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, PhDvincenzodinicola@gmail.com

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, MDemberman@yahoo.com

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