Constructions of Therapy, Race, Ethnicity, and Gender - Springer Link

CONSTRUCTIONS OF THERAPY, RACE, ETHNICITY, AND GENDER; AN ANTHROPOLOGICAL METAPHOR Jon L. Winek Susan C. Carlin-Finch

ABSTRACT: This article develops an anthropological metaphor for conducting therapy with families of a racial and/or gender identification different from that of the therapist. This metaphor is grounded in constructionism. It is suggested that when gender and/or racial issues arise in the course of therapy, the therapist must avoid both adhering too stringently to cultural/racial stereotypes, as well as ignoring such stereotypes altogether. Committing either of these errors not only does a disservice to the family, but jeopardizes the therapy. It is also suggested that such issues must be dealt with openly in order to maximize the effectiveness of the interventions. KEY WORDS: family therapy; race-ethnicity-gender; constructionism; metaphor.

This paper creates a link between client and therapist separated by a difference in race, ethnicity, and/or gender. Through a constructionist stance which is informed by an anthropological metaphor we develop a method for bridging differences. Specifically, we have found that by entering into an open dialogue about difference with clients who are different, we are able to span the differences. A discussion of Jon Winek, PhD, is an assistant professor and program director, Marriage and Family Therapy, Department of Human Development and Psychological Counseling, Appalachian State University, Boone, NC 28607. Susan Carlin-Finch MA, MMFT, is a doctoral candidate in sociology, University of Southern California, and family mediator/ counselor, Mediation and Conciliation Service, Superior Court of California, County of Los Angeles, 1040 W. Ave. J, Room 207, Lancaster, CA 93534. Reprint requests should be sent to the first author at the above address or at [email protected]. Contemporary Family Therapy, 19(4), December 1997 © 1997 Human Sciences Press, Inc.

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the therapeutic processes of joining, problem definition, and problemsolving with clients of difference follows. This model provides an anthropological metaphor of family therapy such as that developed by Schwartzman (1983) and Lappin (1983), and which Hoffman (1990) called for in her essay on constructivism. The anthropological metaphor is attractive for several reasons. First, Constantine (1985) argues that". . . perhaps most significant for family therapy is the way in which the founders of each family system function as 'culture carriers' to shape the family's image of itself and its map of family reality" (p. 15). In other words, a person's family is responsible for his or her map of reality or epistemology. Anthropology has a long history and a well-developed method for discovering the "native" maps of reality. Second, anthropology's emphasis on nonintervention make it an attractive metaphor for therapeutic process in its initial phases. Bateson was the first to point out that therapists have a tendency to rush into a system and try to do things before they know what, if anything, needs to be changed. Progress in therapy is often related to the therapist's ability to understand the "family culture" and to effect change within that culture. Further, we see stagnation or premature termination as the client's response to the therapist who, with missionary zeal, is trying to impose her or his constructions and interventions on the clients. By applying an anthropological metaphor to the therapeutic process, we hope to describe a more genderand ethnic-sensitive family therapy.

RACIAL AND ETHNIC ISSUES With the publication of Ethnicity and Family Therapy (McGoldrick, Pearce, & Giordano, 1982), family therapy has given increasing attention to issues of ethnicity and race. For the most part, racial and ethnic groups have been treated as special cases of "normal" families. This has been called an emic approach by Speight, Myers, Cox, and Highlen (1991) where "the assumption is that when counselors have mastered all of the characteristics of the variety of cultural, racial and ethnic groups, they will possess the skills to be effective multicultural counselors" (p. 30). Such a stance not only eliminates the common traits of all families, but also encourages generalizations of specific groups which ignores within-group variations. Numerous authors have written about family therapy with various racial and ethnic groups utilizing this approach. A cursory review of the literature

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produced more than thirty articles dealing with ethnic family variations. Such sources provide valuable information about "standard" cultural patterns within each of these groups. However, we have found that even if a therapist understands a culture, it is not necessarily a smooth transition from understanding to being able to work successfully with the various clients with which one is presented. Understanding is necessary but it is not sufficient for successful therapy.

GENDER ISSUES Feminist theorists such as Thorne and Yalom (1982) have questioned the idea that the family is biologically determined and a functional universal. They see the family as being defined by social, political, and relational forces. Gluck, Dannefer, and Milea (1980) further raise the field's awareness by looking at the role of women in the family life cycle. Other feminist family therapists (e.g., Hare-Mustin, 1978, 1979, 1989; Hare-Mustin & Marecek, 1988; Gilbert, 1980; Marecek & Johnson, 1980; Margolin, Fernandez, Talovic, & Onorato, 1983; Caplan & Hall-McCorquodale, 1985; Avis, 1985, 1988; Taggart, 1985, 1989; Goldner, 1985, 1989; Braverman, 1988; Boss & Thorne, 1988; Libow, Raskin, & Caust, 1982; Goodrich, Rampage, Ellman, & Halstead, 1988; Walters, Carter, Papp, & Silverstein, 1988; Walsh & Scheinkman, 1989) have increased our awareness of gender as a missing variable in our theoretical understanding of families and the family therapy process. Their critiques highlighted the male gender bias embedded in family therapy theories. For example, Goodrich, Rampage, Ellman, and Halstead (1988) argue: family therapy has accepted prevailing gender roles, ignoring their oppression of women, and accepted a traditional family model, ignoring its oppression of women. This failure to notice has resulted in theory, practice and training that are oppressive to women (p. 13). James and McIntyre (1983) have argued that family therapy's failure to look at a family's social, economic, and political context has made systems theory reductionistic at the level of the family. Jacobson (1983) further argues that because of insensitivity to the politics of therapy therapists unwittingly take positions that are oppressive. Thus, the field needs a way to account for individuals, families, and social collectives. Social construction theory has attracted a number


of feminist theorists (e.g., Hoffman, 1990) by emphasizing the interaction between the individual and his or her environment, thereby providing a theoretical framework which readily incorporates the experience of women. Again, understanding a client's gender experience is crucial to good therapy, but it is still not enough.

CONSTRUCTIONIST THEORY As family therapists have become aware of issues of ethnicity and gender, increasing attention has been given to second-order cybernetics. The first-order cybernetic position rises out of an objective empirical epistemology where families are seen as having difficulties due to a deviation from normality. In contrast, the second-order position emerges from a constructionist epistemology wherein problematic phenomena arise out of the process of social interaction. While in their extremes these views are diametrically opposed, we agree with Simon (1992), who argues that a "both/and" position is most useful for linking these opposing theoretical orientations. As Atkinson and Heath (1990) state, "second-order cybernetics in no way replaces the validity of first-order cybernetics. Rather, they are related in complementary fashion" (p. 145). Taggart (1985) linked the feminist critiques of family therapy and the epistemological movement by calling for an increased emphasis on the broader social context in which family therapy is conducted. If we apply the constructionist assumption, we see that issues of race and gender are the result of the social constructions and cultural practices around those constructions (see, for example, Ridgeway, 1991). This view does not reduce problems of race and gender relations to mere problems of construction which can be simply changed by altering public and private belief. Once a conceptualization of race and gender relations becomes established, it is supported by social institutions. The purpose of these institutions is to promote practices which make the social constructions real, natural, and proper. For members of the majority groups, viewing certain practices as natural and proper allows for smoother social interaction which ultimately maintains the social fabric. Kelly's (1955) pioneering work on constructionism states that "to the extent that one person construes the construction process of another, he may play a role in a social process involving the other person" (p. 95). Thus, to be therapeutically successful, one must have

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access to the other's construction process. Our work has shown us that an open dialogue is the best way to access the client's construction system. This paper discusses a therapeutic stance for working with clients of a race, gender, or ethnicity different from the therapist. We think that therapeutic success is a function of the therapist's ability to understand the construction system of their client. Our stance is not a neutral one. It is a common belief that a therapist can take a neutral stance in therapy; however, Jacobson (1983) has shown us that neutrality is impossible and a dangerous myth. We strive to take a political stance that allows both ourselves and our clients to be experts. We strive to be experts in therapeutic process and to empower our client families to be experts in their lives. Further, in our political position, we strives to be supportive of both the client's individuality and cultural context.

CONSTRUCTIONS OF RACE AND GENDER For the most part, constructions of race, gender, and ethnicity have been viewed as separate issues rather than as related. Pinderhughes (1986) and Wilkinson (1980) provide notable exceptions with their discussions of minority women. However, we find the process in constructing both issues similar and our approach useful for dealing with differences of race, ethnicity, and/or gender in therapy. In the following section we will argue that to avoid making clinical errors, the therapist should treat cultural, racial, and ethnic patterns as a hypothetical construct rather than as clinical or empirical reality. We will then present the three stages of the model for work with families of a background different from that of their therapist. While this model was developed to bridge differences between genders and cultural groups, it is applicable to work with clients of the same gender or culture as their therapist. There is too much variation within these groups to ignore, and ethical practice is based on the recognition of existing differences. One of the difficulties involved in conducting therapy with people different from oneself, no matter the point of difference, is that one can commit either of two possible errors. These errors stem from the amount of emphasis placed on these differences as therapeutic issues. On the one hand, one can look at these differences and say that they have little or no impact on the therapy, thus minimizing their relevance and possibly making interventions that are not consonant with


the clients' interests. On the other hand, one can maximize these issues and make them the central focus around which the therapy revolves. Such a stance would not allow for individual variation within groups, ignoring the similarities that might exist between client and therapist. Models of therapy which fail to address racial and gender issues stray dangerously close to the former position. As Avis (1985), AultRichie (1986), and Luepnitz (1988) have argued, the family therapy field supports the current gender structure within contemporary society. Regarding domestic violence, Bograd (1984,1986) provided a more focused critique of family systems models by arguing that ". . . family systems approaches to violence against wives and daughters may contain biases that perpetuate the social structures that maintain incest, wife battering, and marital rape" (1986, p. 34). This critique can be expanded to show that such approaches to family therapy support the current racial and ethnic structure within contemporary society. Thus, theories of family therapy by and large are laden with white, male, middle-class, heterosexual values. Direct application of such models to non-white, non-middle-class, or non-male headed families can be an attempt to impose foreign values on the family. Such an imposition ignores possible variations and is potentially detrimental to our client families. On the other hand, focusing primarily on the culture or gender roles of the client risks conceptually forcing them into an ideal type which does not necessarily exist. (Ideal type, a sociological term, refers to "a concept that calls attention to important traits by emphasizing, even exaggerating them" Popenoe, 1983, p. 597). When cultural typologies and gender profiles are developed, one always risks performing an exercise in stereotyping. Focusing solely on the cultural or gender issues may take the typical white, middle-class therapist out of his or her context as well, and may thus render him or her tolerable at best and rude and ineffective at worst. Thus, it is as impossible for therapists to abandon their contexts as it is to fit the client family into the therapist's context. This is similar to Hare-Mustin's (1988) concept of alpha and beta prejudices of gender, or to the scientific notion of type I and type II errors. Hence, the trick is not to commit either of the two errors while being able to provide service to the family. Therefore, a model is needed that bridges differences, neither ignoring them nor making them the be-all and end-all. The model is general by definition, allowing it to be used in cases where there are inherent differences between therapist and client(s).


MODEL AND METAPHOR Our model operates under the assumption of a "family culture" where the family, through the process of socialization and coupling, determines reality for its members. This view avoids making therapeutic errors resulting from the assumption that a family matches the racial, gender, or cultural ideal type. "Family culture" implies that each family and each family member is unique within a broader cultural context. That is, each client carries within him or her some aspects of his/her "culture of origin," as well as some unique characteristics. One of the goals of therapy is to discover the family culture, and to evaluate to what degree that culture reflects the broader cultural patterns as well as its own peculiarities. We concur with Collier, Rosaldo, and Yanagisako (1982) who state that an anthropological view of the family ". . . compels us to listen carefully to what the natives in other societies say about relationships with genealogical close kin" (p. 34). The same is true with our work with clients of different gender and/or race where the process first involves listening to discussions about differences. This provides information as to possible sources of strain on the family system, whether from within or without. The model addresses issues of joining, problem definition, and problem-solving by describing the stages of treatment and styles of dialogues useful for bridging differences in each stage. It is a functional model, based on observations of family therapy, useful in its application as a heuristic model of the therapeutic process. Our ideas follow closely those of Constantine (1985) who argues that a general theory of family informs a specific theory of a client family. This specific or idiographic theory is then utilized to design interventions which are seen as "therapeutic experiments." We have found it useful to think that therapy is a process akin to conducting anthropological field studies. Many of the issues therapists face in dealing with people of a different racial or gender culture are essentially the same as those cultural anthropologists face in conducting a field study. The key issues in therapy are those dealing with functionality within a given context rather than pathology as a result of being different. We selected an anthropological metaphor because it addresses differences of context rather than issues of pathology. An appropriate metaphor for working in and with a family is that the process is similar to reading a travel guide before leaving on a trip, but letting the natives take you on your tour. As Korzybski (1973) informs us and Watzlawick, Weakland, and Fisch (1974) and Keeney (1982) remind us, the "name" is not the thing named nor is the map


the territory. In addition, the travel guide is not the tour and the tour is not the culture. However, we assert that the authenticity of the tour is a function of the motivation and trust of your tour guides—the family. Joining The therapist's task of joining is similar to the anthropological task of gaining entree. The therapist's initial task is to put the family at ease with sharing descriptions of its cultural and gender experiences. Gaining accurate information is essential to treatment which is consonant with the client's context. While a cultural anthropologist tries to establish an informant relationship with a select few members of the society, a therapist tries to connect with all members of the family. The reason for connecting with all family members is that perceptions vary within the family. These perceptual differences among family members can split the family; if the therapist joins one side of the split, he or she risks sabotage, whether direct or indirect, by the unjoined member(s) (cf. Broderick 1983). The Milan group's (Selvini-Palazzoli, Boscolo, Cecchin, & Prata, 1980) use of circular questioning exploits this perceptual difference to the therapist's advantage. Thus the therapist's task is to establish a trusting relationship with each client and to instill the belief that the therapy will be useful to them. Part of this task is accepting what the client(s) brings into the session without making any judgment as to whether it is right, wrong, or even relevant. It is also of paramount importance to avoid any stereotyping as well as any stereotypical presentation of self. An effective technique for doing this is simply empathically attending to the family and its presenting problem(s). Failure to do this can result in termination if the therapy is voluntary, and stagnation if not. Problem Definition Diagnosis entails taking a second order view of the family and its presenting problem. It involves an exploration of the interactional patterns within the family system, particularly the interaction around the problem. The therapist seeks an awareness of both the homeostatic mechanisms and the mechanisms of change. The problem definition includes not only a functional description of the symp-


toms, but an awareness of how the symptoms are maintained within the system. This is in line with Keeney (1983) and Keeney and Ross (1985) who call attention to the therapist's need to be mindful of the competing calls for stability and change in the therapeutic process. Within the functional analysis lies an implicit plain for shifting the systemic maintenance of the symptom. When Kelly (1955) asserted ". . . if you do not know what is wrong with a person, ask him; he may tell us" (p. 322), he reminded us that the client's construction of the problem is what is often overlooked in our eagerness to know the "true" problem. If time is spent in empathic exploration of their construction, we gain the family's trust as well as critical information. It is no coincidence that most techniques of family therapy call for an exploration of each family member's view of the problem early in treatment. A therapist working with a client whose experiences are foreign to him or her can utilize information about the client found in the literature. However, we believe that one should accept the "standard" cultural or gender patterns as an ideal type, which is tested with the client before acting on it. Such a test is performed by comparing the ideal type with the information given to us by the clients. The sensitive therapist comes to a session with a theoretical understanding of families, cultures, gender roles, and therapy but believes in the clinical reality rather than their theoretical understanding. If the cultural or gender ideal is verified along the dimensions tested, we know to work with that client within a more "standard" or normative context. If not, then we can further hypothesize that the "family culture" may be one of the sources of their difficulties. Such a situation may include problems of acculturation or striking a balance between their family culture and the wider culture. When the client introduces an issue, the therapist should directly test his or her understanding of the issue. The therapist, however, must first be joined to ensure that accurate information has been obtained in order that an appropriate diagnosis may be made. If they are joined, the cultural hypothesis testing should not drive the client away. The client will then be able to provide the therapist with feedback when he or she commits one of the two possible errors discussed above. There is a long-standing tradition within cultural anthropology which explains behavior within a system in terms of the function that behavior serves. The common stance was that behavior was described in terms of its function to the system alone. This led to the belief that behaviors served some purpose or provided some benefit to the larger


system. Merton (1968) on the other hand, introduced the idea that some things exist without being functional and some things even exist to the detriment of the larger system. These things he labeled as being either non-functional or dysfunctional. It is critical to note that therapists cannot dare to impose their ideas of what is functional or dysfunctional for clients within their contexts. Rather, the evaluation of the functioning of a system must occur from a position within the system and is based on the constructionist notion that for each situation there are a variety of realities. Watzlawick (1990) reminds us ". . . the belief that one's reality is the only reality is the most dangerous if it is coupled with a missionary zeal to enlighten the rest of the world, whether the rest of the world wishes to be enlightened or not" (p. xiii). Up to this point, we have collected information about how the system functions while trying to suspend judgments as to its overall adaptability. We then use our relationship with the clients to explore what they perceive as dysfunctional for them within their context. We assume the clients know what is wrong or what does not work; they are stuck as to how they should go about making things work. Therefore, we establish a therapeutic contract to work on what they perceive as dysfunctional. This is the presenting problem. The ability to share in a caring way in what the client perceives as occurring is a relational issue with the client, and is of paramount importance to the therapy. Problem Solution Once the therapy has progressed through the first two steps, the therapist is ready to plant the seeds of change. Just as anthropologists are cautious about what aspects of their home cultures they impose on their subjects, the therapist must be cautious not to impose his or her culture on the client. The therapist's position is at issue. Does the therapist become a missionary or does the therapist intervene in a manner consistent with the family culture? We maintain that unless the family contracts for alignment with the therapist's cultural pattern, any attempt to force such alignment is ethically questionable and likely doomed to failure. Whitaker (1976) warns us, tongue-in-cheek, "If we can abandon our missionary zeal, we have less chance of being eaten by cannibals" (p. 164). In this stage, the plan developed in the problem definition phase is put into action. As the plan is negotiated, the goal of therapy is

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made more explicit. The therapist no longer passively accepts the client's maintenance of the symptom, but rather actively seeks to effect change within the system. Thus in this phase the therapist is more direct and deliberate in his or her attempts to help the clients change their system. Let us remember that the client has contracted for help in changing. With this contract, it is not an unwarranted imposition of personal values to induce change in the system. Techniques of change such as providing insight, paradox, prescribing the symptom, reframing, and so forth are employed during this stage. Constantine (1986) reminds us "One can only take in what is in one's personal map; one can do only what is in one's repertoire" (p. 74). It is therefore important to provide the client with interventions that are consistent with both the client's map and behavioral repertoire or work with the client to expand the map and/or repertoire. Terms such as denial, resistance, and avoidance are often applied to clients who do not share the therapist's map of the therapy or who are asked to do things not in their repertoire. To a culture-sensitive and gender-sensitive therapist, these terms are linear and the equivalent to non-helpful slurs.

CONCLUSION Therapy begins with joining the clients—making them feel comfortable, empathetically listening to their stories, and engaging each family member. In this phase, the therapist consciously avoids being used by one member against another. This is done to establish trust. The therapist gains information from the family which is tested against his or her theoretical understanding of the issues. This information is utilized to formulate a problem definition. The definition is presented to the clients for their consideration, and as such, they can either accept or reject it. No matter what the response, the therapist continues in the joining process, and further refines or replaces the original definition, eventually reaching a therapeutic contract with the clients. Once this is done, appropriate problem-solving resources are made available. The therapist continually observes and modifies the treatment approach based on the client's response. Once the therapeutic goals have been reached, changes are reinforced and a renegotiation of the contract occurs. The therapist is the initial guide through the therapeutic cycle, but his or her ultimate goal is that the


family guides themselves through a similar process. When this occurs, the movement is accelerated and much more powerful. Each stage has its own potential critical error, which slows progress through any particular cycle. Errors may result in termination prior to realization of therapeutic goals, or they may be explicitly negotiated and dealt with by both client and therapist. When they do arise and are dealt with, the therapist has a framework provided by the metaphor to further aid in the detection of errors and speed their resolution.

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