different attitudes, ranging between deep suspicion and hostility at one extreme to blind, unjustified faith and admiration at the other. Families hold a great variety of views and prejudices with respect to professional help. These are partly derived from the family's own internalized cultural programs. Furthermore, people of disadvantaged sections of the population often mistrust mainstream professional helpers and the organizations they represent. Unfortunately, the distrust is often justified. Phenomena such as institutional racism and preferential treatment for certain segments of the population are well documented. See for instance McGoldrick ( 1998).
The ambivalent relationships between many African American families and professional helpers is thoroughly discussed by Boyd-Franklin ( 1989b). Bilu and Witztum ( 1993) discuss the problematics of offering modern psychiatric services to the ultra-Orthodox Jewish community of Jerusalem. They point out incompatibilities between the religious and the medical psychological models of reality. They claim, furthermore, that therapists are viewed as representatives of the impure secular world, which must be avoided. Despite these difficulties they have attempted to reach this community by adopting a therapeutic language suited to their world-view and values.
All the parameters referring to families' coping with problems and difficulties discussed in this chapter must be taken into account in any culturally competent family diagnosis and treatment. An essential ingredient of the art of culturally sensitive therapy is adapting the therapeutic strategies, the choice of techniques and the style of therapeutic communication to the family's own culture-bound conceptions of distress, coping and help.
This chapter is devoted to cultural differences in the ways people identify, define and explain symptoms, problems, crises and stresses and in their help- seeking attitudes and behavior. These differences co-vary with the family's world-view, ecological goals, values and beliefs.
In designing a therapeutic intervention, the therapist should take into account the family's representation of its problems, its traditional help-seeking attitudes and habits, its sources of help within its own community, and its attitudes with respect to modern professional help. Communication between therapist and family has to be sensitive to anxieties, suspicion and prejudices on both sides.