The work of family therapy with subjects undergoing acculturation has been described as being on the front row seat of the interaction between diversity and the family field. Families undergoing acculturation in the United States offer a unique and challenging experience to family therapy practitioners all over the country.
By highlighting the case of a suicidal Portuguese girl in the United States, this paper seeks to describe the various interventions that can be employed to improve the condition of the girl and her family.
The case of study
Our subject is a young Portuguese female; her family has been in the country for five years. One year ago, her mother died. Since then she has been having audio and visual hallucinations of her mother.
Then she jumped from a window of a one-story building after she had seen and heard her mother beckoning from the street. The initial diagnosis was depression. While formulating a mode of treatment for the girl, a therapist will have to take into consideration the three major issues that the acculturation process might raise.
The value patterns characteristic of the family’s culture of origin
In this case, the Portuguese culture considers the hallucinations that the girl was having as being normal; in fact if a person doesn’t have them after the demise of a parent, then they are considered feeling-less or loveless. All of this stems from a belief that the spirit of the person is hovering around and is interested in the affairs of the family.
The major difference, between the Portuguese and the American culture in this case is the intensity of their belief in the supernatural. As part of the culture that they bring over from Portugal, migrant families have a strong belief that the forces of good and evil are permanently around them and are influencing their day-to-day occurrences. One example is in the belief that someone can possess the power of the ‘evil eye’ and can cast evil spells using the eyes. Curanderos are Portuguese witch doctors with whom some of the immigrants trust their health matters. Additionally, the belief in the devil, known as Diabo, and his ability to cause evil is quite strong; so much so that even saying the name is avoided for fear of supernatural repercussions.
When the families immigrate to America, and carry with them their strong belief in the supernatural, most of their views are seen as baseless superstitions by many of the people who interact with them. No doubt, the in the process of acculturation, the immigrant find it difficult to reconcile their spiritual beliefs to the much-less-convinced one of the Americans.
The retention of some of the identity from the country of origin can be both useful and detrimental to the success of the family therapy. For example, it has been shown that families that retain their exotic identity after settlement in the United States have more successful families than those who discard their identity upon arrival [Fraenkel, 2000].
In this case, family therapy, as opposed to group therapy would be the intervention of choice; some of the causes of the girl’s problems are in fact being fuelled by her family; by believing that the girls mother could be existing in any other form rather than as a living human is being perpetuated by the family. By moving the family away from this line of thought; and discussing freely the issue surrounding the death of the family member will benefit the subject.
Where the family is in acculturation process that is, what values have been or are being changed at the time of intervention
This family should be studied carefully to determine their level of acculturation. This will determine the amount of pressure to be placed on changing some of the issues that may be affecting the girl. Additionally, a clear definition of the cultural status of the family should be done to avoid a blanket transfer of the methods used for the mainstream society onto the acculturating group [Fraenkel, 2000]. This will also determine how much the subject will open up to discussion in the presence of her family members; if the hierarchical situation is still very rigid that the lady cannot fully express herself, then the family therapy may not be as successful.
The process of acculturation involves the modification or the loss of some of the cultural practices and beliefs of an immigrant family in favor of those of the host community, in this case the Americans. In our case, the family has not completely lost all of their cultural beliefs since they still believe that visions of a dead person are normal among the bereaved family members; however, they reported that it was still unusual for a person to be still having the visions one year after the bereavement. In my view, this is a sign that the process of acculturation has started to erode even the strong Portuguese belief in the supernatural.
A specialized approach to therapy, whereby the young lady will be contacted and asked to come in with her family can be used instead of the manual approach where appointment made with the guardian rather than the subject is favored [Fraenkel]. However, even with the specialized approach, the subject’s family has to be engaged fully and carefully for optimum results.
The main approach that the therapist will use is that of self-reflection; the sessions will be guided in a direction that will lead the family into asking themselves critical questions about the logic of their beliefs. The self-reflection hopes to attain a point where the family discovers the cultural aspects that may be detrimental to their stay in their new country; and lead them down a path of transformation into a fully acculturated part of the American society. The exact opposite of this would be the attempt to actively compel the family to dump their culture for the American one; this approach would fail miserably.
The family’s understanding or misunderstanding of mainstream American values
What the individual or the family believes in may not be necessarily similar to what the therapist believes in, for example, from our case study, the whole family actually believes that a dead person can appear to the living ones. While whether this is possible or not is not of immediate concern to the therapist; since the girl has been clinically diagnosed as being depressed, then the due course of therapy should start.
The family therapy may fail if the individual or the family rejects the arguments of the therapist made during sessions. The family may, in addition, not accept some of the therapeutic activities that the therapist may prescribe; for example, as a part of therapy, the family may be required to stop referring to the deceased in the present tense as if she is right there hovering over them, but as a dead person who is no longer among them; this is aimed as breaking the emotional ties of the patient and the family to the dead mother and to effect closure.
What conflicts have occurred or what compromises are being made to compensate for the differences between the two native value patterns
In migrant families, the young people will most likely have a misunderstanding with the old people. What these young people lack is role models; since the older generation that emigrated remained tied to their ancestral home. Consequently, they have nothing to measure their acculturation against [Lee, 2000].
The young people can also face conflicts outside their homes; issues of racism, violent attacks and discrimination will only work to compound the psychological disturbance. Additionally, the youth is trapped in a situation where he or she cannot relate to her country of origin, while at the same time, is not being accepted in her adopted country [Lee, 2000]. The therapist should be very careful during therapy not to alienate the subject further.
The assumption that the depression in our patient is caused by the death of her mother should be avoided; the net should be cast wider than that one event. Issues that need to be deeply explored during the sessions should range to how the patient feels about her new home, has she experienced any racially instigated attack or discrimination; has she been able to relate to anyone else outside her family members; does she have any American friends. The intense need for the patient to reconnect with her mother, fuelled by her cultural belief of the ‘living dead’, may as well be signs that girl may be adapting poorly to American life; and of severe loneliness. The therapist will then guide the girl into accepting her situations (both of loss of her mother and her new home) as permanent conditions.
Assessment and Therapy
In this case, the Bowenian model of therapy would be more appropriate; this model is most comprehensive. The model involves the use of genograms, process questions, relationship experiments, detrianglelising coaching, taking the I-position and displacement stories [Nichols and Schwartz, 2005, pg 128].
Therapy should involve the whole family; however, it is not necessary that the whole family attend the sessions at the same time. From the case description, it is clear that the subject had not differentiated herself emotionally from her mother [Nichols and Schwartz, 2005, pg 117]; and that their relationship had been cut off from her mother before it had transformed from a child-parent relationship to an adult-parent relationship; and the emotional fusion that the girl is having with her mother is giving rise to the psychological problems.
The aim of engaging the subject in therapy will not be to change her but to lead her to a point where she will accept responsibility for her own life [Nichols and Schwartz, 2005, pg 125].
During assessment the first step will be to take the history of the family; the extended family then the nucleus family is thoroughly examined and documented in a genogram; which is a detailed schematic diagram of the family tree and history. The therapist has to be very thorough to avoid missing any detail that may be important.
The various people on the genogram will be connected with lines depicting their relationships; the various triangles that will appear will help define the emotional causes of the psychological problems in the girl. The relationship between the mother and the girl may not be the only cause of the problems as the genogram may reveal.
During therapy, the therapist will aim at asking questions that will induce self-reflection; during the sessions involving more than one member of the family, the questions should be directed at individuals to elicit personal answers rather than creating discussion between the family members. This is the process of active inquiry.
The family members should, in the process learn to manage their anxiety pertaining to the whole situation so that they can handle better the girl’s condition and situation. The progress of the sessions should indicate that the patient is increasingly accepting her own individuality separate from that of her deceased mother; this is the detrianglelisation process.
The main aspect of dealing with an acculturating family is to understand them on their own terms. The therapist has to show them that he respects them and that he doesn’t think that his culture is superior to theirs.
Rather than making sensitivity and rigor opposite aspects to choose from the other during therapy, the therapist should strive to integrate both of them during the treatment of a family of this kind [Hasanoviæ, 2005].
The unique needs of each subject, his or her characteristics and the influence of the family on the effectiveness of the therapy should be thoroughly assessed for the sessions to be effective. The therapist should be able to satisfy all the needs of the family members in their complexity; and within the number of sessions sanctioned by managed care.
The therapist has to come out very clearly from the beginning about his attitude concerning the patient; the latter should not see herself as a subject of social management with the therapist seeking to enforce a societal mandate of controlling her, but rather as a respective and concerned professional out to help her.
Another issue that the therapist will have to deal with is the physical safety of the patient [Pynoos, et al, 1999]; she should be controlled, preferably by her family members to prevent her from trying to commit suicide again.
There may reach an instance during therapy when the family feels that the doctor has run out of his or her solutions for the patient. The best approach is for the therapist to be humble and to accept the responsibility of listening to the family and learning from it.
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