Multicultural Couple Therapy

Mudita Rastogi, Volker K. Thomas

• Publisher: SAGE Publications, Inc
• Year: 2008
• ISBN:
  9781483342870
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Most traditional couple therapy models are based on the Eurocentric, middle-class value system and are not effective for today's psychotherapists working in multicultural settings. Multicultural Couple Therapy is the first "hands-on" guide for integrating couple therapy with culture, race, ethnic identity, socioeconomic status, religious beliefs, sexual orientation, and immigration experiences. The editors and a culturally diverse group of contributors follow a common outline of topics across chapters, related to theory, research, practice, and training. They report on the application of major evidence-based models of couple therapy and demonstrate the integral role played by contextually based values involved in relationships, conflict, and resolution. Key Features

• Presents a multiperspective approach that focuses on specific cultural issues in couple therapy
• Creates a cultural context for couples to help readers better understand key issues that affect relationships
• Features a series of compelling "Case Examples" from the authors' personal therapeutic experience in treatment with couples from diverse backgrounds
• Includes "Additional Resource" sections, including suggested readings, films, and Web sites, as well as experiential exercises and topics for reflection

Intended Audience
This groundbreaking book provides an in-depth resource for clinicians, supervisors, educators, and students enrolled in courses in couple therapy, marriage and family therapy, and multicultural counseling who are interested in how diverse clients define conflicts and what they consider to be functional solutions.

PARTI

---

Overview

One

---

Introduction to Multicultural Couple Therapy

---

Mudita Rastogi and Volker Thomas

A few years ago, a client¹ walked into my (MR’s) clinic. He seemed to be a White man in his 40s, tall and well dressed. After filling out the paperwork, Joe talked for a few minutes about his symptoms of depression and his conflict with his wife. Then, rather abruptly, he sat up and said: “Dr. Rastogi, this may not be obvious to you but my father is Black. My mother is White. Most people can’t tell from looking at me. I just want to mention it.” Then he sat back, looking somewhat tentatively at me.

He was very light-skinned, and I would most definitely not have guessed his biracial identity had he not told me. I was also embarrassed because I had failed to read this fact on his intake form; he had clearly checked the “biracial” category under ethnicity. I thanked him for informing me, apologized for not noting the information earlier, and proceeded to ask detailed questions about his background, his current relationship, and his symptoms of depression. Before the session ended, I specifically probed his feelings about his biracial identity, the fact that he can “pass as White,” and also his feelings about being in therapy with someone ethnically different from him.

The following week, he and his wife Ginny came in for couple therapy. She was White, of European origin, and was raised in a very economically privileged family. The couple had been married for one year, and prior to that had been engaged for seven months while in a long-distance, transcontinental relationship. They discussed their conflict patterns and their feelings of “stuckness” with me. They had been in couple therapy with a previous therapist but had dropped out after two sessions.

Using an Emotionally Focused Therapy (Johnson, 2004) framework, it became clear that he was the “pursuer” in the relationship and she was the “distancer.” He picked fights with her, she withdrew, and he panicked and tried to back-pedal. As I observed them getting stuck in their cyclical pattern, I tried to think of ways to inject new information into their interactions. I asked how their different backgrounds impacted their relationship. There was silence in the room for about 30 seconds. Joe started to say something intellectual about “growing up biracial in the ‘60s.” He stopped, blinked back tears, and described how he frequently dealt with racism as a child. Patrons stared when his family would walk into a restaurant. Friends were not allowed to come over to play after their parents had met his father. Kids called him names at school. His current experiences were not much better. At bars, with acquaintances and coworkers, he had learned to be on guard. “Invariably, they make racist jokes and throw the N-word around,” he said. Joe articulated how much he automatically expected rejection and dreaded having to “out” himself under hostile circumstances. He also hinted that the previous two therapists had empathized with his childhood but minimized his more recent experiences.

In this context, Joe then shared with Ginny that every time they argued, he was convinced she would leave him. This was information he had not shared with her before because he felt she would not understand his views. Further, growing up as a biracial man, he had learned to be both tough and to suppress his feelings. As I listened to Joe’s pain, sadness, and anger, it became clear that Ginny could not immediately relate to some of his experiences and feelings. As a new immigrant, she missed her mother and sisters, and she was also preoccupied with decoding this new environment. Growing up with considerable privilege, and as a White woman in the United States, her experiences were very different. For several sessions, the clients and I struggled with getting them both to hear each other’s vulnerabilities and needs. In addition, I had to be mindful of my own reactions to the clients’ diverse experiences, and their reading of my reactions.

Race relations, ethnic identity, oppression, gender, social class, immigration, and cultural differences played a pivotal role in this couple’s relationship. Intersecting with these variables were my own identity as a female therapist of color, my views on multiculturalism, and the clients’ perceptions of me. Clearly, the case required a “meta” consideration of cultural variables in defining the couple’s problems, sensitivity to multiculturalism in conceptualizing the case, and integrating the above factors in treatment. Further, doing therapy with this couple required skills both to form alliances with the clients and to work effectively with them, while integrating my own awareness of my identity, feelings, and privileges. A novice therapist could have taken a skills-based “textbook approach” by mistakenly focusing on Ginny and Joe’s pursue-withdraw interactions alone and excluding the discussion of larger systems, the therapist-client relationship, and the therapist’s own identity and belief system.

More than 20 years ago, after I (VT) had immigrated from Germany to the United States, I had an intake session with a couple in my private practice who presented with the common issue of “lack of communication” and “excessive arguments” that never got resolved. I felt comfortable with the couple and was confident that I could successfully work with them in addressing their issues. They were highly educated, insightful, and very motivated to make the changes necessary to improve their relationship. During the session, they brought up an argument that had repeatedly occurred on their way to the temple. Perplexed, I looked up and noticed the black hair and brown eyes, which reminded me of people from the Mediterranean (e.g., Spain, Italy, and Greece) that I had encountered many times during my frequent travels from Germany. However, most people in the Mediterranean are Catholic and go to church, not to the temple. For a moment, panic struck me. Fortunately, I was able to contain and hide my affect, while realizing that the couple with whom I was talking was Jewish.

Growing up in Germany right after World War II, I had never met a Jewish person. Yet, being acutely aware of the terrible Nazi atrocities and the Holocaust, I was overcome by guilt and shame. I felt helpless about how to deal with the couple who, in my perception, had changed from a couple with “ordinary” marital problems to one with an “extraordinary” context. They were used to being Jewish and living in a country with several million fellow Jews. But I was not, and I had no idea how to deal with the emotions that the context of our encounter had triggered in me. I mustered all my courage and, combined with desperation, revealed to them my German background and how I felt about meeting Jews for the first time in my life. Both husband and wife smiled at me and, to my surprise, shared with me that my first name (Volker) had given away my German background to them when I had talked to the wife on the phone to set up the appointment. Having had family killed in the Holocaust, they had talked about whether or not they could and wanted to work with a German therapist. Graciously, they had decided to give it a try and came in for the first session. Both expressed to me their appreciation that I had identified myself as German to them and had shared my affective reactions. They took that as me owning my part of the responsibility of the cultural context in which we had met to work together in resolving their “ordinary” couple problems.

Doing this “ordinary” work was a healing experience for all of us—one that went far beyond the communication problems and arguments that had brought the couple to therapy. The cultural, ethnic, political, and historical context of our work shed such a different light on their experience as a middle-aged couple. From this experience (and many other similar ones that followed), I learned that taking the cultural context of therapists and clients into account is not only a necessary condition for successful couple therapy but a sufficient condition and a moral imperative for all mental health services.

As educators and therapists committed to multiculturalism, we believe that all clients deserve to be understood in the entirety of their context. This context includes therapist (or educator/researcher) variables and belief systems. We passionately believe that mental health professionals lose the valuable opportunity to anchor relational data within a systemic framework if we do anything other than multicultural therapy. All of us, whether we are therapists, researchers, educators, students, supervisors, trainees, or clients, are deeply impacted by multiple, intersecting contextual variables, even as we create categories such as race, gender, sexual orientation, social class, ability, and religious beliefs, and interpret them.

This book addresses a very large gap in the couple therapy literature. Couple therapy books (including textbooks) focus primarily on theories that represent a Eurocentric perspective, and research and clinical work based mainly on White couples. Such scholarship often marginalizes issues of diversity; typically, a book will have a chapter each on gender, sexual orientation, and ethnicity added toward the end. Whether we approach multicultural couple therapy from a purely practical perspective of effectiveness, or as a moral imperative, it is clear that diversity ought to be integrated in therapy, training, and supervision so that it is the “main course” and not an afterthought. Every chapter in this book makes the argument that multiple areas of diversity intersect with each other and should be considered at every step of learning or conducting couple therapy. Multicultural therapy includes reflecting on and gaining skills on how to form that all-important alliance with clients in the context of both the therapist’s and the clients’ multilayered reality. This book also addresses the specific knowledge base and culturally sensitive approaches that would be essential to mental health professionals in dealing with different cultures. Finally, some of the culturally focused research published in this book challenges us to expand existing couple research to use representative samples of participants, so as to increase the external validity of our core research. All of us educators, clinicians, students, researchers, and other stakeholders in the field ought to push for these win–win changes to become a priority.

This book is designed for researchers and clinicians, beginning trainees and experienced counselors/therapists, and readers interested in multicultural therapy and in couple therapy. In order to address all these different perspectives, the book is divided into three parts. Part I includes thoughts on developing a multicultural competence; addresses issues of power, privilege, and oppression to be considered by White therapists working with minority couples; and discusses the emotional experience of immigration, which is a central issue for many minority couples presenting for therapy. Part II of the book, Intersections of Diversity, is focused on therapy with interracial couples, interventions with religious minority couples, and evidence-based models of couple therapy with minority populations. The final section, Part III, highlights approaches to working with couples from different racial/ethnic backgrounds, including various perspectives on therapy with African American and Black couples, Asian American couples, Latino/a and Hispanic couples, and Native American and First Nations couples.

In order to cover the pertinent research, examine state-of-the-art treatment approaches, make it meaningful for clinicians, and provide practical resources in the topic areas, all authors have followed the same outline and included nine distinct sections in their chapters: (1) introduction of the topic, the population under discussion, and the contextual context of the author(s); (2) a summary of the most recent research; (3) presentation of novel approaches to working with couples under consideration, using a multicultural and systemic perspective; (4) presentation of clinical material to illustrate the approach (i.e., case example); (5) specific tips for clinicians; (6) implications for training, supervision, future research, and personal growth; (7) exercises for clinicians and suggestions for reflections; (8) additional resources (e.g., films, Web sites, music, books); and (9) a comprehensive reference list.

We hope that this book will be attractive to the wide range of readers for whom it is intended, and that it will contribute to increasing couple and family therapists’ multicultural knowledge and sensitivity with regard to couple therapy. We welcome your feedback and comments. We can be reached at [email protected] and [email protected].

Note

1. Client details have been changed to protect confidentiality.

Reference

Johnson, S. (2004). The practice of emotionally focused marital therapy: Creating connection. Philadelphia: Brunner/Mazel.

Two

---

Power, Privilege, and Oppression

---

White Therapists Working With Minority Couples

Sheila Addison and Volker Thomas

Understanding how race works in the United States doesn’t seem like rocket science to me. There are clues everywhere if white people want to see them.

—Kendall, 2006, p. 1

For the most part, other chapters in this volume are written to address the therapist–client relationship based on client characteristics or presenting problems. This chapter, on the other hand, addresses a “problem” that clinicians may not even be aware of, or one that they may not agree exists: the issue of racial privilege, particularly White privilege, and how it impacts the work of White¹ clinicians from the therapist’s side of the relationship. In short, this is a chapter that is essentially saying “White clinician, treat thyself.”

We assume this is likely to be the most-often-skipped chapter of this book. What hardworking, dedicated, sensitive professional wants to be told that he or she is part of the problem? However, it is our belief as clinicians, educators, and researchers that addressing privilege is as essential to helping clients, to being an effective therapist, as is having all the rest of the knowledge and skills contained between the covers of this book. Perhaps it is even more important. In our work, we have become convinced that issues of power and privilege, and their influence on the therapeutic process, matter. We have had the experience—both enlightening and humbling—of realizing that these issues matter most deeply when the therapist is identified with one or more dimensions of the majority culture. And we have come to suspect that, while some clinicians have more obvious privileged identities than others, all of us to some degree or other represent institutional and societal power when we sit down with our clients. But in cross-cultural therapy, these dynamics are particularly salient. Given the demographics of the mental health professions, which are overwhelmingly White (Northey, 2005), it is likely that the majority of this book’s readers will also be White. Thus, it is impossible for us to imagine the existence of this book without a chapter on White privilege.

We anticipate that readers who have made it this far will be at a wide variety of places along the journey to becoming not just aware of White privilege, but also sensitive to the ways in which it affects our clients. The subjects of race and White privilege can be difficult to address, because White clinicians generally want to see themselves as good people—which in some circles has been defined as “people who don’t ‘see color’” (Bonilla-Silva, 2006). Hardy and Laszloffy (1998) suggest the following:

One of the reasons it is difficult to acknowledge seeing color is that it will automatically be equated with discriminating against another on the basis of color. Many people, Whites especially, live with the fear that they will be accused of being a racist. Because many of these same people believe themselves to be... committed to racial justice, they find it difficult to acknowledge anything that might lead to the accusation that they are racist. (pp. 119–120)

As the authors also note, often words or actions that reinforce racial inequality are unintentional, or even invisible to the person behind them, who may well identify as someone who abhors racism. Similarly, we believe that White privilege is usually exercised outside the conscious awareness of White people; so, too, is male privilege invisible to men, ...