Week 2: Part 1 -Family therapy vs. feminist family therapy approach / Week 2: Part 2 -The home based treatment approach/ Week 2: Part 3 -Exercise/ Week 2: Part 4 Reflection Paper

Goldenberg_2017_Chapter_3_Edition_9th.pdf

Home >Psychology homework help > Week 2: Part 1 -Family therapy vs. feminist family therapy approach / Week 2: Part 2 -The home based treatment approach/ Week 2: Part 3 -Exercise/ Week 2: Part 4 Reflection Paper

Title of book: Family Therapy: An Overview (9th Edition) Author of book: Irene Goldenberg, Mark Stanton, Herbert Goldenberg Chapter Title: Chapter 3 Diversity in Family Functioning Author of Chapter: Irene Goldenberg, Mark Stanton, Herbert Goldenberg Year: 2017 Publisher: Cengage Learning Place of Publishing: United States of America The copyright law of the United States (Title 17, United States Code) governs the making of photocopies or other reproductions of copyrighted materials. Under certain conditions specified in the law, libraries and archives are authorized to furnish a photocopy or other reproduction. One of these specified conditions is that the photocopy or reproduction is not to be used for any purpose other than private study, scholarship, or research. If a user makes a request for, or later uses, a photocopy or reproduction for purposes in excess of fair use that user may be liable for copyright infringement.

DIVERSITY IN FAMILY FUNCTIONING

African American or a Salvadoran refugee. Gender 1 , culture, ethnicity, and socioeconomic

status must be considered in relationship to one another by a therapist who tries to make

sense of a client family's hierarchical arrangement, for example, or the family's social attitudes,

expectations, or relationship to the majority culture.

Sarmiento and Cardemil (2009) show how ethnic background, socioeconomic status,

and immigration status with the associated issues of acculturation to life in the United

States relate to family functioning and the experience of depression in immigrant Latino

families. They found that poor family functioning and a high degree of acculturative

stress (the stresses associated with living in a new culture) yield higher levels of depres

sive symptoms, especially among women. The depression among women is also associated

with family-related factors, whereas male depression was more likely linked to other factors,

such as employment and financial stressors. They attributed these differences to the cultural

traditions of marianismo and machismo among Latino women and men, respectively. In

Latino culture, according to these researchers, Latinas (women) are expected to be caring,

nurturing, and self-sacrificing while always prioritizing the needs of family over their own

needs. Women who adhere to these traditions were found to be susceptible to greater family

conflict and to more experiences of depression. Men adhering to the values of machismo,

on the other hand, feel pressure to financially support and otherwise protect their families.

To be fully competent, a therapist must take into account his or her own cultural back

ground, socioeconomic status, race, ethnicity, sexual orientation, religion, life cycle stage,

and so forth in working with families from different backgrounds, being especially alert to

how these factors interact with those same factors in the client family. This typically requires

clinical training to adopt a contextual lens (Esmiol, Knudson-Martin, & Delgado, 2012).

Christopher, Wendt, Marecek, and Goodman (2014) refer to the need for therapists to adopt

a cultural hermeneutic that facilitates development of "a practical understanding of every

day lived experience" (p. 4) when interacting with a different culture. See Box 3.1 for an

evidence-based report on how therapist background interacts with client gender.

In the case of gender, both the feminist movement and men's studies have drawn atten

tion to the effects of sexist attitudes and patriarchal behavior on family functioning. Gender

inequities are being addressed regarding sex-based role assignments within family groups as

well as the wider culture that defines what relationships are possible within families and who

is available to participate in those relationships (McGoldrick, Anderson, & Walsh,_ 1989).

One result of the societal challenge to fixed gender roles and expectations has been a reassess

ment of family therapy models that were based on men's experiences and value systems, not

recognizing that women's experiences and values might be different. This male perspective

regarding stereotyped gender roles determined what constitutes "healthy'' family functioning

'It is important to draw a distinction between sex (the biological differences between men and women) and gender (the culturally prescribed norms and roles played by men and women). In this chapter we emphasize the latter as an organizing principle of family relationships and as the basis of behavior sociery considers "masculine" or "fem inine." Levant and Philpot (2002) note that gender roles are psychological and socially constructed entities, bring with them certain advantages and disadvantages for men and women alike, and perhaps most important from a therapeutic viewpoint, are not fixed but subject to change.

62 CHAPTER 3

■ BOX3.1 EYIDENCE-B:ASED F'R:AetlCE Therapists' Background Influences Assessment and Treatment

Hertlein and Piercy (2008) surveyed 508 marriage and family therapists to investigate how treat ment decisions might vary in terms of the gen der of the client and the background variables (socioeconomic status, race, ethnicity, etc.) of the therapist. The specific clinical issue they ex amined was how the therapists understood and treated cases of social media infidelity (when a person in a committed relationship makes con tact with someone via social media and engages in behaviors ranging from flirting, to emotional connection, to sexual gratification). The thera pists responded to several typical Internet infi delity scenarios in which the person initiating the

infidelity was the same for half of one sample.

Investigators also asked the therapist-participants to respond to how they might assess and treat each presenting problem posed by the scenarios. They were asked to evaluate the severity of the problem posed, offer a prognosis, estimate the number of sessions necessary for treatment, and indicate the text to which they would focus indi vidually or relationally. The results indicated that there were differences in how therapists assessed and treated clients based on client gender, ther apists' age and gender, how religious therapists reported themselves to be, and the extent of the therapists' personal experience with infidelity. The results clearly show how diversity variables affected treatment approaches and outcomes.

in these models, and as a consequence, Philpot (2004) proposes gender-sensitive family therapy that attempts to overcome confining sex-role stereotyping by therapists in clinical interventions. She suggests that therapists be attuned to the gender-role messages that clients (and therapists) grow up absorbing and, perhaps more important, to help clients (and oneself) recognize, label, and challenge sexist-based messages.

There has also been increased attention to the varied perspectives and lifestyles of the different cultural groups that make up our society. These efforts attend to a larger sociocul tural context to broaden our understanding of cultural influences on family norms, values, belief systems, and behavior patterns. Attention to multiculturalism has also challenged any previously entrenched ethnocentric views by family therapists of what constitutes a "healthy" family. As Goldenberg and Goldenberg (1999) contend, a family therapist today must take a client family's cultural background into account in order to avoid pathologizing ethnic minority families whose behavior is unfamiliar, taking care not to misdiagnose or mislabel family behavior in the process. This requires the therapist to be aware of how these very same factors helped shape their own personalities and professional capacities.

1 Multicultural and Culture-Specific Considerations Understanding families requires a grasp of the cultural context (race, ethnic group membership, religion, socioeconomic status, sexual orientation) in which that family functions and the sub sequent cultural norms by which it lives. Culture-shared, learned knowledge, attitudes, and behavior transmitted from one generation to the next-affects families in various ways, some

DIVERSITY IN FAMILY FUNCTIONING

Recognizing Strengths in African-American Families

It is important for therapists to understand how

different groups understand and experience

their strengths. Bell-Tolliver, Burgess, and Brock

(2009), building on the pioneering work of Robert

B. Hill, interviewed 30 African-American psycho

therapists who used a strengths perspective in

working with African-American families to iden

tify those strengths and clarify how to use them

clinically. Hill (1971, 2003) identified five strengths

for this population: (a) strong kinship bonds;

(b) a strong work orientation; (c) adaptability of

family roles; (d) strong achievement orientation;

and (e) strong religious orientations . To these,

Bell-Tolliver and colleagues added (f) increased

willingness of African-American families (than in

Hill's time) to seek therapy, and (g) family struc

ture. Then the researchers identified strategies

for therapists to consider using the identified

strengths in treatment:

• Utilization of beliefs, attitudes, and strategies for

building trust between therapist and clients that

rely on affirmations, praise, and encouragement

• An appreciation that many clients want ther

apists to understand the history and current

struggles of African-American families, espe

cially with respect to racism

• Listening and being curious about strengths

• The use of storytelling

• The appropriate incorporation of spirituality in

the therapy

Both strengths and any notion of what constitutes pa

thology must be understood as being influenced by

gender and cultural factors.

trivial, others central to their functioning. It is interwoven with our worldview. Language,

norms, values, ideals, customs, music, and food preferences are all largely determined by

cultural factors (McGoldrick & Ashton, 2012).

As family therapists have attempted to apply existing therapy models to previously underserved

cultural groups,2 they have also had to gain greater awareness of their own cultural background

and values and to examine the possible impact of these factors in pathologizing ethnic minority

families whose values, gender roles, discipline practices, forms of emotional expression, and so

forth are different from theirs or those of other cultures (Fontes & Thomas, 1996). Efforts are

underway to develop a culture-sensitive therapy (Prochaska & Norcross, 2014)-one that rec

ognizes, for example, that the White middle-class cultural outlook from which most therapists

operate (prizing individual choice, self-sufficiency, independence) is not embraced by all ethnic

groups with which those therapists come into contact. In many Asian families, for example,

interdependence within the family is expected, as it is that family members will subordinate

individual needs to those of the family and society at large (McGoldrick & Ashton, 2012).

2According to the 2010 survey of California practicing marriage and family therapists, Riemersma (201 0) reports that 89% were of European-American background, a percentage that has dropped from 94% over 15 years. These therapists indicate that they regularly treat other cultures.

64 CHAPTER 3

The evolving view of cultural diversity recognizes that members of racial and ethnic groups

retain their cultural identities while sharing common elements with the dominant American

culture (Axelson, 1999). In many instances, ethnic values and identifications may influence

family life patterns for several generations after immigration to this country. Acculturation is

an ongoing process that usually occurs over multiple generations, as families confront chang

ing gender-role expectations, child-rearing practices, intergenerational relationships, family

boundaries, and so forth common in the dominant culture to which they have migrated.

At the same time, immigrant families often must face changes in social level to lower-status

jobs, ethnic prejudice and discrimination, the acceptance of minority status in the new land,

and in some cases the fear of deportation.

Clearly, family therapists need to be culturally sensitive to the ever-increasing diversity

among client families if they are to deal with such families effectively (Aponte & Wohl,

2000). On the other hand, they must be careful not to blindly adopt an ethnically focused

view that stereotypes all members of a particular group as homogeneous and thus responds

to a client family as if it were a cultural prototype. Here it is useful to note Falicov's (2014)

reminder regarding ethnically diverse groups that a variety of other factors-educational

level, social class, religion, and stage of acculturation into American society, to name but a

few-also influence family behavior patterns. Moreover, individual family members differ

from each other in their degree of acculturation as well as in their adherence to cultural

values (Sue & Sue, 2012).

A multicultural outlook champions a general, culturally sensitive approach with families and

urges therapists to expand their attitudes, beliefs, knowledge, and skills to become more

culturally literate and culturally competent (Sue et al., 1998). Culturally competent thera

pists take client cultural histories into account before undertaking assessments, forming

judgments, and initiating intervention procedures. They assume there is no single theory of

personality applicable to all families but instead urge the adoption of a pluralistic outlook

that calls for multiple perspectives rooted in and sensitive to particular cultures (Prochaska &

Norcross, 2014).

More than learning about specific cultures, many advocates of multiculturalism (Pedersen,

2000; Ponterotto, Casas, Suzuki, & Alexander, 2010) urge the adoption of an open, flexible

attitude about diverse cultures and cultural influences but not one tied to any specific cultural

group. At the same time, they advocate that therapists gain greater awareness of their own

values, assumptions, and beliefs, understanding that these are not absolutes but arise from the

therapist's own cultural heritage. Sue and Sue (2012) emphasize the importance of adopting a

broad viewpoint in working therapeutically with "culturally different" client populations and

learning a set of appropriate intervention techniques suited to diverse clients. See Box 3.3 for

exercises to enhance your multicultural awareness.

Hernandez, Siegel, and Almeida (2009) offer a cultural context model for working with

families from different backgrounds. The model uses three processes to facilitate change in

therapy: (a) the development of critical consciousness, (b) a deepened sense of empowerment,

Cultural Sharing

We generally begin training with cultural shar ing to convey from the outset that all clinical in teractions require building cultural bridges from different perspectives and to engage students in exploring their cultural backgrounds. We ask stu dents in a training group to introduce themselves by: (1) describing themselves ethnically, (2) de scribing who in their family influenced their sense of ethnic identity, (3) discussing which groups other than their own they think they understand best, and (4) discussing how they think their own family members would react to being referred for therapy for a psychological problem. At times we use exercises that enable trainees to have mini converstations with others in their training group to discuss cultural issues such as:

• Describe something you like most about your cultural background and something you find hardest to deal with.

DIVERSITY IN FAMILY FUNCTIONING

• Describe how your family was "gendered" that is , what were the rules for gender behav ior, and who in your family did not conform to its gender stereotypes?

• What is your class background, and what changes have you or others in your family made because of education, marriage, money, or status?

• Describe a time when you felt "other" in a group and how you and others dealt with this "otherness."

• Describe what you were taught growing up about race and how your consciousness about this may have changed over time.

(McGoldrick & Hardy, 2008, pp. 453-454)

and (c) accountability. These processes help in four domains of family experience: (a) con

versational, (6) behavioral, (c) ritual, and (d) community building. By working with fam

ilies alone and in larger groups of others from similar backgrounds (in both same-gender

and mixed-gender versions), the authors strive to create a collective experience that moves

family systems and individuals within these systems to explore the impact of dominant patri

archal discourses on the cultural lives of both men and women and, through their heightened

self-awareness, to new levels of empowerment and accountability.

Those family therapists who advocate a culture-specific approach urge more detailed knowl

edge of common culturally based family patterns of unfamiliar groups. McGoldrick, Gior

dano, and Garcia-Preto (2005) bring together several dozen experts to provide detailed

knowledge about a wide variety of racial and ethnic groupings. Their description of different

lifestyles and value systems underscores that we are increasingly a heterogeneous society, a

pluralistic one made up of varying races and ethnic groups, as millions migrate here seek

ing a better life. The majority of the total population growth in the United States between

2000 and 2010 was due to the growth of the Hispanic population; the Asian population had

the highest group percentage increase (43%) and increased to 5% of the total population

66 CHAPTER 3

(Humes, Jones, & Ramirez, 2011). Similarly, Pedersen, Draguns, Lonner, and Trimble

(2008) offer detailed assistance in working with clients from a substantial range of specific

backgrounds.

One way to assess the impact of a family's cultural heritage on its identity is to learn as

much as possible about that specific culture before assessing the family. This undertaking is

valuable in determining the extent to which its members identify with their ethnic background

and to ascertain the relationship of ethnicity issues to the presenting problem (Giordano &

Carini-Giordano, 1995). Just as it would be a mistake to judge the family behavior of clients

from another culture as deviant because it is unfamiliar, so therapists must also be careful not

to overlook or minimize deviant behavior by simply attributing it to cultural differences.

Taking gender, social class position, sexual orientation, religion, and racial or ethnic

identification into account, a comprehensive understanding of a family's development and

current functioning must assess its cultural group's kinship networks, socialization experi

ences, communication styles, typical male-female interactive patterns, the role of the extended

family, and similar culturally linked attitudinal and behavioral arrangements (Goldenberg &

Goldenberg, 1993).

Family therapists must try to distinguish between a client family's patterns that are

universal (common to a wide variety of families), culture specific (common to a group, such

as African Americans or Cuban Americans or perhaps lesbian families), or idiosyncratic

(unique to this particular family) in their assessment of family functioning. That is, they must

Suppose this family presented for family therapy. Do you think the race of the therapist would have any impact on the treatment? Why or why not?

DIVERSITY IN FAMILY FUNCTIONING

discriminate between those family situations in which cultural issues are relevant and those

in which cultural issues are tangential, but this requires examination of the ecosystemic con

text of the family (Falicov, 2014). In this regard, Boyd-Franklin (2002) notes that unlike the

dominant cultural norms, African Americans adhere to cultural values that stress a collective

identity, family connectedness, and interdependence. Her research (Boyd-Franklin, Franklin,

& Toussaint, 2000) with African-American parents reveals their special concerns about their

children, particularly their sons: survival issues such as racial profiling, the disproportionate

number tracked into special education and juvenile justice programs, drug and alcohol abuse,

gangs, violence, and so forth.

Family therapists also must keep in mind that while gaining awareness of differences that

might be attributable to ethnicity or racial characteristics of a specific group is typically help

ful, there is also a risk in assuming uniformity among families sharing a common cultural

background. Fontes and Thomas (1996) caution that while a culture-specific family therapy

outlook offers useful guidelines, these guidelines should not be considered recipe books for

working with individual families. Even if they share the same cultural background, different

families have divergent histories, may come from different socioeconomic status, or may show

different degrees of acculturation. As an example, these authors observe that members of a

Mexican-American family may identify themselves primarily as Catholic, or Californian, or

professional, or Democrat; their country of origin or cultural background may actually be

peripheral to the way they live their lives. Ultimately, the therapist's task is to understand how

the client family developed and currently views its culture.

Family therapists must exercise caution before using norms from the majority cultural

matrix in assessing the attitudes, beliefs, and transactional patterns of those whose cultural

patterns differ from theirs. Lack of cultural understanding by therapists, especially White

therapists, is frequently cited as a barrier to family therapy in some cultures (Awosan,

Sandberg, & Hall, 2011). The idea of being "color blind" to racial differences is no virtue if

it means denial of differences in experiences, history, and social existence between themselves

and their clients. The myth of sameness in effect denies the importance of color in the lives

of African-American families and thus closes off an opportunity for therapists and family

members to deal with sensitive race-related issues (Boyd-Franklin, 2003a). In Box 3.4, we

illustrate a culturally sensitive approach to a family of Mexican heritage. What the family

presents as a school truancy problem can be seen in a broader social context as a sociocultural

problem.

Further, in working with acculturational and adaptational issues with immigrant fam

ilies (Berry, 1997), therapists need to take care to distinguish between recently arrived

immigrant families, immigrant American families (foreign-born parents, American-born

or American-educated children), and immigrant-descendent families (Ho, Rasheed, &

Rasheed, 2004). Each has a specific set of adaptational problems-economic, educational,

cognitive, affective, emotional. Acculturation has been found to involve differences in each

family regarding the mix of continued endorsement of the culture of origin and adoption

of elements of the new host culture; family processes may mediate acculturation effects on

68 CHAPTER 3

Counseling a Latino Family

The Ortiz family, consisting of Roberto, 47, the father; Margarita, 44, the mother; and two daugh ters, Magdalena, 12, and Rosina, 10, had never been to a counselor before, and they arrived to gether at the school counseling office for their early evening appointment with little prior under standing of what the process entailed. Unaware that they could talk to a counselor at school about child-related problems at home, they were summoned by the school authorities as a result of poor and sporadic school attendance by the chil dren during the previous 6 months. Magdalena had actually stopped attending, and her younger sister, Rosina, had recently begun to copy her sister's behavior, although she did go to class some days.

Arranging for the Ortiz family to come to coun seling presented several problems. Although Mrs. Ortiz had been in this country for two de cades, having arrived from El Salvador by ille gally crossing the border at Tijuana, Mexico, with an older brother when she was 25, she spoke English poorly; and she felt self-conscious about her speech in front of the school authorities. Mr. Ortiz, himself an undocumented immigrant from rural Mexico, had been in this country lon ger and had taken classes in English soon after arriving. He, too, had to be persuaded that all the family members needed to be present. Both parents had recently been granted amnesty under federal immigration regulations and had looked forward to their children having better lives in the United States. Needless to say, both parents were very upset upon learning their children were school truants.

The school counseling office arranged for Augusto Diaz, one of the counselors, to see the Ortiz family. Of Mexican heritage, Mr. Diaz was a third-generation Latino American who himself had learned Spanish in high school, never hav ing heard it spoken at home growing up. He was sensitive to what each of the Ortiz family mem bers was feeling and to the proper protocol for reaching this family. He began respectfully by

addressing the father as the head of the house, thanking him for allowing his family to attend but indicating that the children could not be allowed to skip school and that there were legal conse quences if they continued to do so. Aware that Mrs. Ortiz seemed to be having trouble following his English, Mr. Diaz enlisted Magdalena as trans lator. From time to time, he used Spanish words or idioms when appropriate, although he himself was quite self-conscious about his Americanized Spanish. He, too, turned to Magdalena when un certain of whether he had said in Spanish exactly what he had intended.

The first session was essentially designed to familiarize the family with what they could expect from counseling, to build trust in the counselor, and to show them that he was interested in their situation and would try to help. Mr. Diaz encour aged all family members to participate and com mented several times on the father's strength in bringing his family in to discuss these issues. They arranged another evening appointment for the following week, at a time that would not interfere with Mr. Ortiz's daytime gardening job or Mrs. Ortiz's daytime occupation as a domestic worker.

When Mr. Ortiz finally felt comfortable enough to share his thoughts, he said that girls did not need higher education, that his daughters al ready knew how to read and write, and that had he had boys it would have been different. He was upset, however, that they were disobedient and disrespectful in not telling the parents that they were not attending school but lying instead about how they spent their days. Although Mrs. Ortiz seemed to agree, she also revealed that she her self was suspicious of the school as well as most of what transpired in her adopted country. She hinted that she knew about the truancy, adding that she was afraid for her children in the mixed Hispanic-African-American neighborhood in which they lived and was just as happy that they stayed home rather than being influenced by their rougher classmates. Mrs. Ortiz saw her daughters'

being home as an opportunity for some help for her after a long day and as good training for their eventual marriages.

Both Magdalena and Rosina, mute unless asked direct questions in the first two sessions, be gan to open up in the middle of the third family meeting. They admitted feeling isolated at school, especially because their parents would not allow them to bring classmates home or to visit others after dark. They confessed to being intimidated by gangs, something they had been afraid to reveal to their parents, who, they felt, would not under stand. Staying away from school had started as a result of Magdalena's being attacked by an older girl on the school playground, after which the girl warned her to stay away or she would be seriously hurt. Rosina usually followed her older sister's lead and was certain that if her sister was afraid then the danger was real.

By the fifth session, the counselor, having gained the respect of the family members, had succeeded in opening up family communica tion. Mrs. Ortiz expressed an interest in learning English better, and the counselor guided her to a class in English as a second language (ESL) at the high school at night. Mr. Ortiz was persuaded to allow his wife to go out in the evening to at tend class with one of their neighbors, another woman from El Salvador. He was pleased that she was trying to improve her English, which would lead eventually to gaining citizenship and thus to

DIVERSITY IN FAMILY FUNCTIONING

greater security for the family. Her mother's learn ing English would also free Magdalena from her pivotal role as translator and pseudo-adult in the family. As Mr. Diaz learned of the family's need for other special services, such as filling out various insurance forms and income tax returns, he di rected them to the local Catholic church, where some volunteers were helping parishioners with such problems.

The children were given added support by their mother, who walked them to school every day before she left for work. At the counselor's request, the school looked into the situation of the girl who had threatened Magdalena. That older girl still looked menacing, but as Magdalena and Rosina joined other children in the playground rather than being social isolates, they felt safer, and soon the terrorizing stopped. Magdalena joined the school drill team, and Rosina expressed an interest in learning to play an instrument and joining the school band.

The counselor, in an active, problem-solving way, was able to act successfully as a social intermediary among the family, the school, and the church. Mr. Diaz mobilized the Ortiz family to make better use of neighborhood and institu tional resources and feel more a part of the overall community, thereby aiding them to solve the presenting truancy problem.

(Goldenberg & Goldenberg, 2002, pp. 331-333)

the development of behavior problems (Santisteban et al., 2012) and depressive symptoms

(Perez, Dawson, & Suarez-Orozco, 2011). T herefore, it may be beneficial to tailor interven

tions to the specific cultural characteristics of the family in therapy (Santisteban, Mena, &

Abalo, 2013).

Gender Issues in Families and Family Therapy Men and women experience family life both similarly and differently, in their families of origin

and in the families they form through marriage or partnership. Typically, they are reared with

different role expectations, beliefs, values, attitudes, goals, and opportunities. Generally speak

ing, men and women, beginning early in life, learn different problem-solving techniques,

cultivate different communication styles, develop different perspectives on sexuality, and hold

70 CHAPTER 3

different expectations for relationships. For example, while women traditionally are socialized

to develop attitudes and behavior that derive from a primary value of affiliation (coopera

tion, nurturing, emotional expressiveness, compassion), men are likely to be raised to value

autonomy (power, aggressiveness, competitiveness, rationality). While both sexes are subject

to gender-role expectations, Hyde and Else-Quest (2012) suggest that women are more apt

to face social disapproval and punishment for refusing to acquiesce to socially determined

rules and expectations. A woman may be pejoratively labeled if she exhibits too much of what

is considered the masculine characteristic of assertiveness. Similarly, men may be disparaged

if they appear too passive, emotional, sensitive, or vulnerable-qualities that are considered

the province of women. The pairing of an overtly "bossy" woman and a "meek, compliant"

husband often provokes discomfort in others and subsequent hostile or denigrating remarks

because of its unexpected role reversal.

These gender differences in perception and behavior result from a complex interactive

process between culture and biological forces. As Knudson-Martin (2012) observes, despite

efforts to promote gender equality, many inequities continue to exist and result in overt and

covert impacts on family life. She suggests that gender impacts family structure (decision mak

ing, prioritization of interests, power), emotion and meaning in the family (societal influences

on the interpretation of behavior and affect), and skills (the stereotypical restriction of skill

and trait development by gender prescriptions).

In addition, there are ethnic differences in gender socialization. Research in Latino/a

families suggests a continuing tendency to socialize daughters according to traditional gender

expectations, emphasizing stereotypical feminine behavior (Raffaelli & Ontai, 2004). But

there is variation within each culture, and individual cultures are in the process of transi

tion, so culture-sensitive therapy may appropriately include dialogue regarding sociocultural

attitudes toward gender (Knudson-Martin, 2012).

While the broad strokes of men's lives seem to follow a more or less direct course largely

laid out to them early in life by social expectations and indoctrination, women's lives in

general may seem more varied. They typically experience more starts, stops, interruptions,

and detours as they are called upon to accommodate to the needs of parents, husbands,

children, and other family responsibilities (Bateson, 2001). Men and women typically enter

marriage or alternative relationships and parenthood with different ideas of what will be

expected of them. Not surprisingly, they have different family experiences. The roles of sex,

physical and psychological intimacy, ease and frequency of open communication, relation

ships with family members, power in the family domain, emotional responsiveness, fidelity,

household responsibilities, and financial concerns may all differ in the perceptions of hus

bands and wives (McGoldrick, 201 O). Moreover, those differing experiences and expec

tations may lay the groundwork for future conflict resulting from their polarizing gender

training, outlook, priorities, and senses of entitlement. Knudson-Martin (2012) encour

ages parents to prepare their children for gender equality by considering relative status (do

both daughters and sons have the power to set relationship agendas?), attention to oth

ers (expecting boys and girls to attend to emotions and needs in others), accommodation

DIVERSITY IN FAMILY FUNCTIONING

patterns (expecting balance in accommodation between girls and boys), and well-being

(boys and girls are expected to balance individual accomplishment with responsibility to

relationships).

2 In

family therapy field has been relatively slow in recognizing the extent to which the gen

der-role messages all of us experience during our lifetimes typically affect our current family

life (Enns, 2004). As McGoldrick, Anderson, and Walsh (1989) point out, many early family

therapists operated in a gender-free fashion, as if family members were interchangeable units

of a system with equal power3 and control (and thus equal responsibility) over the outcome of

interactions occurring within the family. The larger social, historical, economic, and political

context of family life in a patriarchal society generally was overlooked; therapists by and large

felt comfortable taking a neutral stance regarding a family's gender arrangement, thus run

ning the risk of tacitly approving traditional values oppressive to women. The overall result,

typically, was for family therapists to perpetuate a myth of equality between men and women

within a family seeking their help (Hare-Mustin & Marecek, 1990).

However, beginning in the 1970s, an increasing number of family therapists, pri

marily women at first, began to challenge the underlying assumptions about gender that

put women at a disadvantage. Several pioneering studies (Avis, 1985; Gilligan, 1982;

Goldner, 1985; Hare-Mustin, 1978; Miller, 1976) faulted existing family therapy models

for failing to pay sufficient attention to gender and power differences in male-female

relationships, in effect ignoring how these gender patterns influence internal family

interaction, the social context of family life. Not yet offering an alternative feminist

family therapy position4-that was to come in the late l 980s-these critics nevertheless

argued that family therapists, reflecting the larger society, often (wittingly or unwittingly)

reinforced traditional gender roles (Avis, 1996) and endorsed traditional male/female

roles that depreciate qualities (dependency, nurturing, emotional expressiveness) tradi

tionally associated with women while extolling qualities (aggressiveness, competitiveness,

rationality) held in high regard by men. Attempting to correct this gender bias, these

3Power within a family typically is gained in various ways: by gender, age, earning power, respect, or fear. In society at large, power is unequally distributed based on such factors as gender, class, race, religion, ethnicity, age, sexual orientation, profession, and degree of physical ability (Fontes & Thomas, 1996). Although gender roles are in transition, and women have assumed powerful positions (business executives, astronauts, Supreme Court justices, foreign heads of state), Risman (1998) points out that overall men still have more power and status than women in all cultural groups. 4There is no single entity labeled feminist family therapy, since there are therapists practicing from all of the ap proaches we will consider later in this text who may regard themselves as feminist-informed and thus may take a variety of approaches with families. Rather, as Avis (1996) emphasizes, feminist family therapy is a "perspective on gender relations, a lens through which a therapist views his or her clients" (p. 223). Regardless of theoretical outlook, all address gender and power imbalances in their clients' lives and all advocate empowerment and egalitar ianism as goals (Worell & Remer, 2002; Enns, 2004).

72 CHAPTER 3

feminist-informed therapists began to challenge the social, cultural, historic, economic,

and political conditions that shaped not only the unique development and experiences of

women but also their relationships with men.

The Women's Project in Family Therapy, co-led by Marianne Walters, Betty Carter, Peggy

Papp, and Olga Silverstein-begun in 1977 and continuing for almost 30 years-examined

gender patterns in family relationships as well as patriarchal assumptions underlying clas

sic family therapy approaches. These family therapists offered a female-informed clinical

perspective that challenged the field's conventional wisdom. They argued that a field devoted

to families had, paradoxically, relied on outdated blueprints of male-determined, stereotypic

sex roles and gender-defined functions within families. Their text, The Invisible Web (Walters,

Carter, Papp, & Silverstein, 1989), describes their experiences in applying a feminist perspec

tive to their understanding of gender- and power-based family issues. This project had enor

mous influence in the field, moving family therapists to look beyond what is occurring within

the family and to consider the influence of broader social and cultural forces (Simon, 1997).

Feminist Reexamination of Family Therapy Theory and Practice

Since early family therapy was largely defined by men, inevitably male language and attitudes

dominated early theories. Hoffman (1990) notes that a male bias was built into fam

ily concepts that take the heterosexual, patriarchal family as the norm, arguing that terms

such as "overinvolved mother" or "enmeshed family" are sexist and tend to blame mothers in

particular for family problems.

Feminist-informed therapists consider such cybernetic concepts as "circular causality"

(to designate a repetitive pattern of mutually reinforcing behavior in a male-female relation

ship) especially unacceptable. They insist this systems-based concept implies that each partici

pant has equal power and control in a transaction, which they dispute. Particularly in the case

of physical abuse (rape, battering, incest) by men against women, they reject the cybernetic

notion that both partners are engaging in a mutual causal pattern and that it is the subsequent

behavioral sequence, for which they are both responsible, that results in the violent episode

(Goldner, Penn, Sheinberg, & Walker, 1990).

Rachel Hare-Mustin, Ph.D.

Feminists are critical of the implication that no one therefore is to

blame-a violation without a violator-thus clearing the aggressor of

responsibility. They emphasize greater masculine power in human rela

tionships, the superior physical strength of men, and the corresponding

vulnerability of women. They contend that the cybernetic epistemology

tends to blame the victim for colluding in her own victimization either

as a co-responsible participant or by remaining in the relationship. Avis

(1996) points out that implying that all interactional behavior originates

within the interaction itself makes it impossible to search for causes out

side the interaction; here she cites such external possible causes as "cultural

beliefs about appropriate gender behavior, a preexisting propensity to use

violent behavior, or differences in power with which each partner enters

the relationship" (p. 225).

DIVERSITY IN FAMILY FUNCTIONING

Rachel Hare-Mustin (1987) describes gender as the "basic category on which the world

is organized" (p. 15); according to Knudson-Martin (2012), gender is "a socially created con

struct that consists of expectations, characteristics, and behaviors that members of a culture

consider appropriate for males or females" (p. 325). Hare-Mustin, often credited with being

the first to raise feminist issues among family therapists, suggested that commonly observed

male-female behavioral differences simply reflect established gender arrangements in society

rather than any essential set of differences in the nature of men and women. A woman's typ

ically greater concern with relationships, according to Hare-Mustin, can best be understood

as a need to please others when one lacks power. In this view, a woman's behavior reflects

her less powerful role position vis-a-vis a man's rather than resulting from an inherent weak

ness of character. Where the powerful advocate rules and rationality, the weak espouse relatedness.

Hare-Mustin (1987) offers the following example:

Thus, in husband-wife conflicts, husbands use logic, wives call on caring. Bur, in parent-child conflicts, parents, including mothers, emphasize rules; it is the children who appeal for under standing. Society rewards rationality, not emotions, but which is used is associated with who has the power, and not primarily with being male or female. (p. 22)

The entry of women at all socioeconomic levels, whether single, cohabiting, married, or

heads of single-parent households, into the world of paid work has had a profound effect on

evolving male-female relationships. The workplace is now half female, and although many

dynamics have changed, many remain the same (Hochschild & Machung, 2012). In recent

years, women have been marrying later (or choosing not to marry at all) and are having fewer

children. Couples who do decide to become parents, as noted earlier, must rearrange the

family system and renegotiate the roles each plays, particularly if the wife continues to work

outside the home, as the overwhelming majority do. Women, especially single mothers or

women among the poor, minority, immigrant, and undereducated populations, have always

been part of the workforce. What is new is the influx of married women, including those with

young children, into work outside the home (Goldenberg & Goldenberg, 2002); see Box 3.5.

Breaking out of stereotypic male-female roles regarding domestic and work responsibilities

is essential to contemporary family therapy. Working wives continue to bear the major respon

sibility for child care and most household chores, although men now are more involved in the

rearing of preschool children and helping with daily domestic tasks than in the past. Women

are likely to tal<:e on the major obligation of caring for sick children or elderly family members,

maintaining contact with the families of origin of both partners, and sustaining friendships.

With the children out of the house and forming families of their own, men and women

may find themselves with differing priorities (McGoldrick, 2010). Men may wish to seek

greater closeness to their wives, while the latter may begin to feel energized about develop

ing their own lives, perhaps through resumed careers or other activities outside the home.

If serious marital tension leads to divorce, as it sometimes does at this stage, McGoldrick

and associates contend that women are especially vulnerable. Not only are they less likely

than men to remarry, but their embeddedness in relationships, their orientation toward

74 CHAPTER 3

Changing Educational, Work, and Family Roles

Changes in work and family roles for men and women have occurred at an astonishingly fast pace in the last 30 years. Women now complete graduate and professional schools at a rate equal to or greater than that of men. They now consti tute half the U.S. labor force and can expect to spend at least 30 years in the paid workforce. The modal American family today is a dual-earner family, and 40% of white, college-educated women earn as much as or more than their hus bands (Barnett & Hyde, 2001). The "feminization" of professional ranks (law, medicine, pharmacy, business administration) should continue to in crease as older, male-dominated groups retire.

However, certain hot-button items remain for many working women: equality of pay, maternity leave, flexible time for family responsibilities (Cox & Alm, 2005).

Men are spending more time on child care and household tasks than in the past, while employed women are doing somewhat less as couples nav igate toward increased equity. Barnett and Hyde (2001) suggest that multiple roles are beneficial for both men and women. Beyond added income, frequently necessary in today's economy, women have opened up opportunities to experience suc cess and to participate in challenging experiences outside the home.

interdependence, their lifelong subordination of achievement to caring for others, and their

conflicts over competitive success may make them especially susceptible to despair.

Finally, since women are apt to outlive men, many may find themselves alone and finan

cially impoverished. Very likely they will turn to their daughters ( or perhaps daughters-in-law)

for support and care, since women in our society shoulder most of the eldercare, with the

possible exception of managing finances for the elderly.

3 's

To be gender sensitive (or feminist informed) is to be aware of the differences in behavior, atti

tudes, and socialization experiences of growing up masculine or feminine, especially in terms of

differences in power, status, position, and privilege within the family and in society in general.

Brooks (1992) observes that past "gender blindness" by family therapists was first detected by

women and thus focused principally on the woman's perspective. However, he reminds us that

men too have been subjected to substantial role constraints and disadvantages as a result of

their masculine socialization experiences. They too may have suffered from sexist therapeutic

interventions that have condoned restricting men to a narrow range of family roles (such as

breadwinner) while robbing them of the experience of participating in roles (say, child rearing)

usually assigned to women. Levant and Philpot (2002) suggest that this type of gender-role

restraint is inherently traumatic to men because it truncates their natural emotionality.

Knudson-Martin (2012) argues for a model of a "mutually supportive relationship" that as

sumes that men value relational skills and want to attend to their partners, advancing equality.

Men's studies extend feminist explorations by attending to role restrictions in men's lives.

These socialized gender restrictions may hinder individual or interpersonal fulfillment. O'Neil

(2013) notes that the fear of femininity results in socialization and norms that program men

Transition into Parenthood

The transition into parenthood by couples who have always cared about equality in their relation ship can introduce stresses into the relationship. This period often involves new or revived strug gles over gender roles, the division of labor in the household, an equal share of the parenting, and the maintenance of a previous sense of egalitar ianism. Often marital satisfaction decreases with the birth of a child. Many women, even when the relationship had at first been more or less equal, will with the birth of their child find themselves with a disproportionate share of household labor, especially when they return to work. Therapists

DIVERSITY IN FAMILY FUNCTIONING

working with these couples may help them in the

following ways:

• Nurture constructive communication patterns between the new parents.

• Help the couple manage affect and to maintain emotional intimacy.

• Make the couple aware of any shifts in power relations between them.

• Support the renegotiation of roles.

• Encourage increased parenting for the father.

(Koivunen, Rothaupt, & Wolfgram, 2009)

toward curtailed emotional expressiveness, conflicts between work and family relations, restricted

affectionate behavior between men, and concern with success, power, and competition. Proof

of masculinity from this perspective often derives from the ability to display power and control,

most likely at the expense of women and children. Curtailed emotional expressiveness can have

devastating effects on men, especially on adolescents. For example, Irene Paz Pruitt (2007) indi

cates that while adolescent males are less likely than adolescent females to report depression, they

have serious risks associated with the disorder, including suicide, future substance abuse, and

a greater likelihood toward future illegal activity. O'Neil (2013) documents extensive research

in multiple cultures over the last 30 years that find that gender role conflict is significantly cor

related with more than 70 intrapersonal (depression, anxiety, substance abuse) and interpersonal

(lower capacity for intimacy, lower relationship satisfaction) psychological problems. Racial iden

tity, culture, and acculturation factors interact with gender role conflict in a complex manner.

Whether warranted or not, men have a reputation for avoiding and even demeaning

therapy. This assumption might introduce challenges in working with any specific man in

therapy. To test the premise that men's lack of awareness of relational problems-another

common assumption about men-contributes to their reluctance to consider, seek, and ben

efit from couple therapy, Moynehan and Adams (2007) examined a group of couples and

found no gender differences in the frequency or pattern of initial problem reports or improve

ment rates. Other research suggests the benefit of addressing gender socialization and sensitive

gender issues in treatment with men while noting that a lack of therapist awareness of male

gender role conflicts and biased assumptions may be harmful (Mahalik et al., 2012). Fali

cov (201 O) argues that family therapists working with Latino clients must reexamine cultural

terms, like "machismo," to ensure that they avoid simplistic negative perspectives and include

positive cultural traits also denoted by the terms. Stereotypes about men (as about women)

may negatively affect therapeutic interventions. Box 3.7: Thinking Like a Clinician presents

ways for therapists to challenge any stereotypes.

76 CHAPTER 3

Challenging Stereotypes

Consider how you would work in psychotherapy with the following scenario and family. Although an emphasis is placed on the father's experience as a man, consider how race, culture, socioeco nomic status, other gender-related matters, and age contribute to your understanding. Use the prompts to help guide your thinking.

An African-American family enters treatment for the first time because its members are always fighting and, as the wife/mother noticed, they don't seem to spend much time together any more. As the session proceeds, she mentions that while she appreciates the affluent life that her husband-the sole income earner-provides, she misses him and wants him to spend more time with her at home. He becomes irritated and cold, saying, "It's hard to have it both ways, Sweetheart. If I don't work, you don't get your fancy gym mem bership and Mercedes Benz." She looks away, and you wonder if she might be feeling shame. The teenage son says, "Actually, I don't care if you're never home." The father shoots the young man an angry look. You expect the father to blow up, but instead he becomes silent and you notice his eyes watering. Very quietly, he says, "Apparently,

my family doesn't understand how much I love

them. They don't understand that as the man, I give my life to work to provide the very best for them that I can."

How might you intervene?

1. What do you notice about how family members interact? Consider their use of language and physical gestures.

2. You know the family is affluent. Does this fact influence any thoughts or emotional reactions you have? Discuss your feelings.

3. How would you describe the interaction between husband and wife?

4. What questions might you consider asking them with respect to the use by their parents and grandparents of money?

5. What might you ask them about the back ground of the family that would have bearing on the present interactions?

6. How do your own finances, culture, ethnic ity, age, and gender influence your perspec tive? What did you learn about yourself in this exercise?

One interpersonal area in which gender, asymmetrical power, and control intersect

is family violence and sexual abuse. Masculine gender role norms play a role in such

violence. Substantial research indicates significant evidence for the relationship between

adherence to masculine gender roles and intimate partner violence, and certain types of

violence (psychological, physical, sexual) may relate specifically to particular types of

masculine gender role stress (Moore et al., 2008). On the other hand, masculine discrep

ancy stress (perceived failure to fulfil society's masculine gender role expectations) may

also create distress that results in intimate partner violence (Reidy et al., 2014). Goldner

(1998), writing from a feminist perspective, acknowledges that both partners are involved

in woman battering but that the violent behavior is the man's responsibility and that it is

important not to blame the victim (e.g., believing that "she provoked it"). Brooks (1992)

argues that to be successful, any antiviolence program must be gender sensitive and in

clude the preventive antiviolence resocialization of men so that they will not rely on vio

lence as an interpersonal strategy.

DIVERSITY IN FAMILY FUNCTIONING

In Box 3.8, a social worker attempts to deal with a difficult case of wife abuse using

a genogram (see fuller discussion in Chapter 8) to help the couple recognize their family

histories in regard to the use of alcohol and, in the husband's case, of violence.

A Couple Confronts Domestic Violence

Jim Kull is referred by the Rock County District Attorney's Office to the Rock County Domestic Violence Program. He was arrested two nights ago for an incident in which his wife, Diane, received several severe bruises on her body and her face. Kris Koeffler, a social worker, has an interview with Jim. Jim is an involuntary client and is reluctant to discuss the incident. Kris informs Jim he has a right not to discuss it, but if he chooses not to, she is obligated to inform the district attorney that he refused services. She adds that in such cases, the district attorney usually files a battery charge with the court, which may lead to jail time.

Jim reluctantly states that he and his wife had a disagreement, which ended with her slapping him and him defending himself by throwing a few punches. He adds that yesterday, when he was in jail, he was informed that she left home with the children and is now staying at a women's shelter. He is further worried she may contact an attorney and seek a divorce.

Kris inquires about the specifics of the "dis agreement." Jim indicates he came home af ter having a few beers, his dinner was cold, and he "got on" Diane for not cleaning the house. He adds that Diane then started "mouthing off," which eventually escalated into them pushing and hitting each other. Kris then inquires whether such incidents had occurred in the past. Jim indicates "a few times" and then adds that getting physical with his wife is the only way for him to "make her shape up." He indicates he works all day long as a carpenter while his wife sits home watching soap operas. He feels she is not doing her "fair share"; he states the house looks like a "pigpen."

Kris asks Jim if he feels getting physical with his wife is justifiable. He responds with "sure," and adds that his dad frequently told him "spare the rod and spoil both the wife and the kids." Kris asks if his father was at times abusive to him when he

was a child. He indicates that he was and adds that to this day he detests his dad for being abusive to him and his mother.

Kris then suggests they draw a "family tree," fo cusing on three areas: episodes of heavy drinking, episodes of physical abuse, and traditional versus modern gender stereotypes. Kris explains that a traditional gender stereotype includes the hus band as the primary decision maker and the wife as submissive to him and primarily responsible for domestic tasks. The modern gender stereotype involves an egalitarian relationship between hus band and wife. After an initial reluctance (related to his expressing confusion as to how such a "tree" would help him get his wife back), Jim agrees to cooperate in drawing such a "tree." (The resulting genogram is presented in Figure 3.1.)

The genogram helps Jim see that he and his wife are products of family systems that have strik ingly different values and customs. In his family, the males tend to drink heavily, have a traditional view of marriage, and tend to use physical force in interactions with their spouses. (Jim adds that his father also physically abused his brother and sister when they were younger.) On questioning, Jim mentions he frequently spanks his children and has struck them "once or twice." Kris asks Jim how he feels about repeating the same patterns of abuse with his wife and children that he despises his father for using. Tears come to his eyes, and he says "not good."

Kris and Jim then discuss courses of action that he might take to change his family interactions and how he might best approach his wife in requesting that she and the children return. Jim agrees to at tend Alcoholics Anonymous (AA) meetings, as well as a therapy group for batterers. After a month of attending these weekly meetings, he con tacts Diane and asks her to return. Diane agrees to return if he stops drinking (since most of the

(Continued)

78 CHAPTER 3

abuse occurred when he was intoxicated), if he agrees to continue to attend group therapy and AA meetings, and if he agrees to go to counsel ing with her. Jim readily agrees. (Diane's parents, who have never liked her husband, express their disapproval.)

For the first few months, Jim is on his best be havior and there is considerable harmony in the family. Then one day, on his birthday, he decides to stop for a few beers after work. He drinks un til he is intoxicated. When he finally arrives home, he starts to verbally and physically abuse Diane and the children. For Diane, this is the last straw.

She takes her children to her parents' house, where they stay for several days until they are able to find and move irito an apartment. She also files for divorce and follows through in obtaining one.

In many ways, this case is not a "success." In re

ality, many social work cases are not successful. The genogram, however, is useful in helping Jim realize that he has acquired and is now acting out certain dysfunctional family patterns. Unfortunately, he is not ready to make lasting changes. Perhaps in the future he will be more committed. At the present time he has returned to drinking heavily.

(Zastrow, 1999, pp. 188-189)

Traditional view

® D� �

Linda _,.y-Jon

.,.

/ /

/®

/ /

@( Verne ,,,,,,

ch,/ Patty

m62

/ /

Kathleen

/ Deena Greg Jim Claire / �92

;d93 � f l

I I /

I I / I ' I /

I 16 I / I · · I /

\ Anne 1/ \

' ' '

Episodes of heavy drinking, incidents of

spouse abuse, traditional view of marriage

Carey David

/ .,. .,.

[�]/(s�{ Donald Bonnie

TI-� G �:P

Hadley Diane

FIGURE Sample genogram: The Jim and Diane Kull family

DIVERSITY IN FAMILY FUNCTIONING

4 a

Gender-sensitive family therapy is intended to liberate and empower both male and female

clients, enabling them to move beyond prescribed roles determined by their biological status

to ones in which they can exercise choice. In practice this means overcoming internalized

social norms and expectations for every client; gender stereotypes in male as well as female

clients require examination. Gender-sensitive therapy is action oriented, not merely non

sexist in viewpoint. Nonsexist counseling attempts to avoid reinforcing stereotypical thinking

regarding gender roles and power differentials in most male-female relationships; gender

sensitive family therapy proactively helps clients recognize the limitations on their perceived

alternatives imposed by internalizing these stereotypes. See Box 3.9 for gender-sensitive family

therapy techniques.

5 Socioeconomic Status and Family Functioning

Every cultural group has socioeconomic divisions, and each socioeconomic status is made

up of members from different cultural groups. Men and women in each socioeconomic

class experience life differently from one another, differently from their counterparts

in other classes, and differently from others of the same class but from another cultural

group.

No one group is monolithic: Not all African Americans are poor; not all Whites are

middle class. In actuality, most of the nation's poor are White, although people of color are

disproportionately represented among the poor. Increasingly it takes two parents-and two

paychecks-to maintain a household's grip on middle-class status in the United States today.

Example of Gender-Sensitive Family Therapy Techniques

Knudson-Martin (2012) notes that therapists need to appreciate the pervasiveness of gender influ ences on all aspects of a relationship and seek to replace gender structures and influences with an emphasis on equality. She provides examples of gender-sensitive family therapy techniques:

• Value relational skills

• Promote a wider range of gendered experience

• Interrupt dominance patterns

• Identify values that promote equality

• Raise conversation about the social context

• Help men attend

• Support silenced voices

• Help families develop their own model of equality

• Promote policies and practices that support gender equality

• Be proactive

80 CHAPTER 3

Socioeconomic differences act as primary dividers within a society. Not only do they largely

determine access to many resources (including therapy), but they also are influential in shaping

beliefs, values, and behaviors (Ho, Rasheed, & Rasheed, 2004). Kliman (2011) categorizes fam

ilies as ruling class, professional-managerial class, working class, and underclass to denote the

long-term dynamics in families that extend beyond annual income, especially for young peo

ple launching from these families. She notes substantial differences in attitude, perspective, and

interpretation of behavior based on class identity. Despite our society's cherished myth that we

are all middle class (or have equal opportunity to become middle class), the facts indicate oth

erwise: more than 14.5% of all American families live below the poverty line, numbering more

than 45 million people, and many more live just above it. Almost 20% of children live in pov

erty and almost 10$ of seniors aged 65 and above live in poverty (U.S. Census Bureau, 2013).

Access to power is also largely determined by socioeconomic status. As Aponte (1994)

observes:

The poor are dependent upon and vulnerable to the overreaching power of society. They cannot insulate themselves from society's ills. They cannot buy their children private school ing when the public school fails. They cannot buy into an upscale neighborhood when their housing project becomes too dangerous. When society stumbles, its poorest citizens are tossed about and often crushed. (p. 8)

Poor African-American families, embedded in a context of chronic unemployment and

discrimination, are particularly limited in their abilities to function in ways that permit family

members to thrive. The decline in marriage rates among African Americans, coupled with the

increased number of teenage mothers, has added to their family crises.

Kliman (2011) notes the persistent effect of social class membership because it impacts

health (access to healthcare and utilization of services when needed), diet, ability to make

long-term decisions versus required focus on immediate needs, and employment conditions

(for instance, the comparison of executives who can work well past age 65 because their work

conditions do not require physical exertion versus those forced to retire on limited funds be

cause they are unable to continue to perform manual labor). Aponte (1987), too, emphasizes

the creation of what he terms underorganized (rather than disorganized) families. Living in

such situations through generations, families of whatever racial background "learn to view

as normal their own impotence" (p. 2). They are forced to accept their dependence upon the

community's network of social institutions (welfare, public housing, publicly funded health

care) without the necessary political or economic power to influence outcomes. Where father

less homes predominate, roles lose their distinctiveness, and children may grow up too quickly

while being at the same time intellectually and emotionally stunted in development.

Life cycle progression among the poor is often accelerated by teenage pregnancy. The

life cycle stages we described in Chapter 2 for middle-class, intact families are often fast

forwarded; the "launching" stage for a young mother's children, for example, may occur when

she is still at her mother's home. Hines (2011) calls this the condensed life cycle because

individuals become parents and grandparents at very early ages. Such early childbearing fur

ther decreases a young woman's already limited prospects for financial security, steady job

DIVERSITY IN FAMILY FUNCTIONING

expectations, educational attainment, and marital stability. Several generations of family are

likely to be alive at the same time in the basic family unit. Such kinship groups at times

function as "multiple-parent families" with reciprocal obligations to one another, sharing

meager resources as efficiently as possible.

The family therapist, likely to be professional-managerial class (in viewpoint if not nec

essarily in origin), must be careful not to regard being poor as synonymous with leading a

chaotic, disorganized life, because, for example, long-term planning may not be present. It

is essential to distinguish between those families who have been poor for many generations

(victims of what Aponte, 1987, calls structural poverty), poor intermittently or temporar

ily (as students or while divorced but before remarriage), or recently poor because of loss

(such as unemployment or the death of the major wage earner). It also helps to be aware that

some poor people, including those who are chronically unemployed, share middle-class val

ues (regarding such things as work and education) while others embrace more survival-based

values of the working class as a result of their life experiences. Some lead lives that are a series

of crises, and others have forged family and social networks that are resourceful and work

able. Above all, any efforts to equate poverty with psychological deviance first must take into

account the harsh and confining social conditions usually associated with being poor.

Therapy and Social Justice Many therapists concerned with the impact of gender, race, ethnicity, social class, economic

status, sexual orientation, spirituality and religion, disability status, and immigration status

have identified the role that therapy could and, from their perspective, should play in the

support and deepening of social justice. Social justice can be understood as the fair and

equitable distribution of advantages and disadvantages within a society to all people regard

less of their status (Toporek, Gerstein, Fouad, Roysicar, & Israel, 2006). For these thera

pists, concern for multicultural sensitivity is not just an issue of clinical efficacy. Therapists

concerned about social justice assert that practitioners need professional competencies to

work toward universal access to justice and equity for marginalized individuals and groups.

Constantine, Hage, Kindaichi, and Bryant (2007) have identified nine competencies they

believe therapists should acquire in training and practice throughout their professional lives:

" An awareness of oppression and social inequities

• Ongoing self-reflection with regard to race, ethnicity, oppression, power, and privilege

• An understanding of the impact of a practitioner's power and privilege on clients,

communities, and research participants 0 Active questioning and challenging of inappropriate or exploitative intervention practices

• Understand and share knowledge, as appropriate, about indigenous healing practices

• An awareness of ongoing international social injustice

" A conceptualized, implemented, and evaluative mental health intervention program

for the multicultural population

• Collaboration with community organizations to provide culturally relevant services

• Advocate for change in the social system

82 CHAPTER 3

Therapists concerned with the social justice dimensions of their professional work often strive

to appreciate their own privileged status in the community and to ensure that professional

efforts not only help clients but the community and society at large.

In this chapter, we have explored how different societal forces, primarily gender and cul ture, affect our understanding of family functioning and the theory and practice of family ther

apy. Research (Keeling & Piercy, 2007) indicates that attention to these dimensions of family

functioning and therapy has become widespread and relatively common not only in the United

States but around the world. The researchers surveyed 20 marriage and family therapists from

15 countries to see how therapists from different locations address the intersection of gender,

power, and culture in therapy. The authors report the widespread application of what they

term a "careful balance" they observed in participant-therapists working with clients. This care

ful balance includes a respect for cultural values and practices and the promotion of equitable

gender relationships, and it was seen consistently across cultures.

SUMMARY

Culture, gender, and socioeconomic status are key in

terrelated factors in shaping lives. Cultural diversity

is an important part of American life, and family

therapists have widened their focus from the family

to include larger sociocultural contexts that influence

behavior. A multicultural emphasis urges therapists

to be more culturally sensitive before undertaking

assessments, forming judgments, or initiating in

terventions with families whose backgrounds are

different from theirs. Otherwise, therapists risk mis

diagnosing or mislabeling unfamiliar family patterns

as abnormal. Gaining greater awareness of their own

culturally based values, assumptions, and beliefs

should help therapists work more effectively with

ethnic families. A culturally specific emphasis asserts

the importance of learning about culturally based

family patterns of specific groups.

In regard to gender, men and women are reared

with different expectations, experiences, attitudes,

goals, and opportunities, and these differences influ

ence later culturally prescribed role patterns in fam

ily relationships. Family therapists have only recently

begun to fully recognize the impact of these early

patterns on current family life. Feminists contend

that psychological research and clinical practice have

been filled with outdated patriarchal assumptions

and offer a male-biased perspective of sex roles and

gender-defined functions within a family. They reject

certain cybernetic concepts such as circular causality

because such concepts fail to acknowledge differences

in power and control between men and women, in

effect blaming the victim for her victimization. The

entry of women across all socioeconomic statuses in

large numbers into the workforce has also helped

break some long-held stereotypic views regarding

the distribution of work and family responsibilities

between husband and wife. Gender-sensitive therapy

is directed at empowering clients, male and female,

to move beyond prescribed sex roles based on biolog

ical status to ones in which they can exercise choice.

Social class considerations also influence fam

ily lifestyles. Living in poverty, whether tempo

rarily or as part of poverty patterns extending over

generations, may erode family structure and create

underorganized families. In poor families, life cycle

progression is sometimes accelerated by teenage preg

nancy, which limits educational or financial security

and future marital stability.

FAMILY DEVELOPMENT: CONTINUITY AND CHANGE 83

Many therapists today assert a link between the

professional values they hold regarding the import

ant considerations of culture and gender in clinical

work and the broader values of social justice. They