Addressing culture in therapy: A multiple case study

Over the past decades there has been an increasing emphasis on the development of cultural competence in the therapy room. It is important for therapists to learn to be culturally competent, especially in the United States where multiple minorities thrive, and the number of interracial marriages has increased 400% in the last ten years. Although there has been a surge of information on specific cultural minority groups, there is limited information on how therapists address culture with families that share multiple racial, ethnic, and cultural heritages. Therapists need to know how to address and view cultural differences within families. However, knowledge can only begin through exploration. We need to know what is going on in the therapy room before we can increase our cultural competence. Only then can therapists begin to break down the myth of sameness.

The purpose of the present study was to explore how therapists address cultural issues with interethnic couples where one spouse is Latino/a and the other is non-Hispanic White, as labeled by the US Census Bureau (“Anglo”). This study utilized a qualitative multiple case study methodology. This design brings together several cases that are seen as instrumental in gaining knowledge about a specific phenomenon, in this case, how therapists deal with issues around culture with interethnic couples. The sample in this study was made up of three cases. Each case was defined as a therapist who had worked with more than one interethnic couple. Two of the therapists had two couples and one therapist had three couples. Information for each case was gathered from therapist's case notes, assessment packets, and videos of taped sessions. The cases were then analyzed at the within-case and across-case level as well as being compared with the available literature on interethnic couples. Additional data included the Multicultural Counseling Knowledge and Awareness Scale which the therapists completed, and the Cross-Cultural Counseling Inventory-Revised which was completed by the researcher and an outside rater when observing sessions.

The within-case and across-case analyses yielded 16 patterns (themes) of how culture is addressed in therapy. The patterns included: 1) Addressing conflicting perspectives; 2) Therapist initiates conversation; 3) Therapist addresses culture straightforwardly; 4) Use of genograms; 5) Influence of couple factors; 6) Couple's willingness to address culture; 7) Therapist addresses alternative/dominant issues; 8) Therapist focuses on behavior; 9) Knowledge & Awareness vs. Skills; 10) Patience and sensitivity; 11) Use of self-disclosure; 12) Client initiation with no follow-through; 13) Clients initiate conversation; 14) Clients become defensive; 15) Differences are initially rejected; and 16) A Latino emphasizes his role as a man.

Overall, findings indicated that some therapists are addressing culture with their clients, while others are not. The manner in which culture is addressed depends on therapist and client factors. The final chapter presents a discussion of the study's results including general comments on the prevalence of Anglo-Latino couples, cultural competence issues, discussion of specific findings, suggestions for marriage and family therapists, limitations of the study, and ideas for future research.