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Cultural Family TherapyIntegrating
Systemic Family Therapy with Cultural Psychiatry
Workshop Co-Chairs: Vincenzo Di Nicola, MD, PhDEllen Berman, MD
American Psychiatric Association Annual Meeting – Atlanta, GAMonday, May 16th, 20163:30 – 5:00 pm
Workshop:
Cultural Family Therapy
Vincenzo Di Nicola, MD, [email protected]
Professor of Psychiatry, University of MontrealChief, Child & Adolescent Psychiatry, Montreal University Mental Health Institute APA Quebec DB Representative & Past PresidentChair, APA Global Mental Health CaucusFounding President, Canadian Association of Social Psychiatry
Ellen Berman, [email protected]
Clinical Professor of Psychiatry, University of PennsylvaniaDirector, Family Therapy Training, UPennPresident, Executive Board, Association of Family PsychiatristsLifetime Achievement Award, American Family Therapy Association
Conflicts of Interest
Neither of the presenters have any financial conflicts of interest
Educational Objectives
At the conclusion of the session, the participant should be able to:
1) Understand families in cultural context to learn to listen to family stories in order to identify their mental and relational predicaments as expressions of their unique cultures
Educational Objectives
At the conclusion of the session, the participant should be able to:
2) Select with cultural sensitivity, using translators and cultural mediators as needed, at least three clinical tools that help families tell their trauma stories
Educational Objectives
At the conclusion of the session, the participant should be able to:
3) Define culture change and identify its mental health impacts on families as a cascade of consequences
Educational Objectives
At the conclusion of the session, the participant should be able to:
4) Learn how to negotiate intervention strategies that are both culturally congruent and clinically effective for families undergoing culture change
Purpose
• This interactive, case-based workshop is designed for clinicians who work with families presenting mental health challenges across cultures
Workshop Structure
In Part I, the workshop leader will present Cultural Family Therapy (CFT), a synthesis of systemic family therapy and socio-cultural psychiatry (25 mins)
Workshop Structure
In Part II, participants will divide into two groups for discussion of CFT theory and practice, illustrated by two family cases in treatment (30 mins)
Workshop Structure
In Part III, the participants will reconvene for an interactive discussion, with a focus on applying CFT treatment strategies to their own clinical work with family across cultures (35 mins)
Part I: Cultural Family Therapy
MARA SELVINI PALAZZOLI
(1916-1999)
Mara Selvini Palazzoli
La terapia familiare è il punto di partenza
per lo studio di unità sociali sempre più ampie.
Family therapy is the starting point for the study of ever wider social units.
Cultural Family Therapy
CFT weaves together family stories that express their mental and relational predicaments and conceptual tools for conducting clinical work
Cultural Family Therapy
• CFT is an ongoing update of our notions of “family” and “therapy,” on one hand, and of “culture” and “psychiatry,” on the other
With individual therapy, something’s missing …
Without cultural understanding,we build walls instead of bridges …
Cultural Family Therapy
CFT was constructed
to deal with threshold peopleundergoing rapid cultural change
A STRANGER IN THE
FAMILY Culture, Families,
and Therapy
(New York & London: W.W. Norton & Co., 1997)
Three CFT Principles and Processes
1) The deep parallels between the notions of “family” and “culture,” mean that “culture” supersedes the notion of family “system”
Three CFT Principles and Processes
1) Culture supersedes the notion of family “system”
Three CFT Principles and Processes
2) Each family is the bearer of the larger culture(s) in which it is embedded and creates a culture of its own, so the family is the vehicle for intergenerational cultural transmission, for maintaining culture (cultural coherence), and for generating its own small-scale cultural adaptations, yielding three yoked family functions: cultural transmission, cultural maintenance/coherence, and cultural adaptation
Three CFT Principles and Processes
2) CFT recognizes three yoked family functions:
cultural transmissioncultural maintenance/coherencecultural adaptation
Three CFT Principles and Processes
3) At the heart of systemic family theory and socio-cultural psychiatry is a relational psychology that inverses theorizing from self to society by redefining the notions of identity and belonging through relations
Three CFT Principles and Processes
3) Relational psychology works from society to self
by redefining identity and belonging through relations
Key Features of CFT
Recognizing families as unique cultures
Immigrants as threshold people in transitional states
Key theme: Liminality versus community
Clinical Tools for CFTTool
• Spirals• Masks• Roles• Codes
• Cultural Strategies
• Bridges
• Suture
• Meeting strangers• Cultural camouflage• Insiders & outsiders• Translation – Cultural &
therapeutic• Adaptation &
acculturation• Family life cycle in cultural
context• CFT as story repair
Explanation
Applications
With its relational and socio-cultural approach, CFT is uniquely responsive to working with families undergoing culture change within and across cultures
Applications
• In a world with huge global flows of migrants and refugees instigated by conflict, disasters, or economic and social reasons, CFT offers clinical tools to understand and treat families experiencing severe stress due to rapid and massive culture change
Part II: Family Cases
“Renata’s Lucid Folly”
“Black Skin, White Mask”
Family Case:“Renata’s Lucid Folly”
An adolescent from Latin America whose disturbing experiences only appear as psychotic out of family and cultural context
Family Case:“Renata’s Lucid Folly”
Renata 16-yr-old teen living in MontrealLives with mother, 15-yr-old sister, Angela, and step-father of 3 yrsDiagnosed schizophrenic at age 14 due to “voices”The “voices” have relational meaningShe heard “voices,” but no was listening to her
Family Case: “Black Skin, White Mask”
A young adult from a multicultural family with parents living in two countries, Canada and the Caribbean, whose uncertain, shifting sense of belonging is as unanchored as her changing tableau of anxious and depressive symptoms
Family Case: “Black Skin, White Mask”
Cassandra, 18 yrs old, just returned from the Caribbean where her francophone Black father livesAnglophone White mother of Eastern European background lives in Montreal with two daughters Referred at 14 for depression, poor diabetic controlFluctuating distress, poor social network, lack of follow-through with school, therapy, & friendsSibling rivalry, family pressure
Part III: Interactive Discussion
The relational dialogue
Letters to a Young Therapist
Relational Practices for the Coming Community
(New York & Dresden: Atropos Press 2011)
Culture Change
Both families have undergone culture change
Renata’s family moved from Latin America to CanadaUnderwent acculturation at different rates, with different models of behavior
Cassandra’s parents constructed a family across culture and class, language and raceOver the last few years, the marital contract has been slowly dissolving as has Cassandra’s
sense of belonging
Culture
Culture is the crucible of human relations
The royal road for understanding mind, self, and identity
Family
I see humanity as a family that has hardly met.
– Theodore ZeldinAn Intimate History of Humanity
BibliographyDi Nicola, V. A Stranger in the family : culture, families and therapy. New York: W.W. Norton & Co., 1997.
Di Nicola, V. Letters to a Young Therapist: Relational Practices for the Coming Community. New York: Atropos Press, 2011.
Di Nicola, V. Family, psychosocial, and cultural determinants of health. In: Sorel, Eliot, ed., 21st Century Global Mental Health. Burlington, MA: Jones & Bartlett Learning, 2012, pp. 119-150.
Mollica, R.F. Healing Invisible Wounds: Paths to Hope and Recovery in a Violent World. New York: Harcourt, 2006.
Acknowledgements
Family Therapy ColleaguesDr. Ellen Berman & AFPDr. Steven Wolin & SSPC
Family Therapy SupervisorsDr. Maurizio AndolfiDr. Mara Selvini Palazzoli
Cultural Psychiatry MentorsDr. Raymond H. PrinceDr. Armando FavazzaDr. Richard Mollica
Turku, Finland