cultural family therapy: the theory and practice of cultural psychiatry with families
TRANSCRIPT
CULTURAL FAMILY THERAPY: The Theory and Practice of
Cultural Psychiatry with FamiliesVincenzo Di Nicola
Steven J. WolinMinneapolis, MN
Thursday, May 5, 2016
Society for the Study of Psychiatry and Culture
Annual Meeting
Vincenzo Di NicolaMPhil, MD, PhD, FAPA
Chief, Child & Adolescent PsychiatryMontreal University Mental Health
Institute Professor of Psychiatry, University of
MontrealFounding President, CASP
APA DB Past President Contact InformationE-mail: [email protected]
Steven J. WolinMD, DLFAPA
Clinical Professsor of PsychiatryFormer Director, Family Therapy Training
George Washington UniversitySSPC Past-President
Contact InformationE-mail: [email protected]
Multiples, Multiplicity & The MultitudeDedication
Raymond H. Prince, MD, MSc (1925 – 2012)
Founder & Director, Division of Social and Transcultural Psychiatry, McGill University
Mara Selvini Palazzoli, MD (1916 – 1999)
Founder & Director, Milan Center for Family Studies, University of Milan
Multiples, Multiplicity & The MultitudeRaymond Prince
Three ethnocentric Western assumptions regarding psychotherapy:
The importance accorded to the individual
Personal independence as a therapeutic goal
Introspection as a therapeutic method
With individual therapy, something’s missing
…
Without cultural
understanding,
we build walls instead
of bridges …
Multiples, Multiplicity & The MultitudeMara 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.
Learning ObjectivesAt the conclusion of the presentation,
the participant should be able to:
1. Identify three key processes that CFT employs to characterize today’s family and understand their functions in creating a unique culture for its members.
Learning ObjectivesAt the conclusion of the presentation,
the participant should be able to:
2. Formulate a clinical role for the family and cultural psychiatrist by specifying three clinical tools for conducting CFT with families undergoing culture change.
Cultural Family Therapy
An integration of cultural psychiatry McGill social and transcultural
psychiatry
and family therapy Milan systemic family therapy
Raymond H. Prince, MD, MSc
(1925 – 2012)
Implications Many of our therapies and
professional constructions are Western cultural products
They form part of the folk psychology of Western postindustrial, postmodern societies
Mara Selvini
Palazzoli, MD
(1916-1999)
Mara Selvini Palazzoli Maurizio Andolfi
Defining Family Therapy and
Cultural Family Therapy
Family Therapy
Family therapy is the space that we open to explore
the possibilities of the family.
Family Therapy
What is the task of family therapy?
To give structure and meaning to the family’s predicament.
Multiples, Multiplicity & The Multitude
Family Therapy
This exploration of the family is done in therapy when it is not possible elsewhere or otherwise.
Multiples, Multiplicity & The Multitude
Family Therapy
Family therapy provides guidelines for research and
instruments for change
Soins partagés en pédopsychiatrieFamily Therapy Interventions
Family therapists do three simple things:
Enhance uncertainty Introduce novelty Encourage diversity
Ref: Di Nicola, A Stranger in the Family (1997)
A STRANGE
R IN THE FAMILY
Culture, Families,
and Therapy
(NY: W.W. Norton, 1997)
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
culture and psychiatry
Cultural Family Therapy
CFT was constructed:
to deal with threshold people undergoing rapid cultural
change
Multiples, Multiplicity & The MultitudeKey Features of CFT
Recognizing families as unique cultures
Immigrants as threshold people in transitional states
Three Basic Principles and
Processes for CFT 1) Cultural coherence: Each family coheres as
and maintains it own culture, reflecting deep parallels between the functions of the family and culture, so that family culture supersedes the notion of family system
2) Cultural transmission: Each family is the bearer of the larger culture(s) it is embedded in
3) Cultural adaptation: CFT’s unique mission is to facilitate cultural adaptation for families undergoing culture change
Three Basic Principles and
Processes for CFT 1. Parallels between the notions of “family”
and “culture” 2. Each family is the bearer of the larger
culture and creates its own unique culture 3. Systemic family theory and cultural
psychiatry share a relational psychology that inverses theorizing from self to society (n > 1)
Three Basic Principles and
Processes for CFT 1. Culture supersedes the notion of family system
2. Families perform three interconnected functions:
cultural transmission cultural maintenance/coherence cultural adaptation
3. CFT refines concepts of identity and belonging, resulting in an advanced relational psychology
Key Words“The Threshold”
Cultural family therapy (CFT)
Families as unique cultures
Liminality versus community
Threshold people and transitional states
Clinical Features of
Cultural Family Therapy
Elements of CFT Milan Sytemic Positive connotation
Family Therapy Tom Andersen Reflecting team Tobie Nathan “Bombardement
sémantique” Mikhail Bakhtin Dialogism Emmanuel Levinas Face-to-face
encounter
Key Aspects Cultural Family
Therapy CFT is a cultural encounter CFT examines the presenting culture CFT generates a subjective perspective CFT adds cultural complexity to family
therapy CFT deals with rapid culture change CFT is itelf a cultural product
Clinical ToolsCultural Family
TherapyTool Spirals
Masks
Roles
Codes
Cultural Strategies
Bridges
Stories
Suture
Explanation Meeting strangers Cultural camouflage Insiders & outsiders Translation – Cultural & therapeutic Adaptation & acculturation Family life cycle in cultural context Narrative – the garden of forking
paths
CFT as story repair
Case Presentation of Marital Therapy
with CFT Reflections
“Learning to Dance” Case presentation by Steven Wolin
Marital therapy in a cross-cultural context
Reflections by Vincenzo Di Nicola
Clinical CFT Tools
See handout
“Learning to Dance” Reflections by Vincenzo Di Nicola
See handout
Clinical CFT Tool #1: Cultural Strategies
Enhance uncertainty Introduce novelty Encourage adaptation & diversity
“Learning to Dance”
Clinical CFT Tool #2: Bridges
Enhancing belonging
Belonging is to social and cultural psychiatry what “attachment” (more narrowly defined) is to child psychiatry
“Learning to Dance”
Clincal CFT Tool #3: The Relational Dialogue
The relationship is the focus of the encounter Flattens hierarchies and creates intimacy
through self-disclosure The relationship between the two interlocutors
is the subject of their dialogue The relational dialogue is to relational therapy
what free association is to psychoanalysis
Multiples, Multiplicity & The MultitudeLetters to a Young
Therapist Relational Practices for the Coming Community
(New York: Atropos, 2011)
“Learning to Dance”
Clinical CFT Tool #4: Suturing – Story Repair
Witnessing the “trauma story” (Richard Mollica)
Recruiting an audience for the story Suturing as “story repair” (narrative
therapy)
ConclusionIn creating a synthesis of systemic family therapy
and transcultural psychiatry, CFT offers a fundamental
redefinition –
the family is viewed not as a system
but as a culture
Taking Stock To sum up, suturing a number of concepts and
practices together –
The family as a storying culture where narrative (Bakhtin’s dialogism) and culture (anthropology) are privileged
liminality is acknowledged and threshold people in transitional states (Victor Turner) become more visible and more present to us
in the face-to-face encounter (Levinas) where witnessing (Primo Levi, Agamben,
Richard Mollica) is possible for the re-signification of past experiences (Freud/Lacan, Michael White)
CultureCulture is the crucible of human
relations.
The royal road for understanding mind, self, and identity.
Multiples, Multiplicity & The Multitude
I see humanity as a family that has hardly met.
—Theodor Zeldin
We are still strangers to each other.
The stranger at the gate … as much as the neighbour, the friend, the face of the other … continues to pose critical questions for relational therapy and cultural psychiatry
Bibliography Di 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
Turku, Finland
Dr. Steven Wolin & SSPC
Supervisors in Family Therapy
Dr. Maurizio Andolfi Dr. Mara Selvini Palazzoli
Mentors in Cultural Psychiatry
Dr. H.B.M. Murphy Dr. Raymond H. Prince
Multiples, Multiplicity & The MultitudeON THE THRESHOLD
Selected Papers of Vincenzo Di Nicola, MD,
PhD
Volume I: Children, Families, and Culture Change
Edited with an Introduction
by Armando Favazza, MD, MPH
Atropos Press2016
Multiples, Multiplicity & The MultitudeON THE THRESHOLD
Selected Papers of Vincenzo Di Nicola, MD,
PhD
Volume II: The Body and Culture Change
Edited with an Introduction
by Barton Blinder, MD, PhD
Atropos Press(forthcoming)