Conclusion - 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
Conclusion: THERAPEUTIC INQUIRY IN EXPRESSION AREAS
by Ronald Mah





The expression areas of cultural differences discussed here are only some examples that may be relevant in the diagnosis and assessment of individual, couple, and family processes for cross-cultural and multi-cultural issues, especially relevant to relationships.  As the therapist becomes alert to potential expression areas of cultural differences, which include differences prompted by family-of-origin experiences, therapeutic inquiry can elicit from clients their relevant manifestations.  While unfamiliar with Adit's Saudi background and/or Helena's Ukrainian culture, or some other client's formative models, the therapist may find potential areas that may be relevant for examination include:

Food, Music, Clothes

Personal Issues:
Neatness/Cleanliness
Fighting
Assertiveness vs. Aggression
Noise
Body Movement - constraint vs. expression
Tempo:
Monochromic- focusing on and doing one thing at a time vs.
Polychromic- doing many things at a time

Interpersonal Issues:
Accepting and Giving Gifts
Giving Praise and Accepting Praise
Showing Humility or Showing Pride
Shame/Shaming/Face
Pleasing
Cooperation vs. Competition
Eye Contact as respect, deference, aggression, or defiance
Proximity - level of comfort, close versus far; acceptable distance vs. invasive proximity
Implicit or covert communication
Non-verbal communication including use of body, facial, and tone expressions to communicate
Office arrangements

Language and terminology

Social/Cultural
Individual to Family to Community Relationships
Attitude towards:
Children
Adolescence
Elders
Responsibility to:
Family
Elders
Community
Society
Past
Future

For example, when working with a couple matched by the leaders of the Unification Church, the therapist owned personal and professional ignorance on the conceptualization of marriage and gender roles in that faith.  Inquiry of how they were matched, subsequent interactions, relative choice, mechanisms of compatibility resolution, and so forth, allowed for more culturally competent therapy.  As both professed faithful commitment to the tenets of their religion and the wisdom of their religious leaders, it became clear that the wife was not happy with the outcome in the marriage.  Her husband was satisfied with the marriage and relationship per se.  He wanted her to adhere to its commandments and to him.  Exploration of her emotional experiential dissonance with her spiritual faith helped her identify what was most important to her.  She explored her struggle to reconcile what seemed to be psychologically incompatible.  She weighed the cost and benefits of choosing one or the other and of continuing to try to reconcile the two needs.  A therapist invested in her faith (as also might religion-based therapists or religious leaders), might have encouraged or even demanded that she continue to follow the strictures of the faith, while effectively discouraging or perhaps dismissing her personal conflict.  Or, the so invested therapist may frame the personal conflict as a test of faith to be surmounted.  As a secular or non-religious therapist, the therapist however mirrored her process back to her, so that she could gain clarity as to what she faced with any choice.  She made a choice that she felt she could live with.

With an intercultural couple with an American woman Peggy and a Moslem Middle-eastern man Hamid, the therapist anticipated that the couple might have issues with gender cultural role expectations- an expression area of cultural differences.  The therapist professed ignorance of role expectations from Islamic perspectives, including modern versus more traditional Islamic perspectives (it turned out that Hamid was a more "modern" progressive Moslem).  The therapist put out to the couple generic American mainstream standards and expectations of role definitions and inquired how relevant or different they were from their perspectives.  As they each explained to the therapist their individual views, cross-cultural contributions to their marital conflict were revealed, along with more individual and family influences.  The follow up question, "How is are these different perspectives working for you two?" challenged the functionality of any cultural determinism and pointed to the necessity of developing a new model for them.  

In another situation, Josie the wife of a white middle-class couple initiated therapy.  In the phone conversation, she said her husband Stanford finally agreed to couples therapy after years of resistance to it.  The therapist noted a potential expression area about problem solving in the marriage, plus a possible male stereotype.  Rather than presuming the husband's full investment in the therapy, the therapist began the first session with the slightly sarcastic jab, "So Stanford, she finally dragged you to therapy.  What she offer you or threaten you with?"  Stanford responded that he had always felt they could handle things on their own and, "It wasn't that bad."  This allowed therapy to explore whether his resistance was a consequence of male training for privacy, denying or minimizing feelings, role fulfillment, and so forth.  Eventually the therapist asked, "Stanford, would your dad have gone to couple therapy?" "Oh, hell no!" was his response.  This prompted exploration of family-of-origin models of communication between the couple and other possibly relevant psychodynamic issues.  When the therapist playfully teased Stanford, "…as a new improved version of husband and dad," the therapist identified and encouraged a cross-cultural process to develop more functional processes in his partnership with his wife and with their children in their family.  The therapist cannot anticipate every issue or every manifestation of issues in clients.  However, greater cultural competence can be exercised through awareness of expression areas of cultural differences followed by therapeutic inquiry.  The knowledge and the practical/functional approaches merge.  Rather than that stereotypes, knowledge of the principles of cultural choices to survive and the areas where they may be expressed, leads to examine the practical outcomes of those choices.  If the outcomes in the relationship are dysfunctional- that is do not work to foster purposeful, healthy, and fulfilling relationships, then the therapist can advocate cross-cultural transition to more functional processes.

All therapy and especially couple and family therapy is cross-cultural and multi-cultural therapy.  In the relationship are the diverse cultures of an individual interacting with another person, or two partners (or multiple family members), and the culture or cultures of the therapist.  More often than not, the metaphor of games with specific rules is applicable in that there are universal healthy function relationship rules that the therapist may explore in discovering specific and unique manifestations for the individual, couple, or family.  Or, there are universal expression areas for fundamental human relationship needs.  The reconciliation of cultural differences between two or more individuals starts with the therapist owning and reconciling the framing of therapy and the relationship within his or her cultural values.  Theories of change, of therapy, of couple or family therapy, and of relationships are inherently embedded with the therapist's personal and professional heritage.  They are his or her "relationship game" or "developmental game" or "human game" foundation or internalized rules for living.  A client, partners, or family members may present one or more issues as important or problematic in their relationship, while assuming that the underlying values are self-evident and mutually accepted- by another individual, the other partner, another family member and/or by the therapist.  The therapist may be relatively wary of this assumption when clients have clearly distinct ethnic, racial, religious, or other cultural experiences than his or her background as would be the case with a white American therapist with little or no experience with Saudi, Ukrainian, immigrant, or Moslem culture working with Adit and/or Helena.  However, there may be important cultural differences that are more subtle despite apparent match between or among individuals such as Hannah and Petey and/or the same therapist.  Personal professional awareness and ownership of his or her cultural perspectives and expectations allows the therapist to prompt clients for their cultural foundations for communication and their relationships.  Cross-cultural assessment, theory, and interventions may be as relevant for different family-of-origin experiences among session participants as racial and other cultural differences.  As a result, recommendations for working with intercultural individuals, couples, or families may be critical for all clients in any composition.

ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
(510) 614-5641 or (510) 582-5788
fax: (510) 889-6553
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