with tragedy or to engage in mourning (McGill and Pearce, chapter 21).  Historically, WASPs have perhaps less misfortune than most other peoples.  But optimism becomes a vulnerability when they must contend with tragedy.  They have few philosophical or expressive ways to deal with situations in which optimism, rationality, and believe in the efficacy of individuality are insufficient.  The WASP strengths of independence and individual initiative work well in some situations, but WASPs may feel lost when dependence on the group is the only way to ensure survival.

Naturally, what behavior groups see as problematic will differ as well.  WASPs may be concerned about dependency or emotionality, the Irish 'making a scene,' Italians about disloyalty to family, Greeks about any insult to their pride, or filotimo, Jews about the children not being 'successful,' or Puerto Ricans about the children not showing respect.

Groups differ also in what they see as the solution to problems. WASPs tend to see work, reason, and stoicism as the best solutions.  Jewish families often consult with doctors and therapists and seek understanding and insight.  The Irish, until recently, solve problems by going to the priest for confession, 'offering up' their suffering in prayers, or (especially men) seeking solace through drink.  Italians may prefer to rely on family support, eating and expressing themselves.  West Indians may see hard work, thrift, or consulting with the elders as the solution, and Norwegians might prefer surgery, fresh air, or exercise.

Groups also differ in attitudes toward seeking help.  In general, Italians rely primarily on the family and turn to an outsider only as a last resort (Gambino, 1974; Fandetti, 1976; Rotunno &McGoldrick, chapter 16; Zborowski, 1969).  Black Americans have long mistrusted the help they can receive from traditional institutions except the church, which with only one that was theirs (Hines and Boyd-Franklin, chapter four; Pinderhughes, chapter five; McAdoo, 1977).  Puerto Ricans (Garcia-Preto, chapter eight), Greeks (Welts, chapter 13), and Chinese (Kleinman, 1975; Tseng and McDermott, 1981; Lee chapter 25) are likely to somatize when they are under stress and may seek medical rather than mental-health services.  Norwegians, too, often convert emotional tensions into physical symptoms, which they consider more acceptable, thus, their preference for the surgeon rather than the psychotherapist (Midelfort and Midelfort, chapter 20).  Likewise, Iranians often view medication and vitamins as a necessary part of treating symptoms, regardless of their origin (Jalali, chapter 14).  Many potential patients, perhaps even the majority, experience their trouble somatically and strongly doubt the value of psychotherapy.  And many groups may tend to see their problems as a result of their own sin, action, or inadequacy (Irish, blacks, Norwegians) or somebody else's (Greeks, Iranians, Puerto Ricans).

Cultural differences are often ascribed to class rather than to ethnicity…"

This relatively short excerpt has a tremendous amount of information.  Or, does it contain an expanse of potentially useful but superficial characterizations.  How can these characterizations be applied to clinical work with actual individuals?  Are they useful generalities?  In other words, how many ethnic or racial or national stereotypes did you find?  About 70!  What did you find?    Is this great information?  Absolutely, yes!  Does the information offer significant insights?  Yes!  Is it potentially useful in therapy?  Yes, again!  And, the information is also potentially great stereotyping.

What makes a WASP act WASPish?  Are Hannah and Petey sufficiently WASPy?  What makes Italians have Italian values? What makes an African-American develop African-American perspectives? What makes a West Indian act like many other (most?) West Indians? What makes Jews Jewish?  What does that mean? What is a Chinese interpretation of life and family? Where do Norwegian beliefs come from? What makes an Irish act Irish? Irish Catholic… Irish Protestant… Black Irish…  And so on… and so on.  Stereotypes can be informative but do not necessarily explain how and why characteristic attitudes, values, beliefs, and behaviors developed for a group of people in a particular time and place.  Without this deeper knowledge, the therapist or other professionals will not know how and why a specific person will act.  He or she may behave according to a seemingly relevant cultural stereotype or can and will transcend it.  How and why has he or she been able to transcend it?  The therapist needs greater knowledge and conceptual clarity to ascertain the operational moral system of any individual, couple, or family and their functionality, whether there are obvious differences such as Adit and Helena or apparently shared demographics such as Hannah and Petey.  For example, how and why does this individual, couple, or family see and discipline children this way rather another way?  When the therapist considers the multiplicity of cultural factors in an individual, couple, or family, the therapist is immediately confronted with how to conceptualize and then approach such factors clinically.  The following approaches are both problematic therapeutic approaches taken by the therapist and dysfunctional approaches to the relationship taken by the individual or by members of the couple or family.

3056 Castro Valley Blvd., #82
Castro Valley, CA 94546
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
office: (510) 582-5788
fax: (510) 889-6553
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