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RE-VISIONING FAMILY THERAPY

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Ethnicity and Family Therapy, Third Edition Edited by Monica McGoldrick, Joe Giordano,

and Nydia Garcia-Preto

Teens Who Hurt: Clinical Interventions to Break the Cycle of Adolescent Violence

Kenneth V. Hardy and Tracey A. Laszloffy

RE-VISIONING FAMILY

THERAPY Addressing Diversity in Clinical Practice

T H I R D E D I T I O N

edited by

Monica McGoldrick Kenneth V. Hardy

THE GUILFORD PRESS New York London

Copyright © 2019 The Guilford Press A Division of Guilford Publications, Inc. 370 Seventh Avenue, Suite 1200, New York, NY 10001 www.guilford.com

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The authors have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards of practice that are accepted at the time of publication. However, in view of the possibility of human error or changes in behavioral, mental health, or medical sciences, neither the authors, nor the editors and publisher, nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or the results obtained from the use of such information. Readers are encouraged to confirm the information contained in this book with other sources.

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ISBN 978-1-4625-3193-6 (hardcover)

We dedicate this new edition to the next generation. May they find the courage not to accept constraints

that impede our systemic understanding and practice, but most of all may they find the courage to dare— to work in ways that respect all the complexities of history and identity and potential that our clients bring to the clinical situation. May they refuse to

make molehills out of mountains but rather insist on expanding our efforts to think out of the box.

—M. M. and K. V. H.

To Margaret Pfeiffer Bush and Aunt Mamie Cahalane and all those like them, whose invisibility

was a hidden shame and who bravely transformed the constraints of their lives into a love that inspires

and carries us through life.

—M. M.

To my family—both those with whom I share blood and ancestry as well as those with whom

I share only a common ancestry—for teaching me the life-transcending lessons of survival, humility,

and perseverance. Your quiet dignity, sacrifice, and grace have been a source of strength and have provided clarity of vision and purpose to my life.

—K. V. H.

vi

Monica McGoldrick, LCSW, PhD (h.c.), is Director of the Multicultural Fam- ily Institute in Highland Park, New Jersey, and Adjunct Associate Profes- sor of Clinical Psychiatry at Rutgers Robert Wood Johnson Medical School. Her videos on clinical work with diverse families are among the most widely respected in the field. Her numerous books include Ethnicity and Family Therapy, Third Edition. Ms. McGoldrick is a recipient of the Distinguished Contribution to Family Therapy Theory and Practice Award from the Ameri- can Family Therapy Academy. An internationally known author, she has lec- tured around the world on such topics as culture, class, gender, the family life cycle, and loss.

Kenneth V. Hardy, PhD, is Professor of Family Therapy at Drexel University in Philadelphia and Director of the Eikenberg Institute for Relationships in New York City. He is also President and Founder of the Eikenberg Academy for Social Justice. Dr. Hardy is a recipient of honors including the Distin- guished Contribution to Marriage and Family Counseling Award from the International Association for Marriage and Family Counselors and the Dis- tinguished Contribution to Social Justice Award from the American Family Therapy Academy. He maintains a private practice in New York City special- izing in family therapy.

About the Editors

vii

N. Norma Akamatsu, MSW, private practice, Northampton, Massachusetts

Kiran Shahreen Kaur Arora, PhD, School of Education, Long Island University, Brooklyn, New York

Deidre Ashton, MSSW, private practice; The Therapy Center of Philadelphia; The Race Institute for K–12 Educators; and Widener University, Philadelphia, Pennsylvania

Christiana I. Awosan, MFT, PhD, Department of Professional Psychology and Family Therapy, Seton Hall University, South Orange, New Jersey

Saliha Bava, LMFT, PhD, School of Social and Behavioral Sciences, Mercy College, Dobbs Ferry, New York; Taos Institute, Chagrin Falls, Ohio; Houston Galveston Institute, Houston, Texas

Joanne Bowen, PhD, Anthropology Department, The College of William and Mary, Williamsburg, Virginia

Nollaig Byrne, MD, Department of Child and Family Psychiatry, Mater Misericordia Hospital, Dublin, Ireland

Fernando Colón-López, PhD, Ann Arbor Center for the Family, Ann Arbor, Michigan

Donna Dallal-Ferne, LMFT, private practice, Syracuse, New York

Sarita Kaya Davis, PhD, MSW, Department of African American Studies, Georgia State University, Atlanta, Georgia

Ken Dolan-Del Vecchio, LMFT, SPHR, GreenGate Leadership, LLC, Palmer, Massachusetts

Contributors

viii Contributors

Ken Epstein, PhD, Department of Psychiatry, University of California, San Francisco, and Department of Public Health, San Francisco, California

Celia Jaes Falicov, PhD, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California

Linda Stone Fish, PhD, Department of Marriage and Family Therapy, Falk College, Syracuse University, Syracuse, New York

John D. Folwarski, MSW, Raritan Bay Mental Health Center, Perth Amboy, New Jersey

Nydia Garcia Preto, LCSW, Multicultural Family Institute, Highland Park, New Jersey

Robert-Jay Green, PhD, Rockway Institute, California School of Professional Psychology, San Francisco, California

MaryAnna Domokos-Cheng Ham, EdD, LCP, LMFT, College of Education and Human Development, University of Massachusetts Boston, Boston, Massachusetts

Kenneth V. Hardy, PhD, Eikenberg Institute for Relationships, New York, New York; Department of Family Therapy, Drexel University, Philadelphia, Pennsylvania

Ana M. Hernandez, PhD, LMFT, Rising Ground, Inc., Yonkers, New York; Seton Hall University, East Orange, New Jersey

Paulette Moore Hines, PhD, private practice, training, and consultation; Center for Healthy Schools, Families, and Communities, Rutgers, The State University of New Jersey, New Brunswick, New Jersey; Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey

Evan Imber-Black, PhD, Mercy College, Dobbs Ferry, New York; Center for Families and Health, Ackerman Institute for the Family, New York, New York

Christian Jordal, PhD, LMFT, CST, Department of Counseling and Family Therapy, Drexel University, Philadelphia, Pennsylvania

Hugo Kamya, PhD, School of Social Work, Simmons College, Boston, Massachusetts

Jodie Kliman, PhD, Clinical Psychology Department, William James College, Newton, Massachusetts; Boston Institute for Culturally Affirming Practices, Boston, Massachusetts

Imelda Colgan McCarthy, MSW, PhD, private practice, Dublin, Ireland

Monica McGoldrick, LCSW, PhD (h.c.), Multicultural Family Institute, Highland Park, New Jersey; Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey

Peggy McIntosh, PhD, Wellesley College Centers for Research on Women, Wellesley, Massachusetts

Marsha Pravder Mirkin, PhD, School of Social Sciences, Humanities, and Education, Lasell College, Newton, Massachusetts

Contributors ix

Matthew R. Mock, PhD, Counseling Psychology Program, John F. Kennedy University, San Jose, California; private practice, Berkeley, California

Elijah C. Nealy, PhD, MDiv, LCSW, Department of Social Work and Equitable Community Practice, University of St. Joseph, West Hartford, Connecticut

Elaine Pinderhughes, MSW, Boston College School of Social Work, Boston, Massachusetts

Salome Raheim, PhD, ACSW, School of Social Welfare, State University of New York at Albany, Albany, New York

Rockey Robbins, PhD, Department of Educational Psychology, University of Oklahoma, Norman, Oklahoma

Sharla Robbins, PhD, private practice, Norman, Oklahoma

Robert Shelby, LMFT, Men’s Center for Counseling and Psychotherapy, Berkeley, California

Tazuko Shibusawa, PhD, LCSW, Silver School of Social Work, New York University, New York, New York

Walter Howard Smith, Jr., PhD, Department of Human Services, Allegheny County, Pittsburgh, Pennsylvania

David Trimble, PhD, Center for Multicultural Training in Psychology, Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts

Froma Walsh, MSW, PhD, Chicago Center for Family Health; and School of Social Service Administration and Department of Psychiatry, Pritzker School of Medicine, University of Chicago, Chicago, Illinois

Marlene F. Watson, PhD, Department of Counseling and Family Therapy, Drexel University, Philadelphia, Pennsylvania

Hinda Winawer, MSW, LCSW, private practice; Princeton Family Institute, Princeton, New Jersey; The Center for Family, Community, and Social Justice, Princeton, New Jersey; Faculty Emerita, Ackerman Institute for the Family, New York, New York

x

The goal of this book is to transform the focus of our work beyond the inte- rior of the family, offering an opportunity and invitation for our readers to see how our clients’ lives are constrained by larger societal structures and to develop new ways of working based on a more contextual understanding of ourselves, our society, our history, and our clients’ lives.

We have long struggled to envision systemic theory and practice in ways that transform our field to see our clients and ourselves more clearly and thus more complexly and to provide services that are more trauma-informed and healing. We have espoused approaches that take account of our connection to each other and to all that has gone before and all that will come in the future. Striving to build a sense of belonging for all who seek our help seems the only way to pursue our work. Our original companion volume, Ethnicity and Fam- ily Therapy, began with the lens of ethnicity in its exploration of culture; Re- Visioning Family Therapy, Third Edition: Addressing Diversity in Clinical Practice explores the intersections of multiple cultural perspectives (ethnicity, social class, race, gender, sexual orientation, and religion), attempting to view families and family therapy from more inclusive cultural perspectives.

The aim of this book has been to provide in one relatively short, accessible volume a broad range of brief contributions by many of those who have been working to “re-vision” the family therapy field through a cultural lens. The chapters in this volume are reflective of the authors’ efforts to make a truly paradigmatic shift toward systemic thinking and practice, which we believe is sorely needed in our field and in our world. We have worked assiduously to include chapters that expand our definition of knowledge from an exclusive reliance on evidence-based, scientifically tested practice to one that validates also the “evidence” of subjective knowledge, creating space for the inclusion of personal stories of suffering, subjugation, and strife born out of experiences

Preface

Preface xi

with oppression, which honor a different kind of knowledge. There is great wisdom in learning from the experiences of those relegated to the margins of our society. This book includes many personal stories, a few of them known over the years to some of us, but here available for a wider audience, which help us pay attention to those who have been hidden from history. Creating a space for personal stories and experiences enriches our work as therapists and is central to our view of re-visioning family therapy. We have also included chapters that expand the systemic perspective to larger systems in terms of both conceptualization and intervention. We hope that these perspectives will inspire future therapists to think as broadly as possible about the contextual aspects of our work and our lives.

This new edition is appearing at a time when our world seems fraught with polarities, discontinuities, and regression in the development of social justice. Our search continues to strive toward finding ways to contain oppo- sites, contradictions, and ambiguities—not oversimplifying the issues and at the same time not obfuscating the prejudices and oppression that are increas- ingly defining and destroying our world and us.

Each author was given frustratingly little space and asked to present a few key ideas of clinical and theoretical relevance in a reader-friendly format to contextualize the oppressions that are their work’s focus and to suggest re-visions for our clinical work. We applaud the authors for their courage to contend with these difficult issues and rejoice that they are our collaborators, going through life with us, knowing we are not yet clear about how these power dimensions operate on us, but striving with each other’s help to see the road more clearly.

Re-Visioning Family Therapy is intended to be exciting and suggestive rather than comprehensive in its articulation of where we need to go in our work. Most of the material is intentionally personal. We want to make clear how hidden aspects of our history have influenced our need to change the future. Our ideas have evolved from our frustrations with the traditional boundaries of clinical practice and our wish to expand our vision to see more clearly where we must go to create a better world for everyone. This book has been an opportu- nity to push our own and each other’s boundaries in hopes of helping to trans- form clinical practice toward more contextual and systemic work with clients. We trust readers will give us the benefit of the doubt, realizing that many of these ideas are still in progress, awaiting the leavening of future conversations to better see the issues. We know we have inadvertently left out or marginalized some in this book and will continue to push ourselves to learn from our “sins of omission” in the future. We hope, as we have expressed before, that this edition will soon be out of date again, as the ideas expressed here become commonplace and accepted practice. When this re-visioning occurs, we hope we will be in the fortunate position of trying once again to reformulate the ideas to accom- modate our evolving understanding and insights about change and healing and that others will follow us to expand this endeavor. We hope this book will pro- vide a small window into new possibilities.

xii Preface

PART I. THEORETICAL PERSPECTIVES

Like the other institutions of our society, family therapy has been structured in ways to support the dominant value system. And, again like the other insti- tutions of our society, our field has evolved many conceptualizations and practices that keep invisible certain hidden organizing principles of our lives, including social class, race, gender, sexual orientation, and religion. This book aims to unpack some of these issues in hopes that they become easier to hold in our minds and in our hearts so that we can better go about our work.

The chapters on theoretical perspectives, and, indeed, the book as a whole, evolved out of the work many are doing to uncover those dimensions of “home” and “family” that have been kept hidden and to transform our definitions of home and family so that all families may feel safe and included. These chapters offer a framework for the possibilities of re-visioning family therapy toward a more contextual perspective.

In Chapter 1, we have tried to locate this re-visioning in the history of the family therapy field in general. Following the path established by Peggy McIntosh in the field of education, we try to contextualize the history and possible future of our field. McIntosh’s framework has provided a practical tool for assessing where our field is, as well as where we need to get to in this re-visioning process. We have expanded our overview on issues of social class, spirituality and religion, poverty, gender, and power, with new chapters by Walsh, Hardy, and Ashton and Jordal to expand therapists’ awareness of the centrality of these issues.

Froma Walsh and I (KVH), in our respective chapters (Chapters 3 and 4), provide provocative discussions of these most poignant, volatile, and sensitive issues that are integral to the process of re-visioning related to social class. In Chapter 3, Walsh thoughtfully lays out the dimensions of class, one of the essential and, until now, one of the most invisible elements of re-visioning family therapy from a cultural perspective. It goes unacknowledged that many groups in society are not represented in our institutions and do not have the same entitlements to participate even in our world of family therapy. It goes unsaid that where you come from does matter; that you cannot shed your past, become whatever you want, or move up in class just through hard work and desire. Walsh addresses directly the therapeutic implications of class relations and invites us as therapists to consider the ways in which our work is shaped by the nuances of class. In Chapter 4, I (KVH) discuss poverty as sociocul- tural trauma, illustrating how the limitation of resources organizes the lives of those in need, and the psychological fallout of the assaults of poverty on dignity, the learned voicelessness, shame, stigma, secrecy, and silence that fol- low. This chapter offers suggestions on ways of transforming this fallout and empowering clients through our acknowledgment, countering the devaluation that typically accompanies poverty and encouraging clients to lean in toward transformative possibilities of their survivorship and their voices.

Deidre Ashton and Christian Jordal (Chapter 2) take on some of the aspects of gender and gender nonconformance as they play out in our own

Preface xiii

lives and in the lives of our clients and the intersectionality of race and sexual orientation, offering helpful insights into the hidden dimensions of power as they affect our views of gender. They both remind and caution us that we have outgrown the traditional binary constructions of gender that leave so many clients, therapists, family members, and other loved ones sentenced to a life sentence of invisibility.

Religion and spirituality also play a powerfully influential role in virtu- ally all areas of family life. Yet having a critical discussion about religion is not only difficult to do, but it is often considered inappropriate, sacrilegious, and taboo. Although seldom acknowledged overtly, religion is a major organizing principle in our society. Chapter 5 by Walsh is a firm but gentle reminder of the role that religion and spirituality play in our everyday lives. Race, like religion, is also an important factor that must be placed at the forefront of the agenda for re-visioning family therapy. We believe religion is a salient vari- able because it influences many of the more controversial issues that we, as a society, seem to grapple with passionately on a daily basis. Family-related issues such as same-gender marriages, abortion, masturbation, premarital sex, mother employment, and child-rearing practices ignite strong feelings, even seemingly irreconcilable acrimony, because they are all connected to reli- gion. Former President Barack Obama was forced to claim and reclaim his Christian identity amid numerous allegations that he was really both foreign and a Muslim. In a society that exalts “freedom of religion,” whether he was Muslim, Christian, or Sikh should not have mattered, but it did, because reli- gion matters. By denying its significance, we give its hidden power even more significance.

PART II. SOCIOCULTURAL TRAUMA AND HOMELESSNESS

The authors in this section have given voice to experiences that have also gen- erally been marginalized in the main cultural stories of our society. In a sense, this section is devoted to all of our respective journeys to find home—that is, a place of belonging and acceptance of our multiple identities. In so doing, we share our triumphs and our tribulations. The process of finding home involves each of us, as a fundamental part of the existential search, identifying and claiming disavowed parts of ourselves that we have to make peace with as part of the journey.

In a world that is often divided into the haves and have nots, the valued and devalued, finding a sense of home can be a relentless and often futile endeavor. The chapters in this section highlight how home, homelessness, and trauma are intricately interwoven. As we pulled together our ideas for this book, issues of immigration dominated the national news and raised an array of thorny clinical issues regarding family therapy with populations who are increasingly non–U.S. born, non–English speaking, non-white,1 and from countries often considered “Third World” or whose citizenry is believed to have little to offer this country. We have also been ever more conscious of the

xiv Preface

sense of anomie of those pushed to the margins of our society because of race, gender, sexual orientation, religion, poverty, disability, and other disadvan- tages. I (MM) have told aspects of my own story (Chapter 6), trying to sepa- rate out some of the threads of privilege from those of oppression in my jour- ney trying to dissect the complexities of racial and class privilege in relation to a history of gender and ethnic oppression. This section includes a rich and thoughtful chapter (Chapter 7) by Celia Jaes Falicov on issues of culture and cultural identity in relation to migration and the complexities of transnational families, including issues of loss, adaptation, and network reconstruction. The ideas discussed by Falicov will be enormously helpful to all who work with immigrant families, both documented and nondocumented.

Even though Obama made concerted efforts to avoid mentioning race, it was still an integral part of our nation’s discourse and reality, sometimes overtly but mostly by innuendo and the use of code words. Race is a prime definer of all interactions in our society, with sharp differences that often exist between the racially based perceptions of whites and African Americans. In Chapter 9, I (KVH) remind us that race and other manifestations of oppres- sion are always, at every moment, influencing our perceptions and ultimately our relationships, both in and outside of the family.

In Chapter 8, Paulette Moore Hines discusses hope as a critical tool of assessment and intervention. She examines issues of transcendence, spiritual- ity, hope, and resilience, which have long been eschewed in our theory and practice. For thousands of years such ideas have been the primary resources for people in emotional distress. It is high time we reintegrate this dimension into our conceptual formulations. The belief in something beyond our indi- viduality and our personal self-interest is our only hope to have a future. We trust that in the future this area will begin to receive the attention it deserves, as more therapy incorporates transcendent ideas into our clinical assessment of families under stress and in our approaches to healing.

PART III. RACIAL IDENTITY

Typically, discussions of culture and racism focus on the marginalized group as the “other.” Whiteness, and the multitudinous ways in which it shapes interac- tions, both inside and outside of families, almost always remains invisible. Re- visioning our field requires that we explore most carefully and explicitly those who see themselves as the norm and those who have established the norms. The chapters included in this section are attempts to deconstruct race both for those who have been historically subjugated and for the dominant group.

Rockey and Sharla Robbins’s discussion of Native American families and culture is an eye-opening perspective on trauma, healing, and the meaning of belonging and home. Their chapter (Chapter 10) reminds us how easy it is to “for- get” and define people by their DSM numbers rather than by whom they belong to. Instead, we should all be dedicated to remembering, and “re-membering,”

Preface xv

shattered communities and bearing witness. Their illustrations offer invaluable suggestions on possibilities for working with Native American families.

Peggy McIntosh’s classic challenge to our “invisible knapsack of white privilege” is part of her crucial series of articles that have helped us to begin re-visioning race as well as gender in the field of education. In Chapter 15, McIntosh takes the lofty, virtually abstract concept of white privilege and makes its impact visible through the most mundane everyday experiences. Ken Dolan-Del Vecchio (Chapter 16) offers a critique of white male domi- nance and considers what must change so that white men can be collaborative partners with everyone else in families and communities in the 21st century. In Chapter 17, Jodie Kliman, Hinda Winawer, and David Trimble examine “the inevitable whiteness of being (white)” in family therapy training. These authors make the pervasive invisibility of whiteness visible.

Nydia Garcia Preto, in Chapter 11, explores her own and her family’s complex and multiple identities as they evolved over time and through the life cycle. She illustrates, with her broad and inclusive perspective, a profound openness to the complexity of building bridges to hold the sense of belonging to what came before and building connections to what lies ahead of us, which highlights a significant facet in the transformation of family therapy.

Marlene F. Watson (Chapter 14), Ana M. Hernandez (Chapter 13), and MaryAnna Domokos- Cheng Ham (Chapter 12), each in her unique way, discuss the powerful connections that exist between race and identity devel- opment. Watson provides a gripping and heartfelt account of what it means to grow up as an African American female in an oppressive society where societal messages regarding race, class, and gender often collide. Ham offers a critical and insightful examination of the life experiences of a multiracial person searching for a sense of belonging. In a society that is obsessed with binary notions of race, this chapter brings much-needed attention to the chal- lenges of what it means to be a person of mixed-race heritage. Kiran Shahreen Kaur Arora (Chapter 18) also asserts the importance of thinking about race beyond the Black–white binary and how the experiences of those who identify as Brown can be deemed not to belong.

The collective work and wisdom of the authors in this section remind us how the toxic messages that emanate from racism can leave indelible scars on the psyches and souls of people of color through the unconscious internaliza- tion of debilitating negative racial messages.

PART IV. CULTURAL LEGACIES AND STORIES: THERAPISTS’ EXPERIENCES

Personal narratives are a major part of our attempt to shift our paradigm to re-vision families and family therapy. From Murray Bowen’s first account of his own family at a 1967 research meeting, which stunned the field by break- ing the rules of academic and professional discourse, we have gradually been stretching and transforming the boundaries of our dialogues to create more

xvi Preface

inclusive ways of thinking about our work. The individualistic models of “sci- entific” discourse have proven inadequate to the realm of healing and therapy. These linear models are of limited relevance in a world where our lives are so profoundly interconnected. It is often through personal narratives that we learn most about those aspects of our experience that do not fit into our theo- retical and clinical models. These stories may be key to liberating us toward new visions of our work.

Elaine Pinderhughes’s classic chapter (Chapter 19) describing her research on her own family explores the silenced history of white exploitation and internalized racism in her Black and white ancestors. Her story is a remark- able unpacking of the multigenerational traumatic impact of racism on a fam- ily. Fernando Colón-López’s narrative in Chapter 21 about his search for his past and his identity in his lost mother’s story is a remarkable example of the hidden oppressions of colonized groups and of the power of uncovering the submerged cultural dimensions of one’s history. It is also a striking example of the interface of racial and cultural oppression and mental illness.

John D. Folwarski’s personal recollection (Chapter 22) of a childhood in a Polish orphanage is a profound reflection of the effects of Polish subordina- tion in European history, as well as a story of the impact of immigrant cultural disruption. Folwarski’s narrative is also an indirect testimonial to other salient themes that are replete in many of the stories told in this volume: stories of belonging and disconnection, stories of home and homelessness, and stories of suffering and survival.

The other authors in this section—Linda Stone Fish, Donna Dallal- Ferne, Saliha Bava, Robert Shelby, and Elijah C. Nealy—all share stories of cultural legacies and of their recurring efforts to integrate the frayed threads of their histories into their contemporary lives. Shelby’s pathway to finding home (Chapter 20) required him to come to terms with the white privilege, pathological shame and guilt, and the perversion of morality often associated with whiteness. Acknowledging and claiming this ugly part of his past was in many ways a necessary precursor to the modern-day clarity that he brings to his antiracism work. His story, along with other authors’ accounts of what it meant to grow up in a racist family, should provide inspiration to other white and majority-group therapists regarding how the process of embracing disavowed parts of our cultural legacies can liberate and motivate us to be advocates for social justice.

Linda Stone Fish, a gifted teacher and therapist, provides an in-depth look at how issues associated with her Jewish identity and that of a P

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