The Therapeutic Alliance in Culturally Competent Family Therapy
Establishing and maintaining a good therapeutic alliance in culturally competent family therapy is a thorny problem. Cross-cultural communication in general--and the context of therapy is no exception--is often fraught with ethnocentric prejudices, suspicion and misunderstandings. The difficulties are particularly great if the therapist and the family are unfamiliar with each other's culture: The therapist represents the dominant culture, and the family belongs or believes itself to belong to a disadvantaged minority. Some of the main problems arising in such situations are discussed in this chapter. Ways for solving the problems and overcoming the difficulties are proposed.
As specified in chapter 6, families of different cultures differ in their conceptions of and attitudes toward symptoms, problems and therapy. The differences are related to questions such as what constitutes a symptom, which situations are considered stressors, how all these are explained, what is considered help, what cures, how cure is explained and what the roles of traditional and modern therapists are.
Cultural differences between the therapist's and the family's conceptions and attitudes concerning all these questions can have a decisive influence on the nature and effectiveness of the therapeutic alliance. This is illustrated in the following example. Shosh, a participant in a culturally competent family therapy course for social workers (which will be cited throughout this chapter as SW) had this to say about the characteristic attitudes of clients of the Ethiopian Jewish community in Israel toward therapy.