Culture and System in Family Therapy

Inga-Britt Krause

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429912474
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Starting with the MacPherson Report and its pronouncements on racism in Britain and in particular 'institutionalised racism', Dr Krause focuses in this important book on the practice of family therapy and draws on her expertise as both anthropologist and systemic family psychotherapist to formulate a cogent critical evaluation of the field. At the heart of her book, furnished with very useful clinical material is a concern to identify the necessary conditions for an 'anti-discriminatory, non-ethnocentric and ethical way of working cross-culturally'. In illuminating the way in which underlying and frequently unexamined assumptions serve to perpetuate institutionally discriminatory outcomes, the author outlines a model for the development of a culturally sensitised, questioning, and self-reflexive practice. This book will serve as an individual reference-point for all those concerned to avoid and eliminate institutional discrimination.

CHAPTER ONE

Introduction

In 1998, a significant event took place in race relations in Britain. This was the Stephen Lawrence Inquiry. Stephen Lawrence was murdered by a small gang of young white men as he waited for a bus. His murder was not properly investigated, and to date no one has been found guilty of it. However, the public inquiry that eventually took place found the Metropolitan Police guilty of negligence and institutional racism, and in the weeks that followed the publication of the report on the inquiry (Macpherson, 1999), radio and television news, newspaper editorials, and commentaries as well as private conversations were focused on these events and their implications. Many people, including young Afro-Caribbean, Asian, and white British, attended the inquiry, and a play—The Colour of Justice—based on verbatim transcripts of the inquiry was screened on television at peak viewing time. The inquiry into the murder of Stephen Lawrence openly placed an obligation on the Establishment to address issues of racism and discrimination in a different way from what had previously been done. This was no easy matter, and although there have since been important and essential initiatives—such as the introduction of the Race Relations (Amendment) Act into the public sector during 2000—it is perhaps too early to say whether the implications of the Macpherson Report have been recognized by the public, the government, and professionals in key public services in Britain. These implication are indeed far-reaching and therefore difficult to face.

The difficulty is to be found in the notion of institutionalized racism to which the report drew attention. Lord Justice Macpherson and his team defined institutionalized racism as

The collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture and ethnic origin. It can be seen or detected in processes, attitudes and behaviour which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantage minority ethnic people. [Macpherson, 1999, p. 28]

Why is this difficult?

The key words in the definition are “collective failure”, “unwitting prejudice”, “ignorance”, and “thoughtlessness”. These are notions that suggest that a person may not quite know what he or she is doing and that addressing these areas is more complicated than simply saying “I won’t do it again” or “If only we can find persons who are not at fault in this way”. Taking this view of race relations in Britain was a step forward from a previous report, The Brixton Disorders, produced by Lord Scarman after the uprisings in several English cities in 1981 (Scarman, 1981). This earlier report had acknowledged that some police officers were racially prejudiced, but it had also suggested that this was an occasional occurrence in a few instances and that it was irrational.

The period between 1981 and 1993, the year of Stephen Lawrence’s murder, was characterized by an impasse in race relations. The identification and removal of individual persons known to be racist in the police and in other institutions did not change the situation much. In some ways, this approach actually helped maintain the racist status quo by obscuring the real issues. Why? Because racism and discrimination cannot be explained solely by referring to mechanisms residing inside individuals (Henriques, 1984). They are also produced in the processes and interactions that make up social relationships. They are collective rather than individual, and, being collective, they are not always fully within the awareness of persons. Macpherson’s focus on collective failures and unwitting prejudice acknowledged this and was a step from the individual to the relational or socially constructed point of view. However, this shift also challenges the Establishment and our institutions in several different ways and is difficult to pursue as a public debate.

I have drawn attention to these events firstly because they are relevant to psychotherapy and secondly because they set the frame for the questions that I want to address in this book. These are questions that must be addressed specifically when working with families cross-culturally in therapy, but they also are relevant to intracultural work. The Stephen Lawrence Inquiry and the Macpherson Report remind us that it is not only in the therapy-room that intimate aspects of awareness, accommodation, and understanding take place. These are also political concerns and questions of human rights. These different spheres are not disconnected. Public and private domains are not separate, because values and attitudes are reproduced and shaped in both (Geertz, 1998). Racist murders and the public response to such events are also relevant to psychotherapists, because as citizens and participants in social processes in Britain, psychotherapists are no different from other persons who, whatever their culture, ethnicity, or skin colour, are touched and implicated in some way in these processes. Collective failures implicate everyone, although those who start out from a privileged position are implicated in a different way from those who do not.

Where, then, in systemic or family psychotherapy do we find the “collective failures” mentioned in the Macpherson Report? This is one of the questions that I address in this book. The general answer is that we find them in our assumptions—that is to say, in our public and personal values and norms. More specifically, we find them in the way our organizations work and in our ideas about gender, about the family, and about kinship and social relationships. We also find them in our professional theories and concepts, which sometimes—supported by histories of scientific developments, trials of clinical practice, a “fit” with prevailing ideology, and a particular arrangement of relations of power—take on such status of “truth” that they become part of the way that things, naturally, are for us.

This is above all when failure sets in: when our theories and conventions prevent us from recognizing that they may not be universally shared and when we fail to keep in mind that some of the things we ourselves do, and the ways we feel or think, are also socially constructed.

This book aims to help the psychotherapist who works with clients who are culturally and ethnically different from herself to address these difficult issues and find an anti-discriminatory, non-ethnocentric, and ethical way of working cross-culturally.* I do not suggest that therapists or anyone else annul their own assumptions. To my mind this would be impossible and would produce thoughts and actions without coherence and of no use. Rather, I shall suggest how we can use our knowledge about our own assumptions to ask appropriate and curious questions and, in this way, with our clients enter a common space for communicating. Entering this space entails that as far as is possible we try to see things from our clients’ point of view, and this means aiming to understand them against the background of the contexts in which they live. I think that this must be a necessary condition for ethical and non-discriminatory cross-cultural therapy.

Contexts are, of course, physical and local. This means that they are social (economic, political, familial) and cultural, and this is why I here consider as I have elsewhere (Krause, 1998), that cross-cultural therapy requires a systemic approach. As I see it, the strength of systemic psychotherapy is the importance placed in this approach on relationships between parts, individuals or events rather than on these entities in themselves. This is a characteristic of all systemic psychotherapy approaches, whether first-order, second-order, strategic, or constructionist/narrative, and this accords well with sociological or social anthropological approaches. Societies, nations, or groups of people are made up of embodied individuals in multiple overlapping relationships (Giddens, 1984; Ingold, 1986; Jenkins, 1997) in which meanings are expressed, reconstituted, or changed over time (Bateson, 1973; Taylor, 1985). It is impossible to have a theory about society which makes propositions only about individuals and not about their interaction and communication. But it is also the case that in all societies the idea of relationships and relating is valued, even though, as in England, America, and parts of Europe today, this may be articulated negatively. The idea of relationships captures a universal human predicament, even when in some societies this idea is framed and expressed in unique cultural and local terms. For these reasons, I consider that therapeutic approaches that aim to address social and cultural issues (and none can avoid this altogether) must also incorporate a systems view in some way.

In this respect, I do not want to draw a distinction between family therapy and systemic psychotherapy. To me, family therapy is an earlier name for an approach that focuses on relationships. This name tells us something about how the approach came about historically, and, although the approach has since been developed and improved by its practitioners becoming interested in wider systems and in culture, something fundamental remains to be recognized about “first relationships”. The “family” is a cross-cultural idea even though the processes, functions, shapes, terms, and structures that are associated with this idea are not. The same is not quite the case for “system”. “System” is more of an abstraction. That is to say, “systems” are everywhere but may not be recognized and named, and there is much less cross-cultural agreement. This does not mean that the idea of “system” cannot be useful, but that “system” as well as “family” are examples of the care and thought needed in order to avoid institutionalized discrimination. I do not therefore see my own approach as being in one camp rather than another, and I use the terms “systemic psychotherapy” and “family therapy” interchangeably to refer broadly to this field. I shall, however, discuss the different emphases that different approaches bring forth, and even though I consider that any systemic approach has a head start over individual ones, in the chapters to come I shall also show that systemic approaches are not necessarily culture-free. In fact, in a general sense nothing is culture-free, and this is why an emphasis on culture may provide a profoundly critical evaluation of what we do as therapists.

In this book, then, I suggest ways of thinking and theorizing about this, and I also suggest practical steps that can be taken to ensure that such a critique is carried out in a responsible and disciplined way. Part I offers a theoretical overview of how modern and postmodern approaches may be integrated; part II examines some of my own cross-cultural clinical material. Finally, the Appendix outlines a model—which, following Barbara Herrnstein Smith, I call “a reflective loop”—that can be used in the beginning stages of therapy and in training and also at any point when therapists feel that the cross-cultural validity of their work may be in question. In the spirit of Macpherson, I shall urge that cultural questioning and self-reflection become integral to the ongoing practice and theorizing in family therapy. I think that only in this way will therapists be able to claim that they try to avoid practices that are institutionally discriminating and unjust.

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* In general discussions, feminine pronouns are used for therapists and carers, and masculine pronouns for infants.

PART I

CULTURE AND SYSTEMIC THINKING

CHAPTER TWO

System

The transition from modern to postmodern practices in family therapy has been described in different ways—first-order/second order, objective/constructionist, systemic/narrative (Anderson, 1999; Bertrando, 2000; Combs & Freedman, 1998; Dallos, 1997; Dallos & Urry, 1999; Falicov, 1998; Gower, 1999; Hoffman, 1998; Minuchin, 1998, 1999; Pocock, 1995, 1999; Weingarten, 1998). Another way of describing this is to say that there has been a shift in the use of the idea of “the system”. Early systemic ideas were influenced by cybernetics as applied to mechanical systems: steam engines, pistons, and central-heating systems, and so on (Watzlawick, Beavin, & Jackson, 1967). In contrast, in postmodern thinking about systems in family therapy, a system is unmistakably a social system. Of course, social bonds between people have been considered before. Family therapists such as Murray Bowen, Salvador Minuchin, and the early Milan team based much of their practice on the emotional connectedness between family members and in this way implicitly acknowledged the influence of social systems. Gregory Bateson too had a social system in mind when he applied cybernetics to the Iatmul Naven ritual (Bateson, 1958). His analysis of this ritual was a milestone in the attempt to incorporate the two models into a theory about human communication which could unite physical and social phenomena (Bateson, 1973, 1979). The important synthesis of Bateson’s work was not, however, fully recognized at that time, and when Paul Watzlawick published Pragmatics of Human Communication (Watzlawick et al., 1967), a classic family therapy text, Bateson was hurt and angered that his close colleague should independently have published work that did not, in as far as it considered communication in isolation from cultural communication, adequately reflect the complexity of the issues on which they had both been working together (Harries-Jones, 1995, p. 28).

Other points of difference emerge from these two different ways of conceptualizing a system. Mechanical systems operate according to rules or forces that are assumed to operate in the same way anywhere and at any time if the external conditions are the same. This is pretty much the case, for example, with a central-heating circuit. When Bateson worked with the Iatmul, this was also the way anthropologists understood the working of societies: as patterns that could be discovered (Krause, 1998). What above all was to be discovered was whether cross-cultural patterns could be identified everywhere and to what extent regional social differences and similarities existed and (within a more hidden agenda) how “we” could make sense of “them”. Anthropologists are now less likely to write about patterns or about “structure” and “organization”, but for Bateson a social system consisted of patterns of emotions, cognitions, and behaviours (Bateson, 1958). In the context of anthropology, this emphasis on “relationship” or relationality has always been important (Ingold, 1986; Krause, 1994) and is receiving new scrutiny (Strathern, 1999). In the context of psychiatry, it was this insight that provided the possibility of a radical shift from a focus on the patient to a focus on the patient-in-relationships central to systemic approaches in family therapy.

In contrast, postmodern approaches to family therapy are not explicitly concerned with rules and patterns. The emphasis tends to be on individual variation and on the uniqueness of individual stories, and this uniqueness is seen to be derived from the complex interaction of persons in social systems and from the way individual persons access ideologies such as beliefs and language in particular ways. From this point of view, the world is a place where patterns or systematic processes are themselves bundles of variation, and accordingly observation or research are aimed at the effects of the destabilization of patterns (Gergen, 1994, p. 135). Constructionist and narrative approaches in family therapy therefore tend to place less emphasis on repetition, routinization, and regularity and more on variation and multiplicity.

This description is, of course, a bit of a caricature. Constructionists do not dissociate themselves completely from systemic thinking. Indeed, this would be impossible. The emphasis on individual variation is possible because it is variation from a pattern, and the constructionist makes a choice about what to concentrate on. The constructionist emphasis on the individual-in-social contexts, albeit at the expense of the collectivity, therefore is an emphasis on social relationships, and implicitly it is based on some notion of a social system. When Minuchin recently complained that post-modern family therapists are no longer concerned with the family, he appeared to be commenting on what he saw narrative family therapists do and not on how narrative family therapists think about what they do (Minuchin, 1998). But if we consider both levels of activity, it is clear that the idea of “a system” has not disappeared; rather, it has gone out of focus. One could say, therefore, that because postmodern approaches in some way have developed from modern ones, the idea of system has become an assumption to which it is no longer necessary to refer or to theorize directly about.

I believe that this is unhelpful because assumptions easily become hidden as “the way things naturally are” and are difficult to critique. I also believe that to leave “system” as an idea that is unexamined from a cross-cultural point of view may be or may become a collective failure in family therapy (Macpherson, 1999). In this book I therefore want to bring the idea of “the system” back into the foreground of thinking in family therapy and I want to suggest that in cross-cultural work such a re-examination is crucial. This is because culture itself is a systemic idea. I begin by showing how “system” has become a hidden assumption of narrative approaches in family therapy.

System and constructionism in family therapy

Constructionist or narrative therapy are general labels that categorize several different styles and approaches together. So, for example, experience may be accessed in a number of different ways: it can be accessed narrowly through a scrutiny of language and text using discourse analysis (Burck, Frosh, Strickland-Clark, & Morgan, 1998; F...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgements
• Editors’ Foreword
• Foreword
• Chapter One Introduction
• I Culture and systemic thinking
• II Cross-cultural clinical work
• Appendix: The Reflective Loop
• References
• Index