The Handbook of Systemic Family Therapy, Systemic Family Therapy and Global Health Issues

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• Publisher: Wiley-Blackwell
• Year: 2020
• Print ISBN:
  9781119702269
• Edition: 1
• eBook ISBN:
  9781119702238
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Volume IV of The Handbook of Systemic Family Therapy considers family-level interventions for issues of global public health. Information on the effectiveness of relational treatment is included along with consideration of the most appropriate modality for treatment. Developed in partnership with the American Association for Marriage and Family Therapy (AAMFT), it will appeal to clinicians, such as couple, marital, and family therapists, counselors, psychologists, social workers, and psychiatrists. It will also benefit researchers, educators, and graduate students involved in CMFT.

Part I
Overview

1
A Systemic Conceptualization of Interventions with Families in a Global Context

Mudita Rastogi

Twenty‐six‐year‐old Kamal ¹ drives a taxi through the winding mountain roads surrounding the picturesque town of Nainital in the Indian state of Uttarakhand. There is a high level of poverty in this region, with the primary occupation being agriculture. The villages and towns are small, remote, and often bereft of many educational, commercial, or specialized medical services. Nevertheless, many towns have recently seen rapid expansion with the development of vacation homes and resorts frequented by tourists who yearn to catch a glimpse of the Himalayas on a clear day. Kamal, who has 10 years of education, ferries tourists, businesspeople, and wedding guests up and down the mountain roads and feels lucky to have a job that brings him a steady income to support his family. He lives with his parents, his two younger brothers, and his paternal grandmother. His younger sister was married 2 years ago. The family identifies as Hindu and speaks the local Kumaoni language. Kamal is also fluent in Hindi and has picked up conversational English through his regular contact with tourists. The family owns their two‐room home and some patches of land surrounding the home. The women in the household grow rice and vegetables, primarily for the family’s own consumption. Milk from their two cows provides them with additional nutrition and income. Kamal partially financed his cab by selling some family property and obtained a bank loan for which he must make sizable monthly payments. He also owns a cell phone so his customers can reach him with ease.

Kamal would like to get married but is weighed down by “family problems.” His father is unemployed and suffers from a puzzling list of health‐related complaints, but the results of medical tests have all been negative. Both of his younger brothers are heavy consumers of alcohol and “charas” (a form of cannabis), are unemployed, and do not have the education or skills to move away to the “Plains” to get a job. In fact, Kamal names about six close friends, all of whom have a problem with drinking. He estimates that in his hometown, 70% of all boys and men over the age of 11 drink heavily. Kamal reports that a lot of students skip school to use substances, and he chalks up their addiction to “boredom” and a “lack of a future.” Among the adult men in his neighborhood, Kamal has observed the role alcohol plays in couple conflict and domestic violence. These boys and men use any cash on hand, including money earmarked for school tuition or essential household expenses, to pay for liquor. Some illegally transport and distribute alcohol to pay for their own habit. Though locally brewed alcohol is cheaper and widely available, the drink of choice is the more expensive “English liquor” (brand name alcohol). The latter is associated with higher status and is de rigueur at weddings and celebrations.

Kamal and his mother would like to see Kamal’s younger brothers move away to a large city to escape negative peer influence and find jobs. Kamal recognizes his brothers have a problem but is unaware of any services to treat substance abuse near his village or anywhere else for that matter. Kamal notes the consumption of cannabis and alcohol is seen by village elders as a moral problem and a family flaw, as well as a “modern problem” as the consumption of alcohol mushroomed in this region only in the last 25 years. Some years ago, the local women, including Kamal’s mother, tried to approach the district administration and politicians to enact “dry laws” and stricter enforcement of existing regulations. They carried on their campaign for months. However, this public outcry did not result in any change in policy or the arrival of treatment services.

In contrast to Kamal, Mina, a 7‐year‐old girl, was referred to Dr. Cooper, a psychotherapist in clinical practice in a large city in the United States. Mina’s teachers had noticed she was withdrawn at school and did not seem to have friends. They were concerned about her lack of attention and anxious demeanor and wished for her to be assessed. The school social worker and psychologist were both part time and did not have the time to conduct an assessment for the rest of the semester.

Dr. Cooper met Mina’s mother, Sara, to conduct an intake. Mina’s father, Ben, was very upset that the school had “accused” his daughter of having mental health problems. He thought the appointment was completely unnecessary, but Sara insisted on following through with it. Ben had a work conflict and therefore chose to skip the appointment entirely. Mina, her parents, and her 3‐year‐old younger brother lived in a middle‐class, primarily White/Euro‐American, Christian neighborhood in the suburbs. Sara had a college degree and Ben had attended a trade school. They both owned a small business and Ben held a second part‐time job. Both were very concerned about the cost they would incur (of approximately $1,200) for the full psychological assessment despite having health insurance. The family members were observant Sunni Muslims and spoke Arabic at home. They traced their family’s origins to the city of Fes in Morocco, but their family had lived in the United States for over 20 years. Several extended family members lived in Europe and the United States, and they visited each other for celebrations and vacations. The family also had many local friends who belonged to their mosque.

While meeting with Mina, in an attempt to connect with the little girl, Dr. Cooper made a reference to the upcoming celebration of Eid al‐Fitr. She asked Mina what she liked most about this special day. The girl looked terrified, was close to tears, and whispered, “How did you guess I was Muslim?” The therapist, sensing something was amiss, fetched Sara from the waiting room to join them in the therapy room. Dr. Cooper later learned the family had strictly instructed their children not to reveal their religion or discuss any religious issues with anyone outside of their social circle for fear of being the target of discrimination or hate crimes.

We inhabit a world separated by unequal wealth and conflicting military interests. These divisions are reflected in the increasingly strident “us‐versus‐them” positions taken by leaders and at times by regular citizens. Below the surface homogenization offered by widely available consumer goods and growing Internet access, our disparities have not disappeared. Access to social media has facilitated the easy exchange of information but not necessarily increased our tolerance for differences. Further, globalization has resulted in the dominance of the values and interests of high‐income countries (HICs) (Melluish, 2014). On the other hand, some emphasize the connectedness and interdependence (Giddens, 2000) borne out of global forces. Steger (2009) defined globalization as a process through which identities are transformed in that people see themselves as a part of a common global entity and national identities grow weaker. Globalization has resulted in increased trade, the rapid exchange of ideas and people, and a growing bicultural identity that combines both local and international influences. In evaluating the impact of globalization on psychological and cultural processes, Melluish (2014) reminded mental health professionals to search for commonalities across people while also paying attention to what makes individuals and groups unique so as to avoid inadvertently reinforcing the existing structures of inequality. It is a daunt...

Table of contents

• Cover
• Table of Contents
• Title Page
• Copyright Page
• About the Editors
• List of Contributors
• Preface
• Volume 4 Preface
• Foreword
• Part I: Overview
• Part II: Severe Family Disruption
• Part III: Mental and Substance-Use Disorders: A Systemic Context
• Part IV: Health Across the Lifespan
• Part V: Future Directions
• Index
• End User License Agreement