understanding the family’s ethnic and cultural background
It is important that a family therapist understand the family’s ethnic and cultural background. (See the example in the text box below.) Failure to do so may be partially responsible for the large dropout rate by ethnic minorities after the first therapy session (Soo-Hoo, 1999). To successfully promote change within a family system, the therapist will need the family’s permission to share their closely held secrets. The therapist’s approach, however, must vary according to the cultural background of the family. Working with a Filipino family recently settled in the United States, one therapist had to request a letter from the family elder in the Philippines in order to allow members to reveal family matters to an outsider. Once the family opened up, however, the therapist was seen as an “elder” and was accorded the respect he needed to promote positive change. In another example, a therapist working with a client who belonged to the Southern Baptist fundamentalist movement found that the client was immobilized by the shame that surrounded drinking in her family and the difficulty of talking about it. The client approached the family’s minister to help frame the situation so that the family could face the problem together and find a solution. (For more information on family therapy for those from unfamiliar cultures, see McGoldrick et al., 1996; Sue and Sue, 1990.)
The language used to describe dynamics within the family system is charged with specific cultural meaning. For example, if a client belongs to a culture that values lifelong interdependence among family members, the therapist would be ill advised to encourage greater independence from the family. However, the therapist might encourage the client to become more effective within his family and explain ways that would allow some freedom within the cultural parameters of the family. Ablon (with middle-class Catholic families) and Kaufman and Borders have drawn attention to the importance of ethnic and cultural differences to understand and treat families with substance abuse problems (Ablon, 1980; Kaufman and Borders, 1988). Many substance abuse treatment programs have developed culturally specific family therapy models for Latino families (Flores-Ortiz and Bernal, 1989; Laureano and Poliandro, 1991; Panitz et al., 1983; Szapocznik et al., 1991), African-American families (Aktan et al., 1996; Ziter, 1987), and Native American families (Hill, 1989), among others.
A family therapy approach that has been successful with substance-using Hispanic adolescents combines elements from structural, strategic, and Milan therapies (Szapocznik and Kurtines, 1989; Szapocznik et al., 1988, 1991). This approach focuses considerable effort on overcoming initial resistance to treatment because the process embodies the family’s issues around the adolescent’s substance use (Santisteban and Szapocznik, 1994; Szapocznik and Kurtines, 1989).