“Attuning to the sociocultural perspective was never a choice but our culture of

dominance invisiblizes it, creating colonizing conditions for therapeutic practice. But no
more! McDowell, Knudson-Martin, and Bermudez’s socioculturally attuned framework
offer theoretically dynamic, contextually sensitive, and relationally ethical ways to
unpack the invisible, yet highly felt, role power plays to create third-order change. They
show us how this change is an imperative, not a choice, to create just relationships. One
of the rich features in this edition are diverse practitioner reflections, across contexts,
which afford the reader to engage one’s unique intersectional positionalities in practice.
This book needs to be required reading for all practitioners.”
Saliha Bava, PhD, Associate Professor, MFT Program,
Mercy College; Co-founder & Executive Council Member,
International Certificate in Collaborative-Dialogic Practices Network

“Systemic, third-order thinking requires profound and authentic engagement making

transformative change at many contextual levels impossible without socioculturally
attuned praxis in family therapy. This compelling book challenges family therapists to
stay true to their systemic training and consider all the intersections of our relational
contexts. It uses a social justice and inclusion lens and has uniquely included the voices of
many engaged in transformative third-order thinking and change. It is a must-read for
anyone claiming to be a family therapist.”
Manijeh Daneshpour, Distinguished Professor of
Family Therapy, Alliant International University, California
Socioculturally Attuned Family Therapy

Socioculturally Attuned Family Therapy, 2nd edition, is a fully updated and essential textbook
that addresses the need for marriage and family therapists to engage in socially responsible
practice by infusing diversity, equity, and inclusion throughout theory and clinical practice.
Written accessibly by leaders in the field, this new edition explores why sociocultural
attunement and equity matter providing students and clinicians with integrative, equity-based
family therapy guidelines and case illustrations that clinicians can apply to their practice. The
authors integrate principles of societal context, power, and equity into the core concepts and
practice of ten major family therapy models, such as structural family therapy, narrative family
therapy, and Bowen family systems, with this new edition including a chapter on socio-
emotional relationship therapy. Paying close attention to the “how to’s” of changes processes,
updates include the use of more diverse voices that describe the creative application of this
framework, the use of reflexive questions that can be used in class, and further content on
supervision. It shows how the authors have moved their thinking forward, such as in clinical
thinking, change, and ethics infused in everyday practice from a third order perspective, and
the limits and applicability of SCAFT as a transtheoretical, transnational approach.
Fitting COAMFTE, CACREP, APA, and CSWE requirements for social justice and
cultural diversity, this new edition is revised to include current cultural and societal changes,
such as Black Lives Matter, other social movements, and environmental justice. It is an
essential textbook for students of marriage, couple, and family therapy and important reading
for family therapists, supervisors, counselors, and any practitioner wanting to apply a critical
consciousness to their work.

Teresa McDowell, EdD, is a professor emerita of MFT at Lewis & Clark’s Graduate
School of Education and Counseling. She is a social researcher, program evaluator, con­
sultant, and educator.

Carmen Knudson-Martin, PhD, is a professor emerita of MFT at Lewis & Clark’s

Graduate School of Education and Counseling. She is a founder of Socio-Emotional
Relationship Therapy (SERT).

J. Maria Bermudez, PhD, is an associate professor in the MFT program at the University
of Georgia. Her work centers feminist-informed, culturally responsive approaches to therapy,
research, and supervision.
Socioculturally Attuned Family
Therapy
Guidelines for Equitable Theory and Practice
Second Edition

Teresa McDowell,
Carmen Knudson-Martin, and
J. Maria Bermudez
Cover image: Getty Images
Second edition published 2023
by Routledge
605 Third Avenue, New York, NY 10158
and by Routledge
4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2023 Teresa McDowell, Carmen Knudson-Martin and J. Maria Bermudez
The right of Teresa McDowell, Carmen Knudson-Martin and J. Maria Bermudez to be
identified as authors of this work has been asserted in accordance with sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form
or by any electronic, mechanical, or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or retrieval system, without
permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks and
are used only for identification and explanation without intent to infringe.
First edition published by Routledge 2017

ISBN: 978-1-032-10680-9 (hbk)

ISBN: 978-1-032-07441-2 (pbk)
ISBN: 978-1-003-21652-0 (ebk)

DOI: 10.4324/9781003216520

Typeset in Bembo
by MPS Limited, Dehradun
 We dedicate this book toward a more equitable future for the
generations to come, and to colleagues and students who tirelessly
work as agents of third order change.
Contents

Foreword to First Edition by Fred P. Piercy xi

Foreword to the Second Edition by Stephanie Brooks xiii
Preface to the 2nd Edition xv
Acknowledgements xix
List of Contributors xxi
Author Bios xxiv

1 What is sociocultural attunement and why is it important? 1

2 Guiding Principles for Socioculturally Attuned Family Therapy 21

3 Third Order Ethics and Contextual Self-in-Relationship 53

4 Socioculturally Attuned Structural Family Therapy 74

5 Socioculturally Attuned Brief and Strategic Family Therapies 94

6 Socioculturally Attuned Experiential Family Therapy 116

7 Socioculturally Attuned Attachment based Family Therapies 139

8 Socioculturally Attuned Bowenian Family Therapy 163

9 Socioculturally Attuned Contextual Family Therapy 187

10 Socioculturally Attuned Cognitive Behavioral Family Therapy 209

11 Socioculturally Attuned Solution Focused Family Therapy 232

12 Socioculturally Attuned Collaborative Family Therapy 251

x Contents
13 Socioculturally Attuned Narrative Family Therapy 276

14 Socio-Emotional Relationship Therapy: An Example of Socioculturally

Attuned Couple and Family Therapy 299

15 Socioculturally Attuned Praxis: Consciousness in Action 330

Index 358
Foreword to First Edition

This book is a timely gift to our field. McDowell, Knudson-Martin, and Bermudez offer us
both the theory and practical guidelines we need to support equity in the face of sociocultural
factors at play in all relationships. They explain socioculturally attuned family therapy, as a set of
transtheoretical considerations that they apply to family therapies to support third order
change. That is, they provide a way to understand and address sociocultural factors that
promote and maintain unearned privilege and misuses of power.
The authors explain that it is not possible for a therapist to be neutral in the face of power
imbalances. Tolerance and acceptance are not enough. We must address the dynamic
interplay between societal systems that privilege some over others. Uneven influence and
opportunities can be, as the authors explain “based on social class, gender, race, ethnicity,
languages, sexual orientation, age, nation of origin, abilities, and (even) looks.” The authors
show family therapists how they can integrate cultural attunement within a wide range of
family therapy theories.
As a long-time author and editor, as I read this book, I reflected on the qualities that I
value in professional writing. For example, does the author answer the “so what?” question.
Why is a work important? What does it add to the field? This book’s potential impact is easy
to see. There is no more important issue in our field than how to provide culturally attuned
therapy that appreciates the strengths of one’s culture and family, identifies inequities,
addresses inequities, and applies our family therapies in a manner that addresses these
inequities.
As an editor, I also look for interventions that are theoretically grounded and brought to
life through clinical dialogue, and practical exercises. McDowell, Knudson-Martin, and
Bermudez do this in every chapter. They introduce each major model of family therapy,
discuss its history and application, identify the enduring concepts of each model, then show
how sociocultural attunement might be applied to each particular theory. I particularly liked
their last chapter, that identified the steps in their approach that can be applied to any existing
family therapy.
As for accessibility and tone, other editorial values of mine, McDowell, Knudson-Martin,
and Bermudez have made difficult concepts clear, engaging, and eminently transferrable to
practice. Also, in this era of political and societal bullying, the authors’ approach doesn’t
shame or bully. They work with clients in a sensitive and kind manner that invites
understanding and collaboration.
Perhaps the most important value in contemporary family therapy is cultural sensitivity.
Indeed, the authors support greater cultural understanding, equity, and critical social
consciousness. Their work is both impressive and important. I can see it transforming the
way we practice family therapy, regardless of model. It is good that we are talking about
social justice in our field. The authors operationalize this concept for family therapists. They
provide an accessible, useful, affirming socioculturally attuned family therapy that examines
xii Foreword to First Edition
sociocultural structures, supports relational equity, and thus social justice. McDowell,
Knudson-Martin, and Bermudez’ book will not only transform our practices and our
clients but ourselves, as well.

Fred P. Piercy, PhD., recently retired from the family therapy

doctoral program at Virginia Tech, Blacksburg, VA.
From 2012 through 2017, he was the editor of the
Journal of Marital and Family Therapy.
Foreword to the Second Edition

For more than 25 years I taught Introduction to Family Therapy to couple and family
therapy students. In this course, students were invited to use culturally responsive practices,
larger systems, power, and privilege to critique and modify family therapy approaches. How I
wished for a textbook that provided a practical framework for navigating relational,
sociocultural, and political intersections in clinical practice. The first edition of
Socioculturally Attuned Family Therapy generated excitement and stimulated the hearts and
minds of couple and family therapists across identities, experiences, and philosophies. As the
former Executive Consultant for the American Association for Marriage and Family Therapy
Minority Fellowship Program (MFP), the concept of third order change helped to frame and
name the MFP Fellows’ commitment to social change. This was a clear signal that their work
mattered, and they too had a seat a table. It was moving to witness our professional
community reflect, recognize, and renew their personal and professional commitment to
action inside and outside the therapy room.
Like the first edition, this contribution by Teresa McDowell, Carmen Knudson-Martin,
and Maria Bermudez will forevermore shape how and what we think, practice, and teach
about family therapy. The second edition of Socioculturally Attuned Family Therapy refines the
guiding principles of the ANVIET approach and expands on how to facilitate change within
and across embedded systems. The authors updated the chapters to include contemporary
issues, added new references and for clarity restructured key graphic representations.
Chapters 1 and 2 are significantly revised to include some of the most challenging health
and societal issues we’ve encountered over the past five years such as COVID-19, climate
change, and mental health. They shine a light on racism, trauma, power, and privilege how
these matters promote and maintain structural inequality in the US. The introduction of
socio-relational determinants of health is a timely analysis and further details our obligation to be
socially responsible family therapists. These topics will without question influence our
present and future work.
Several new features and chapters demonstrate the progression of McDowell, Knudson-
Martin, and Bermudez’s ideas about equity-based therapy. Chapter 3 includes their current
reflections on third order ethics and self of the therapist. In the new chapter 14, the SERT
model is comprehensively presented as an exemplar of an equity-based therapy approach.
Chapter 15 is new, including a section focusing on third order thinking and third order
transformative change across contexts such as community agencies, research and policy
making. This chapter provides clear links and illustrations for socioculturally attuned family
therapy and consciousness in action. Finally, the authors invited our colleagues who are
engaged in transformative work to share examples of how their work reflects third order
thinking and change. The inclusion of over two dozen voices makes this book truly
exceptional and elucidates for the reader how to think and practice equity-based therapy.
xiv Foreword to the Second Edition
This book is a call for action. It will continue to generate dialogue about the future
directions for couple and family therapy practice and the profession. The inclusion of C/
MFT practitioner voices is a brilliant example of how to use your platform and harness
community power to create a new reality of an equitable place.

Stephanie Brooks PhD, LCSW, LMFT, Drexel University,

Philadelphia, PA, Counseling and Family Therapy Department,
Senior Associate Dean for Health Professions & Faculty Affairs,
Interim Program Director, Couple and Family Therapy Program
Preface to the 2nd Edition

Since completing the first edition of Socioculturally Attuned Family Therapy: Guidelines for
Equitable Theory and Practice in 2017, we have continued to work together and expand our
original ideas. This has included the opportunity to publish several book chapters and journal
articles on various aspects of socioculturally attuned family therapy, to present at family
therapy conferences, and to further integrate the approach into our teaching and supervision.
This second edition reflects advances in our thinking, including a focus on socio-relational
determinants of health, third order ethics, and historical and contemporary sociopolitical
issues.
Over the past five years, we have witnessed an explosion of what we consider third order
thinking and practice among colleagues who have published or otherwise shared their
conceptual frameworks and practices. We are most excited to be able to showcase many of
these innovators by including their voices in this edition. Their contributions provide
examples of engaging in transformative praxis across multiple contexts, within and beyond
family therapy, including work in communities, municipal and legal systems, medical
systems, educational organizations, research, and policy-making.
We use a variety of terms throughout this text to refer to sociopolitical identities.
Contemporary preferred terms change quickly as the contested landscape of identity shifts.
The freedom to self-identify, potential power of claiming group identity, and colonizing
effects of being identified by others reflect the brutal struggle between structural equity and
inequity. Given that this text will be used across disciplines, in different countries, regions of
the US, and by diverse contexts and readers, by the time you read this text, some of the terms
we use may be perceived as offensive and/or outdated. Even now, we move between terms
in ways that are likely to feel dismissive, irrelevant, or uninformed to some readers. In
numerous places across this volume, we advocate for calling in rather than calling out,
connecting rather than polarizing, and being patient with ourselves and others who are on a
journey of becoming increasingly socioculturally attuned. We ask readers to engage with our
intention to be inclusive, compassionate and just, as we attempt to describe the complexities
of diverse identities and social locations across and within cultural contexts.
As socioculturally attuned family therapists, we want readers to know who we are, our
social locations, our intentions, our values, and some of our individual and collective herstory
in the field of family therapy. We have a lot in common with each other. We are all family
therapy educators, supervisors, and clinicians with various types of professional experiences.
All three of us are highly relational beings, dedicated to putting relationships first, including
our relationships with each other. We are hard workers who have shared our energy and
creativity over the course of writing both the first and second edition of this text, struggling
to make sense of how, as family therapists, we can all expand our work to support more just
relationships. We have deeply valued the differences between us, which allows each of us to
xvi Preface to the 2nd Edition
see with more than our own eyes. Following we each share a few thoughts about our
journeys thus far in the field of family therapy.

Teresa
I became a family therapist in the 1980s. I remember myself walking around amazed, gaping
at patterns I was seeing everywhere. I was hooked! Wrestle as I might, I couldn’t pull myself
away from a field that was teeming with energy, pushing to find new ways of creating
change. I fell in love with counterintuitive thinking; with the MRI model, as well as
Structural and Strategic family therapy. As the field developed I embraced Solution Focused
and Narrative practices. Being active, intuitive and imaginative––taking risks using
experiential techniques––became central to my practice. I balanced the burden of trying
to do therapy right with an entrepreneurial drive to think creatively. I reminded myself often
in the early years that they called it practice for a reason—I was just practicing.
Along the way I became deeply disconcerted about social inequity and began looking
outside family therapy for answers. A doctorate in liberation-based adult education helped
me rethink family therapy and set the stage for challenging my own Eurocentric thinking,
unexamined Whiteness, heterosexual and cisgender privilege, and middle class legacy.
The first half of my career I looked to family therapy to help me understand the world. The
second half I searched in and out of family therapy to find ways to understand and challenge
unjust social and familial arrangements.
When I find an idea in my travels (usually in the land of critical social theories), I drag it
home to family therapy and find somewhere to put it––somewhere it might make a
difference. Of course, others have been doing the same, creating momentum for socially just
family therapy. Carmen, Maria, and I tasked ourselves with systematically inventorying and
mapping relationships between many of these collective ideas; relying on our years as family
therapists to develop guidelines for just practice across models. Working with Carmen and
Maria has been a gift. Beyond their friendship, scholarly acumen, and clinical expertise, they
have helped me find a place to belong––a home where I can remain unsettled––in constant
motion between the center and the borderlands of family therapy.

Carmen
Before I came to this field, I taught family life education in high schools. I found myself
fascinated by students who struggled, not by their “problem behavior,” but by their stories of
hurt, pain, and unfairness. Seeing students labeled as troublemakers, while misdeeds of
“good” students (as I had been) escaped notice, heightened my curiosity about the systemic
dynamics that create and maintain these inequities.
Then I moved to Iran. As a young woman of Scandinavian heritage raised on a farm in
North Dakota, I experienced being on the outside and had to learn how to negotiate a
social system organized so differently than I was used to. How did I buy groceries? How
did I get from one place to another? Who could I trust? When the Tehran-American
School hired me to teach family life education and psychology, I had to consider human
behavior and relationships from perspectives different than my own. Later living in Senegal
and then teaching at international schools in Jordan and Costa Rica, I learned to see
my North American world from the outside and to take apart and examine my taken-for-
granted expectations. I experienced the privileges accorded English speakers and US
citizenship.
In 1983 I began to study family therapy as part of a PhD program in sociology. This was
pure luck! Since then I have focused on how the larger societal context operates in the
 Preface to the 2nd Edition xvii
moment by moment of therapy. New collaborators in each place I worked (Montana,
Georgia, Southern California, and Oregon) stretched my thinking and a diverse range of
students and clients gave me windows into their worlds. As a White, monogamous cisgender
heterosexual temporarily able-bodied wife, mother, and grandmother, I am continually
humbled by the limits of my understanding and the ease with which I am usually able to walk
through this world. Yet as a therapist, I regularly witness the effects of societal inequalities.
To me, promoting equitable relationships is both an ethical and clinical issue. Grappling with
the intricacies of this work with Teresa and Maria has been exceedingly challenging and
enriching. Our understandings will always be a work in progress.

Maria
I have been a couple and family therapist for almost 30 years. I consider myself a “purist”
in family therapy. I graduated from two COAMFTE (Commission on Accreditation for
Marriage and Family Therapy Education) graduate programs and have taught in two
COAMFTE graduate programs, and my studies have been strongly rooted in academic
departments of human development and family science. What initially drew me to the field
of family therapy was a non-pathologizing focus on families in therapy. Simple enough. But
what fascinated me was the way in which family therapists think. I enjoy examining the
multiple contexts of people’s lives and seeing complex processes as they unfold. I greatly
value all the family therapy theories and models, but being from Honduras, I was especially
drawn to ideas that reflected my collectivistic, communal, and collaborative values, such as
with postmodern and social constructionist approaches to family therapy.
Nonetheless, I did not fully immerse myself in diversity studies until I started teaching an
undergraduate course called Gender Roles across the Lifespan. I taught it every semester for
five years. It was life changing and learning from my colleagues in Women’s Studies was
enlightening and empowering. Learning critical theories helped me examine how structural,
systemic, and relational dynamics shape our identities, social location, and lived experiences.
Learning from feminist scholars profoundly altered the way I integrated family studies and
family therapy models and theories into the different aspects of my work. It was a paradigm
shift that expanded my worldview and pushed me to deepen my understanding of diversity,
social justice, and equity–– professionally and personally.
I remember first being aware of disparities at a young age. Although I am from Honduras, I
was mostly raised in Texas. During my childhood and adolescence, my mother and I would
return to Honduras to see my father and my family there. We went four times; at age 4, 11,
15, and 19. Each time was impactful for me, especially given that this travel occurred during
different stages of my own development. Not only was it strange for me when people fussed
over my fair skin and light blue eyes (awareness of my White privilege), I was extremely
unsettled by seeing young children in the street, begging for money, selling gum and candy,
and staring into the windows of the restaurants where we ate (awareness of my class
privilege). It was confusing and no one explained to me what was happening. I wasn’t
exposed to this in the US. Although my family was mostly “working” class, as I got older, I
developed a sincere and deep gratitude and appreciation for our privileges. We had a house,
reliable and consistent electricity, food, clean water, washing machines, a reliable postal
system, good public education, new clothes and shoes, and a peaceful way of life. Although I
could not name what I knew, early in my life I learned about the effects of immigration,
transnational families, colorism, language fluency, colonization, heteronormativity, and
mixed documentation status.
What I later learned through my studies is that this “better way of life” is not accessible to
everyone in the same way in the US or anywhere. The structural barriers and the trajectories
xviii Preface to the 2nd Edition
of cumulative advantage and disadvantage lay the groundwork for the ways in which the
“American dream” can be accessed and lived. The course of my life was altered with
immigration, as it is for so many of us, almost all of us in the US. Although I am the only one
of my siblings to obtain a college degree, I would not have been in the position to influence
others in the way I do today if my mother would not have been able to change the course of
our lives. As a consequence, I am greatly humbled and honored to co-author this book with
Teresa and Carmen- my friends, mentors, and sister scholars. I will always cherish this
remarkable journey we have shared. It is my hope that, along with our amazing contributors
who have shared their work with us, that our theorizing and call to action will help others
attune with a sense of urgency as agents of third order thinking and change.

In Conclusion
Stepping out of what is familiar and trying something new takes a special mix of courage,
excitement, and humility. As authors putting forth the new ideas in this and our last text, we
have been immersed in that mix. We pass our work on to you now with the hope that you
will have courage to both use and challenge our ideas, that you will bear the humility of not
always doing equity based family therapy “right,” and that you will join in our excitement
about the future of our field.
Acknowledgments

We love this field and hold deep respect for all the family therapists and social scientists who
advanced systems/relational thinking and practice before us. We would like to acknowledge
the work of the many, many family therapy, family studies, psychology, social work,
counseling, sociology, critical geography, public health, philosophy, education, history,
global studies, and legal scholars, as well as others we reference throughout this text. Their
collective efforts to understand and improve human relationships and societal conditions are
incalculable. It is our privilege to build on their work as we simultaneously challenge
ourselves to trust our own voices and experience. We set for ourselves a delicate balance
between getting concepts “right” and telling the family therapy story through our own lens.
Along our different journeys each of us was transformed by critical, feminist, and social
constructionist scholars and activists. As the three of us discussed the 2nd edition of this book
and what it might accomplish, we continued to speak of the courage of our founders to
question and transform the assumptions, practices, and ethics of mainstream mental health
treatment; the wisdom of Bateson and other systemic thinkers who helped us see individual
consciousness and behavior as part of a much larger whole; and the strength of the many
feminist, anti-racist, LGBTQ, and decolonizing family therapists who have said, “enough!”
In this new version of the text, we turn to those who are currently engaged in transformative
work who share their voices—their experience and wisdom—by contributing to the text.
We are deeply grateful, inspired, and informed by their praxes.
We are also deeply honored, grateful, and moved by the insightful, generative, and equity-
based work of Stephanie Brooks, who graciously agreed to write the forward for this version
of our text. She has been inspirational as a leader in diversity and social equity in family
therapy, particularly through her devotion to inspiring equity-based practice among the next
generation of family therapists and her tireless devotion to the American Association for
Marriage and Family Therapy (AAMFT) Minority Fellowship Program. Dr. Brooks has a
way of making all of those around her—including us—feel welcome, valued, and included.
Thank you, Stephanie, for writing the forward for this book.
Each of us would like to acknowledge a few of those who supported us through the
writing of this second edition. I, Teresa, would like to thank my sons, Quentin, Flynn, and
Rob, for the many conversations that propelled my thinking forward, and my lifelong
partner, John, for doing all the chores, bringing me tea, and patiently waiting for me to look
up from my computer. I also want to thank my grandchildren (Rooney, Ewan, Nina, Adina,
William, Elizabeth, and Lindsey) for keeping me active, engaged, and ever hopeful for the
future.
I, Carmen, thank the students at Lewis & Clark college who continue to push me to
expand my thinking and were willing to take the extras steps to be part of my research team,
who along with colleague Lana Kim, helped further detail the processes of learning and
practicing socioculturally attuned family therapy and the SERT model. I channel every day
xx Acknowledgments
the lessons learned about working hard for what matters from my parents Phoebe and Nels
Knudson. I am grateful to my husband John for understanding the life of a scholar-
practitioner and his steadfast support. My children Chris and Kyara and their partners
Melanie and Jerome continue to give me purpose and perspective, while grandsons Ethan
and Kai remind me why working toward a socially just future is so important. Thank you all
for your love––and for reminding me to keep the fun and pleasure in living!
I, Maria, would like to thank my incredible community of feminist scholars, therapists, and
activists, who, wearily, day in and day out, fight the good fight, doing the work of equity and
social justice as luchadoras en la justica social. And to my parents, Judith and Rene Perez, my
devoted and loving husband, Romulo Rama, to our amazing children, our siblings, their
spouses, my nephews and nieces, their children, and my dear lifelong friends…. you all are
my anchors and continuous source of support, joy, love, light, and encouragement. Thank
you! I love you with all my heart and soul. And to the readers of this text, thank you for
wanting to learn, grow, and be on this journey with us as compassionate, committed, co-
strugglers. It’s the only way forward.
We would also like to thank each other (Teresa, Carmen, and Maria) for our unwavering
support and professional collaboration and friendship. It is through the synergy of coming
together to talk, listen, challenge, question, and affirm that we were able to create, examine
and share the ideas presented in this book. For this we are eternally grateful!
Finally, we are deeply honored by, and grateful to our colleagues who have contributed to
the second edition of our book (listed alphabetically). They are champions of third order
thinking and change in family therapy and their respective disciplines.
Contributors

Rhea V. Almeida, PhD, LCSW developed the Cultural Context Model and has been a
leader in liberation-based practice for more than four decades. She is also the director and
founder of the Institute for Family Services. (Text Box 2.3)
Fatma Arıcı Şahin, PhD is an Assistant Professor at Kastamonu University in northern
Turkey, with interests in couple and family therapy, feminism and gender studies, art
therapy, and creativity. (Text Boxes 6.2 & 14.1)
Timothy Baima, PhD, LMFT is an Associate Professor at Palo Alto University,
with interests in Whiteness, self-of-the-therapist training, and family play therapy.
(Text Boxes 3.2, 6.1 & 7.3)
Saliha Bava, PhD, LMFT is an Associate Professor at Mercy College in New York and
does private practice and organizational consultation. (Text Box 2.1)
Stephanie Brooks, PhD, LCSW, LMFT is Senior Associate Dean of Health Professions &
Faculty Affairs at Drexel University. Her interests include MFT Education and Training,
Supervision, ADHD in Black Couples, Trauma, Depression and Addiction, and
Leadership. (Text Boxes 3.3 and 9.1)
Andraé Brown, PhD, LMFT is a transformative, feminist family therapist and
psychologist. His work centers a critical Black perspective that includes spirituality as
well as analysis of race, gender, sexual orientation, social class, and other identities.
(Text Box 15.7)
Jessica ChenFeng, PhD, LMFT is an Associate Professor of Marriage and Family Therapy
at Fuller Theological Seminary. Her interests include social contextual issues such as race,
gender, and spirituality. (Text Box 15.5)
Manijeh Daneshpour, PhD, LMFT is a Professor and Systemwide Director of the Alliant
International University Marriage and Family Therapy Programs. Her interests include
issues of multiculturalism, social justice, third wave feminism. (Text Box 15.2)
Justine D’Arrigo, PhD is an Associate Professor at California State University San
Bernardino. Their interests include the intersections of relational activism and therapy,
navigating critical theory and poststructuralism, post-oppositional approaches to
relationships and change, and exploring compositionism and curiosity in therapy. (Text
Boxes 1.2 & 12.2)
Elisabeth Esmiol Wilson, PhD, LMFT is an Associate Professor and Director of Clinical
Training at Pacific Lutheran University and currently engaged full time in private practice.
xxii Contributors
Her clinical and research interests focus on socially just approaches to integrating couple
therapy, sex therapy, and spirituality. (Text Box 7.2)
Peter Fraenkel, PhD, Licensed Psychologist, is an Associate Professor at City University
New York (CUNY). His reflections in this text are drawn from years of work with his
graduate students at CUNY in which they developed, implemented, and evaluated a
program for families living in homeless shelters. (Text Box 12.3)
Marisol Garcia-Westberg, Ph.D., LMFT, is an experienced family therapy educator who
is currently in private practice providing sex therapy. She has published numerous articles
on equity, social justice, and activism. (Text Box 3.5)
Shawn V. Giammattei, PhD, is a Clinical Family Psychologist and private practitioner in
California and founder of the Gender Health Training Institute and the TransFamily
Alliance. He a World Professional Association for Transgender Health certified gender
specialist and mentor and teaches at the California School of Professional Psychology.
(Text Box 13.2)
Lana Kim, PhD, LMFT is an Associate Professor and Program Director of the MCFT
program at Lewis & Clark College in Portland, OR. Her work focuses on culture and
cultural identity, gender, couples therapy, and parent–child relationships. (Text Box 1.1)
Iva Košutić, PhD is a scholar and social researcher. She is the author of numerous
publications that support social equity and activism in, and beyond, family studies and
family therapy. Much of her current work involves evaluation of social and health
programs. (Text Box 15.9)
Mario Fausto Gómez Lamont is a licensed psychologist, practicing family therapist, and
faculty member in Superior Studies Iztacala of the National Autonomous University of
México. He is a doctoral student in Research Psychology at the University
Iberoamericana studying Gender, Science, and Technology. (Text Box 15.8)
Quentin R. McDowell, MA is the Head of Mercersburg Academy, an independent
secondary school in Pennsylvania. His work has primarily focused on educational
leadership and organizational transformation. (Text Box 15.4)
Hoa Nguyen, PhD is an Assistant Professor at Valdosta State University in Georgia. Her
work draws from her Vietnamese immigrant family history of resettlement and rebuilding
home in the United States post-Vietnam War. (Text Box 2.2)
Elizabeth Oshrin Parker, PhD is a family therapist and researcher. She has done research
on a variety of topics including complex trauma, effects of discrimination on mental
health, and quantitative research methodologies. (Text Box 10.1)
Mudita Rastogi, PhD, LMFT is a Clinical Professor of Psychology and Department
Chair at the Family Institute at Northwestern University. She has an abiding interest
in systemic intervention, gender, diversity, equity and inclusion, race, culture, ethnicity,
multiculturalism, diasporas, global mental health, South Asian families, trauma, and
intergenerational relationships. (Text Box 2.1)
Rockey Robbins, PhD is a Professor in Professional Counseling at the University of
Oklahoma. His work with families, both as a counselor and researcher, integrates holistic
Native American philosophy and healing practices and is situated in the air, mineral, plant,
and animal worlds. (Text Box 3.1)
 Contributors xxiii
Laurel Salmon, MS, LMFT is the Executive Director of CANDLE, in New York, where
she focuses on providing community support for youth and families. She is dedicated to
socially just mental health practice and has worked extensively to integrate strategies for
interrupting oppression and understanding the ways sexism, racism, heteronormativity,
and religious oppression impact therapy. (Text Box 13.1)
Dana Stone, PhD, LMFT is an Associate Professor at California State University in
Northridge. Her work focuses on multiracial experience and supporting early career
therapists with marginalized aspects of identity in navigating the field of marriage and
family therapy and counseling. (Text Boxes 3.4 & 15.3)
Sally St. George, PhD is a Professor in the Faculty of Social Work at the University of
Calgary. She is currently developing a new phase of professional life primarily focused on
supporting others as they develop their work. (Text Box 15.10)
William Turner, PhD, LMFT serves as Distinguished Professor of Leader and Public
Policy and Special Counsel to the President for Equity, Diversity and Inclusion at
Lipscomb University, Nashville, TN. His teaching and research interests are focused on
African American family strengths and the intersections of hope, justice, policy, and faith.
(Text Boxes 4.1, 15.1, & 15.6)
Dan Wulff, PhD is a Professor Emeritus, Faculty of Social Work, at the University of
Calgary. He now invests in reading all those books he intended to read for many years
and is writing about the things he most wants to write about. (Text Box 15.10)
Toni Schindler Zimmerman PhD, LMFT is a Professor in the Human Development and
Family Studies Department at Colorado State University. She has been acknowledged for
excellence in community engagement and much of her work has focused on diversity,
equity, and social justice. (Text Box 11.1)
Author Bios

Teresa McDowell, EdD, is a professor emerita of marriage and family therapy at Lewis &
Clark’s Graduate School of Education and Counseling. She currently serves as a social
researcher, program evaluator, consultant, and educator. She is a licensed marriage and family
therapist, American Association of Marriage and Family Therapy (AAMFT) clinical fellow,
and approved supervisor. Her work in family therapy includes a focus on applying critical
social theory to education and practice.

Carmen Knudson-Martin, PhD, is a professor emerita of marriage and family therapy

at Lewis & Clark’s Graduate School of Education and Counseling. She is an AAMFT clinical
fellow, approved supervisor, and licensed marriage and family therapist. She is a founder of
Socio-Emotional Relationship Therapy (SERT), which addresses the political and ethical
implications of therapist actions on personal and relational development and on the Board of
the American Family Therapy Academy.

J. Maria Bermudez, PhD, is an associate professor in the marriage and family therapy
program in the Department of Human Development and Family Science at the University of
Georgia. She is an AAMFT clinical fellow, approved supervisor, and licensed marriage and
family therapist. Her work is anchored in feminist-informed and culturally responsive
approaches to therapy, research, supervision and outreach.
1 What is sociocultural attunement and
why is it important?

It would be difficult to find a family therapist today who does not acknowledge the im-
portance of sociocultural systems and environmental context to mental health and relational
well-being. The impact of interconnecting cultural, economic, political, social and en-
vironmental systems is ubiquitous, affecting every aspect of daily life––how and where we
live and die; what we have access to; our level of autonomy and respect; the influence we can
bring to bear on others; the breadth of choices we have; our sense of value, safety, and
security; our health and life expectancy; and the dynamics of our most intimate relationships.
These systems are mutually reinforcing in ways that maintain uneven landscapes that privilege
some over others, while also being in flux, at times yielding to transformative change. The
struggle for equity can be found everywhere—from the most nuanced couple interactions
to the collective voice and steady pressure for social change, such as with the Black Lives
Matter movement.

⤝⤞

Attention to equity is vital to the practice of family therapy because unjust

social and interpersonal relationships create and/or exacerbate mental health
symptoms and relationship problems.

⤝⤞

Good Therapy is Equitable Therapy

In this text we illustrate why attending to issues of justice is a clinical responsibility––why
equity necessarily goes hand in hand with good practice. Indeed, people tend to respond
negatively to acts of harm and oppression, experiencing a common urge for equity—for what
is fair and just. Our job as therapists, who prioritize client care and improving the lives of
those with whom we work, necessarily includes encouraging relational values of reciprocity,
mutuality, and fairness as couples and families interact with each other (Knudson-Martin &
Kim, 2022). The actions we take based on these shared values require awareness of our own
positionality and accountability for how we conceptualize relationships and clinical concerns
within sociocultural contexts.
Fred Piercy (2020, p. 756) recently asserted that “therapy with a sensitivity to difference
and oppression should be a top priority for our field.” This is more than making a choice to
take a position. It is, rather, a practical matter that must be considered in order for family
therapy to be effective and successful (Knudson‐Martin, 2013). There is no way to claim
neutrality while working with the mental health and relational consequences of inequity. We
either work to change oppressive dynamics or we help clients accept and adjust to what is
DOI: 10.4324/9781003216520-1
2 What is sociocultural attunement and why is it important?
unjust. In other words, failing to notice and/or to act can make us complicit in what is
harmful and unjust, inadvertently helping to maintain inequity (Piercy, 2020; Watson et al.,
2020). According to Watson et al., (2020):

Given the fact that family therapists may unwittingly function as the best ally of an
economic and political system that perpetuates institutionalized racism and class
discrimination, we need to utilize a set of principles, values, and practices that are not
just palliative or after the fact but bring forth into the psychotherapeutic and policy work
a politics of care. Therefore, a strong call to promote and advocate for the broader
continuum of health and critical thinking, preparing professionals to meet the challenges
of health equity, as well as economic and environmental justice, is needed. (p. 1)

Our charge as systemic family therapists is to promote health and well-being for all clients,
across all sociocultural contexts. This includes creating space to explore dynamics within and
across multiple systems. Equity-based practice relies on our ability to situate problems within
comprehensive contextual frameworks that include both common systemic and relationally
idiosyncratic dynamics. Taking a multi-ocular view allows us to recognize institutionalized
systems of privilege and oppression (e.g., racism, sexism, patriarchy, homophobia), alongside
unique relational dynamics (e.g., differing levels of investment in the relationship, histories of
relational injuries, the impact of adverse childhood experiences) that create and maintain
power imbalances within relationships.

Family Therapy and Societal Context: A Brief Historical Overview

Family therapy has a history of attending to societal context, providing a foundation for our
evolving awareness of the impact of unjust social, economic, political, and environmental
structures on individual and family well-being. Greater awareness should lead to action;
however, when we see links across individual, relational, community, and societal systems,
we may not know how to intervene in helpful ways. We wonder how to fluidly move
between assessing the impact of societal systems and making specific socioculturally attuned
clinical interventions, particularly while being guided by family therapy models.
The field of family therapy arose as a challenge to the dominant system of its time–– the
medical model. At that time, psychotherapists were trained to understand and treat dys-
function, and the family was considered primary in creating and maintaining psycho-
pathology, especially in the form of mother-blaming (Caplan & Hall-McCorquodale, 1985).
Early family therapists were rebels who used new systemic perspectives and actually involved
family members in therapy. Family therapy models emerged that were separate and unique
from those in psychology and social work.
As the field developed, so did ideas about cultural and societal context (Hair et al., 1996).
Auerswald (1971) was one of the first to develop an ecosystemic approach to families, in-
tegrating community systems into practice. It was during their years working with Auerswald
at the Wiltwyck School that Minuchin and colleagues turned their focus toward what they
called “disorganized” families living on low income, developing the framework for Structural
Family Therapy. Early on, this group (Minuchin et al., 1967) recognized the impact of
poverty, discrimination, and oppression on family well-being. While not always practiced
with the broader context in mind, structural family therapy’s origins in structural func-
tionalism encouraged us to conceptualize the family as a social institution in systemic in-
teraction with other social institutions. This includes an understanding of the potential
impact of extra-familial forces and stressors on family roles and power dynamics. Aponte
(1976) built on these ideas, developing an eco-structural approach to working with families
 What is sociocultural attunement and why is it important? 3
in the context of their communities. Others, including Wynne (1967) and Keeney (1979),
argued for an ecosystemic epistemology that links open systems at individual, family, com-
munity, societal, and environmental levels (Hair et al., 1996).
Imber-Black (1992) described families as part of multiple embedded systems within so-
ciety. Over time, culture and societal context became foundational to understanding and
treating families (Falicov, 2015; Ho et al., 2004; McGoldrick et al., 2005). The feminist
movement (e.g., Hare-Mustin, 1978; Luepnitz, 1988; Walters et al., 1988) shattered the view
of families as apolitical, reciprocal systems by connecting intimate interaction to power
dynamics in the broader society.
The argument that family therapists are in a position to create positive social change and
should intentionally promote social equity is also not new. For example, in 1988 Goodrich
et al. wrote:

Whether intended or not, [family therapy’s] impact on individual families … leads to an

impact on our collective social life … This influence serves either to support or to
change prevailing structures of belief and action regarding family life. Those of us who
want this influence to be in the direction of changing prevailing structures must work
to reform fundamental aspects of our professional field. (p. 180)

Several approaches routinely conceptualize and intervene across multiple systems in ways that
support social and relational equity. Critical conversations were introduced to family therapy
practice by Eliana Korin in 1994. Korin (1994) argued that critical conversations, based on
the work of Paulo Freire, could be used to create emancipatory change. According to Freire
(1970/2000), critical consciousness, or conscientização, can be raised through dialogue and
reflection, which in turn leads to informed action. Social psychologist, Martin-Baro, along
with his colleagues (1994, p. 40), built on this tradition arguing that “people must take hold
of their fate, take the reins of the lives, a move that demands overcoming false consciousness
and achieving a critical understanding of themselves as well as of their world and where they
stand in it.”
Rhea Almeida and colleagues (2007) developed the cultural context model, which has
been at the forefront of practice that helps clients better solve problems by understanding
how societal systems affect their relationships. This approach is well known for using
therapist-facilitated “cultural circles” in which clients across societal contexts work together
to raise each other’s awareness of social positionality in order to move toward empowerment
and accountability. As early as 1994, Almeida began broadening the concept of inter-
sectionality to include gender, race, class, sexual orientation and LGBTQ, able-bodied, and
other identities.
Waldegrave et al., (2003) have also been leaders in equity-based practice via their Just
Therapy model that places context at the core of relational well-being. Just Therapy and
Narrative Family Therapy (White & Epstein, 1990) share roots in social constructivism.
Societal context is highly relevant in these approaches as dominant social discourses shape not
only how we think about ourselves, but how we interact with and think about others––the
meaning we assign to all experience through language. Feminist family therapy (Hare-
Mustin, 1978; Prouty Lyness & Lyness, 2007; Silverstein & Goodrich, 2003) and Socio-
Emotional Relationship Therapy (Knudson-Martin & Huenergardt, 2010; Knudson-Martin
et al., 2015, chapter 14 this volume) are examples of approaches that regularly pay attention
to how culture and societal systems create and maintain relational power imbalances that in
turn create individual and relational symptoms.
In recent years, the field of family therapy has seen a burgeoning number of contributions
to equity-based practice and calls for social action. These include understanding
4 What is sociocultural attunement and why is it important?
intersectionality (Almeida & Tubbs, 2020), engaging in advocacy (Hodgson & Lamson,
2020; Holyoak et al., 2021), attending to global power dynamics (Rastogi, 2021), working
toward racial equity (Watson, 2019), supporting Black Lives Matter (Kelly et al., 2020;
Watson et al., 2020), advocating for LGBT-affirmative clinical training (McGeorge et al.,
2018; McGeorge et al., 2021), responding to the COVID-19 pandemic, and acknowledging
the impact of climate change (Watson et al, 2020), to name a few.

Changes in Practice Standards

Mounting research on social determinants of health points to the impact of our social,
cultural, economic, political, and environmental contexts on our physical, mental, and re-
lational health (Adler et al., 2016; Alves-Bradford et al., 2020). This understanding has led to
a greater emphasis on, and commitment to, diversity and social equity in practice standards
across mental health fields, calling all of us into action. The complete picture of changing
standards is beyond the scope of this chapter; however, as an example, the Commission for
Accreditation of Marriage and Family Therapy Education (COAMFTE), requires graduates
develop “awareness, knowledge, and skill to responsibly serve diverse communities.”
Programs must include content which

facilitates the development of competencies in understanding and applying knowledge of

diversity, power, privilege, and oppression as these relate to race, age, gender, ethnicity,
sexual orientation, gender identity, socioeconomic status, disability, health status,
religious, spiritual, and/or beliefs, nation of origin or other relevant social identities
throughout the curriculum. It includes practice with diverse, international, multicultural,
marginalized, and/or underserved communities, including developing competencies in
working with sexual and gender minorities and their families, as well as anti-racist
practices. (COAMFTE Version 12.5. FCA 3)

The Commission for Accreditation of Counseling and Related Educational Programs

(CACREP), the Council on Social Work Education Commission on Accreditation (CSWE
COA), and the American Psychological Association (APA) Commission on Accreditation all
have similar requirements related to social and cultural diversity. Changing accreditation
standards are driving educational programs to move toward increasingly inclusive practices
and equity-based curricula (Katafiasz & Patton, 2021) with the goal of preparing cadres of
future family therapists, counselors, social workers, and psychologists who are able to work
within diverse societies in which access, resources, and influence, and respect are unevenly
distributed.

Socio-Relational Determinants of Health

Marlene Watson and colleagues (2020) recently called on family therapists to address
health inequity and climate crisis, citing mounting research that points to the impact of
our social, cultural, economic, political, and environmental contexts on our physical,
mental, and relational health. As family therapists, we tend to conceive mental health and
relational well-being as a matter of interconnected internal (e.g., cognitive, neurobio-
logical) and relational (e.g., patterns of interaction, attachment) systems that are situated
in longitudinal (e.g., families of origin, legacies of trauma) and latitudinal (e.g., societal
positionality, social discourses) frameworks. While these ways of thinking are highly
contextual in many ways, they can lead us to underestimate the significance of physical
space (Cashin, 2014; Soja, 2010).
 What is sociocultural attunement and why is it important? 5
When we train family therapists in classrooms and meet families in therapy rooms or
through virtual platforms, we create spaces that are dis-located––suspended from the physical
realities of daily life. Our theoretical frameworks and relational concepts (e.g., intergenera-
tional legacies, social discourse, and family dynamics) can occupy these spaces as if they are
autonomous webs of influence without connection to time and place. Consider, for example,
completing a typical genogram. Asking questions about family members, illnesses, deaths,
religious beliefs, relational dynamics, mental health, intimate partner violence, adverse
childhood experiences, etc., results in a two-dimensional schematic that hints at, but is not
grounded in, time and place. Now consider completing a cultural genogram (Hardy &
Laszloffy, 1995) and/or a critical genogram (Kosutic et al., 2009) that adds multiple layers of
sociocultural context to explore social location, migration, immigrant status, oppression,
privilege, social class, race, gender, sexual orientation, historical setting, community factors,
and so on. These types of questions can help therapists think in highly contextual ways and
lead us to consider and value the significance of physical space in our lives, relationships,
and well-being.
According to the US Department of Health and Human Services (Healthy People 2030),
“social determinants of health (SDOH) are the conditions in the environments where people
are born, live, learn, work, play, worship and age that affect a wide range of health func-
tioning, and quality-of-life outcomes and risks.” SDOH are most often grouped into five
domains: economic stability, education access and quality, health care access and quality,
neighborhood and built environment, and social and community context. These determi-
nants are produced and maintained by multiple interconnecting political and economic
factors that produce and maintain inequality and inequity. The results are stark contrasts:
gated communities vs. barred windows, private vs. public transportation, high-end grocery
stores vs. food deserts, quiet vs. loud environments, clean air vs. smog, lowland flooding vs.
homes with a view, policing for protection vs. policing to control, concrete surroundings vs.
natural landscapes, homes near outdoor malls vs. homes near factories, and choice of provider
vs. inadequate and fragmented public healthcare.
Some individuals, families, and communities benefit from positive and supportive factors
while others suffer negative effects of SDOH. Those with adequate income to live in
safe neighborhoods, meet educational needs, and enjoy food security—those whose social
locations place them at the center free from discrimination—do not experience the same
type of stress, limited options, or risk as those at the bottom or in the margins.
Compounding social determinants create a social gradient of health, reflected by those
with greater resources and status living longer lives in better physical and mental health, while
those with lower status and fewer resources have shorter life expectancies with greater
physical and mental health problems (Alegria et al., 2018). Political economies impact health,
including mental health (McCartney et al., 2019). In fact, there is evidence that those living
in nations with high-income inequality are more likely to experience depression (Patel et al.,
2018). Likewise, several studies (Ahern, 2020) have correlated dollar increases in the US
minimum wage with decreases in the rate of suicide.
There is also ample evidence that discrimination and oppression are detrimental to health.
For example, race is a determining factor in the likelihood of physical illness, incarceration,
addiction, and shortened life span (Jones, 2000) and LGBTQ+ youth are at greater risk for
homelessness (Norman-Major, 2018) and suicide (Fulginiti 2020). The negative physiolo-
gical responses to discrimination are also well documented (Harrell et al., 2003). A number
of studies have linked equity to relational satisfaction (Gottman, 2011; Knudson-Martin &
Mahoney, 2009; Luttrell et al., 2018). Couple therapy research has also exposed the im-
portance of attuning to social and relational equity (Johnson & Wittenborn, 2012; Knudson-
Martin et al., 2015).
6 What is sociocultural attunement and why is it important?
These processes are cumulative, leading to the increased vulnerability of those who suffer a
lifetime of structural inequality and discrimination (Dannefer, 2003; DiPrete & Eirich, 2006;
Merton, 1968). While family therapists can and should participate in “upstream” interven-
tions (e.g., advocacy for changes in policies and laws that focus on prevention), we are called
upon daily to provide “downstream” interventions as we work with what are often the most
vulnerable populations to understand and help mitigate the impact of these forces on mental
health and intimate relationships.
Relationships play an important role as a SDOH. This includes the influence of day-to-day
interactions across and within all levels of social systems (e.g., families, communities,
workplaces, governmental and educational institutions, health care). According to Healthy
People 2030, relationship factors including social cohesion and solidarity, social capital, social
networks, and social support significantly impact the domain of social and community
context. Helping clients strengthen social networks and develop and effectively use social
capital (Garcia & McDowell, 2010) is one way family therapists can intervene in SDOH.
While families are recognized as part of the social community and context, there has been
little attention paid to the relationship between SDOH and families. According to Deatrick
(2017, p. 424), “the family is not typically theoretically justified and identified as central to
social determinants of health.” Yet, for those of us who work with families, the role close
relationships can play in mitigating or exacerbating the effects of SDOH seems obvious.

⤝⤞

What we are callingsocio-relationaldeterminants of health refers to the impact of

social determinants on the interconnections between physical health, mental
health, and relational well-being. Attuning to socio-relational determinants of
health is central to our work as family therapists.

⤝⤞

Families and other important relationships play a significant role in amplifying and/or di-
minishing the positive and negative impacts of social determinants of health (Bergeron et al.,
2020; Deatrick, 2017). When family relationships are organized in ways that are isomorphic
to unjust societal systems (e.g., power-over relationships, male dominance) it can exacerbate
the effects of discrimination and oppression on less powerful family members. On the other
hand, when family members are able to socioculturally attune to each other, they are better
able to resist and mitigate societal inequities and negative effects of SDOH. In other words,
when family members are aware of social dynamics and conditions that put them at risk, they
are often better able to work together to navigate and buffer the effects.

The Role of Climate Change in Social Determinants of Health

It has been argued that climate change should be considered an SDOH given the uneven
impact of global warming and climate crisis on food production, water, ambient heat, and air
quality (Cianconi et al., 2020; Ragavan et al., 2020). Climate change is proving to have a
direct negative impact on physical and mental health (Hayes et al., 2018; Ebi & Hess, 2020;
Mullins & White, 2018). World-wide consequences to physical health include rise in water
and food-borne diseases, respiratory conditions, heat-related deaths, undernutrition, skin
cancer from UV exposure, and kidney disease from dehydration. Mental health consequences
include post-traumatic stress disorder, depression, anxiety, complicated grief, and substance
abuse. Weakened infrastructures due to climate change also exacerbate stress resulting in a
 What is sociocultural attunement and why is it important? 7
heightened risk of violence and likelihood of displacement (Hayes et al., 2018). In a recent
systematic review of the literature on climate change and mental health, Cianconi et al.
(2020) found that extreme climate events (e.g., flooding, tornados/hurricanes, heat waves,
drought, wildfires) and long-term environmental change (e.g., increase in surface tempera-
tures and sea level, deforestation) not only result in and/or exacerbate mental disorders but
disproportionately affect the mental health of those who are most vulnerable, including
refugees and migrants, racial and ethnic minorities, and those living in poverty.
According to the American Public Health Association (2020), climate change and health
disparities share many of the same root causes, including institutional drivers of energy and
land use, transportation, agriculture, and other socioeconomic systems that contribute to
pollution and shape living conditions. In other words, the political economy—the inter-
connection of politics, social institutions, and individuals who drive economic decision-
making—sets into motion and maintains social determinants of health (Sami & Jeter, 2021)
that affect the daily lives of those with whom we work.

Social Determinants of Health and Lessons from COVID-19

The recent pandemic has shaped the concerns individuals and families bring to therapy as
well as how therapy is delivered. All of us, clients and therapists alike, have been deeply
affected by the pandemic. Few, if any, were spared the psychological and relational impact of
isolation, uncertainty, and fear. That said, COVID-19 has provided a stark example of social
and economic inequity, with the impact being particularly severe on communities of color
and those living in poverty. According to Tipirneni (2021, p. 620) “COVID-19 is a ‘syn-
demic’ in which inequalities in social and medical risk factors disproportionately burden
historically disadvantaged communities with negative health and economic effects, creating a
vicious cycle of cumulative disadvantage.” The Centers for Disease Control (2022, p. 1)
declared that “the COVID-19 pandemic has brought social and racial injustice and inequity
to the forefront of public health,” citing that SDOH have historically prevented those most
marginalized “from having fair opportunities for economic, physical, and emotional health.”
African American, Native American, and Latinx communities have disproportionately
suffered the effects of COVID-19 (Obinna, 2021). According to Indian Health Services (2022),
American Indians and Alaska Natives have endured a rate of COVID-19 infection that is three-
and-a-half times higher than non-Hispanic Whites, are over four times more likely to be
hospitalized, and have higher rates of mortality as a result. Interrelatedly, the Centers for
Disease Control and Prevention (2021) recognizes racism itself as a serious risk to public health
by gravely impacting the SDOH among communities of color. Racial discrimination affects
the likelihood of dying a violent or preventable death, premature aging, poverty, addiction,
food insecurity, unemployment, displacement, school dropout, deportation, maternal mor-
tality, disease, imprisonment and negative effects of being incarcerated, and abuse of police
power, among others. Oppression and discrimination create and exacerbate mental health and
emotional problems, strain relationships, and limit strategies for coping with stress.
The COVID-19 pandemic has also highlighted the economic differentials in the US.
According to Parker and colleagues (2020), African Americans and Hispanics were over
twice as likely to report having trouble paying bills and paying rent or mortgages due to the
pandemic, and more than three times more likely to have visited a food bank. Only 5% of
families living on upper income reported having trouble paying bills compared to 19% of
families living on middle income and 46% of families living on low income.
As family therapists, we are challenged to help all families navigate difficult decisions about
vaccinations, work, school, and family obligations, while recognizing that the terrain is
uneven and the medical, educational, economic, social, and familial impact of decisions varies
8 What is sociocultural attunement and why is it important?
across clients based on social location. Who is able to shelter in place? Who is able to work
from home? Who is or is not able to be home to school children? Who can access quality
medical care? Who has access to vaccines and testing? Who is eligible to receive pandemic
relief funds? Who must care for children, elders, go to work, and take public transportation
despite the risks? Who can “stock up” to avoid going without? Choices are more limited and
consequences more severe for those who are at the margins—often creating intergenerational
effects.

History of Trauma and Structural Inequity in the US

Family therapists have traditionally paid close attention to intergenerational family dynamics.
What happened in the past, including how the past is storied, makes a difference in how we
help families shape their futures. In recent years, therapists have become more aware of
legacies of trauma and resilience, broadening the lens from a family’s intergenerational dy-
namics, to viewing trauma and resilience as collective transgenerational phenomena that
affect groups of people within the social and historical context. Awareness of transgenera-
tional legacies of trauma allows family therapists to better understand individual families
within their collective past. Likewise, understanding how groups of people have been treated
over time, and why, helps us access a fuller, more complete understanding of contemporary
structural inequity. In turn, this helps family therapists place contemporary social movements,
and other types of resistance to unjust systems in historical perspective and to encourage
families to identify and amplify transgenerational resilience.
Consider, for example, how race has been historically constructed to create and maintain
social structures that privilege some over others. Returning to COVID-19 health disparities
mentioned above, the structural conditions that place some groups in greater jeopardy are not
simply a result of racism as a problematic attitude or marginalizing force. They were his-
torically created by design (Pirtle, 2020; Williams et al., 2022). Racial inequity has been
foundational to the formation of the US and most countries impacted by colonization. Racial
capitalism began in the Americas in the 17th century as a way to acquire economic value
from the racial identity of another. Racial capitalism continues in the present-day system in
which Whites routinely derive social and economic advantage from the racializing of Black,
Indigenous, People of Color (BIPOC) (Pirtle, 2020). The plantation system, in which
wealthy Whites lived safe, prosperous, and fulfilling lives as a result of enslaving and de-
humanizing people of color, has taken multiple forms over time (e.g., segregation, redlining,
Jim Crow, unemployment, imprisonment) resulting in substandard living conditions for
many African Americans nearly 400 years later. “Control-over” solutions (e.g., overseers,
slave catchers) used to maintain this system, remain in place via multiple mechanisms, in-
cluding police brutality, US/Mexican border patrol, and the cradle to prison pipeline.

⤝⤞

Historical and contemporary structural violence and institutionalized inequity

are causal factors in social determinants of health, and directly affect economic
stability, educational equity, health care access and quality, neighborhoods and
built environments, and social and community contexts.

⤝⤞

Acts of resistance such as the slave rebellions, the resistance of Indigenous peoples, and the
Civil Rights movement are replete throughout this history of oppression. According to Kelly
 What is sociocultural attunement and why is it important? 9
et al. (2020) the multiple, publicized police shootings that coincided with heightened
awareness during the COVID-19 pandemic of institutional racism gave further impetus to
the Black Lives Matter movement.
Native Americans who were not eliminated by the attempted genocide were displaced via
the US 1851 Indian Appropriations Act, which confined Indigenous people in substandard
lands without adequate resources and away from sacred places. The first Indian school was
founded in 1860 to “civilize” native children by removing them from their families, com-
munities, language, culture, spiritual beliefs and practices, and histories. In the 1950s the US
government attempted to solve “the Indian problem” by increasing efforts to eliminate
Indigenous cultures altogether through assimilation. And although Native Americans/Alaska
Native people represent approximately 2% of the US population, they have the highest
poverty rate of any racial group (26.3%). Long-term structural violence has resulted in over
twice the number of Native Americans living in poverty than the US poverty rate in general
(14%) (US Census, 2017).
Latinx communities have also suffered from structural violence throughout US history.
They were removed from their lands during US Expansion and those of Latin descent were
either removed or made citizens after the Mexican-American War. In 1862, the US
Homestead Act made it possible for vacant land, much of which belonged to Mexican-
Americans, to be claimed by squatters moving West. In 1921 the US began limiting the
number of immigrants and soon after the “Border Patrol” was created. During the 1930s,
300,000-500,000 Mexican Americans were forced out of the US without regard to citi-
zenship cite (Tourse et al., 2018). Discriminatory practices have continued into the present,
as evidenced by unconscionable acts such as the US government separating children from
their families and caging them at the US-Mexico border.
In addition to African Americans, Native Americans and Mexican Americans, Social
work scholars, Tourse et al. (2018), described Chinese people as also being one of the core
groups in the US who systematically experienced the legalization of systemic and in-
stitutional racism. Chinese people experienced the push-pull (Lee, 1966) related to im-
migration, as they were leaving an extremely repressive imperial regime in China and
allured by the California Gold Rush in the 1840s (Sung, 1967, as cited by Tourse et al.,
2018). As they began to arrive in large numbers, they were seen as a threat to the es-
tablished White residents. Centuries of laws, acts, and policies served to exploit them for
cheap labor, and to restrict their access to rights and freedoms associated with US citi-
zenship. Similar to African Americans, they were subject to terrorism and violence as a
means of control by police, politicians, and those in power. Discrimination and violence
against Chinese and other Asian Americans have continued into the present. This has been
evidenced most recently by propagating the COVID-19 pandemic as “the Chinese
plague” and “Asian hate” as evidence of systemic racism and violence against Asian
Americans. (Elias et al., 2021; Le et al., 2020).

Connecting the Dots: Family Therapy and Relational Equity

At this point in the chapter, you may be asking, how do socio-relational determinants of
health, climate change, and historical systems of oppression affect my work as a family
therapist? The ability to connect the dots by mapping the ways in which larger systems affect
our lives at the local level is central to the work of third order thinking and socioculturally
attuned family therapy. Understanding the histories of the collective past within and between
groups places contemporary disparities in context. It expands our lens to better understand
and attune to each client. It guides how we think about therapy and how we respond
(Williams et al., 2022).
10 What is sociocultural attunement and why is it important?
What we are calling Socioculturally Attuned Family Therapy is a set of transtheoretical con-
siderations that can be integrated into existing family therapy models. We use the term socio-
cultural to describe interconnections of societal systems, culture, and power. This includes not
only shared meanings that define culture, but the dynamic interplay between societal systems
that privilege some over others, resulting in uneven influence and opportunities based on social
class, gender, race, ethnicity, language, sexual orientation, age, nation of origin, abilities, and
looks. Patterns that occur at individual, relational, and societal levels are recursive and con-
tinuous vs discrete and unilateral. Families impact community and society and vice versa.
Consider an example of a middle-class family that is eager to ensure their children excel in
school, stand out in athletics and music, and demonstrate qualities of prosocial leadership.
These efforts are aimed at maintaining or improving the social class of the next generation.
This in turn reinforces the values, ideology, and cultural practices of those with the greatest
influence in societal institutions to set these norms, e.g., those who are in positions to grant
college scholarships and offer employment. In other words, the interconnection between
societal systems, culture, and power supports hegemony, i.e., dominant cultural group
control over major societal systems. Left uninterrupted, the routine practices, rules, and
values of societal systems (e.g., education, government, professional associations, commerce)
continue to benefit those with the greatest social influence.

⤝⤞

Sociocultural attunement refers not only to awareness of societal systems,

culture, and power but to a willingness to pay close attention and be responsive
to the experience of others.

⤝⤞

The worldview of those in non-dominant groups is often marginalized, creating what

Fricker (2007) termed epistemic injustice. This includes those in centered, dominant groups
routinely devaluing or dismissing the testimony of those in marginalized groups (Tatum,
1997). It also includes difficulties members of marginalized groups may have in assigning
credibility to their own experience due to fewer shared resources for identifying and legit-
imizing collective meaning. Attunement infers being at one with others, bearing witness to
their testimony, and helping them make meaning of their social experience. Notice in Text
Box 1.1, how Lana Kim describes attuning to clients within sociocultural context. Her
description reflects the type of empathy and care toward others that is evident in con-
tributions throughout this text. As Dr. Kim has expressed elsewhere (Kim et al., 2022),
critical consciousness and movement toward social justice require a relational approach. In
other words, taking a critical stance and being critical of others based on our evaluation of
their social awareness are very different positions, with the latter contributing to an “us and
them” relational framework that creates polarization rather than equity and inclusion.

Sociocultural Attunement and Common Factors

Common change factors have received a great deal of attention in the helping fields, in-
cluding family therapy (Karam & Blow, 2020). Debates have ensued regarding the relative
importance of models, including the argument that common factors work through or en-
hance models (Sexton et al., 2004). While the same factors are not uniformly defined across
theorists, they are frequently categorized as client and extratherapeutic factors, therapist
factors and therapeutic alliance, hope and expectancy for change, and the use of models and
 What is sociocultural attunement and why is it important? 11

Text Box 1.1 Lana Kim, PhD, LMFT

Lana Kim (she/her) holds a PhD in MFT, is a licensed MFT, and associate professor
and program director of MCFT at Lewis & Clark College in Portland, OR. She
identifies as a second generation Korean Canadian, cishet woman.
My teaching, clinical work, and scholarship seek to decenter dominant White,
individualistic, middle class, cis-het discourses and illuminate the ways in which
these are privileged in our social structures and consequently marginalize other
realities. I situate therapeutic problems in the context of who clients are and the
inequitable societal ideologies and structures that produce problems. I seek to
help trainees and clients draw these connections conceptually as well as translate
these awarenesses into new relational ways of being with themselves and others.
I tend to conceptualize issues through the lenses of social constructionism and
narrative therapy, but I work experientially in the therapy room. These models both
relate strongly to socioemotional relationship therapy (SERT), and as such, this
model undergirds much of my practice.
I believe that in order to understand any clinical issue or aspect of human
experience, you have to start with a deep curiosity about the person’s(s) social
identities, social location, and their respective stratification within societal
structures and how these relate to the problem. However, this is not a simplistic
or linear process, as in order to attune to sociocultural context, one has to attend
simultaneously to both larger systems as well as one’s local, generational,
cultural, and geographic context.
In my opinion, simply naming the dominant discourses or oppressive influences
of the larger context in theoretical terms rarely seems to have a strong therapeutic
impact. I find that bringing forth what narrative therapists would call “experience
near” connections for clients that relate to the larger context evokes emotional
responses within clients that enable them to viscerally “get” and engage with the
significance of power processes and larger context influence in their lives.
I ask, listen, validate, and affirm. There is something so healing and empowering
about having someone outside of your experience witness and say that it matters.
This act of legitimizing another’s experience can in and of itself be transformative.
I also connect the oppression and marginalization to larger social structures.
Naming the impact that silence and marginalization have had on the problem and
client(s)’ experience as well as acknowledging that there are others who
experience it too serves to counter the isolation that one can feel.
Beginning with the first session, I pay close attention to the dynamic power
exchange happening within the system, assess the interaction in the context of
larger systems, and track the relational impact. I try to bring the inequities into
focus in the therapeutic conversation in a way that clients feel understood rather
than blamed and then can start to see how it relates to larger societal structures
beyond themselves.
I use positive connotation to name the relational intents I see from clients that are
getting derailed by problematic discourses that persuade them to replicate
patterns that don’t serve the relational system. I help clients experientially connect
to their own and one another’s pain as well as validate strengths so they can feel
motivated and empowered to resist harmful societal scripts and choose alter-
natives that better support their relational goals. I join with the system as a
therapeutic partner by expressing my sense of belief in their ability to practice and
12 What is sociocultural attunement and why is it important?

live out preferred realities. I then help them claim, envision, and practice this
change experientially in session.
I draw from my heritage and bicultural identity in both collectivist and indivi-
dualistic cultures, but I tend to privilege relational values and ways of being in my
work. I use a socioculturally attuned lens to understand my clients, get the
problems they face, and facilitate transformative change.

techniques. D’Aniello et al. (2016) encouraged family therapists to enhance common factors
through cultural sensitivity and attunement. Following we discuss how common factors are
positively impacted by sociocultural attunement.

Client and Extratherapeutic Factors

Social location (i.e., intersection of identities such as race, gender, sexual orientation, and social
class within specific local, social, and global contexts) determines many of the social and eco-
nomic resources any of us have to help solve problems. Socioculturally attuned family therapists
pay close attention to the impact of identity within societal structures as well as standpoints that
shape clients’ experiences. Expanding the treatment system beyond an individual (Karam &
Blow, 2020) allows family therapists to more effectively intervene in these factors.
Consider a white, middle class, heterosexual couple in the US who are in their mid-60s.
They enter therapy when the wife announces her intention to divorce. The husband begins
the conversation by expressing his utter dismay at his wife’s dissatisfaction with what he has
experienced as a good marriage. From his perspective, they have had their share of problems
raising kids, making financial ends meet, and getting along, but nothing he wouldn’t expect.
They have both worked and he has always respected his wife’s right to make decisions on her
own. From the wife’s perspective, she has spent a lifetime accommodating a difficult man
who seems to remain unaware of her experience regardless of the number of times she tries to
tell him he is controlling and dismissive. She reports a lifetime of mediating relationships
between her husband and children, endless efforts to keep the peace in the family, and a
desire to be on her own during the final stages of life. How could these perspectives be so
different when the couple identifies as the same race, age, social class, and sexual orientation?
Understanding the complexity of gendered power dynamics and being aware of changing
gender roles in the US are foundational to understanding this couple’s differing perspectives
and experiences. This includes awareness of the extratherapeutic factors that have affected
their journey together (e.g., gender oppression, women’s rights movement, male privilege,
religious heritage).

Therapist Characteristics and Therapeutic Relationship

Cultural awareness is core to the therapeutic alliance. Family therapists are expected to know
themselves, to identify and work on their cultural and personal biases to prepare for working
with all families. Sociocultural attunement takes this expectation a step further.
Socioculturally attuned family therapists must be able to take a multi-ocular view, simulta-
neously attending to the 1) complexities of societal structures and clients’ social locations
within those structures, 2) significance of standpoint and worldview on individuals and re-
lationships between individuals, 3) nature of presenting problems as embedded within local,
national and global contexts, 4) impact of societal systems on power dynamics in all
 What is sociocultural attunement and why is it important? 13
relationships, and 5) felt experiences of clients in sociocultural context. Attending to so-
ciocultural context is primary to expanding alliance (Karam & Blow, 2020) by accurately
empathizing with each member of the family and the family as a whole, which in turn
enhances therapeutic alliance.
Within-system alliance, that is the alliance and bond between family members as well
as their agreement on therapeutic goals and tasks, is also predictive of successful ther-
apeutic outcome. Anderson and Johnson (2010) researched the relationship between
therapist-client alliance, couple alliance with each other, and levels of distress in the early
stages of heterosexual couples’ therapy. They found that when therapists formed stronger
alliances with more powerful partners (in this case men), less powerful partners (in this
case women) became more distressed. The opposite did not hold true. Men did not
become distressed over therapists forming initially stronger alliances with their female
partners. The authors suggested this outcome challenges the belief that when therapists
are not able to join with all family members equally, they should form an alliance with
the most powerful and/or distant family member. This practice, which is intended to
keep families in therapy, seems to be contraindicated as it reinforces unjust social ar-
rangements. It makes sense that those in less powerful positions would become concerned
and disheartened, perceiving therapists as maintaining the status quo and/or contributing
to relational inequity.
In short, the therapeutic alliance is impacted by power dynamics in a societal context.
Socioculturally attuned family therapists must be able to assess the nuances of power in
relationships (Knudson-Martin, 2013), connect intimate relationships to larger social
forces, and navigate their roles in ways that support relational equity. This includes
improving within-system alliances by encouraging attunement of more powerful mem-
bers to the experiences, feelings, and needs of less powerful family members (Knudson-
Martin, 2013).
Socioculturally attuned family therapists integrate multiple knowledges, including dis-
ciplinary, interdisciplinary, and non-disciplinary knowledge. Disciplinary knowledge
draws from family therapy theory, models, and techniques. Interdisciplinary knowledge
includes sociology, economics, political science, and other areas of study that inform how
we conceptualize families in societal context. Non-disciplinary knowledge honors in-
digenous knowledges, lived individual and family experiences, children’s knowledge, non-
Western knowledge, and the multiplicity of lifeworlds. Non-disciplinary knowledge is key
to practicing from a decolonizing stance that embraces multi-directional pluriversal
practice.

Expectancy for Change

Families come to therapy seeking relief from emotional and/or relational problems that
they frequently define as residing in an individual. Family therapists help families view
problems relationally (Karam & Blow, 2020), broadening possibilities for change. This
allows families and therapists to set the agenda for change together in solvable terms.
Clients sometimes enter therapy at the will of others such as child welfare institutions and
the justice system. Societal institutions may expect family therapists to serve as social
control agents by influencing families to change in what is considered prosocial ways. Care
must be taken not to unintentionally recreate unjust social arrangements. Socioculturally
attuned family therapists ask questions such as “Who is expecting change and why? What is
my role in facilitating change?” And “How is my role contributing to maintaining the
status quo of inequity and/or promoting social equity?” Whose agenda is being privileged
and why?
14 What is sociocultural attunement and why is it important?
Understanding the complexities of societal systems, culture, and power allows socio-
culturally attuned family therapists to identify opportunities for change. They recognize
and support resistance that draws from and leads to resilience, which in turn inspires
authentic hope. Consider a heterosexual couple who entered therapy when Miguel be-
came depressed. Miguel identified as Mexican American and Sally identified as European
American. They met each other when working to support the rights of migrant workers.
They shared political and social ideologies. Miguel was the only Latino administrator at a
utility department where he routinely experienced racism from colleagues and customers.
He felt isolated in a white community, remaining there at Sally’s request. Sally described
herself as anti-racist offering her activism and marriage to Miguel as “proof.” The
therapist noticed, however, that Sally rarely acknowledged Miguel’s experiences of op-
pression and marginalization. Unraveling this dynamic, including the differences in their
racial experiences and daily stressors, led to increased hope for change. The husband’s
depression lifted as the couple began routinely attending to acts of daily racism, con-
sidering together how to resist racism, and entertaining the idea of moving to a more
supportive community.

Application of Models
Sociocultural attunement improves the ability to use existing models in ways that support
social equity. Family therapy models enhance change by offering clients and therapists a
coherent framework from which to understand and find relief from problems. They serve
as road maps that can inspire hope and confidence in the therapeutic process. Models share
one of the common factors that are unique to family therapy, i.e., disrupting relational
patterns (Karam & Blow, 2020). The primary purpose of this text is to offer conceptual
clarity and practical guidelines for socioculturally attuned practice across family therapy
models, enhancing their role in the change process. Integrating concepts and practices
from across models is also common among many, including those who are engaged in
equity-based work.
It is important to note that the field is constantly changing and our thoughts are con-
tinuously evolving. In Text Box 1.2, Justine D’Arrigo describes the importance of remaining
aware in the present that one will likely change in the future.

Text Box 1.2 Justine D’Arrigo, PhD

Justine D’Arrigo (they/them) holds a PhD in MFT and is an assistant professor at

California State University San Bernardino. They identify as White and queer with
particular interests in intersections of relational activism and therapy, navigating
critical theory & poststructuralism, post-oppositional approaches to relationships
and change, and exploring compositionism and curiosity in therapy. (More of their
work is described in Chapter 12).
I think it is important to note that my thoughts a month or 6 months or a year from
now will probably be very different. My ideas and the ways I work always feel in
transition, which I think is characteristic of my life as a queer person as well. I hope
I always feel “on the way” to knowing how to do this work, and hope I never arrive
at a place where I feel like I know how. Being “on the way” to knowing keeps me
ever reflexive on how I show up in this work.
 What is sociocultural attunement and why is it important? 15
What Follows
We are joined in this 2nd edition of Socioculturally Attuned Family Therapy: Guidelines for
Equitable Theory and Practice, by voices of many others who are engaged in transformative
practices and third order thinking across diverse settings. We collectively address the need
to practice family therapy in ways that infuse diversity, equity, and inclusion throughout
theory and clinical practice. This includes attention to societal systems that shape our daily
lives at intimate, local, national, and global levels. A variety of family therapy theories and
models are routinely taught in advanced educational programs and practiced by clinicians
worldwide. We join those who struggle to teach these models while helping students and
supervisees integrate critical social awareness into actual practice. As practitioners our-
selves, we share difficulties professionals face in realizing truly just practice without
abandoning their theoretical foundations. The primary question that guides our work is:
How do we continue to use the models we so value in family therapy in ways that in-
tegrate the impact of culture, societal context, and power as essential considerations in
therapeutic change? The focus of this text is on bridging theory to practice; maintaining
the integrity of established models while integrating a contemporary understanding of
diversity and social justice.
In this first chapter, we argued for the importance of paying attention to how societal
context and power dynamics affect mental health and relational well-being. Chapter 2
centers on the concept of third order thinking (McDowell et al, 2019) and highlights the
relevance of third order change (McDowell, 2015) in socially transformative practice.
This includes defining societal systems, diversity, and socially just practice and introducing
ANVIET, a transtheoretical set of socioculturally attuned guiding practices. Therapists
engage in third order thinking and encourage third order change by inviting families
to inspect systems of systems, raising awareness, and questioning the impact of societal
context on presenting problems in an effort to promote relational equity. We argue
that third order change occurs when families are able to recognize the impact of
societal systems on their relationships, envision relationally equitable alternatives, and take
liberatory action.
In Chapter 3, we explore contextual self-of-the-therapist and third order ethics. In the
chapters that follow (Chapters 4–14), we integrate principles of societal context, power, and
equity into the core concepts of major family therapy models, paying close attention to the
“how to” of change processes. In the final chapter (Chapter 15) we explore applying third
order thinking and ANVIET practices to equity-based interventions across community,
organizational, and governmental systems; family therapy education and supervision; inter-
national relationships, and environmental contexts, highlighting the work and wisdom of
a number of colleagues who act as change agents within these various contexts.
Chapters on family therapy models offer variety in how concepts are explained and
examples are offered, however, each follows a similar format. We first introduce the
model, offering examples of its application and historical highlights. We do not attempt
to offer a thorough overview of how to practice each therapeutic approach but identify
what we consider the most enduring concepts of each model. We then integrate prin-
ciples of sociocultural attunement, relying on theories of societal systems and power that
are particularly applicable to the family therapy model at hand. We offer guidelines for
practicing the model from a socioculturally attuned perspective and apply these guidelines
to a case illustration. As you go from one chapter to another, we invite you to become
aware of the commonalities of socioculturally attuned practice from one model to an-
other, while also appreciating the richness and differing perspectives of each foundational
family therapy model.
16 What is sociocultural attunement and why is it important?
Limitations
There are limits associated with any perspective or practice framework. What we ad-
vocate for is no exception. The first is what we chose to include. We offer an overview
of what we consider enduring concepts from each of the eleven family therapy models.
We did not attempt to include all models of family therapy. We have been deeply en-
gaged in identifying enduring concepts across models in a field to which we have devoted
most of our working lives. We are aware, however, that others may choose different
concepts as primary in each of the models we present, or define these concepts differ-
ently. The second limit involves the decision to offer an overarching framework of each
model rather than an exhaustive overview. This decision relies on readers accessing fuller
historical and in-depth practice knowledge of each model from other sources. Finally, our
ideas are still forming and changing. New ideas continuously emerge that deeply inform
how we are thinking about and doing family therapy. Our hope is that this work, and the
ways in which others are applying third order thinking to their practice, will serve as an
impetus for you to add to this body of work in meaningful ways that are uniquely
situated in your contexts. In each chapter, we invite you to respond to reflexive questions
and hope that engaging with these questions will stimulate other questions that lead to
generativity and transformational processes.

Reflexive Questions
• How do you define equity? What does it mean for you to conduct equity-based family
therapy?
• As a therapist, how can you examine the effects of socio-relational determinants of health
and intervene in ways that are meaningful and useful to your clients?
• How do your social location and intersectional identities position you and your clients in
ways that are impacted by space, place, and climate-based inequities? Was this apparent
to you during the COVID-19 pandemic? What advantages or disadvantages did you and
your clients experience?
• Who is most likely to be attuned to others in any given system? Who has the privilege to
not attune and respond to the needs of others?
• What does it mean for you to acknowledge the history of trauma-based structural
inequity in the US and/or your country of origin?
• How does the influence of oppressive legacies (e.g., slavery, genocide, racism, misogyny,
sexism, ableism, homophobia, colonization, xenophobia) influence your beliefs about
what is normative, good, healthy, and best practice?

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2 Guiding Principles for Socioculturally
Attuned Family Therapy

One of the hallmarks of being a family therapist is the ability to discern relational patterns and
draw connections within and across systems. We move from the most intimate relational
dynamic to a focus on the individual, while simultaneously expanding our lens to track family
patterns over time and place within complex societal and cultural systems. We also con­
tinuously bridge theoretical frameworks with actual practice, i.e., how we think about what
we do. So, what does all of this mean when trying to make sense of clients’ concerns? What
do we choose to pay attention to? What do we look for? What informs what we see? How
do we work together with clients to consider ways of thinking and doing that will expand
possibilities for desired outcomes? These questions invite us to take a metaperspective in
thinking about how we think; about the difference our thinking makes in what we do to
engage families in positive, sometimes transformative change.

Third Order Thinking

Early family therapists developed a new way of thinking and practicing by viewing clinical
problems as embedded within relational systems. This initial first order, general systems
approach was limited and relatively short-lived. It relied on a metaphor that reduced and
compared complex human relationships to biological or mechanical self-correcting systems.
General systems theory was challenged by feminist scholars who pointed out that family
members often do not share the same level of relational power and cannot, therefore, be
equally influential or accountable for how the system is created, maintained, or its interac­
tional outcomes (Hare-Mustin, 1978; Hair et al., 1996). Intimate partner violence (IPV) is
perhaps the clearest example of this; repetitive patterns of interaction can be traced, yet
partners do not share equal influence or responsibility for the abuse. This critique was fol­
lowed by a call for second order systems thinking and practice (Anderson & Goolishan, 1988;
Hoffman, 1981, 1985; Keeney, 1983) by which family therapists began viewing the inter­
actions between themselves and family members systemically.
Second order thinking takes a metaperspective that recognizes families and therapists as part
of therapeutic systems. The therapist’s social position and contextual viewpoint effects how
they understand and “know” families. Consider tracking a pattern of interaction among family
members in which a more powerful partner is doing all of the talking; when the less powerful
partner attempts to interrupt, they are quickly silenced. Now step back and add the therapist to
the pattern of interaction. When you do so, you notice that the therapist is primarily looking
and asking questions of the more powerful partner. When the therapist attempts to interrupt,
the more powerful partner talks over the therapist leaving both the therapist and the less
powerful partner silenced. Second order thinking not only urges us to consider the impact of
the therapist on the therapeutic system, it also opens the door to understanding the practice
of family therapy itself as a potentially contested, polyvocal, and situated process.
DOI: 10.4324/9781003216520-2
22 Guiding Principles for Socioculturally Attuned Family Therapy
Yet another shift was ushered in by social constructionists who expanded the focus on
social context and challenged the foundation of family therapy as uniquely relying on the
metaphor of systems and systems theory (Dickerson, 2014). These critical, feminist, and social
constructionist understandings of societal context and power have prompted a shift toward
third order thinking that makes systems of systems more visible (McDowell et al., 2019). In
this way of thinking, mental health and relational well-being are impacted not only by family
but by societal systems at all levels, including complex interactions within and between
systems (e.g., political, social, economic). Looking back at the example above from a third
order perspective, you notice that both the therapist and the less powerful partner is a woman
and the more powerful partner is a man. By ineffectively attempting to intervene, the
therapist is worsening the situation; now neither woman—even the professional therapist—is
able to interrupt societal systems of men’s privilege and patriarchy that are being exhibited in
the therapy room.
Third order thinking includes and expands second order and critical thinking by taking a
metaview of mental health, relational well-being, and the therapeutic endeavor itself as nested
in complex and dynamic systems of systems that are continuously shaped by collective
meaning-making, culture, and power dynamics (McDowell, 2015; McDowell et al., 2019).
Thinking from a third order perspective changes how we make sense of everyday life by placing
experience and interactions within societal context and power dynamics. It broadens our lens,
thereby increasing available information and ways of understanding situations, which in turn,
provides more pathways for change. As with any perspective, this frames what we see, what we
look for, and how we organize and make meaning of our observations. This inclusive and
expansive way of thinking shapes what we can envision and co-envision with others.
While not labeled as third order thinking, similar processes are described across other
disciplines and theories, including decolonizing theory (Laenui, 2006), critical geography
(Soja, 2010), and liberation-based education (Freire, 1970/2020). For example, Paulo Freire
(1970/2020) described those who are oppressed often feeling powerless to do anything but
conform (first order thinking). Becoming aware of the dynamics of oppression that affect
one’s life provides insight into how unjust relationships might be challenged (second order
thinking). Liberation becomes possible through increased awareness of societal systems and
institutionalized power that privilege some by oppressing others. Third order thinking helps
discover, or unveil, how systems of systems (e.g., economic, political, social) and social
discourses create and maintain material and social inequities. Figure 2.1 provides a visual map
for practicing transformative family therapy by conceptualizing first, second, and third order
thinking within sociocultural context in ways that include power dynamics across multiple
interconnected systems.

⤝⤞

Socioculturally attuned family therapists use critical, second order, and third
order thinking by applying a multifocal lens that can be expanded to view the
broadest levels of societal systems and environmental contexts while magni­
fying the most intimate nuances of individual and relational dynamics.

⤝⤞

First, Second, and Third Order Change

A framework for considering first, second, and third order change can be found in one of the
earliest, groundbreaking annals of family therapy. Gregory Bateson (1972, p. 298) referred to
 Sociocultural Context

Environmental Context in
Space and Time

Global Context

Governments, Economics,
Policies Family Therapy Models
Third Order Thinking
Third Order Change
Organizations, A.N.V.I.E.T.
knowledge, production

Culture &
Community

Individuals &
Families

Power Processes

Figure 2.1 Conceptual framework for socioculturally attuned family therapy.

Guiding Principles for Socioculturally Attuned Family Therapy
23
24 Guiding Principles for Socioculturally Attuned Family Therapy
four levels of learning in Steps to an Ecology of Mind, the first two of which correlate with what
has become commonly understood as first and second order change. The following excerpt
of Bateson’s description of levels of learning shows a parallel with first and second and third
order change

Learning I is change in specificity of response by correction of errors of choice within a

set of alternatives.
Learning II is change in the process of Learning I, e.g., a corrective change in the set
of alternatives from which choice is made, or it is a change in how the sequence of
experience is punctuated.
Learning III is change in the process of Learning II, e.g., a corrective change in the
system of sets of alternatives from which choice is made. (Bateson, 1972, p. 298)

According to Bateson, first level learning or first order change occurs when change is made
but relationship dynamics and schemas (i.e., cognitive structures) remain the same (Bartunek
& Moch, 1987). Possibilities for difference are limited to what is available within what he
referred to as a set of alternatives; in other words, what can be imagined within a schema.
Second level learning or second order change is change in the schema itself and resulting
change in sets of alternatives. It focuses on the process level of relationships, creating new
schemas (Bartunek & Moch, 1987). This allows relationships to be punctuated differently and
members of a system to choose from different sets of alternatives.
Third order change or third level learning involves major shifts in how we see the world
(Ecker & Hulley, 1996) through a focus on meta-processes and meta-narratives. Third order
change––what Bateson referred to as level 3 learning––necessitates a meta-perspective in
which we consider sets of alternatives, leading to being able to choose not only between sets
of alternatives but between schemas (Bartunek & Moch, 1987). When therapists target third
order change, they are active and intentional, working in a space in which taken-for-granted
assumptions are inspected, taken apart, and disrupted to reveal multiple perspectives and
possibilities. This critical meta-perspective is in itself a paradigm shift; an epistemological shift
in how we think and how we know what we know.
Knowledge and understanding is not neutral. We often refer to first order solutions as
“common sense,” knowing their impact will be limited and make no real lasting difference in the
way relationships are organized. For example, new parents who are arguing over who gets up at
night with the baby might be coached to alternate, one taking odd days and the other taking even
days. This might be helpful, but it rings of “common sense” first order change that fails to address
the dynamics that prevented the couple from agreeing on this kind of obvious arrangement in
the first place. Looking a little closer at the concept of common sense reveals the ubiquitous
nature of the relationship between power and knowledge, i.e., the dynamic between dominant
cultural worldviews or discourse and what we consider to be the natural order of things
(Gramsci, 1971). In other words, what we consider to be common sense is often dominant sense.

⤝⤞

What is commonly understood as true or common sense often reflects the

views, and maintains the privilege of those with the greatest influence over its
definition.

⤝⤞
 Guiding Principles for Socioculturally Attuned Family Therapy 25
Family therapists routinely target second order change, i.e., qualitative, discontinuous
change that alters a system’s rules, structure, and/or order (Watzlawick et al., 1974).
Second order change is said to have occurred when system rules and shared meaning
change along with interactions. Compared to second order change, we often consider
first order change as cursory since it does not alter the structure or rules of a system and
maintains meaning frameworks or schemas. Second order change might involve addressing
power dynamics that have been exacerbated and made more urgent by the couple
becoming parents.
When purposefully considered and carefully sequenced, first and second order changes
are both essential to the practice of family therapy. Second order shifts are followed by a
series of first order changes within the new meaning-making schema and system rules.
When new alternatives are created, everyday patterns of interaction shift as a result,
which in turn support second order change. The new parents exemplified above might
engage in second order change as they increase their attunement toward each other’s
needs and begin to share more equal influence. First order change such as alternating
nights might then be a practical extension of this more foundational level change. First
order change can be also important when a family is in crisis and needs stability. First
order change is only a problem in therapy when it takes precedence or is present without
attention to second and third order dynamics.

⤝⤞

Third order change expands possibilities and enables transformation.

⤝⤞

Even though third order change is a new concept in family therapy (McDowell, 2015), it is
not necessarily a new practice in family therapy. When therapists integrate sociocultural
awareness into their approaches and open space for socially transformative change, they are
engaging in third order change (e.g., Cultural Context model, Socio-Emotional Relational
Therapy, Just Therapy). When therapists engage in third order change, they help families
connect their lived experience to broader systems of systems, raising awareness and ques­
tioning the impact of cultural norms, values, and societal power structures on relational
dynamics and presenting problems. For example, the new parents mentioned above might
now reflect on gender roles and gender equity, cultural norms embedded in systems of
patriarchy across families and social institutions, as well as the impact of living in a capitalist
society relative to social class and work demands.
Consider as another example, an intergenerational pattern of sons in conflict with their
fathers. At a second order change level, a father might be encouraged to remember what
it was like when he was a boy trying to please his father, feeling no matter what he did he
could not live up to his father’s expectations. This might soften his approach and increase
his emotional attunement to his own son. If the therapist were to engage the family in
dialogue or socioeducation about the bind in which fathers and sons often find themselves
in patriarchal societies (e.g., sons being invited into patriarchy by their fathers who also
insist on maintaining power over them), the family might be able to see how they
participate in a widespread system that exacerbates unwanted conflict within the family.
These types of revelations promote third order change that can be liberatory, releasing
families from imposed societal structures and norms.
26 Guiding Principles for Socioculturally Attuned Family Therapy
Socioculturally Attuned Family Therapy
Socioculturally Attuned Family Therapy is an interdisciplinary, transtheoretical framework that
supports the development of new family therapy models and builds on existing ones in ways
that expand our abilities to understand the impact of societal systems and power dynamics on
presenting problems and tailor interventions accordingly. This includes simultaneously
supporting cultural democracy and just relationships. Socioculturally attuned family therapists
attend to how each family member’s well-being is reflected in the ways relationships are
organized, communication occurs, and decisions are made. They respect and integrate
idiosyncratic perspectives and cultural values while simultaneously challenging oppression.
Relational dynamics that harm family members may be common occurrences in a culture
without being just. Again, intimate partner violence (IPV) serves as a clear example of a
practice that is ubiquitous across cultures, yet not a consensual and mutually beneficial
cultural arrangement (Stith & Spencer, 2021).
Following, we describe and relate principles of socioculturally attuned family therapy,
emphasizing the concepts of third order thinking (McDowell et al., 2019) and third order
change (McDowell, 2015). This includes how dimensions of power and societal context
can be integrated into family therapy models to guide practices that support just relationships
(see Figure 2.1).

Societal Context
Ecosystems include both living and nonliving organisms situated in space, place, and time. A
family in rural Uganda awakens in a modest thatch-roofed hut to the sound of their farm
animals—pigs, chickens, and goats—waiting to be fed. Their morning water must be boiled
to drink the local tea. The air is clear and the sun is reliably bright. Their beautiful tropical
setting is rampant with malaria-bearing mosquitos. The economy suffers from a history of
colonization, civil war, and global capitalism. Oil has been found beneath the ground, which
signals social change as companies from China and the West begin circling. The family’s
ecosystem includes the entire context in which they are embedded, from the smallest insect
to the largest landmass.
Societal context refers to the organization of human activity that emerges within and is
dependent on all other aspects of ecosystems. A European American family wakes up in a
small apartment in a large city in the United States (US). They hear familiar street noises
and the sounds of neighbors arguing. The refrigerator holds nothing suitable for school
lunches so children are gathering coins from purses, pockets, and between couch cushions
as the family cat looks on. A parent hurries the children, scolding the oldest for not making
sure lunches were ready while grabbing an umbrella to walk the children safely to school
against their objections. Clean water runs out of the tap, but the air is polluted. Buildings
along the way are being remodeled as the neighborhood becomes gentrified, soon to be
too expensive for the family to remain. Several miles away an African American family
rushes to grab ready-to-eat breakfast bars as a father warns their only child to be in the car
in 10 minutes or he will face having to walk to school. Fifteen-year-old James throws his
iPad into a backpack that contains shorts and a t-shirt for after-school sports. He is worried
that the Nike shoes he picked out for basketball might be too bright and will draw the
wrong kind of attention from his teammates. James’ mother is calling out spelling words
they studied together the night before. They look forward to dinner out that evening.
These families’ morning activities and interactions have already been deeply shaped by
differing incomes within their urban ecosystem.
 Guiding Principles for Socioculturally Attuned Family Therapy 27
⤝⤞

When we use the term societal context, we are referring to shared meanings
that define culture, inform identities, and situate experience, as well as the
dynamic interconnection of social systems that shape constraints and oppor­
tunities within specific spatial settings.

⤝⤞

The family in Uganda is headed by a 15-year-old girl, Dembe. Her maternal grandmother is
alive but living on a separate family plot. She has two younger brothers and a younger sister.
She is one of more than half of the families in her village that are child-headed, most of
whom lost their parents to AIDS. She and her 13-year-old brother, Jimiyu, are HIV positive
but receiving recently available antiretroviral (ARV) treatment. Dembe must stay on the
family land to protect the family belongings from those who might steal them when they are
away at school. Jimiyu has been challenging Dembe, siding with their late father’s family who
argues that the land and children should go back to the paternal clan as is customary when no
adults are living. Dembe knows this will leave her and her siblings with nothing and refuses
their interference, relying on Ugandan laws that protect the young family’s right to their
parent’s property. Jimiyu has been yearning for items from the West, now increasingly ad­
vertised on city storefronts, the internet, and television. He recently accepted a pair of Adidas
athletic shoes from a local NGO. Dembe is angry, fearing peers and extended family will be
jealous and no longer help if they believe an NGO is supporting the family. Jimiyu is refusing
his sister’s and maternal grandmother’s authority as women and elders.
Every moment of Jimiyu and Dembe’s life is affected by the complex nature of socio­
political and ecological contexts, including traditional gender roles affected by colonization,
tribal and clan customs, Western NGOs, Ugandan government and laws, access to physical
space and ownership of property, world economy, international power dynamics that in­
fluence the availability of ARV treatment, and so on. Societal systems are not simply benign
organizational patterns that create a sense of wholeness. They are theaters where struggles for
power, influence, and material advantage are acted out.

Social Structures
Third order change requires therapists to carefully examine the influence of social structures.
Social structures include socioeconomic stratification, social institutions, and other large
systems.

⤝⤞

Social structures shape the meaning we make of our lives and relationships, the
organization of our daily (even most intimate) interactions, the material
realities in which we are situated, and the location and expression of our
emotional, spiritual, and existential experiences.

⤝⤞

Social institutions include (among others) family and kinship, community, religion, social
welfare and health care, education, economy, mass media, and government/politics. Social
structures impose constraints and opportunities over possible individual, group, and
28 Guiding Principles for Socioculturally Attuned Family Therapy
institutional actions. Third order change is change in systems of systems within and/or across
these social structures. For example, the US legal structures include laws for governing ac­
tions and systems for controlling law-breaking behavior, as well as avenues to protect civil
rights and seek compensation for wrongdoing. Justice and protection are not, however,
equally distributed among all citizens. As a case in point, institutionalized racism embedded in
the educational, legal, economic, criminal justice/police, and other social systems remains
resistant to the change promised in the 14th Amendment of 1866. At the time of this writing,
there have been eight Civil Rights Acts aimed at enforcing the 14th Amendment, i.e., at
pressing toward third order change at the broadest levels of US society. These include the
Civil Rights Act of 1964, after which Critical Race Theory emerged as a legal discourse that
continues to inform legal actions aimed at enforcing racial equity as promised by the 14th
amendment. The Black Lives Matter Movement further presses for third order change to­
ward racial equity in US society, yet the homeostatic pull toward racialized inequity and
injustice persists.
Social structures largely determine the material realities of our lives, which in turn
deeply affect our well-being. The first US family mentioned above is also female-headed.
Melinda is 35; her oldest daughter, Maya, is 15, followed by a 9-year-old daughter and a 6-
year-old son. Melinda fled from a physically abusive husband and spent 6-months in a
family shelter before finding a job and apartment. Her daily schedule includes working the
night shift as an aide in a nursing home before coming home to help her children get to
school. Despite the Equal Pay Act of 1963, as a White woman, Melinda makes ap­
proximately 82% of what a White man would make with a similar educational back­
ground, yet considerably more than most people of color in the US (http://pewrsr.ch/
29gNnNA). Systems of male dominance and patriarchy that promote and maintain vio­
lence against women have also deeply affected her family, and continue to be prevalent
worldwide (Akhmedshina, 2020). The increasing focus on capitalism and the individual in
the US has driven a trend toward warehousing the elderly, creating a need for professional
caretakers (Esiaka & Adams, 2020). This provides Melinda with work, but work that is not
highly valued in an ageist society that prioritizes productivity. Melinda must rely on her
oldest daughter to help manage the family. When she enters family therapy because one of
her children is failing in school, the therapist pathologizes Melinda for Maya’s role as a
“parentified child.”

⤝⤞

Our relationships are shaped by context, but contexts are not neutral.

⤝⤞

All societies are plagued with social structures and institutions that promote and maintain
unearned privilege, power imbalances, and misuse of power. Our interconnected
identities––race, social class, age, sexual identity, gender, nation of origin, language, im­
migration status, looks, abilities, and other identity markers––shape our opportunities and
constraints. People who hold greater social power typically have the strongest influence over
the creation of social institutions, including their governing values, norms, and rules (Tatum,
2017). For example, in the US most universities and knowledge produced through uni­
versities privilege Western, Euro-centered cultural frameworks. Social welfare institutions
likewise set expectations for family interaction and parenting based on dominant middle-
class, Euro-centered cultural assumptions. As family therapists, we are in a unique position to
analyze, navigate, disrupt, and intervene in these systems.
 Guiding Principles for Socioculturally Attuned Family Therapy 29
Culture
Another facet of socioculturally attuned family therapy is having an intentional and critical
stance related to culture. Culture refers to beliefs, values, traditions, ways of being and doing,
collective meaning-making, shared knowledge and attitudes, and conceptual frameworks for
understanding the universe, including spirituality and religion. Culture is fluid and con­
tinually shifts as we collectively adapt to changing circumstances. In the example above, both
Melinda and Dembe value their families and put the needs of others first. This is a cultural
expectation for women in most societies. While it plays out differently in each cultural
context, as women, both are struggling with patriarchy and both are deeply affected by global
capitalism. Dembe holds cultural values of filial piety and respect for elders. This contributes
to her conflict as elders in her father’s clan, to whom she might have turned, no longer have
her best interests in mind. Cultural traditions that once helped children in her situation now
work against her as the dearth of resources leaves most of the country in need. When there
were few children left without parents (there was no word for orphan in Dembe’s native
language prior to civil war and the AIDS pandemic) and clans had enough to share within
tribal structures, children would have been protected when their holdings were turned over
to elders, along with their care. In the US, Melinda personally cares for elders within a
context that has created a growing demand for paid professional caretakers, but within a
larger sociocultural context entrenched in ageism that devalues older adults. Maya and
Dembe are both 15-year-old girls who love and support their younger siblings. They both
spend time each day making sure their siblings are fed, sleep well, and follow family rules.
What their dedication means and how it is valued or supported are vastly different across the
cultural contexts of the US and Uganda.
James lives in the same city as Maya in one of the most prosperous countries in the world,
yet their lives are quite different. James, also 15, gets annoyed with the constant attention of
his parents, but knows he can rely on them for meeting the majority of his needs. He feels
pressured to do well in school, as both parents are highly educated and expect him to
maintain the family’s social class advantage. Lately, his grades have been dropping as he
spends increasing amounts of time in the privacy of his own room late at night gaming on the
internet. When they enter therapy, the therapist fails to understand the nuances of internet
addiction. She prioritizes Euro-centered cultural values of privacy and autonomy, subtly
discouraging James’ parents from insisting they have access to his room or that he is not
allowed to access the internet.

⤝⤞

It is generally agreed that culture is largely a social construction, a shared

system of meaning-making and agreed-upon knowledge. What is often less
clear, however, are the dynamics of power embedded in what we refer to as
shared knowledge and meaning.

⤝⤞

According to Bourdieu (1986), those whose cultural practices are closest to dominant
groups have the greatest advantage in society. This includes language, interactional styles,
speech patterns, attitudes, and beliefs that can be instrumental in upward class mobility.
Bourdieu used the term cultural capital to refer to the advantage of being able to navigate
and mirror the culture of those in the center who have the greatest access to influence and
economic advantage. In the US the most valued and centered cultural capital is that of
30 Guiding Principles for Socioculturally Attuned Family Therapy
White, middle and upper class, heterosexual, able-bodied, young to middle-aged men.
Those most closely affiliated with this group secure lateral advantage while vertical ad­
vantage is secured via their legacies.
Walk into most banks in the US and notice who is sitting at the managerial desks.
Most often these positions are filled by White men followed by White women and men
of color. They typically share the dress, language, and mannerisms of the White corporate
world. Those already established in the system maintain cultural capital by hiring others
who are culturally like them, adhering in turn to organizational culture. Cultural capital
promotes social capital and social networks that reproduce individual, in-group advantage
(Kaasa, 2019). In our example, the social capital necessary to move up in corporate
structures provides entrance into social networks. The bank managers mentioned above
are hand-picked by those with power in the corporation’s social network. This capital is
the most valued currency in societal systems and social institutions, reifying the privilege
of some and marginalizing others. This same dynamic is at play in most therapeutic
settings.
Consider for example differences that are likely to occur in therapy for high and low-status
clients. High-status clients are likely to have greater choice in where they go for services.
They have greater access to a different therapist should they dislike their provider or feel
uncomfortable in a particular context. In contrast, it is likely that stressors that exacerbate
problems in the first place (e.g., inadequate transportation, lack of flexibility in work hours,
economic stressor, language barriers) contribute to difficulties families with low status might
have in even attending therapy. This in turn may be interpreted as low motivation for change
by therapists in agencies that have strict “no show” policies. The currency of cultural and
social capital also impacts the work of therapy (Garcia & McDowell, 2010). Think for a
moment about how you might think and feel as you are getting ready to see a supreme court
judge in couples therapy versus a single mother who has been court-mandated for parenting
skills. How might this feeling affect your way of working with them?
The processes mentioned above are similar to colonial processes in which the culture and
knowledge of colonizers is centered and imposed as superior. Colonization often relies on the
meta-narrative that military strength, technological advancement, and scientific knowledge
are evidence of a natural, linear progression of societies. Colonization is internalized, as those
being colonized are compelled to assimilate and adopt colonizer language, dress, social
practices, values, and beliefs.
Let’s refer back to our example of the child-headed family in Uganda. Dembe and her
siblings are Christians and benefit from the help of their church. They speak English and dress
in Western clothes provided by church members in the US. Jimiyu is being inducted into the
world market through media exposure to goods he has come to expect and view as superior
but cannot afford. He is beginning to internalize Western values that privilege self over the
collective, creating conflict between what he wants and what Dembe expects from him as a
brother.
Colonization happens within societies as well. As therapists, we are often faced with
externalized and internalized superiority and/or oppression (e.g., racism, sexism, classism,
homophobia, ableism, ageism, nationism) in ourselves and in those with whom we work.
Left unchecked, our own practices as family therapists can be oppressive and colonizing
(Almeida, et al., 2017; McDowell, 2015). For example, consider a family entering therapy
because their three-year-old is having trouble sleeping in her own room. The therapist may
inadvertently promote Euro-centered cultural values of independence and individuality if she
simply assumes this is a problem that will result in long-term dependence or is a sign
something is going wrong in the child’s development. Wherever the child ends up sleeping,
it is important that the therapist is able to help the parents think through their assumptions
 Guiding Principles for Socioculturally Attuned Family Therapy 31
and how their concerns may be being influenced by dominant values with which they
themselves may or may not agree.

Space, Place, and Environmental Justice

As described in chapter one, socioculturally attuned family therapists understand mental
health and relational well-being as situated within the geography or spaces in which families
live. Space (Soja, 2010) refers to the natural environment as well as what is constructed
within environments (e.g., homes, hospitals, parks, shopping centers, transportation).
Physical space is essential to understanding worldview and culture. The spaces we inhabit
determine and reflect our access to resources such as employment, food, education, and
medical care. In other words, the distribution of services and goods is not equal across
geographies, which in turn limits possibilities for some while enhancing opportunities for
others. Environmental justice also includes, among other things, access to clean air and water,
protection from harm, freedom from sound pollution, and equal participation in collective
community decision-making.
Place is a related concept that refers to our sense of being within space. Interactions within
space are negotiated differently within various cultures, however, the need for personal space,
privacy, safety, and social interaction are relevant across cultures (Fitzpatrick & LaGory,
2000). Consider your own experience in relationship to place—where you feel safe, spiri­
tually awake, emotionally moved, or at home—the space, privacy, safety, and social inter­
actions afforded to you in these places. Who gets access to these places and why? Do you
have the privilege to live near or in these places and/or the means to visit them? Access to the
most environmentally pleasant and culturally rewarding places is often associated with pri­
vilege, influence, and economic resources.

⤝⤞

Socioculturally attuned family therapists consider the impact of space and

place; how safe and comfortable clients are, how much privacy they are
afforded, the nature of the social interactions that surround them, and their
access to goods and services that help meet their basic needs.

⤝⤞

The dynamics of privilege and oppression are not only interconnected across local, national,
and global space and place, but present in the most intimate territory of home. That is, those
who are more powerful often have greater influence over interactions and set the emotional
climate that determines the sense of place in families. Consider a patriarchal family with a
mother, father, and three children. When the overbearing father opens the door to come in
after work, his heavy steps can be heard throughout the house. His silence is broadcasted
“loudly” as conversations and playful activities come to a swift stop. The children listen for
clues to his mood and shift their attention to focusing on their father’s first words to their
mother. The youngest child runs quietly to her room and closes the door. The internal
“weather” in the home has gone from relaxed and playful to tense and cautious.
Bourdieu (1986) argued that it is within what he called habitus, i.e., physical and social
space, that we develop shared values, beliefs, and ways of thinking and doing. Even in the
most diverse societies, we tend to share space with those who are similar to us culturally and
who have similar social capital. In effect, space is organized via social, including power,
arrangements, which in turn are shaped by space. According to Soja (2010):
32 Guiding Principles for Socioculturally Attuned Family Therapy
Viewed from above, every place on earth is blanketed with thick layers of macrospatial
organization arising not just from administrative convenience but also from the
imposition of political power, cultural domination, and social control over individuals,
groups, and the places they inhabit. (p. 540)

The emotional and relational impact of where families live, the safety and comfort of homes
and neighborhoods, and the level of control and privacy they have over their immediate
environment are rarely considered in family therapy. This is in spite of consistent evidence
that living in adverse conditions due to poverty negatively impacts mental and physical health
(Hudson, 2012). Inadequate physical space limits meeting basic human needs including the
need for privacy and personal space, social interactions, and safety (Fitzpatrick & LaGory,
2011). Melinda is unsure of her children’s safety when they walk to school. Those moving in
and gentrifying the neighborhood are exercising their class and economic privilege to
transform the space for the upwardly mobile. Melinda and her family will be forced to search
for new housing which is likely to be less desirable. Melinda does not have the means to start
fresh in a new community. Her move will have to be carefully calculated to maintain access
to her job and meet her children’s needs, while again saving for first and last month’s rent. A
therapist who underestimates this situation and is working to help Melinda become em­
powered or raise her self-esteem may be baffled by Melinda’s caution when relating to her
employer or considering a move.
On the other hand, James lives in a relatively safe community but must deal with the very
real impact of racism when he leaves his home. He may be viewed as dangerous in spite of
never having committed a crime or even losing his temper. His parents teach him racial
socialization skills by instructing him on what to do if he is profiled by the police and how to
handle racism on a daily basis. Part of their anxiety about his lowered grades is from living in
a societal context that requires James as a young black man to outperform his White
counterparts. A therapist working with James who fails to recognize the dangers of racism
may interpret James’ parent’s reluctance as resistance to therapy and/or as an attempt to keep
him from eventually leaving home.
As mentioned throughout this section, all of these processes occur within global, national,
and local contexts, highlighting the importance of taking a global perspective throughout our
work. In Text Box 2.1, Mudita Rastogi shares her Systemic Integrative Framework (2020)
that integrates a global perspective that pays close attention to pancultural, contextual, in­
tersectional, and integrational aspects of identity, worldview, and just relationships.

Power
Socioculturally attuned family therapists will also carefully attend to the matrix of power
dynamics across contexts.

⤝⤞

Power is a set of social processes by which individual and collective interests are
determined.

⤝⤞

Social context and relational equity are not add-ons but central to the development and
maintenance of symptoms. At the beginning of the chapter, we referred to a married, het­
erosexual woman entering therapy for depression. Locating the depression inside of her as an
 Guiding Principles for Socioculturally Attuned Family Therapy 33

Text Box 2.1 Mudita Rastogi, PhD, LMFT

Mudita Rastogi (she/her) is a Clinical Professor of Psychology and Department

Chair at the Family Institute at Northwestern University. She has an abiding interest
in systemic intervention, gender, diversity, equity and inclusion, race, culture,
ethnicity, multiculturalism, diasporas, global mental health, South Asian families,
trauma, and intergenerational relationships.
The Systemic Integrative Framework (SIF) emphasizes that systemic concep­
tualization and interventions must include an integration of a global perspective.
We must include contextual and historical knowledge about communities and
knowledge from the Global Mental Health (GMH) movement to be fully inclusive
and culturally sensitive in our work as systemic family therapists. The body of work
in the area of GMH focuses on inequities, differences, and diversity in thinking in
families and communities across the globe, and especially for those who have
connections across the diaspora due to their identity, immigration, displacement,
and kinships.
Use of the SIF allows therapists and clients to pay special attention to the
ongoing impact of sociopolitical events around the world ( Rastogi, 2020). In a
world of high connectivity, people are deeply impacted by events even in far off
locations. The SIF actively encourages practitioners, students, clients, and
readers to examine the underlying assumptions of Euro-American frameworks
and ask themselves how they can pursue a just approach, whether it is through
validation of a different perspective, listening to stories of resilience, and/or
advocacy.
Client-therapist conversations are both an assessment and an intervention.
Using circular and open-ended questions and the 4 domains of the SIF helps
glean a multilayered picture of the client’s worldviews (Pancultural), relationship
to sociopolitical events (Contextual), past and present identities (Intersectional),
and unique situation (Integrational). This process is cyclical and repeated in
greater depth as therapy progresses. Clients’ responses inform interventions and
lead to deeper questions about their sociocultural context.
From the moment a client connects with me, I share that we will consider their
challenges in the context of larger social realities and intersections. I use the SIF
to guide the exploration of various areas of the clients’ experiences. This might
include proximal issues like difficulty finding a therapist who appreciates the
nuances of the clients’ culture all the way to traumatic feelings from having
watched the evacuation of civilians in Afghanistan. I spend time in sessions linking
the clients’ responses to their presenting problems, relationship challenges, and
larger systems.
I tune in keenly to the ways in which clients name, identify, and present
themselves. I validate clients by saying something to the effect of: “You make an
important point that this is not fair. You are not imagining this. You were treated
unfairly. Sometimes, a lack of fairness comes from how institutions work, or
commonly held beliefs about certain groups of people, or socialization practices,
etc. This does not make it okay. If you would like, we can discuss this feeling of
disempowerment a bit more today or in the future.” Clients are encouraged to
share stories of transgenerational adversities and also gently challenged to
identify their own blind spots and revisit them for fairness and accuracy, after
which they are invited to repair what they can or make meaning of it.
34 Guiding Principles for Socioculturally Attuned Family Therapy

The above process allows for new linkages and insights that sometimes relocate
client challenges from within the individual and family, to societal processes. I
help name the oppression and/or microaggressions that might not be voiced
otherwise and encourage clients to do their own reflection and make connections
around these issues outside the therapy room. Using the insights gained in the
session, clients are encouraged to set goals that include not just personal and
family changes, but social action, advocacy for self and community, and/or steps
that impact larger systems. I also keep in mind that this is the client’s journey, and
it will progress at their pace.
As part of applying the SIF in diverse situations, the client-therapist-community
systems are agents of 3rd order change and are themselves transformed. From an
SIF perspective, intervention is expansive, aspires to be sustainable, and includes
change at all levels.
Outside of the therapy room, I have engaged in community work that can impact
larger groups of people who might not have knowledge of or are unable to easily
access mental health services. I direct my research, scholarship, and community
work towards 3rd order change, such as interrupting injustice, reducing barriers,
and increasing access to mental health services globally.
I identify as a systemic thinker, a teacher, a globalist, feminist, cultural
interpreter, challenger, and a Couple, Marriage, and Family Therapy integrator.
Being a wife, mother, daughter, sister, aunt, and friend are as important to me as
my professional roles. I often describe myself as having two homes, namely the US
and India, and am passionate about relationships in all corners of the world.

individual would likely limit her ability to think differently. Encouraging her to increase her
physical activity and/or begin taking antidepressants, and offering a venue for her to express
her feelings and concerns are important; however, imagine we include these potentially
useful interventions but in the context of relationships and taking power into account. We
help the couple develop an equal, mutually attuned relationship in which they both feel
heard and connected. They eventually share equal influence with each other as they ne­
gotiate to get their needs met within the relationship, as well as the social awareness to
traverse a societal context that routinely privileges one over the other.
Power dynamics are central to understanding emotional and relational well-being. While
family therapists routinely explore emotion, we rarely contextualize emotion within social
and relational power dynamics. Sociologists have found that those with influence and pri­
vilege tend to experience more negative emotions, including hurt, anger, guilt, and shame
(Turner 2007). Not getting what we perceive we deserve often results in negative emotions.
For example, the third order nature of the Black Lives Matter Movement is often met with
an angry backlash from those who fear their chances of getting what they expect and believe
they deserve will be diminished, even if these expectations are based on a sense of entitlement
and racial privilege.
There is ample evidence that equality in adult relationships promotes individual and re­
lational well-being, and analysis of nuanced power dynamics between couples has become
increasingly sophisticated (Knudson-Martin, 2013). According to Knudson-Martin (2013)
“the ability of couples to withstand stress, respond to change, and enhance each partner’s
health and well-being depends on their having a relatively equal power balance” (p. 6). She
further contended that, “clinical change is hard to sustain unless therapists assess for and
 Guiding Principles for Socioculturally Attuned Family Therapy 35
attend to the power processes underlying … relational dynamics.” This calls for therapists to
be able to assess and interrupt power imbalances rather than maintaining the illusion that one
can be neutral in the face of relational inequity.

Power in the Practice of Family Therapy

Power dynamics have been theorized in a number of ways by family therapists over time. Early
family therapists tended to view power as a pragmatic issue relevant to symptom formation and
maintenance within family systems. Communications theorists (Jackson & Jackson, 1968)
identified couple relationships as complementary or symmetrical. Complementary relationships
were defined as those in which one partner was in charge and leading while the other was
following. Symmetrical relationships were defined as those in which both partners wanted to
lead, creating competition and escalating conflict. Nearly a decade later, Salvador Minuchin
(1974) conceptualized power in families as vertical and horizontal through a focus on hierarchy
and boundaries. Later, Cloe Madanes (1981) considered relational power imbalances as central
to understanding and treating symptoms, the symptom itself being part of the power equation.
Relational power dynamics were, however, not often placed in societal context. Hierarchical
incongruencies and power imbalances were not routinely linked to systems of privilege and
oppression until the feminist critique.
More recently critical social theory (e.g., critical race theory, critical geography, critical
sociology) has been applied to broaden the understanding of and contextualize relational
power in family therapy (McDowell, 2015). Critical social theorists tend to view power as
relational and bi-directional. Those with greater available resources are in positions to impose
their objectives or will on others. For example, a parent often has a greater physical presence
that can be imposed, as well as social power and financial resources needed by a child. The
child can bring refusal to cooperate and emotional withdrawal to bear on the relationship, but
a parent can deny the child movement within and beyond the home, withhold food and
other wants or needs, and threaten or use physical and emotional pain to exert influence.
Ultimately the child has the power of social institutions that protect children, but only if
parents exert power that causes harm beyond what is allowed by law.
Descriptions of power mentioned above fall within a modern, structural functional
paradigm. Postmodern approaches to family therapy attend to power in a different way,
primarily based on the work of Michel Foucault (1972). What in the modern era was
considered universal and natural came under further attack with the postmodern critique in
which knowledge and power are seen as inseparable, i.e., what is considered knowledge
depends on societal power relations. Power is not held, but enacted. According to this view,
we don’t possess power; power is constructive and generative as well as constraining. Power
is not simply coercive, but a productive organizing force in society. Power is generated via
interactional choreography.
For example, power is produced when we get in line to ride a bus and are admonished
when others cut in front; when we enter a lecture hall and expect everyone to take a seat; or
when we comment on someone’s overly casual attire at a wedding or funeral. This type of
power results in policing ourselves and each other to create, shape, and conform to common,
expected practices in societies and families. Take a typical, rather unnoticed family routine.
All members of a family come to the table when called, sit and wait for the blessing to be said,
pass food to others, begin eating using prescribed manners, and engage in lively conversation.
Everyone knows what to do in this common social practice. If all family members don’t
come to the table, someone is designated to go and get them.
It can be difficult to reconcile postmodern, modern, and critical analyses of power to
effectively use them in family therapy practice. Viewing power from a critical postmodern
36 Guiding Principles for Socioculturally Attuned Family Therapy
perspective allows us to 1) acknowledge the impact of multi-directional power and perva­
siveness of dominant discourses in our daily lives while; 2) considering the real material
consequences of uneven distribution of power. From this perspective, power dynamics re­
verberate across all levels of societal systems and social structures, including our most intimate
family relationships. Our face-to-face interactions are impacted by our access to power and
resources on societal levels.
Consider another family that gathers for dinner. When these children come to the table,
they sit quietly out of the view of their father who often performs power through scowling or
demanding silence. The mother attempts to mediate the effects of the father’s exertion of
power by predicting his needs, sending non-verbal cues to children if they complain about
the food, and keeping dinner moving swiftly. This family performs a common social practice
of having dinner together while reflecting broad organizing principles of their society in
which women must be more attuned to needs and desires of men as men take on more
authoritative roles; male privilege and dominance in the family mirrors males being centered
and dominant in government, business, religious, and other social institutions.
McDowell (2015) offered the following description that integrates modern, postmodern,
and critical understandings of power:

Power is pervasive and unevenly distributed; systematic and idiosyncratic. Imagine

power as everywhere shaping our collective and individual decisions about how to
interact with each other across diverse contexts. We basically know what to expect
within our cultural groups and familiar settings. We maintain social practices by policing
each other and ourselves. Now imagine that power also pools up or thickens in some
places; that some of us have more resources and greater influence to bring to bear in
shaping singular and collective interactions. Collectively, those with greater resources
and influence shape cultural practices and ideologies in ways that benefit their own
group and maintain greater access to resources. Now imagine all of this in motion with
those being threatened reacting to potential and actualized power by yielding,
withdrawing, navigating, and/or pushing back … In other words, imagine a complex
web of influence that is systematically designed to maintain power and access to
resources of some over others but is also filled with idiosyncratic, highly nuanced power
dynamics in local specific contexts. It is this type of complexity we deal with daily in the
practice of family therapy. (p. 6–7)

Decisions about Using Power and Influence

We are all deeply influenced by broad social power dynamics, yet as individuals within
relationships, we still have choices about how to enact and/or garner influence with each
other. We consider a plethora of immediate and long-term consequences of our actions. We
may attempt to limit another’s power over us by reducing their potential to overpower. At
times we accommodate others to avoid harm or access power by proxy. We decide pur­
posefully or inadvertently how to exert influence––what methods to use and how far to press.
We evaluate the costs of persuading or demanding others bend to our will, calculating the
nature and history of the relationship and how others are likely to respond.
For example, one of the partners in a same-gender couple demands the other come out to
family and friends as their relationship moves toward the possibility of marriage. Has the
situation become unbearable, warranting the risk of losing the relationship if there is a refusal
to live openly married? Is the demand unreasonable, creating unwarranted risk or emotional
stress for the partner who wants to move more slowly due to homophobia within their
family? We also consider our own values and ideal selves as well as how we want others to see
 Guiding Principles for Socioculturally Attuned Family Therapy 37
us. Was it difficult for the partner to make such a demand, as doing so goes against an easy
going, caring view of self?

Power and Resistance

Wherever there is oppression there is also resistance to oppression. Presenting problems can
sometimes be identified as resistance to oppressive relationships. This can be imagined
throughout the examples above: children run away or constantly fight with parents, a partner
refuses to listen when feeling pushed by the other’s demands, a family accommodates a
domineering power figure but only in that figure’s presence, a withdrawal into the safety and
power of depression. Routine responses to being overpowered can become automatic,
creating problems in future relationships. Resistance can, however, also create resilience and
promote relational equality. For example, family members who learned to constantly ac­
commodate an oppressive parent fine-tune their abilities to read moods, context, and
nuanced power dynamics. The child who fights back develops the ability to speak out and
weather conflict.

⤝⤞

When we miss power dynamics, we not only overlook the opportunity to build
on resistance and resilience but risk inadvertently contributing to the problem.

⤝⤞

Less powerful persons can be pathologized and/or made to carry the greater burden for
change when well meaning therapists center their attention on simply removing symptoms of
oppression. For example, it is not uncommon for a partner who is in a one-down position to
feel dismissed by a more powerful and (therefore) less attuned partner. This may lead the
one-down partner to common sense solutions such as repeating arguments and escalating in
anger in attempts to influence the relationship. When the couple arrives in therapy, the
therapist is faced with one partner who seems unreasonable and out of control and one who
presents as cool and collected, even patiently enduring unreasonable wrath. In these situa­
tions, we may inadvertently reinforce relational inequity by resting our attention on calming
the partner who resorts to screaming and nagging, seeing this partner’s actions as the greater
problem. If one of the partners is diagnosed, it is likely to be the one who is (actually
attempting to be) out of control.
When we miss power dynamics, we also run the risk of missing what cannot be said in
families. While this is often highly nuanced, the readiest example occurs where there is
intimate partner violence. Hopefully, all family therapists now screen for violence, spending
at least some time with each partner to offer opportunities for disclosure. Just as being
overpowered can lead to angry outbursts, physical and emotional symptoms, and withdrawal,
it can also lead to silence.

From Principles to Practice

Socioculturally attuned therapists sensitively apprehend and resonate with clients’ social
contexts (D’Aniello et al., 2016; Pandit et al., 2014). Therapists must be vigilant in our
understanding and consideration of the impact of intersecting social, historical, economic,
religious, political, and cultural systems each time we intervene in a local “here and now”
context. We must keep multiple systems levels in mind while considering the interaction
38 Guiding Principles for Socioculturally Attuned Family Therapy
between these systems, societal power processes, and specific family dynamics. In other
words, therapists engage by continually connecting the dots between broad social levels and
intimate and family relationships.
Socioculturally attuned family therapists continuously make the connection between
power dynamics at larger social levels and problems at the most intimate relational levels. The
concept of isomorphism is familiar to family therapists and can be used to understand the
ways in which family systems reflect the organization of larger social systems in which they
are embedded. Sociologists refer to isomorphism as mimetic, normative, or coercive
(DiMaggio & Powell, 1983). Families are affected by all three of these processes, i.e., they
often mimic the organization, structure, and rules of larger social systems (e.g., patriarchy);
follow social norms and values that govern institutions across societies (e.g., valuing hard
work); and/or experience pressure from outside systems to conform to particular ways of
being (e.g., parenting in socially sanctioned ways). From postmodern perspectives, families
are thought to reflect and make meaning of their experiences through dominant social
discourses. In turn, these discourses affect every aspect of life including how we feel and
what we do.
Finally, therapists working from a socioculturally attuned perspective need to be diligent
not to inadvertently reproduce the status quo of societal context and power relations in the
therapy process or in their work as advocates. Not noticing or intervening in relational
inequity, failing to address sexism and racism, and practicing from White middle-class
perspectives are just a few of the many ways we contribute to unjust systems. Likewise,
taking a first-order, “us and them” stance in which we expect to create change by de­
nouncing others, contributes to maintaining structural inequity via social, political, and
relational polarization. Third space (Soja, 2010) can be created by engaging in critical
dialogue and reflection (Freire, 1971/2000), imagining and supporting just relationships,
and collaborating with families to create strategies for action that support third order
change.

ANVIET: Transtheoretical Socioculturally Attuned Practices

Practicing socioculturally attuned family therapy requires us to infuse the practice of family
therapy models with an understanding of how societal context and power dynamics con­
tribute to mental health and relational problems. The transtheoretical goal of socioculturally
attuned practice that supports equity can be integrated into interventions within all family
therapy models. The six guiding practices below help disrupt inequalities in social re­
lationships that are largely invisible, taken-for-granted, or assumed natural and open options
for relational systems that equitably support the health and well-being of all. Because
awareness typically precedes action and transformation (Freire, 1970/2000), we present the
practices in the order most likely to be effective: attune, name, value, intervene, envision,
and transform. In practice, they are interconnected and used in varying ways across each
phase of therapy (Figure 2.2).

Attune to Context and Power

Applying socioculturally attuned principles to each of the models described in this book
means therapists intentionally attune to the connections between the larger social context
and clinical issues from the very beginning of therapy. This is critical. A study of how
therapists practice sociocultural attunement (Pandit et al., 2014) found therapists inter­
nalized a guiding lens that led them to explore the connections between the emotions,
behaviors, patterns, and ideas expressed in session and sociocultural processes. This lens
 Guiding Principles for Socioculturally Attuned Family Therapy 39

ANVIET: Sociocultural Practices that Promote Third Order Change

Transform
Attune Value Intervene Envision
Name to Make the
to context What is in Power Just
injustices Imagined a
and Power Minimized Dynamics Alternatives
Reality

Figure 2.2 ANVIET: Sociocultural practices that promote third order change.

prompted an internal dialogue regarding how societal discourses and power structures might
underlie client behavior and expressions. The lens also guided what therapists reflected back
to clients and the questions they asked to help create a sociocultural interpretation that
resonated with client’s experience.
Client resonance was key. Sociocultural attunement occurred when clients appeared to
feel understood; therapists “got” their sociocultural experience. When this happened “clients
expanded their level of disclosure, showed more emotion, became more relational in con­
versation, and physically connected with therapists; i.e., nodding, maintaining eye contact”
(Pandit et al., 2014, p. 524). For example, when a therapist recognized and reflected a
disabled woman’s guilt because she could not care for her children “the way a mother
should” as sociocultural, the woman “began to tear up, nod, and share her struggles and fears
about not being a “good mother” (p. 524). If clients did not resonate and instead avoided eye
contact, disagreed, looked confused, changed the direction of the conversation, or told the
same story again, therapists did not abandon their sociocultural lens. They modified their
questioning/reflecting until client resonance was achieved.
The goal of attunement is to not only understand the sociocontextual factors involved in a
particular case, but to apprehend and emotionally resonate with how they connect to clients’
experiences (D’Aniello et al., 2016). A study of senior family therapists known for addressing
social justice issues found they tend to be transparent with clients about what they see
through their sociocultural lens, use inquiry rather than telling to bring these concerns to the
foreground, and stay close to client experience when exploring sociocultural issues rather
than using abstract concepts (D’Arrigo-Patrick et al., 2017). Another study found that novice
therapists often felt compelled to address “the presenting issues’’ before applying a socio­
cultural lens (O’Halloran et al., 2017). If this happens, underlying inequities persist as therapy
unfolds. Socioculturally attuned therapists begin by expanding the lens.

⤝⤞

Attending to all perspectives may seem like simply good therapy, but beneath-
the-surface sociocultural power dynamics easily shape what gets identified as
the clinical focus.

⤝⤞

Socioculturally attuned therapists recognize and attend to how power dynamics are part of
clients’ experiences and are reflected in session. They do not allow more powerfully situated
40 Guiding Principles for Socioculturally Attuned Family Therapy
members to define the direction of therapy. As they help families explore problems, so­
cioculturally attuned therapists are aware that not all voices in a relationship come from equal
positions. For example, when a father says that the problem is that the mother and the boys
fight, and the family seems ready to agree to this problem, socioculturally attuned therapists
invite other perspectives before determining the problematic sequence.

Name Injustice
In the process of “naming” we select some experiences or ways of knowing and directly or
implicitly link them to possible feelings and actions (St. George & Wulff, 2014).

⤝⤞

It matters how we talk about clinical concerns.

⤝⤞

What therapists listen for, highlight, and name is not neutral and carries the weight of
professional privilege (Hernández-Wolfe, 2013; Paré, 2014). When unfair or unjust cir­
cumstances and expectations are overlooked or minimized in clinical discourse, individuals
are pathologized and clients blame themselves without connecting their troubles to larger
conditions (St. George & Wulff, 2016). Socioculturally attuned therapists guide the con­
versation to name unfair or unjust circumstances and amplify voices whose experiences are
likely to be silenced.
St. George and Wulff (2016) offered an example from their work in Canada. A middle-class
biracial stepfamily sought therapy because their 16-year-old daughter had been caught lying and
stealing. The parents had “developed a stern attitude of discipline using accusation, yelling, and
punishment … as well as ‘giving up’ on their daughter” (p. 3). When the therapist attuned to the
social context around this family’s struggles, the daughter said she “didn’t care what people at
school said” and the parents described comments by co-workers and people at school that “mixed
race families were always trouble” and “innuendos about blended families.” Comments like these
shamed the parents and led them to believe they were bad parents, exacerbating (or perhaps even
causing) the family pattern of control and defiance. Naming the biases and the discrimination the
family experienced expanded the conversation beyond the therapy room and enabled them to
more thoughtfully address their responses to societal expectations and each other.

Value What is Minimized

Socioculturally attuned therapists acknowledge the worth of that which has been minimized
or devalued in the dominant social structure and use these values and practices to promote
healing (Hernández-Wolfe, 2013). By so doing, the therapeutic process begins to counter
social inequities and sets the stage for transformation.

⤝⤞

Socioculturally attuned therapists develop special radar for ferreting out and
highlighting strengths that dominant cultural and power processes mask.

⤝⤞
 Guiding Principles for Socioculturally Attuned Family Therapy 41
These include almost any strength associated with females or with cultures that place less
emphasis on individuality and competition, such as caring for others, empathy, accom­
modating to preserve harmony, or prioritizing family and relationship bonds. They also
include the skills and mindsets needed to survive with few economic resources or with
physical disabilities.
Let’s imagine a male client who sought help for depression. He has internalized an identity
as “not assertive enough” and was recently overlooked for a promotion at work. He feels like
a failure, like he does not fit. Rather than agreeing with the dominant culture assumption
that what matters is that he learns how to better assert himself or promote the products he is
selling, the therapist asked questions about other aspects of his identity and listened for
culturally minimized strengths.

Therapist: It sounds like there is a strong force for you to be assertive, to press your product,
or stand up for yourself. I’m wondering about the other side––when you are
there for others. Does that happen?
Client: I think I am there for others a lot. That’s always been important to me, you
know. But I need to learn not to do that so much, to be more aggressive.
Therapist: It seems like being there for others is a pretty important thing. Have you seen
ways that that’s been good in your life, or has made life better for others?

Validating this client’s capacity and desire to support others countered patriarchal expecta­
tions that men should lead or dominate others. The therapy enabled him to feel good about
himself, improve his relationship with his wife, and develop career goals that did not require
him to discount the value of focusing on others. His depression dissipated.
Therapists also absorb dominant cultural values. The ability to recognize and explicitly
value that which is socially marginalized or does not fit into dominant expectations re­
quires reflective practices on the therapist’s part. For example, an African-American
therapist presented a case in supervision. The client was a 28-year-old African American
woman who lived with her mother and younger siblings and helped support them. The
therapist initially defined the client’s problem as a lack of maturity and differentiation
from the family of origin, stating that she was sabotaging her own growth for the sake of
the family. Despite her own identity as a Black woman, she evaluated her client through
an individualistic lens promoted in academia and treatment systems. A socioculturally
attuned approach would have been to explore and honor the client’s ties to her family
before automatically focusing on her autonomy. The therapist would be aware of how
easily obligations to others can be discounted and create space to value and reinforce
them.

Intervene in Power Dynamics

Positioning therapy to disrupt oppressive power dynamics and support relational equity takes
active intervention. This does not mean that therapists need a directive stance toward therapy.
Rather, they use their facilitative role to recognize when societal power dynamics are at play
and use interventions that interrupt and challenge inequitable power while empowering
clients to create ways to transform them.

Envision Just Alternatives

It is not enough to identify injustice or power inequities. Therapists need to provide space to
imagine just relational alternatives. A task analysis found heterosexual couples dealing with
42 Guiding Principles for Socioculturally Attuned Family Therapy
infidelity only moved toward equity when therapists invited them to envision alternatives to
gender stereotypes (Williams et al., 2013). For example, they suggested enactments in which
powerful partners initiate relational repair or asked partners to discuss what shared respon­
sibility for maintaining the relationship would look like for them (an alternative to the idea
that this is a woman’s job).
When clients’ social identities are marginalized, they may blame themselves for
their problems– “I am lazy,” “I have low self esteem,” or “I have anger problems.”
Interventions into power dynamics will begin from the premise that these self-referents are
examples of how persons located outside the dominant culture have been colonized by it
(Hernández-Wolfe, 2013). For example, A socioculturally attuned cognitive behavioral
therapist (Chapter 10) would help clients recognize the root of these thoughts, notice
when they are being triggered, and envision a new response. A socioculturally attuned
structural family therapist (Chapter 4) would explore the family rules and patterns around
these ideas, help family members link these to the effects of social structures, and use
enactments to encourage potential alternatives.

Transform to Make the Imagined a Reality

Third order change results when what is imagined is made real. Socioculturally attuned
family therapists collaborate with clients by being responsively persistent (Sutherland
et al., 2013). They keep bringing clients back to sources of strength and equity in their
lives that enable their preferred vision of themselves. For example, In Boszormenyi
Nagy’s contextual family therapy (Chapter 9), socioculturally attuned therapists help
people be intentional about their response to family and societal injustice, and what they
want to see going forward for themselves, their children, and posterity. They encourage
and support clients’ commitment and accountability to these ethical values, giving due
credit and care to each other.
Socioculturally attuned family therapists help clients identify and solidify the changes
they are making. They help clients see themselves as part of larger systemic processes and
consider how others may respond as they make third order changes that resist dominant
norms. They help clients develop social supports and strategies to sustain them, not only
within their families, but in their communities and social networks. In Text Box 2.2, Hoa
Nguyen describes situating her work with queer immigrant families within sociocultural
context.

Integrative Approaches That Center Social Equity

Following are two examples of clinical models that explicitly integrate principles of so­
cially just practice with multiple family therapy theories. We retrospectively apply
ANVIET to two models—the Cultural Context Model and Just Therapy. Illustrating
these models helps illustrate a more robust description of these principles. Both models
assume that just relationships within families, communities, and the larger society are
essential to positive therapeutic change. Presenting issues are viewed in relation to larger
sociopolitical social contexts and therapists take an ethical stand that if we do not attend
to larger context issues, we may unintentionally help people adapt to unjust circumstances
or collude with existing power structures. Each approach draws on familiar family therapy
concepts from multiple models, while also expanding the clinical lens in ways that target
transformation at societal as well as interpersonal levels. In various ways, they challenge or
restructure mainstream assumptions about the therapist’s role and boundaries of the
therapeutic relationship.
 Guiding Principles for Socioculturally Attuned Family Therapy 43

Text Box 2.2 Hoa Nguyen, PhD

Hoa Nguyen (she/her) is an Assistant Professor at Valdosta State University in

Georgia. She teaches courses in diversity, inclusion, and social justice, and draws
from her Vietnamese immigrant family history of resettlement and rebuilding home
in the United States post-Vietnam War.
My work focuses on navigating the spaces between cultural and sexual identity,
which is inherently embedded in social, economic, political, and environmental
contexts. When considering the experiences of queer immigrants, their personal
and relational problems are tethered to their social and cultural capital. In
particular, experiences of home and diaspora are complexified for queer immi­
grants whose lived experiences may be challenged, erased, or marginalized by
political and social discourses.
I believe it is important to decolonize family therapy and become more attuned to
the Western, individualistic lens that inevitably shapes psychotherapy. I attune
to exploring dominant narratives that subjugate our clients’ lives and work
to construct possibilities that resist these marginalizing experiences. In-
betweenness has been incredibly important in holding space for the complex
experiences of queer immigrants. I’ve found that this amplifies their stories and
counters the narratives of having to choose one way of being by noticing these
patterns, calling attention to them, and exploring other possible ways that counter
or resist these systems. In addition, I work with other professionals and systems in
their lives to support them and disrupt the pattern of societal blaming and
scapegoating of marginalized individuals. In particular, it is critically important
that their voices and experiences are heard throughout the therapy process to
avoid perpetuating oppressive relations within the therapy room.
One aspect of my work is to bring into discussion the political, economic, and
social injustices that are occurring in clients’ lives. By naming these problems as
contextualized within systems of power and oppression, clients are liberated from
the blame and shame that are often produced through injustice, opening up other
ways of being, other solutions, and other possibilities of seeing themselves and
relating to others. I also think it is useful to find opportunities to advocate for clients
when possible and with their consent. I also take into consideration intergenera­
tional traumas as contextualized within histories and systems of oppression.

The Cultural Context Model

Rhea Almeida and her colleagues developed the Cultural Context Model (CCM) as a way to
address the connection between justice and family therapy. CCM expands therapeutic
models to include non-related persons in the change process (Almeida et al., 2008). Rather
than work with only a single therapist, CCM reduces the dependency between clients and
therapists by engaging them in cultural circles composed of community members concurrently
with individual, couple, or family therapy as needed. Clinicians work as a team. The clinical
milieu is designed to consider healing a community endeavor rather than an individual one.
In Text Box 2.3, in which Rhea Almeida shares her approach to liberation praxis (2019),
including an example of applying the Cultural Context Model. We follow with a brief
description through the ANVIET Lens.
44 Guiding Principles for Socioculturally Attuned Family Therapy

Text Box 2.3 Rhea V. Almeida, PhD, LCSW

Rhea V. Almeida (she/hers), director and founder of the Institute for Family
Services, has been a leader in liberation-based practice over the last 4 decades.
I view liberation praxis, which is how I describe my work, as resonating with the
“disruption” of coloniality. This endeavor involves disengaging with the status quo
and erecting/installing instead knowledges and structures from border spaces.
This is contiguous with providing families paths to disengage/disrupt the status
quo in the spirit of healing and transforming lived experienced embedded in
oppressive spaces.
Liberatory healing today could not be more needed across sites and institutions,
including schools, corporations, health and mental health institutions, and aca­
demic environments. That is, if there is a will to disembark from the project of
coloniality and our collective moral compass of inhumanity.
Critical consciousness refers to awakening to the realities of the social and
political order which are no longer viewed as unchangeable. Conscientizació n
does not occur in a one-to-one individualized isolated context. It happens in
community or healing circles as I call them. Using the graphic of Power, Privilege
& Oppression, popular movies, songs, magazines, newspaper articles, and other
forms of social media along with handouts/tools that reflect multiple intersects
of social location, societal structures, and systems of inequity, the process of
identifying and naming these lived experiences begins.
The path forward requires synthesis: Simultaneous attention to multiple oppres­
sions and privileges, linking public and private matters through dialogues and
reflection. This process within a context and connection to people from varied
backgrounds and complex lived experiences establishes the platform for identi­
fying, naming and challenging trajectories of power, privilege and oppression.
Critical consciousness is an essential precursor to liberatory healing.
The process is a generative one in that the voices and lived experiences of
dominance and those silenced and otherized are scaffolded. These conversations
within the therapeutic space launch the imagination of interruptions and chal­
lenges of systems engaged/complicit in the evisceration of multiple lived experi­
ences. This imagination of border spaces moves into action strategies through
linking of collective connections.
An example of this process is that of Brianna, a Latina woman, working class,
language challenged, single parent was faced with Rosey, her daughter, being
labeled ADHD and continuously receiving notes about her out of control behavior
in the classroom. The school was relatively diverse with a larger percentage being
White and middle to upper class. In bringing her daughter to therapy she was
invested in aligning with us to teach her daughter to acquiesce to the school
values and expectations of her behavior.
The problematized narrative by the school, and adopted by Brianna, did not
occur in our space. Rosey was respectful, did not appear to have any behavioral
issues but did appear to have difficulty reading at her grade level in our circle
sessions. Upon receiving requested school documents, it became apparent that
Rosey at the end of 3rd grade was reading at a 1st grade level. Throughout the
second and third year of her behavioral problems in school, there was no
remediation or testing of her reading skills. We recommended to Brianna that
 Guiding Principles for Socioculturally Attuned Family Therapy 45

Rosey be tested with the goal of receiving some form of remediation. She was not
convinced.
We explored her family of origin and her immigration stories from Costa Rica.
She was raised by a single mother who made a living cleaning houses. Her father
left when she was a toddler and she rarely saw him. She described a childhood of
loneliness and deprivation–a childhood she would not want for any child,
especially her own. She met her husband who lived in the US when he was
visiting his family in Costa Rica. After a few years of a long-distance relationship,
they married and she moved to the US. She was in the process of completing her
GED when she became pregnant. Since the relationship was already turbulent,
she did not want to have the baby. She got an appointment for an abortion and
planned to have her cousin take her. On the day of the appointment, she was
informed that her mother did not approve and therefore her cousin refused to take
her. Her husband was an active alcoholic and did not care one way or the other.
She went on to have Rosey. We had her engage in a ritual of letter writing to Rosey
about the ambivalence of her pregnancy, ways in which she felt trapped with the
pregnancy and ways in which her nurturing was inconsistent.
She participated and witnessed numerous sessions where others in the circle
were addressing either their work or family situations that were oppressive and
they were targeted in different ways, carefully crafting threads and plans to
challenge and bring some accountability to their lives. After continuing in multiple
critical consciousness sessions, with some members of the circle being in
different systems of education, she moved from her belief that the school was a
fair system that would not target her child to understanding the depth of this
institution’s targeting of her daughter. She came to understand her daughter’s
emotional acting-out as directly related to the school’s reckless abandonment of
her daughter’s academic needs. Building alliances with various members of the
circle, she was successful in demanding that the school test her daughter and
provide her with an IEP necessary to provide the appropriate accommodations.
This shift in her standpoint towards institutions further allowed her to file for
divorce from the father of her daughter who paid minimal in child support, yet
bought a home with his lover, while she lived in a two-bedroom apartment with her
daughter and mother. The economic benefit of this choice coupled with her
daughter finally receiving the services she was entitled to exponentially altered
her lived experience from the marginal space she was confined to.
The process of identifying and naming processes and systems/institutions/
people who create and sustain harm to others creates a space for imagining
transformative/liberatory spaces. Once there is an imagined location bolstered by
connections in community that amplify that vision, the process of personal
evolution is inevitable, albeit at different speeds.

Attune
Therapists working from the Cultural Context Model attune to families’ presenting issues in
context of historical and current processes of privilege and marginalization. They initiate
conversations that help clients begin to consider the problems they are facing against the
backdrop of intersecting sociopolitical processes, such as patriarchy, capitalism, racism,
46 Guiding Principles for Socioculturally Attuned Family Therapy
heterosexism, and ableism. A first session may be structured to ask questions that raise po­
tential areas of power and privilege: How much money do you earn? Who makes decisions?
How are household and family-care responsibilities distributed? How is your workplace
organized? (Almeida et al., 2008).

Name
Raising critical consciousness is important in the Cultural Context Model. After an initial
intake session, all clients participate in 6–8 week same-gender social education groups that
help them become aware of the social, political, and cultural influences in their lives through
reflection on handouts, film clips, music, poetry, and readings. Power and control wheels
around domestic violence, homophobia/heterosexism, gender oppression, racism, coloni­
zation, and imperialism help guide the discussion. Groups are divided by gender and typically
include a range of intersecting social locations and presenting issues. Partners and family
members attend the gender groups with which they identify. They may also do genogram
work to help see and name how larger contextual forces have been part of historical family
processes.

Value
As people grasp how societal systems of domination and subjugation affect their lives (critical
consciousness), two other values follow and organize clinical work (Hernández et al., 2005).
The first is accountability. It “begins with acceptance of responsibility for one’s actions and the
impact of those actions on others” (Almeida et al., 2008, p. 14). But it also requires reparative
action; e.g., actions that demonstrate empathic concern for the well-being of others. The
other value is empowerment. A person gains empowerment through accountability. For ex­
ample, a man and his family are all empowered when he is accountable and takes actions that
promote “power with” rather than “power over.”

Intervene
Most of the clinical work in the Cultural Context model happens in on-going cultural
circles. These are based on the work of Freire (1970/2000). Culture circles move therapy
from an individual process to a community effort. Culture circles include other clients as well
as volunteer helpers and a team of therapists. Members of the culture circles help each other
resist “norms that maintain hierarchies of power, privilege, and oppression” (Almeida et al.,
2008, p. 15). Members support each other toward accountability and empowerment.
Therapists help connect presenting problems with social realities that maintain them.

Envision
Reparative measures require that clients be able to envision alternative actions that promote
just relationships. Almeida et al. (2008) offered the example of Frank, a White, middle class
corporate executive who shared how culture circles increased his awareness and helped him
create a new vision of how to engage more justly with his wife:

When I began coming to the group here, I slowly realized that I had a lot in common
with these other men. I realized that these sponsors are here for a purpose, that they are
much farther down the road than I am … There was Stan [another White man in his late
fifties, a physician’s assistant]. He asked me detailed questions about my financial
 Guiding Principles for Socioculturally Attuned Family Therapy 47
situation and the role that my wife played in the economic management of our lives.
Even more surprising to me, Stan then offered details of his own and his family’s
financial life. I never imagined talking to anyone about my finances in such detail and
most certainly not to a stranger I had known just a few weeks. Our conversations and his
respectful suggestions gave me a small window into the possibilities here. (p. 101)

Transform
Culture circles do not just raise possibilities; members hold each other accountable to them.
Actions may be personal like an accountability letter written to family members one has
abused or collective action, in which some members use their privilege to counter injustice.
Hernández and colleagues (2005) described such an example:

David, an African American college student, was stopped by university police, and his
car was impounded. This harassment was part of the police’s profiling endeavor. A group
of Caucasian men supported him financially to obtain legal counsel. They assisted him in
suing the police department and supported his settling out of court. (p. 14)

Creating communities of resistance and support is one of the transformative outcomes of the
Cultural Context Model.

Just Therapy
Just Therapy expands conventional therapy boundaries by engaging extended families,
working within cultural and spiritual practices, and extending the clinical role to include
collaboration with community projects and efforts to transform social policy (Waldegrave,
2009). Just Therapy was developed at the Family Center in Wellington, New Zealand to
connect clinical practice to the impact of colonialism on the Maori, Pacific Islander, and
Pakeha (European) families that comprise their community. Founders Charles Waldegrave,
Kiwi Tamasese, Flora Tuhakla, Warihi Campbell (2003a), and colleagues saw that much of
what brought people to them related more to poverty, unemployment, housing, sexism, and
racism than problems within the families themselves. They directed agency resources to
community projects and social research and action.
The term “just” is used in two ways (Waldegrave, 2003). First, the structure of the
treatment system is designed to reduce institutional power of the dominant European culture
to create more equitable or just outcomes. Secondly, “just” (or simply) therapy demystifies
the therapeutic process to value and welcome skills, experience, and knowledges that emerge
out of communities. Therapy is viewed as a sacred exchange. People come, deeply vul­
nerable, with problem centered stories. The task of the Just Therapy Team is to offer al­
ternative meanings that inspire resolution and hope.

Attune
Every aspect of agency structure and clinical process is structured to attune to power dif­
ferences among cultural and gender groups, “Rendering power to those who have been
denoted as powerless” (Tamasese and Waldegrave, 2003, p. 138). Agency leadership is dis­
persed among cultural sections that protect cultural equity. Family group conferences are
used to attune to and respect cultural resources and views of extended family members in
creating safe spaces for children (Waldegrave, 2009).
48 Guiding Principles for Socioculturally Attuned Family Therapy
Name
The Just Therapy team names injustices such as having no control over a situation, e.g., in
housing or the language a child is made to speak. Whenever possible, they honor families’
survival and management practices. For example,

I just want to say how impressed I am with how you manage your household budget. It
is very tough today with all the demands for food, rent and kid’s needs, and it requires a
lot of responsible decision making. You do that very well. I see a lot of families and there
are not many that I reckon can manage their budgets as well as you do. That is a great
contribution to your family. You guys have a very able mother. (Tamasese &
Waldegrave, 2012a, p. 14)

Value
The Just Therapy Team measures the quality of their work against three values (Tamasese &
Waldegrave, 2012a). The first is belonging. It refers to the essence of identity, to who we are,
our cultured and gendered histories, and our ancestry. The second is sacredness. It refers to
the deepest respect for humanity, its qualities, and the environment. The third is liberation. It
refers to freedom, wholeness, and justice. Accountability to these values at the organizational
level is fostered through caucus groups based on gender and culture. Reflection is required
for both dominant and marginalized groups. Responsibility to stop certain behaviors or
discriminating practices rests with the dominant group (Tamases et al., 2003).

Intervene
Just Therapy does not use universal interventions. Rather than the professional world of the
therapist defining the problems and the cures, therapists view themselves as invited to bring
their skills into families’ cultural worlds. They use metaphors and rituals of the culture and
identify sources of resilience and social capital. Figure 2.3 illustrates a “Tree of Life” exercise
that helps build self and collective efficacy and social capital. Therapists craft questions that
help transform perceived failure into seeds of resistance, often drawing on the wisdom and
resources of earlier generations.

Self and Collective Efficacy

Tree of Life Exercise

Roots: Who are your people and places of belonging?

Trunk: What are your strengths? What things can you do?

Branches: What are your hopes and dreams?

Leaves: Who are the people close to your heart?

Fruits: What are the gifts you’ve been given by others?

Figure 2.3 Tree of life exercise.

Source: Adapted from Just Therapy team, Family Centre, Wellington Aotearoa/New Zealand ( http://www.
familycentre.org.nz/).
 Guiding Principles for Socioculturally Attuned Family Therapy 49
Envision
The Just Therapy team supports the emergence of new knowledge and paradigms among
family members and encourages cultural capacity building. Waldegrave (2003) offered an
example of the team’s reflection to a Samoan immigrant family whose children were assigned
to a State Home. The therapist conveyed appropriate cultural respect to the parents while
also supporting accountability. This excerpt from a larger statement addressing each member
of the family helped them envision themselves and their future positively:

[to father] Sami, the team has heard today from you, and all the members of your family,
about your changes. They know that you know just how dangerous your drinking has
been to the family. Your family can smile again now that you don’t come home drunk.
Because you have succeeded in this, your children and your wife are not afraid of you
like they used to be … [to all] you are beginning to trust each other and the team knows
that all of you know this is the start of good and happy family life. (p. 46–47)

Transform
At the micro-level, families transform problem-centered visions of themselves to create new
meanings that inspire hope and resolution. At the macro-level, staff and the community
become involved in projects that promote social and economic well-being. The goal of one
such project is to restore well-being and resilience to families, children, youth, elders, and
villages in Samoa severely impacted by the September 2009 tsunami (Tamasese &
Waldegrave, 2012b). The project addressed outcomes such as appropriate and affordable
housing re-established, water and electricity supplies connected, and young people returning
to school, as well as looking out for each other and drawing on positive and liberative
elements of culture.

Summary
Socioculturally attuned family therapists begin by attuning to the societal and power contexts
that surround and give meaning to the presented client concerns, as well as the sociocultural
context of the therapy itself. Knowing therapy holds the potential to replicate and reinforce
inequitable societal structures and discourses––or to challenge the status quo and invite more
equitable possibilities––SCAFT therapists are attentive and intentional regarding the values
their work represents. They therapeutically identify and name qualities and experiences
dominant social systems overlook or minimize, especially those that resist domination and/or
help maintain resilience in unjust circumstances. SCAFT therapists connect the dots between
larger societal processes and what happens in the therapy room, developing interventions that
disrupt oppressive power dynamics and support equitable relationships. They help clients
envision third order change—just relational alternatives beyond the limits of dominant social
discourses—and they help clients make what they envision real, transforming the ways they
relate to each other and the larger society.
We conclude with a checklist of ANVIET practices (Figure 2.4). We encourage you to
keep it handy. Look for how they are applied across contexts and in the models that follow in
this book. As you pay attention to the many clinical examples, consider what they will look
like in your practice, how you will make them yours, and what you will need to learn and
develop to apply and advance these practices. Consider that each therapist will implement the
ANVIET practices through their preferred clinical models, social locations, and personal
styles. We encourage practice and innovation. In the next chapter, we address third order
50 Guiding Principles for Socioculturally Attuned Family Therapy

Attune: Understand, resonate with, and respond to experience within societal contexts

Name: Identify what is unjust or has been overlooked - amplify silenced voices.

Value: Acknowledge the worth of that which has been minimized or devalued.

Intervene: Support relational equity - disrupt oppressive power dynamics.

Envision: Provide space to imagine just relational alternatives.

Transform: Collaborate to make what is imagined real - third order change

Figure 2.4 ANVIET practices checklist.

ethics and self of the therapist issues that will be important as you immerse yourself in so­
cioculturally attuned practices and make them yours.

Reflexive Questions
• In your own words, how do you describe third order thinking? How does it lead to third
order change?
• What does it mean to be able to connect the dots between individual and relational
problems, power dynamics, and broader societal systems and environmental contexts?
• Who and what gives legitimacy to certain types of knowledge? How does this affect your
practice?
• Which social structures have the greatest impact on the families/clients/communities
with whom you currently work?
• What advantages and disadvantages do you have based on your cultural and social
capital? How does this affect your work as a therapist and the persons with whom you
see in your practice?
• What do the spaces and places that you inhabit or frequent say about you, your social
location, and your privilege and/or disadvantage? Are these spaces mostly similar or
different from your clients?

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3 Third Order Ethics and Contextual
Self-in-Relationship

Family therapy has progressed into an era in which we better understand the impact on
individuals and families of sociopolitical contexts at local, national, and global levels. As a
field, we better understand the negative impact of oppression and the consequences of in-
terconnected social locations on material and social circumstances that impact family life.
Responding to these unjust social processes is an ethical issue that requires purposeful action
(Williams et al., 2022). We are called upon to integrate foundational, tried, and true family
therapy clinical practices with intervening to promote equitable relationships to help solve
everyday problems. Socioculturally attuned ethical decision-making requires integrating the
impact of culture, power, and societal systems into everyday practice. Family therapists must
be able to honor clients’ cultural values and worldviews while simultaneously challenging
unjust relationships. Third order ethics begins with being aware of and accountable for the
impact on the everyday practice of how we think—what we consider to be right and true.
Third order thinking brings to the forefront dilemmas that may otherwise be veiled.
Expanding our understanding of individuals and families within cultural and societal contexts
adds a layer of complexity to what it means to “do the right thing.” For example, what do we
do when clients’ goals are at odds with what is just for all family members? How do we
position ourselves when we believe honoring cultural values and beliefs contributes to op-
pression? How do we navigate the process of raising awareness when doing so may disrupt
relationships? How do we differentiate between what is simply common in a social setting
or cultural group but not truly culturally supported as beneficial to all? What is our role in
encouraging clients to unveil taken-for-granted cultural assumptions and practices that are
unjust and harmful to themselves or others? How do we navigate differences in cultural
values and worldviews between clients and/or between ourselves and clients? Making these
types of decisions requires us to not only be socially and culturally aware in general but to
continuously consider how our own context shapes how we think and what we do. In effect,
we are perpetually embedded in the process of ethical decision-making (Larner, 2015;
Scher & Kozlowska, 2012).

Codes of Ethics
At the most basic level, ethical positioning is a stance in which one is clear about the need to
engage with clients in ways that are consistent with ethical guidelines and principles. We
typically think of ourselves and others as practicing ethically as long as we don’t break our
professional code of ethics. We tend to “notice” ethics when ethical dilemmas arise, which in
turn leads us to carefully consider and consult others regarding the best course of action.
While this is essential to professional practice, we agree with Larner (2015) that attending
only to these types of dilemmas tends to eclipse the everyday nature of ethical decision-
making. Everything we do––or don’t do––reflects what we consider to be ethical and right.
DOI: 10.4324/9781003216520-3
54 Third Order Ethics and Contextual Self-in-Relationship
There are nine standards in the American Association for Marriage and Family Therapy
(AAMFT) Code of Ethics. It is noteworthy that the very first standard, 1.1 is Non-
Discrimination. It reads as follows: “Marriage and family therapists provide professional as-
sistance to persons without discrimination on the basis of race, age, ethnicity, socioeconomic
status, disability, gender, health status, religion, national origin, sexual orientation, gender
identity or relationship status” (American Association for Marriage and Family Therapy,
2015). In spite of its primary position in the code of ethics, many students and licensed family
therapists intentionally or unintentionally position themselves in ways that are not aligned
with this standard. Rejecting this standard may be overt, involving a conscious choice due to
conflicting personal codes of morality, values, religious beliefs, cultural norms, or biases
(Caldwell, 2013; Priest & Wickel, 2011). For example, the statement “I don’t believe I can
work with same-sex couples because I cannot in good conscience support their union
or marriage or help them work toward their clinical goals,” is a stance that knowingly
contradicts our non-discrimination standard. Failing to align with this standard may also be
less obvious. In these cases, family therapists are not likely to realize they are engaging in
discrimination. Examples include working harder with a high-status client than a low-status
client; failing to acknowledge one’s own racial, class, gender, or sexual orientation privileges;
using Eurocentric models without considering cultural fit, and expecting women to take
on the majority of emotional work in couple therapy.
It is not always easy to discern complex ethical dilemmas inherent to practicing socio-
culturally attuned family therapy. Consider AAMFT Code of Ethics Standard 1.8, which
requires respecting client decision-making autonomy. At first glance, it is easy to agree
that clients should make up their own minds about whether or not they divorce, how they
arrange child custody, what family form they choose, and so on. On the other hand, what
happens when we think beyond individual autonomy? What if one family member has
decided to accommodate another due to a power imbalance, even though doing so con-
tributes to mental health issues or somatic complaints? What about when we expect clients
to be able to make and carry out “autonomous” decisions without factoring in varying social
and economic constraints?
Third order ethical practice embraces the collective commitment to professionally and
ethically serve the public, while at the same time recognizing that all decisions are grounded
in cultural values and assumptions within social context. Codes of ethics themselves reflect
the cultural values of those who authored them. For example, the AAMFT code of ethics
serves as a set of standards that are situated within and reflect common or dominant (Western)
cultural values within a North American context, yet considered universally benevolent. This
can inadvertently lead to colonization when the code of ethics and best practices in North
America are “transplanted” to other countries without consideration of cultural and societal
context. Sociocultural attunement requires careful consideration of cultural biases and how
those in dominant positions of power unevenly impact what is deemed ethical practice.

Practicing Third Order Ethics

Third order ethics involves reflecting on how we conceptualize what we consider ethical as
well as what we assume to be in the realm of ethics. Ethics are by definition relational,
however, a number of scholars in the field (Gergen, 2015; Hecker & Murphy, 2015;
Boszormenyi-Nagy & Krasner, 1986) have used the term “relational ethics” to refer to the
ubiquitous nature of ethics in our everyday relationships with clients (Larner, 2015). This
includes a focus on meaning-making (Gergen, 2015) within societal contexts in which
dominant cultural values are often accepted as right across the broadest and most intimate
levels of relationships (Hecker & Murphy, 2015). When we are fully embedded in the
 Third Order Ethics and Contextual Self-in-Relationship 55
societal and cultural contexts in which we work––that is, unable to step back and think about
how we think––we risk being relatively unaware of everyday ethics. Gergen (2015) referred
to this as first order morals. He argued that second order morality is possible when we are
aware of how meaning is made between us on a relational level.
Hecker and Murphy (2015) added what we would consider a third order ethical position
by taking a meta-perspective of relationships within context, which includes analyzing power
dynamics at the broadest and most intimate levels. By taking a third order perspective,
therapists are able to recognize ways in which dominant cultural standards and practices
tend to better serve those with more social power (e.g., male, white, high SES, cishet).
Socioculturally attuned family therapists are intentional about interrupting processes in which
social power operates through those with more privileged social identities being viewed as
more credible and having greater influence over what is considered right and true. As Fricker
(2007) noted, processes in which those with more power shape social meaning result in
invalidating or minimizing the experience and “truth” of those with less power (e.g., BPoC,
women, LGBTQ, low SES, differently-abled, citizens of the Global South). Fricker referred
to devaluing and dismissing non-dominant knowledge––in effect rendering it silent––
as epistemological injustice. Thoughts and experiences that are not part of dominant (or
sometimes even public) discourses become further marginalized without language to express
them or create collective meaning.
Third order thinking includes thinking about how we think and the effects of our thinking
on the lives of those with whom we work. We rarely consider our ontologies—how we
view the very nature of being—when practicing family therapy or producing professional
knowledge. Our ontological imaginations (Norwalk, 2013) are limited by what we “know”
to be true within our accepted realities. Consider the gravitation of Western family therapists
toward integrating advancements in neuroscience in our understanding of relational at-
tachment. Contrast this with a relative lack of interest in the West of accessing the spirit
world to help families. As you read these last two sentences, you may have found yourself
thinking “but, neuroscience is real!” What we consider to be real is, in effect, filtered
through an ontological lens.
Epistemology, which is closely tied to ontology, refers to what we consider to be legit-
imate knowledge, which in turn is determined in part by how knowledge is created and
acquired. Consider the evidence-based therapy movement. Those models that have gone
through a systematic research process that demonstrates desired outcomes are valued from
a Western scientific epistemology (Harding, 2008). Contrast this with the knowledge of
experienced family therapists who stay current with existing research, are informed by theory
and guided by models or frameworks, yet go beyond this knowledge by using their “clinical
wisdom,” embodied knowledge, and clients’ wisdom to create a gestalt that guides the
process in any given situation. This type of knowledge may be delegitimized and pushed to
the margins in favor of what can be more easily manualized and measured. Ontological and
epistemological flexibility allows us to move across and within diverse ways of understanding
while thinking beyond limiting dichotomies and single systems of thought.
In Text Box 3.1, Rockey Robbins describes decolonizing, Native healing practices that
resist White-dominated ontologies and epistemologies that are foundational to the Western
conceptualization of mental health and mental health practice.

Contextual Self-in-Relationship
Third order ethics asks us to routinely inspect our assumptions, values, and preferred the-
oretical concepts and practices; to engage in continuous reflection about what we are doing
and why.
56 Third Order Ethics and Contextual Self-in-Relationship

Text Box 3.1 Rockey Robbins, PhD

Rocky Robbins (he/his/cisgender) is a professor in Professional Counseling at the

University of Oklahoma. His work with families, both as a counselor and researcher,
integrates holistic Native American philosophy and healing practices and is
situated in the air, mineral, plant, and animal worlds.
While narrative therapy, with its emphasis on storytelling, deconstruction, use of
metaphors and social justice, supplements my work, it is not the core foundation
that guides me. All Western psychological approaches re-inscribe preferred White
knowledges. The primary healing principles and ways I draw from are those
provided in the sweat, peyote, and sun dance ceremonies I attend. Western
psychological approaches typically emerge out of the English language and have
epistemological and ontological assumptions that are foreign to Native American
ways of seeing and being in the world, as has been aptly demonstrated in my
research with Western psychological assessment instruments and other studies.
This said, many Native Americans have become assimilated, though never
completely, into mainstream American society. Working with many “assimilated”
Native Americans in my research and counseling, I have combined Native
American healing practices with Western counseling. Every attempt to tap into
traditional Native American healing ways is an apocalyptic form of resistance
against a white system that dominates every particle of the air we breathe. I have
attempted to honor our tribal cultural capital, as I have consistently discussed and
researched the healing impacts of visits to tribal geographic origins, sweat
ceremonies, sun dances, stomp dances, vision quests, work with medicine
people, and communication with ancestor spirits.
Conducting family therapy (which always includes grandparents), I utilize a
variety of techniques relevant to Native Americans. To name only a few: I have
facilitated families in their deconstruction of Christian colonization, delineated
White surveillance, imploded internalized Western cardinal virtues showing how
their opposites are embedded within the concepts themselves, used “completing
the circle” technique for clients to consider any part they may have played in any
conflict they might have, a “healing rock” technique in which family members
gather a “ugly rock” to represent negative experience with their family and a
beautiful rock” for something positive, and used a “story telling grafting”
technique having family members to retell and expand their stories having heard
stories describing the same event by other members.
Recently I have conducted many multi-family marathon groups. I have written
a half dozen research articles on their effectiveness in promoting ecological
awareness, improved interpersonal and familial relationships, and enhanced
tribal/cultural identities. Traditional songs, dances, and medicine people are often
a part of these group activities. Some of the activities involve: beauty walks
through nature and journaling, mother-earth/father sky meditations, and brief
expeditions into wooded areas in search of certain kinds of trees, medicine
plants, and flowers (always honoring nature with tobacco).
The most common positive outcomes in both single and multi-family therapy
reported has been in improved relationships among family members, enhanced
tribal/cultural identity, improved lateral relations in cross tribal relations, greater
critical awareness concerning the impact of colonization on themselves and
their family and tribe, more profound relationships with nature, and balancing
 Third Order Ethics and Contextual Self-in-Relationship 57

living among White folks in a healthy way and maintaining traditional Native
American ways.
Lastly, I attempt to help those I work with to transcend the anxiety that is
typically associated with transformation, to instead simply return to being in a
balanced meaningful way, experiencing contentment in the context of the larger
surroundings, even amid strife.

⤝⤞

Third order ethics requires therapists to make clinical decisions with an eye
toward societal and cultural context, including the impact of therapeutic
interventions in relation to power and privilege.

⤝⤞

Doing so results in questions such as: Why am I favoring this way of looking at things?
Where do my routine assumptions come from? Whose worldview do they represent?
Whose interests are centered? In what ways does my approach to understanding and
helping to solve problems marginalize or minimize some clients’ perspectives and ex-
periences? How do my ways of thinking reflect and reproduce dominant cultural values
and practices? How is what I am doing and saying supporting equity and/or challenging
what is unjust? In Text Box 3.2, Tim Baima shares insights about the importance of being
intentional in this process.

Text Box 3.2 Tim Baima, PhD, LMFT

Tim Baima, (he/him), Ph.D., LMFT is an associate professor at Palo Alto University
in California. More of his work is described in chapters six and seven.
As a White cis-gendered straight man, I am seldom required to be mindful of
sociocultural context as I go about my day-to-day life. Over time, with intentional
effort, I have become more attuned to the significance of sociocultural context,
and the role of power and oppression in my life and the lives of others. However, in
order to attune to sociocultural context in my work, I remind myself that I am deeply
conditioned to be misattuned, unresponsive, and emotionally disengaged from
sociocultural context. If I am going to be attuned to sociocultural context, I must be
intentional about it.
The work I do to support 3rd order change in therapy is first and foremost rooted
in the work I do on myself. I do not believe it is possible to embrace 3rd order
thinking in our role as therapists alone. In order to be effective in facilitating
3rd order healing and transformation, it is essential to commit to dismantle
systems of oppression in every aspect of our lives, including in the most intimate
spaces in our relationships and in our own hearts and minds. In my view, this
commitment is a commitment of radical transformative love that nurtures spiritual
healing and growth.
58 Third Order Ethics and Contextual Self-in-Relationship
Therapist Social Location
⤝⤞

Ethical positioning is not possible without self-reflexivity, critical social

awareness, and the ability to support relational justice.

⤝⤞

Self-reflectivity and critical social awareness are especially important for those in structurally
ascribed positions of power, including family therapists. Arguably, those who have the most
social capital and ability to influence are most responsible for facilitating necessary and im-
portant changes that lend themselves to equitable and just practices (Almeida et al., 2008;
Hernandez & McDowell, 2010). Socioculturally attuned family therapists need to develop
contextual consciousness in addressing issues of gender, societal power, and culture in clinical
practice (Stone & ChenFeng, 2020). This includes attending to one’s own experience of
racial privilege and oppression (McDowell et al., 2003) as well as the impact of one’s own
cultural background (Ellenwood & Snyders, 2006; Hardy & Laszloffy, 1995; Hardy &
McGoldrick, 2008). Stephanie Brooks shares her experience of navigating dominant ex-
pectations with her social location, cultural values, and activism in the family therapy field
in Text Box 3.3.

Text Box 3.3 Stephanie Brooks, PhD, LCSW, LMFT

Stephanie Brooks is a professor and Senior Associate Dean of Health Professions

& Faculty Affairs at Drexel University. More of her work is described in chapter nine.
Post my family therapy training, I spent many years trying to reconcile my
intersecting identities, collective/relational perspectives and daring to be visible,
and finding my voice as a black woman. The definition of “good family therapy”
created tension and clashed with many of my cultural values. My goal was to learn
how to be a therapist that honored my whole self vs. the dominant culture. I am
because of the We. I bring that awareness to my work and seek to be intentional to
create space for people to honor who they are and transform clinical and
educational systems that are rooted in racist practices and perpetuate historical,
structural and systemic oppression.

To successfully attune to clients within their social and cultural contexts, family therapists
need to uncover and correct biases that contribute to social inequity and inadvertently
support unjust relationships (D’Aniello, et al., 2016; Knudson-Martin et al., 2020). It is vital
for family therapists to reflect on their heterosexist biases, and heterosexual and cisgender
therapists to examine their privilege (Adams & Benson, 2005; McGeorge & Stone Carlson,
2011; Nealy, 2008). Additionally, we must develop an awareness of how internalized op-
pression, such as internalized sexism and racism, operate within us to perpetuate patriarchal
structures, white privilege, and androcentric norms (Ellis & Bermudez, 2021; Sharp et al.,
2007). This process is ongoing. People, cultures, and societal systems are always changing.
Attunement is a way of being in which we never fully arrive; we must humbly commit to
ongoing reflexivity and growth.
 Third Order Ethics and Contextual Self-in-Relationship 59
Awareness of Power
Power dynamics are ubiquitous. We are often blinded by our own positions of power and
the mechanisms that support our privilege. This occurs by simply failing to inspect and
acknowledge the ways in which our epistemological frameworks marginalize the lifeworlds
and experiences of others (Fricker, 2007). Mental health symptoms and relational problems
may be outcroppings of ways of resisting oppression. By accepting at face value symptoms
that result from subjugation, we risk contributing to oppression by defining those who
express symptoms of inequity as the problem.
We also engage in subtle cultural wars in daily practice as we press colleagues and clients to
accept our practice models and perspectives of mental and relational health. That said, we
often hear beginning family therapists say they want to “flatten the hierarchy in order to
empower clients.” They appear nervous about taking a stance, perhaps assuming that in-
fluencing clients is by its very nature unethical. We join others who have postulated that
attempts to reject the varying levels of power we hold as therapists can inadvertently support
the status quo of social inequity. We also acknowledge that some therapists may be viewed by
clients (supervisors and/or administrators) as not having the legitimacy required to hold
therapeutic influence based on marginalized social locations.

⤝⤞

Awareness of power is a critical first step in engaging in ethical practice

regardless of theoretical orientation.

⤝⤞

We must also attend to power outside the therapy room, relative to our communities and
practice settings (McGoldrick et al., 2021). Not all therapists and supervisors are in a position
to challenge systems in which families are embedded or in which therapy takes place.
Supervisors from the dominant culture may be surprised to learn that supervisees may not be
willing to challenge people in a system that exacerbates their vulnerability. For people of
color, women, those with disabilities, immigrants, etc., this vulnerability may always be
present, regardless of the years of experience, educational degrees, or positions of power
(Hernandez et al., 2009). Challenging powerful people within a system has to be done
carefully, always gauging and balancing risk and reward. It is vital that we work together,
sharing our power to collectively interrupt and transform harmful power dynamics
(see Chapter 15).

Myth of Neutrality
Early on, therapists were expected to be objective and neutral to avoid contaminating or
negatively affecting clients’ clinical processes with their own biases and assumptions (Slife
et al., 2003; Tjeltveit, 1986). As described in the preceding chapters, therapists are neither
neutral umpires nor one who stands above the conflict.
They take the side of each family member, being empathic and fair toward everyone while
positioning their work to promote just relationships—a position similar to what
Boszormenyi-Nagy and Sparks (1973) called multi-directed partiality. Each person is im-
portant; deserving to be understood and valued. Socioculturally attuned, multi-directed
partiality is vital in gaining and restoring mutual trust within the family, maintaining cred-
ibility as a therapist, and ultimately prompting just relationships (Knudson-Martin & Kim,
60 Third Order Ethics and Contextual Self-in-Relationship
2022). At this point in history in which families and communities are being stressed and
pulled apart due to political polarization, it is more important than ever that therapists are able
to connect and create bridges across disparate points of view.
Feminist family therapists were among the first to challenge the myth of neutrality,
pointing to ethical concerns surrounding the assumption that therapists can be objective.
Early on, Betty Carter (1985, p. 78) argued that “You cannot not act out of your age, gender,
sibling position, experience, belief system, and wisdom, or lack of it. Your only choice is
whether to do this consciously or unconsciously.” They critiqued foundational notions of
circularity, neutrality, and complementarity, arguing that these concepts do not address issues
of power and control inherent in family life and therapeutic processes (Bograd, 1984;
Goldner, 1985); that neutrality is far from neutral. In fact, because most therapists have the
power to influence clients in significant and lasting ways, postmodern and critical feminists
asserted that therapists must operate from a transparent value position (Knudson-Martin &
Kim, 2022; Leslie & Southard, 2009; Melito, 2003). We must engage in ongoing, thoughtful,
contextual self-reflexivity to take an intentional relational stance that supports just re-
lationships in equity-based practice (Hardy & Bobes, 2017).

Use of Power in Practice

Power inherent in the very nature of being an expert (i.e., role power as a therapist) does
not necessarily ameliorate power based on social location. Therapists with less privileged
social positions may need to use their power to gain credibility and influence when clients are
unconsciously discrediting them or needing more leadership. For example, therapists who are
young and/or persons of color may not be afforded the privilege of lowering their profes-
sional position of power when their structural and systemic levels of power threaten their
stance as therapists. It is at times necessary for people in less powerful social or structural
positions (e.g., women, persons of color, or those with a particular disability or difference) to
embrace and elevate their power to help clients achieve their goals. This is done carefully,
with humility and confidence that therapists know how to use their power as leverage to help
them be effective, credible, and compassionate.
Therapists must be able to maintain their positions as experts while addressing interactions
in ways that encourage clients’ accountability and change. Let’s consider racism directed at
Cecilia, a therapist of color as an example. McDowell and colleagues (2003) described their
participation in a group working on racial awareness and taking anti-racist stances in therapy.
Following is an excerpt from their paper (p. 189-190).

Client: I always thought when you called someone Mexican that it was derogatory.
Cecilia: Why do you think that?
Client: I guess it’s just the way people use it. I’ve always tried to use Hispanic because I
thought it was much more proper.
Cecilia: When you use the word Mexican, what do you think of ? … . You are not going to
offend me.
Client: It’s like there are different classes. When I think of Mexican, I think of people in a
lot of trouble, people who don’t speak English, more straight from Mexico. When I
think of Hispanics it could be anybody else.
Cecilia: So Mexican conjures up bad things for you.
Client: They are a different class of people.
Cecilia: So for you when you think of Mexican, the terms that come up for you are not as
good as White.
Client: Yeah, mm-hmm.
 Third Order Ethics and Contextual Self-in-Relationship 61
Cecilia: So now that you know I am Mexican, (Cecilia used this term purposefully to
challenge the client’s view of Mexicans) what does that mean to you?
Client: No matter what race anyone is, it doesn’t bother me. I’m not racist; the only thing
that bothers me is when someone can’t speak English. I think they are ignorant.
I can’t help it.
Cecilia: But I am still wondering, does the fact that you know I am Mexican, does that
affect how you think of me?
Client: I don’t think of you as Mexican. I think of you as Latina.
Cecilia: What if I would have called myself Mexican instead of Latina, would you have
thought differently of me?
Client: No, I would have thought of you as Hispanic. The only people that fit my negative
view of Mexicans are people I don’t know. Everyone I have ever gotten to know
doesn’t fit the stereotype.
Cecilia: Once you meet someone that doesn’t match the stereotypes––What do you do?
Client: Every Hispanic person I have ever met doesn’t fit the stereotype.
Cecilia: This is very interesting. What is it like for you for us to be talking about race like
this?
Client: I like it, I guess I’m not racist, but maybe I have a lot of misconceptions. I don’t
want that. My parents were very prejudiced.
Cecilia: So is it okay if we talk about this again as it comes up?
Client: Yes, I would like to get into the topic of race. Like I have always wanted to date
cross racially but don’t know how I would deal with my family.
Cecilia: Okay. We are learning together here. You are helping me understand also. We can
work together on this.
Client: I’d like to talk to my family about it.
Cecilia: Yeah, race is a difficult thing to talk about. It seems important that we find a way
for you to talk to your family about this.

The authors (McDowell et al., 2003) discussed co-author Cecilia’s ability to regulate her own
emotions while her client expressed overt racism toward her. They pointed out that the
therapist was able to maintain an inquirer stance, slow the process down to allow space for
the client to explore thoughts about race/ethnicity, and connect the client’s (lack of) racial
awareness to therapeutic goals. The therapist in this scenario had the knowledge, fluency, and
self-awareness to challenge what was happening in the moment while leading a conversation
that allowed the client to openly express and begin inspecting his racism.

Self-Disclosure and Relational Engagement

Issues around therapist self-disclosure are complex (Roberts, 2005). Socioculturally attuned
family therapists recognize these complexities and navigate self-disclosure in ways that allow
them to use their identities to encourage equitable relationships in families. In the example
above, Cecilia decided to disclose her Mexican heritage to help her client recognize racism
and its effects. The decision to disclose was carefully timed to both maintain and leverage
the positive relationship between the client and therapist. In Text Box 3.4, Dana Stone
shares making decisions about self-disclosure and inspiring self-awareness as an educator and
supervisor.
There are some aspects of our identities that are (correctly or not) assumed by clients and
other aspects we have control over sharing. Abilities, sexual identity, gender, race, and age
may be visible or invisible, confounding what is known or assumed about us as therapists. We
have at least some choice (depending on our context) over how much and what we share
62 Third Order Ethics and Contextual Self-in-Relationship

Text Box 3.4 Dana Stone, PhD, LMFT

Dana Stone (she, her) is an associate professor at California State University in

Northridge, and identifies as a multiracial Black-white, cisgender female, hearing,
temporarily able-bodied, heterosexual, and non-religious. Her work focuses on
multiracial experience and supporting early-career therapists with marginalized
aspects of identity in navigating the field of marriage and family therapy and
counseling. More of her work is described in chapter 15.
Specifically as an educator and supervisor, it is innate in me to foster connection
with others by sharing parts of my identity, my journey in this field, and to invite
students and supervisors to share parts of their stories with me and each other.
I believe sharing of the “self” in this way levels the hierarchy. While I know that
I hold power and privilege as the teacher or supervisor, I genuinely believe that
students in my classroom and supervisees in the group offer so much and can
“teach” each other in ways I cannot. I integrate conversations about power and
privilege regularly to encourage ongoing critical engagement with the self.

about our life experiences. This is the topic most associated with training in self-disclosure.
We ask ourselves questions like “Am I sharing this to help the client? How will it be helpful?
How will it impact our therapeutic relationship?” and “How does self-disclosure fit into the
model I am using?” But what about differences that put the therapist in a one-down position
relative to the broader societal context? How are these decisions made when the therapist has
a choice about whether or not to disclose an experience or social identity? What about when
a pansexual, gay, or lesbian therapist is working with a homophobic client? Or with a family
in which a teen is coming out to parents who are fundamentalists? When does the therapist
disclose sexual orientation to show solidarity and ally with a client or some members of
a family?
There are no simple answers to these questions. In the example above, Cecilia was able to
engage the client in a discussion about race and, in the process, disclose her own identity
because she was guided by her relational socioculturally attuned stance that invited questions
based on curiosity and respect, while also using her role as a therapist to open questions
related to race and equity. Cecilia was able to take this stance and make appropriate ethical
clinical choices in the moment because she regularly engaged in critical self reflection, be-
coming what Stone and ChenFeng (2020) call contextually differentiated.
It can be difficult to attune to the emotions of those in social positions that differ from
our own. In fact, we often assume what we feel, or imagine ourselves feeling, in another’s
situation is normal without considering culture, relational power, or societal context.
Exploring sociocultural context, including our own positionality, perspectives, and
emotions relative to societal contexts, is vital to our ability to assess and analyze power
dynamics on both broad social and intimate relational levels, and as much as is possible,
take in and resonate with another’s sociocultural experience. When one is contextually
aware, it is possible to be in touch with one’s emotions and use this information to guide
relationally directed clinical responses that promote equity and third order change (Garcia
et al., 2015). In socioculturally attuned practice and application of third order ethics,
thinking relationally and thinking contextually go hand in hand (Hardy & Bobes, 2017;
Kim et al., 2017).
 Third Order Ethics and Contextual Self-in-Relationship 63
Tensions in Socioculturally Attuned Practice
There are a number of tensions we experience as we come to define ourselves as socio-
culturally attuned family therapists. At times these tensions seem like irreconcilable differ-
ences. At other times it seems perfectly compatible to take a both/and position. We
encourage readers to not see these tensions as dichotomous, but as continuums or at times
competing values and goals. While there are many tensions in ethical equity-based work, we
have chosen to emphasize the importance of recognizing the ways in which societal systems
constrain personal agency, helping clients grapple with decisions about resistance to op-
pression, honoring clients’ perspectives, being culturally sensitive while challenging
oppression, and using power to balance power. We do not attempt to offer universal so-
lutions, rather we hope the following will help readers consider the complexities and prepare
to make decisions involved in equity-based therapy.

Recognizing Societal Constraints on Personal Agency

Equity-based therapists are often in a position of reconciling tensions between encouraging
clients’ personal empowerment and helping them negotiate societal constraints that limit
their agency. Many of us fall into the trap of thinking everyone can choose a different way of
thinking, being, and living. This is a privileged perspective that leads us to assume we all have
(enough) choice. We often assume clients can achieve anything they put their minds to if
they change their thoughts and perspectives, or assume responsibility for their situation and
actions. This rings of the myth of meritocracy, which is a common belief that we can “pull
ourselves up by our bootstraps” to overcome adversity, be successful or achieve our goals.
We can fail to acknowledge that all of us, to varying degrees, have social and structural
constraints that block our agency. For example, worldwide, women and girls are still pre-
vented from having equal access to education, safety, control, voice, leadership, employment,
and equal pay. LGBTQ people live with the daily oppression of heteronormativity and
homophobia. People of color continue to experience the oppressive effects of colorism/
racism, white supremacy, and internalized racism. Those who live on low income are often
geographically limited without equal freedom of movement or access to food or employment
opportunities (McDowell, 2015).

⤝⤞

Therapists help families identify strengths and tap into resilience, yet when the
session is over, many return to oppressive contexts.

⤝⤞

It is difficult and disconcerting to acknowledge the complexity of social position, inequity,

and socioeconomic status. People reared in a privileged or even moderate income bracket are
often oblivious to the struggles of those living on severely low incomes. Economic security
buffers many of us against the real material consequences of limited or scarce resources
(McDowell, 2015). For example, in a natural disaster, state of emergency, or crisis situation,
wealthy individuals and families have greater access to resources that help buffer the crisis.
The real life consequences of inequitable access are tangible and affect how we embody
space, pursue or access resources, and both perceive and realistically gauge our choices.
Furthermore, mechanisms of marginalization and oppression have a cumulative effect placing
those in the most disadvantaged positions at higher risk, which in turn creates greater
64 Third Order Ethics and Contextual Self-in-Relationship
disadvantage across the lifespan (Merton, 1973, 1988). Therapists can help clients resist in-
ternalizing oppressions while navigating the effects and maximizing agency within con-
straining contexts. Therapists can also be allies for change by supporting clients’ efforts to
transform social arrangements within their spheres of influence, e.g., individual, family,
community, broader society.

Case Example
Marty, a white middle-class lesbian family therapist landed her first job out of graduate school
providing in-home therapy to primarily people of color living on low income. She exuded
positivity and consistently demonstrated the ability to deeply care about all of those with
whom she worked. She had firsthand experience of marginalization, oppression, and micro-
aggressions that stemmed from homophobia. She was nervous but excited to get to work, to
help her clients change their lives. She engaged clients in hopeful conversations drawing on a
strength-based therapeutic approach.
Within a few months, Marty found herself feeling increasingly less competent, even
dreading the work she had once been so excited about. After a particularly frustrating family
session, she finally blurted out “I just don’t see what I am doing wrong! Why my clients
aren’t getting better!” Marty’s supervisor asked her to explain what she meant by “getting
better,” as Marty’s clients typically reported that therapy was going well. During the su-
pervisory conversation, Marty was surprised to realize she held the assumption that anyone
can change their social status if they overcome psychological and relational problems. She
held unquestionable goodwill and an unwavering belief that clients have the strengths they
need to overcome problems. What she hadn’t realized is that the assumption she held about
her work––that as a therapist she could help clients overcome poverty by encouraging in-
dividual and relational change––was not only naive but inadvertently blamed clients for their
own oppression. With time and experience, Marty would begin to recognize her role in
supporting clients being able to both navigate and transform unjust systems within their
families and community.

Working with Complexities and Potential Costs of Resistance

Family therapists witness daily the mechanisms and impact of everyday resistance. According
to Vinthagen and Johansson (2013), “everyday resistance is about how people act in their
everyday lives in ways that might undermine power” (p. 2). Everyday resistance is not always
easy to discern, as it is often hidden or disguised, in some cases as mental health or relational
symptoms. Socioculturally attuned family therapists pay close attention to the nuances of
power and carefully scan for forms of resistance to locate what is unjust and help families
move towards equity-based solutions.
This process of ferreting out and responding to resistance is complex and replete with
tensions. A common tension is related to assessing the extent to which clients respond to
subjugation by resisting, coping, or a combination of both. For example, some people re-
spond to intimate partner violence by enduring for a while, for a long time, or indefinitely.
Another option is to fight back using covert or overt resistance. In many cultures, such as
those in Latin America, women are valued for emulating the Virgin Mary by being sub-
missive, virtuous, and enduring hardship or suffering with acceptance and grace (Falicov,
1992). Even when faced with maltreatment and subjugation, girls and women in strongly
patriarchal and misogynous cultures are taught to endure, “aguantarse” as stated in Spanish, as
a badge of honor (Falicov, 1992). These cultural values can create tension in equity-based
work that values both culture and liberation. Solutions may need to be complex, including
 Third Order Ethics and Contextual Self-in-Relationship 65
covert resistance if clients cannot leave a violent or oppressive system. Decisions to resist and
decide which forms of resistance to use must be balance what is healthy, necessary, and useful
with very real and tangible potential consequences.
There are many forms of resistance to abusive or subjugating power. Strategies include
education about societal systems and power dynamics (Freire, 1970/2000), disloyalty or
disobedience to oppressive systems, identity movements, coalition building to take collective
action, engaging in revolution, and refusing to accept dichotomous thinking and choices
(Heldke & O’Connor, 2004). Other types of resistance include yielding when the cost of
overtly challenging is too high, withdrawing when situations are unbearable, and under-
standing how to navigate dynamics of power and oppression. Directly challenging oppressive
and dominant systems can be risky. Potential costs include not being believed and/or being
labeled as a problem. These must be weighed against the likelihood of positive change.
Those with the greatest privilege take the least risk in speaking out directly to promote
change in family, community, and societal systems. They are most likely to be believed and
be able to influence change with the most modest personal consequences. Conversely, those
most marginalized take the greatest risk, being less likely to be believed and potentially paying
the greatest personal cost. Another way to resist is to recognize and challenge how un-
examined thoughts and emotions inadvertently maintain oppressive structures (Medina,
2013). Refusing to explore our own perspectives or those of others, may be a fear-based
reaction, particularly for members of dominant groups (DiAngelo, 2018; Goodman, 2011).

Case Example
Consider Chloe and Deidra, a female African American couple in a small Southern town
who kept the intimate nature of their relationship a secret from their families and church. If
their therapist believed that openness is a mark of emotional differentiation and that the
couple suffered from having to maintain their closeted position, she may have engaged the
couple in discussions about “coming out” without recognizing the important role the Black
church played in their lives and importance maintaining the story that they are “just friends
and roommates” may have been in their ability to access other important forms of support
and resilience.

Honoring Perspectives, Being Culturally Sensitive, and Challenging Oppression

⤝⤞

Socioculturally attuned therapists honor clients’ cultural values and personal

perspectives while simultaneously challenging oppression.

⤝⤞

Clients’ beliefs and preferred directions for therapy may seem in opposition to what is just.
How do therapists honor client beliefs, values, and goals when we believe they may inad-
vertently support the client’s own subjugation or the oppression of another? This goes hand
in hand with considering unintended consequences of raising critical consciousness, in-
cluding disruption to family relationships as worldviews change. The goal of being culturally
sensitive can obscure the decision between what is acceptable and what is unjust; what should
be supported as part of someone’s culture and what should be challenged even if culturally
supported.
66 Third Order Ethics and Contextual Self-in-Relationship

Text Box 3.5 Marisol Garcia-Westberg, (she/her) Ph.D., LMFT,

Therapist and Educator

I don’t feel that I am completely right about things. I know my thinking is limited, so
I have to act accordingly. I don’t want to ignore the silence and marginalization
that abounds. I try to catch myself when I am in the minutia of the issues––when I
am hyper focused on what happened. Then I pull myself out and stand on the
sidelines, looking and feeling the whole. My intellect gets me far, but I can miss
injustice and disempowerment if I don’t suspend my thinking and focus on the
energy in the room. My thinking can be biased, so I use my perception of energy to
fill in the gaps. I am limited in identifying and naming issues by my biases,
emotional wounding, and lack of awareness.
I encourage transformative change by working on my own emotional growth and
being open to challenge and to being wrong; being willing to not abide by norms
and rules which are put in place to keep injustice; understanding that systems of
oppression will not be dismantled by following rules, and supporting those doing
the same.

It is often difficult to discern when to be confident in our knowing when to be trans-

parent, when to be cautious, or when to make a direct statement that challenges or affirms a
stance. Marisol Garcia captures a thoughtful, tentative, and embodied stance about knowing
in Text Box 3.5.
Receiving feedback from therapists can be important and helpful to clients (Sundit, 2011).
This includes professional knowledge that helps families see their situation from outside
themselves. Professional knowledge, however, has the potential to be liberating and/or
oppressive. An example of this is the Harry Benjamin International Gender Dysphoria
Association, now known as World Professional Association for Transgender Health. The
Association was first created in 1979 to establish the standard of care for transgender people
seeking hormone replacement therapy. The strict guidelines were meant to help ensure that
the health and well-being of clients were held in the highest regard, even though the pro-
fessional guidelines may have not been aligned with the client’s goals or timeline. These
guidelines have proven to be liberating in some ways, including legitimizing hormone re-
placement therapy as a medical need. They also continue to be oppressive as they assume
transitioning is a problem to be publicly investigated by clinicians and agencies that often
require an undue number of sessions and a process of intrusive questioning before being
willing to support medical treatment.
Equity-based therapists view understanding of societal context and power dynamics as part
of their professional knowledge, which like other professional knowledge, has the potential
to help solve presenting problems and improve clients’ lives. Honoring clients’ choices seems
reasonable enough, but it is not always easy when a therapist believes choices are harmful to
clients or others. Can we truly respect clients’ choices if we believe they are unjust? In the
end, there are times when therapists must take a both/and stance, instead of an either/or. We
can honor a family’s way of knowing and doing, respect their choices and decisions, and
question institutional and structural practices that negatively affect them, while still honoring
the practices of the profession. We can help clients explore the nuances and implications of
cultural practices knowing that taken-for-granted cultural assumptions are not always just,
cultures are not monolithic, and oppression is routinely met with resistance in all societies.
 Third Order Ethics and Contextual Self-in-Relationship 67
Case Example
Thomas, an Asian heterosexual, middle class, male therapist entered therapy with a family
that immigrated to the southern US from China. Thomas noticed during his initial
meeting with Tina, a 45-year-old daughter, and her 81-year-old mother, Maylee, that
Maylee was often sharp tongued and critical of Tina. Tina described being married,
working in a demanding job, and caring for two teenage children in addition to caring
for her aging mother. Thomas recognized the importance of intergenerational family life
and shared Tina’s value of caring for elders. The situation resonated with his having
grown up with his own grandmother in his parents’ home. As he listened to Tina, he
reflected on what it must have been like for his mother, who was the primary caregiver
to his paternal grandfather. Thomas noticed that Tina was reluctant to stand up to verbal
abuse from her aging parent and found himself at a loss for how to help. Thomas got
caught between the shared value of caring for and respecting elderly members of the
family and the need to help his clients confront an unjust and abusive parent-child re-
lationship. Thomas needed to be able to help Tina name this conflict and work with her
to explore her options.

Using Power to Balance Power

Family therapists are in the unique and challenging position of facing competing dominant
discourses and societally supported power dynamics that differently affect clients in the
same family, often privileging some over others. Practicing from an equity-based perspective
requires therapists to be both countering and collaborative, moving flexibly between the two
to analyze power dynamics, connect and collaborate with all family members, and position
themselves to be able to disrupt oppressive relationship dynamics.

⤝⤞

Socioculturally attuned therapists value all voices in the family, not allowing
any voice to overpower that of others.

⤝⤞

Therapists must be able to challenge power to create opportunities for equitable relationships
to develop. Consider adult children who are trying to impose or dictate what they think their
parents must do in their final years. If an aging parent is able to make choices, their voice
must be heard. The therapist must intervene when the loudest voice is not that of the one
who is most negatively affected by decisions being made. The therapist is confronted with
their own power. What does this mean for the therapist? A study of how equity-based family
therapists use their power to promote equity showed that they regularly balance interventions
that actively counter injustice, with maintaining a collaborative relationship (D’Arrigo-
Patrick et al., 2016). These therapists tended to deal with their power by asking questions
rather than telling and being open and transparent as they used inquiry to help clients make
connections about social issues that impact their lives.

Case Example
Kimberly, a White, young, (cisgender heterosexual) female therapist-in -training began
working with a cishet, middle-class, White couple. The wife, Amy, had persuaded her
68 Third Order Ethics and Contextual Self-in-Relationship
husband, Kurt, to enter therapy after a particularly volatile argument. While they both
reported that their relationship had never been violent, they agreed that the level of rage
and conflict was not what either wanted or expected in their marriage. During the first
session, Kimberly was careful to talk to both Amy and Kurt to ensure they both felt heard.
She noticed, however, that Amy often repeated her complaints to Kurt who routinely
dismissed them. When Kimberly attempted to interrupt and redirect, Kurt dismissed her as
well. Kimberly firmly adhered to her interpretation of a collaborative stance in therapy,
not wanting to impose her agenda on clients. This stance left her deadlocked, unable to
find a way to challenge the power dynamic that fueled the couple’s conflict. Without a
way to facilitate the therapeutic process and use her influence as an expert to challenge
Kurt’s more powerful position, Kimberly was unable to intervene to support Amy or help
the couple develop a more just relationship.

ANVIET Informed Supervision

Socioculturally attuned family therapy supervision would require a text of its own; however,
we would be remiss in not mentioning the role of supervision in developing sociocultural
attunement and equity-based therapy. Table 3.1 provides examples of how ANVIET can be
used in supervision to guide discussions that explore contextual self-in-relationship, socio-
cultural attunement in working with clients, and sociocultural relational dynamics in su-
pervision.

Conclusion
Equity-based family therapists are faced with difficult ethical decisions and tensions relative to
our role in the change process. At times this means challenging common cultural practices
that are oppressive. It also requires us to find hidden strengths in all cultures that may have
been minimized or marginalized. To engage in ethical socioculturally attuned family therapy,
we must rigorously examine our cultural assumptions, values, beliefs, and attitudes
(Bermúdez, 1997; Hardy & Laszloffy, 1995). We must find ways to develop accountability
systems that identify when we are actively or passively oppressive in our practices. This
includes moment-by-moment processes of awareness and self-reflexivity in the process of
therapy as we implement our clinical models. Contextual self-of-the-therapist deserves more
attention than we have been able to offer in this chapter. We urge readers to expand their
awareness of self via additional readings, such as Dana Stone and Jessica ChenFeng’s (2020)
“Finding your Voice as a Beginning Marriage and Family Therapist” and/or Monica
McGoldrick and Kenneth Hardy’s (2019) “Revisioning Family Therapy (Third Edition):
Addressing Diversity in Clinical Practice.” In the following chapters, we offer guidelines that
help address tensions related to equity and illustrate the relational nature of socioculturally
attuned practices.

Reflexive Questions
• What are the ways in which we can differentiate between what is common, yet
oppressive and culturally endorsed?
• In what ways are we accountable to recognize and support resistance to oppression?
Where does our use of power, or refusal to use power, fit in?
• How can you honor—yet challenge—beliefs, goals, and values that you believe may
inadvertently oppress another or contribute to a client’s own subjugation?
Table 3.1 Application of ANVIET to contextual reflexivity in supervision

ANVIET Guideline Questions regarding contextual Questions regarding client Questions regarding supervisor-supervisee
self-in-relationship relationship

Attune: Understand, resonate with, What is it like for you as a [specific What do you think it is like for this How may power differences in our social
and respond to experience within social location] to interact with this client to live as a [insert social locations affect our supervisory
societal contexts client [specify social location]. locations] in this world? relationship?
What assumptions or ideas about How do you think others in their How do each of our expectations
[people in client’s social location] do community view him/her/them? regarding hierarchy and social worth/
you bring to the therapeutic How do they respond? value affect how we relate to each
encounter? What messages about what it means to other?
How might your social location be successful/a good [insert social
influence what feels appropriate in role or identity] do you think this
this case? client may have received?
Name: Identify what is unjust or has What skills or qualities of the What skills or qualities of the client are What skills or qualities discredited in the
been overlooked—amplify silenced supervisee are likely to be discredited likely to be discredited or larger societal context need to be
voices or overlooked in the dominant overlooked in the dominant validated within the supervisory
discourse? By others? By self? discourse? By others? By self? relationship?
What skills or qualities in others may What skills or qualities in others may How might our supervisory relationship
the supervisee tend to discredit or the client tend to discredit or contribute to discrediting or
overlook due to influence of overlook due to influence of pathologizing skills and qualities not
dominant discourses? dominant discourses? valued in the dominant discourse?
What societal inequities has the What societal inequities has the client How may power differences between
supervisee experienced? How may experienced? How may these supervisor and supervisee silence voice
these influence supervisee’s approach influence how the client responds to and perspectives? How may these be
to therapy? clinical concerns? How they feel nuanced due to intersecting social
about themselves? locations?
Value: Acknowledge the worth of What societally overlooked values and What societally overlooked values and What societally overlooked values and
that which has been minimized or characteristics does the supervisee characteristics may client endorse characteristics do we need to value so
devalued. wish to support to promote justice? when space is created for them? that our relationship promotes justice?
What societally overlooked values and How may valuing societally What will our supervisory relationship
characteristics does the supervisee overlooked characteristics support look like when we validate and enact
struggle to validate? How may these this client’s well-being? qualities disvalued and discouraged in
relate to internalized values of the How can therapist intentionally the dominant culture?
dominant discourse? validate the worth of what has been
minimized or devalued in this case?
Third Order Ethics and Contextual Self-in-Relationship 69

(Continued)
 70

Table 3.1 (Continued)

ANVIET Guideline Questions regarding contextual Questions regarding client Questions regarding supervisor-supervisee
self-in-relationship relationship

Intervene: Support relational equity; How may supervisee’s internal What kinds of interventions will help What is required on the part of the
disrupt oppressive power dynamics. responses to the presence of societal clients interrupt power imbalances in supervisor to insure that the
power dynamics interfere with their their lives? supervisory relationship does not
ability to intervene in oppressive How can the therapist create awareness replicate oppressive power dynamics?
power dynamics? of power dynamics when they are How can it be safe for the supervisee to
What will help the supervisee have the present in the processes between identify and disrupt inequities in the
courage to intervene in oppressive clients or in their descriptions of supervisory relationship?
societal power processes? interpersonal dynamics? How can the supervisory relationship
What is required on the part of the respond to inequities in the workplace
supervisor to insure that therapy does or larger context of therapy and/or
not replicate oppressive power clinical concerns?
dynamics?
Envision: Provide space to imagine How does supervisee/therapist What will clients’ relationships look How do the ways we discuss client cases
just relational alternatives. envision working with client in ways like when they are able to enact make space for us to envision and
that promote justice (third order more equitable relationships? support just relational alternatives?
change)? How would they know? How may clients’ preferred values How do we envision our relationship
What will therapist’s practice look like support more just relationships? with each other supporting justice in
Third Order Ethics and Contextual Self-in-Relationship

when guided by preferred values/ What have you noticed that suggests clinical practice and the larger mental
relational systems? your clients are able to envision health system?
alternatives to societal inequities?
Transform: Collaborate to make How is the therapist working in ways In what ways are clients enacting their How does our supervisory relationship
what is imagined real/third order that promote justice and third order preferred, more just relational goals? support just relational goals?
change change? What does it look like? What does this look like? How do we recognize and encourage
What enables the therapist to maintain What enables clients to maintain focus equity within our relationship and the
focus on just relational goals? on their just relational goals? How larger clinical system? Who do we
does the therapist support this draw on for support?
process?
 Third Order Ethics and Contextual Self-in-Relationship 71
• How can you navigate the potential consequences of raising social awareness among
family members when doing so may disrupt relationships?
• How can we help clients explore the implications of taken-for-granted cultural practices
and assumptions that are not just? How do you as a therapist know when a practice or
relationship is unjust?

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4 Socioculturally Attuned Structural
Family Therapy

The development of structural family therapy (SFT) by Salvador Minuchin and colleagues
(1967, 1974) gave the field a way to map the organization of families and concisely describe
their dynamics. This approach enabled practitioners to think about families as a unit and
make sense of complex interactions. In SFT, families are understood as open systems that
respond and adjust to the outside world. Presenting problems reflect and maintain family
structures. SFT focuses on interactional patterns and the relative power of family members
to influence these patterns. Structural family therapists recognize the inherent strength of
families to positively adapt to changing circumstances. Therapeutic goals include re­
structuring interactions in ways that support the development of the family system and the
well-being of all members.

⤝⤞

Socioculturally attuned structural family therapy invites families to consider

third order change in how they organize their lives in relationship to broader
societal contexts.

⤝⤞

In this chapter, we highlight enduring concepts in SFT and demonstrate a link between
family and societal structures. We illustrate how therapists can integrate principles of so­
ciocultural attunement in assessing family problems and offer practice guidelines that can
lead to third order change.

Primary Enduring Structural Family Therapy Concepts

Following are six concepts core to practicing SFT. The first three focus on how families are
organized, including repetitive patterns of interaction, family and individual development,
and family structure and hierarchy. The other three focus on interventions, including the
importance of joining, challenging assumptions, and restructuring.

Patterns of Interaction
One of Minuchin’s (1967, 1974) earliest discoveries was that families engage in repetitive
patterns. Patterns are essential to daily functioning and living predictable lives. When patterns
become rigid, however, they constrict the range of possible behaviors. Problems occur when
families get caught in patterns of interaction that they find unsatisfactory yet difficult to alter.

DOI: 10.4324/9781003216520-4
 Socioculturally Attuned Structural Family Therapy 75
Patterns interlock and repeat across situations. Even the most routine interactional patterns
can reflect and reinforce broader problematic relational dynamics.
Think about a simple morning routine, e.g., getting up, managing breakfast, getting ready
for school, and going to work. Consider John, Emanuel, and their 16-year-old son, Max.
John came from a White, upper-middle class family. Emanuel’s Mexican American family
considered themselves working class. Max was adopted and is multiracial. John and
Emmanuel share a business in which John takes the lead and serves as the “face” of the
business while Emanuel manages the finances and personnel. John also attempts to take the
lead at home, resulting in the couple arguing over tasks and struggling to negotiate differ­
ences. Now let’s go back to the simple routine of getting up and getting ready for the day.
Emanuel is the first one awake. He makes coffee and prepares breakfast for Max and John.
When John gets up, he is anxious to get to work and calls out to Max to wake up. Max delays
his response until John opens his door and yells “Get up now!” Max slowly gets ready for
school and avoids eye contact with John when he sits down to eat. No one talks until John
leaves for work. Once alone, Emanuel and Max enjoy a relaxed and playful conversation as
Emanuel takes Max to school. Similar patterns of interaction occur across situations, leading
the family to define Emanuel and Max’s relationship as “close” and Max as “rebellious.”
These repetitive, observable patterns of interaction are the basic unit of analysis for de­
scribing family structure. Through observing repeated sequences of behavior among multiple
family members, structural family therapists hypothesize about how a family is organized;
who is in charge, who is aligned with whom, and the nature of individual, subsystem, and
family boundaries. Exploring family members’ thoughts and feelings that both inform and
result from patterns of behavior provides information about family rules and roles as well as
the impact of family structure on the well-being of each individual.

Family Development
Structural family therapists assume families evolve through stages of development. Each stage
creates new demands and opportunities. The family must continuously accommodate
changing needs of its members as each grows and ages. The family must also accommodate
changes in circumstances (e.g., economic shifts, illnesses, political climates, moves) through
time (Minuchin & Nichols, 1993). A well-functioning family promotes and supports the
development of all family members and can adapt to necessary changes. Family relationships
or structures that limit the growth and development of children or adults are considered
problematic.
Structural family therapists do not take it upon themselves to determine ideal family
structures per se, however, the link between how a family is organized and the development
of its members guides decision-making relative to restructuring. Consider a family in which
there were two White, heterosexual parents—Jim and Lacey. They had three adolescent
children. The oldest was a 17-year-old girl, Laura. The second was a 15-year-old boy,
Jimmy, and the third was a 13-year-old boy, Tim. Lacey worked as an administrative assistant
to put Jim through medical school before staying home to care for their three children. She
went back to work managing Jim’s practice when all three kids began middle school. Once
both parents worked full time, they relied heavily on Laura to cook meals and watch after
Jimmy and Tim. Jim and Lacey bought Laura a car with the stipulation that she pick up her
younger brothers and get them to sports events after school. The couple entered therapy
when Lacey discovered Jim had an affair with a woman who worked at the hospital.
It was important to the family for Lacey to spend her time raising the children. She
appreciated an upper middle class lifestyle and the status associated with being married to a
physician. She was devastated by the affair, feeling vulnerable and angry. Jim allayed her
76 Socioculturally Attuned Structural Family Therapy
concern with a promise that the affair meant nothing and would not happen again. This
family structure privileged the developmental needs of the males, expecting females to play
supportive roles. Jim’s career was primary and while the couple worked together toward his
success, it was he who has been able to fulfill his developmental potential in a more powerful
role. Lacey’s development had been routinely compromised in favor of the development of
all others in the family. Jim’s affair highlighted the unfairness of the relationship, leaving
Lacey increasingly disillusioned and resentful of the inequity between them. During therapy,
it became clear that Laura was being ushered into a similar inequitable arrangement as a
young woman. In her role as a sister, she was expected to place the needs of her brothers
before her own, mirroring her mother’s role as a wife, who is expected to sacrifice her adult
development for the sake of her husband’s.

Family Structure and Hierarchy

The use of structure as a metaphor for describing this observable organization reflects
Minuchin’s early training as a physician who understood the human body as a system with an
internal structure (Minuchin & Nichols, 1993). The observable interactional patterns in fa­
milies that are referenced as a family’s structure include who is close with whom (alliances),
who sides with each other (coalitions), who is grouped together based on role and common
interests, and age (subsystems), who has access to whom and what type of access (boundaries)
and who has more or less influence over others (hierarchy).
Family maps are often used to describe, communicate, and track the way a family is
organized. The map typically starts by drawing circles or using names, initials, or roles (e.g.,
mom) to indicate how close family members are to each other and their relative influence or
power. For example, in the case described above, Jim and Lacey were both in a parental or
executive subsystem and a spousal subsystem, however, they were not equal in power
in either of these. A therapist might start the map addressing the structure of the spousal
subsystem when Jim was having the affair and once the affair was over (see Figure 4.1).
Both maps acknowledge that Jim had more power in the relationship. The map on the left
shows an open boundary between Jim and the woman at work with whom he had an affair.
The map on the right of Figure 4.1 shows a solid line of disconnection once the affair ended.
The individual boundary between Jim and Lacey shows more distance between them when
Jim was having the affair. Now the therapist might add the rest of the family (see Figure 4.2)
The map in Figure 4.2 describes the family in the following way. Jim had more power
than his wife and co-parent. The solid line beneath the subsystem demonstrates that Jim and
Lacey kept their adult relationship as partners private and didn’t share their relationship
problems with their children. As parents, they each had different boundaries with the
children. Lacey was more accessible to them than Jim who maintained more distance. At this
point, what we know about the family leaves some questions regarding the power dynamics
among siblings. At first glance, it would seem that Laura, as the oldest child and the one who

Jim Jim
……………. __ __ __ __ _ ______________ - - - - - -
Spousal Woman at work Lacey Woman at work Lacey
Subsystem _ _ _ _ _ _ ____________ to __________________________

…. Diffuse boundary -- Clear boundary ____ Rigid boundary

Figure 4.1 Boundaries within spousal subsystem when an affair is present.

 Socioculturally Attuned Structural Family Therapy 77

Spousal Jim
Subsystem Lacey
____________________________

Parental Jim
Subsystem Lacey
__ __ __ __ __ _ _ _ _ _ _ _ _

Sibling Laura Jimmy Tim

Subsystem

Figure 4.2 Entire family map including subsystems and how power influences subsystems.

is responsible to help her parents with the younger two kids, would be above her brothers in
the hierarchy. The therapist would need to investigate further by asking to what extent do
her brothers listen to her, if her parents back her up, if she is in more of a supportive than
authoritative role, and so on.
The therapist might have noticed that mom and Laura had a close connection as the two
females in the family. This might be considered an alliance between mom and Laura. Upon
further investigation, we might discover that Lacey and Laura frequently complained to each
other about Jim’s authority and undermined him when they thought he was being un­
reasonable. This would be described as a coalition between them against the father.

Joining
Structural family therapists recognize the necessity of joining with all family members to be
able to both challenge and invite them to entertain alternatives. The family will only follow a
therapist’s directives if members feel connected and cared for. Joining is an ongoing process
throughout therapy, a relational commitment from start to finish.

⤝⤞

According to Minuchin, “Joining has nothing to do with pretending to be what

you are not. It means tuning in to people and responding to the way they move
you” (Minuchin & Nichols,1993, p. 42).

⤝⤞

Joining requires the therapist to treat each family as unique. According to Minuchin, et al.
(2014), joining is “a mindset constructed out of respect, empathy, curiosity, and commitment
to healing” (p. 4). This can be difficult at times.
Think about working with a family in which a parent is emotionally and verbally abusive
to a teenage child. It may be quite easy for many of us to identify and join with the child, but
more difficult to genuinely join with the parent. The therapist must find a way to be equally
respectful, empathetic, curious, and committed to the well-being of all family members to
help them restructure the system. Structural family therapists join with families by using the
family’s language and reflecting the family’s relational style (mimesis). They glean informa­
tion about the family by becoming part of the system without being caught in the system.
Let’s consider a family therapist getting caught in the system with Jim and Lacey’s family
described above.
78 Socioculturally Attuned Structural Family Therapy
Jim: It is tough working every day to support this family. Between office
hours, hospital rotations, and being on call I put in 70 hours a
week! I don’t think they really appreciate how hard I work to get
everything this family needs and wants!
Lacey: Of course we do. This is not about how hard you work! How hard
any of us work.
Jim: How hard ANY of us work? I’m the one out there busting my
back …
Therapist: Clearly you work hard, Jim, but I think what Lacey is saying …
Jim (interrupts therapist): You know, Lacey, for once I would just like to see you …
[Therapist falls silent as she begins thinking how unfair Jim is
being]

It is likely in the scenario above that while the therapist was trying to connect with all family
members and ensure everyone felt understood, she got caught in the pattern of Jim dom­
inating conversations and setting the terms by which discussions occur. The therapist was
drawn into what was likely Lacey’s experience of being overridden by Jim. In this way, the
therapeutic system became isomorphic or parallel to the family system.

Challenging Assumptions
When families enter therapy they typically “know” what the problem is and often have an
idea of what (and who) needs to change. They have tried a number of solutions based on
their definition and understanding of the problem (Jackson & Landers, 2020). These at­
tempted solutions have not worked or the family would most likely not be seeking help.
Most clients expect help to come in the form of alternative solutions, not in alternative
definitions of the problem.
Minuchin et al., (2014) asserted that the family’s certainty in their definition of the pro­
blem works against change. It is up to the therapist to engage the family in co-constructing
new ways of viewing the problem that will lead to different types of solutions. A mantra in
SFT is “make sure you are solving the right problem.” Too often therapists accept the
family’s definition of the problem and get caught in attempting common sense and/or linear
solutions. Below is an excerpt from a session with John, Emanuel, and Max in which the
therapist gets caught in content, inadvertently increasing the certainty family members have
of the problem.

John: The problem is that Max is having trouble growing up and taking responsibility.
Emanuel: He is a teenager! Your problem is you want everyone to be just like you!
John: I thought we agreed to focus on Max.
Max: (sighs and rolls his eyes)
Therapist: Lots of families worry about teenagers learning to take responsibility and it is
normal for teens to rebel a little. In fact, it is healthy!

While the therapist in this interaction attempted to normalize and smooth over the conflict,
they were paying more attention to content (e.g., a teenager taking responsibility) than
process (e.g., parents not acting as a team).
Structural family therapists introduce alternatives in how families think about problems.
When problems are viewed differently, families are often able to see new possibilities and
solutions. As mentioned above, the certainty of the problem and resulting sets of solutions
are often the crux of how families get stuck. While early structural family therapists were
 Socioculturally Attuned Structural Family Therapy 79
more likely to determine a new framework and use their expert stance to get the family to
accept a different reality (i.e., reframe), many contemporary therapists (Minuchin et al.,
2014) see the process as one of co-construction. Let’s continue with John, Emanuel, and
Max to see how the therapist might have invited a new understanding of the problem.

Emanuel: Yes, we understand that teenagers often rebel but Max is a good kid. John just
expects too much.
John: (rolls his eyes and looks away)
Max: This is stupid!
Therapist: As fathers, you expect different things from your son?
John: I expect Max to act his age and take responsibility.
Emanuel: He does. Max is doing great in school.
Therapist: Max, it seems like your dads have different ways of looking at things. What is it
like for you when they argue about you?
Max: What do you think? I hate it!
Therapist: John and Emmanuel how are you at being a team in other parts of your lives
besides parenting? Your business? Your relationship?

Here the therapist moved the focus from Max to the parents working together. The
therapist was trying out a new way to view the problem, inviting the family to see things
differently. This effectively moved Max out of the role of being the problem. As long as
there is a person designated by the family as “the problem” it is difficult to move out of
linear, individual, common sense solutions in favor of relational, contextual change. In the
example offered above, the therapist might have been caught in the view that Max was the
problem because he was being rebellious, or that John was the problem because he was
controlling, or that Emanuel was the problem because he failed to back up his co-parent.
Accepting Max as the identified problem would have invited the therapist to get stuck
where the family was stuck.
Challenging assumptions includes exploring family rules and expectations relative to
family roles. The nature of assumptions is that they guide thinking, feeling, and inter­
acting often without being overtly discussed or intentionally considered. They operate
without inspection, limiting alternatives. In the example above, John and Emanuel are
operating from ideas they each have about how to be a parent, who, if anyone, should be
in the lead, what teenagers need from parents, what Max’s intentions are, and so on.
The therapist would guide enactments in which these assumptions could be identified,
made overt, and intentionally altered or agreed upon. Following is an example of how
a therapist might have challenged assumptions when working with Jim and Lacey in a
couple session:

Therapist: Jim and Lacey, would you tell each other what you hoped your relationship
would be like? Do you know when you first decided to marry? Lacey, can you
start? Jim, while Lacey is talking will you please do your best to really listen.
Then you will have a turn and it will be Lacey’s turn to listen.
Lacey: I guess I thought we were going to be in this together. You know, me and you
the whole way.
Jim: We are! We work together, live together … we’re together 24-7! What more do
you want?
Therapist: I want to make sure each of you understands what the other expects without
interrupting each other. You have different ideas about what it means to be
80 Socioculturally Attuned Structural Family Therapy
together through life. Lacey, can you say more about what you meant when you
said “I thought we were going to be in this together?”

The therapist would continue to explore assumptions each holds about gender and power,
paid versus family work, time together in contrast to making decisions together, the meaning
of intimacy, and so on. The therapist would also explore family roles: What does each expect
of a father, mother, husband, wife? Where were these ideas about roles formed? In what ways
are expectations around family roles helpful or not helpful to the family as a whole; to each
individual?

Restructuring
Enactments are a cornerstone intervention in SFT. A significant part of each session includes
asking family members to talk directly to each other while the therapist pays attention to and
helps shape interaction. Talking directly to each other in therapy offers families a new ex­
perience of purposefully rather than spontaneously interacting (Minuchin et al., 2014). The
therapist can notice how they interact, watching for patterns that are problematic as well as
those that work well. Enactments allow therapists to help families modify their interactions,
set clear boundaries, better understand each other, and connect with each other emotionally.
At first, the therapist is likely to want to observe even when communication escalates, is
derailed by other family members, and/or reaches a stalemate. This provides important
firsthand information about family dynamics. The therapist often comments on the inter­
action to help families take a meta-perspective of their relationships, i.e., learn to “talk about
how they talk.”
Therapists do more than observe and learn about family patterns through enactments.
They interrupt, pause for interpretation, ask for emotional expression, and coach commu­
nication. They help distant family members come closer emotionally, help establish clear
boundaries, and encourage members of subsystems to work together in part by using en­
actments. Butler and Gardner (2007) suggested five stages of enactments depending on the
family’s ability to successfully talk directly with each other. When conflict is high and direct
communication seems to do more harm than good, they suggest asking family members to
talk through the therapist. The therapist becomes less of a “go between,” interrupts less often,
and coaches interactions less when family members are able to communicate directly and the
communication leads to solving problems. Below is an example of an enactment using the
example above of John, Emanuel,and Max, a little later in therapy.

Therapist: John and Emanuel, I am going to ask the two of you to talk directly about your
vision of parenting together. What kind of team are you hoping to be? John, will
you turn your chair to face Emanuel and Emanuel, will you start the
conversation?
Emanuel: John, I want us to work together to be more understanding of Max.
John: I think we are understanding. Maybe too understanding.
Max: This is hopeless!
Therapist: For now, Max, I am going to ask you to let your dads talk. It can be tempting to
interrupt them to help, but let’s see how they do.
Max: I wasn’t trying to help. It just drives me crazy when they do this.
Therapist: (turns away from Max and back to parents) Ok John, can you tell Emanuel what
being a team looks like to you?
John: I think we should set rules and back each other up.
 Socioculturally Attuned Structural Family Therapy 81
Emanuel: Yes, but you are setting the rules and then expecting me to follow them just
like Max.
Therapist: So are you both saying that you want to set rules together and back each other
up, but you want to really agree? Is that right?
Emanuel: (looking at therapist) Yes, but it can’t all be on John’s terms.
Therapist: Emanuel, can you look directly at John and say that to him rather than to me?
Emanuel: (looking at John). It can’t all be on your terms.
Therapist: Emanuel, you also said earlier that you wanted the two of you to be more
understanding of Max. Can you tell John directly what you mean?

The therapist in this scenario was unbalancing the system by offering Emanuel support in
making his perspective heard by John. This temporarily disrupted the power dynamic in
which John has more voice in the family. The therapist also unbalanced the system by
ensuring the couple’s interaction was not detoured through Max. Unbalancing is an im­
portant concept in SFT. It is assumed that the therapist has the necessary influence or
power in the therapeutic system to direct interactions and can “lend” power to family
members. Interrupting typical dynamics that stabilize conflict, such as detouring, is also a
way to unbalance the system, opening possibilities for alternative interactions and solu­
tions. Another typical unbalancing technique is to raise the intensity. Therapists can raise
intensity in a number of ways including pressing the family to continue interactions at the
point in which they typically stop and slowing down interactions to explore and express
deep emotions.
Structural family therapists consider boundaries across all interventions. In the example
above, the therapist worked on helping the family set a clear boundary between the parental
and child subsystems by not allowing Max to interrupt his parents or help them out of their
conflict. The therapist would not always have Max in the room, respecting the separation
between spousal/parental and child/sibling subsystems. In the conversation above, Max
being there gave the therapist the opportunity to block him from becoming part of the
parental subsystem. It is likely that more conversations about fathering and about the couple’s
relationship would need to occur without Max present. Max, as a teenager, would also likely
need to meet with the therapist alone from time to time to discuss his experience and prepare
for how to talk to his parents about his needs.

Integrating Principles of Sociocultural Attunement

SFT can be practiced in ways that focus only on the interior of the family, with limited
attention to sociocultural context. According to Williams et al. (2016),

from the black feminist perspective, hierarchies exist beyond the family system that
place individuals at a disadvantage. These include gender, race, political standing,
and class. Structural Family Therapy fails to directly and explicitly address the
overarching societal hierarchies that pressure family systems with prescribed roles
and norms. (p. 42)

In this section, we integrate principles of sociocultural attunement into SFT by exploring

connections between societal systems and family systems, between societal rules and
structures and family rules and structures. This includes attention to how interactional
patterns and power dynamics are reproduced across levels and settings in complex social
systems.
82 Socioculturally Attuned Structural Family Therapy
Societal Context and Structure
⤝⤞

Socioculturally attuned structural family therapy expands the structural

analysis of families to a structural analysis of families within societal structures.

⤝⤞

Socioculturally attuned SFT assumes that organizational patterns affect and are affected by all
levels of interlocking systems, including families, communities, and societies as well as by
social locations that intersect these systems (e.g., gender, race, social class, ability, sexual
orientation, immigration status). Chappelle and Tadros (2021) offered an example of ap­
plying the tenets of SFT to societal contexts to better understand African American ado­
lescents who have experienced poverty and trauma. In effect, they expanded the structural
framework to understand how broader levels of systems impact the family. This is in keeping
with using the metaphor of structure at a societal level to refer to systems of systems at
a macro level. Repeated patterns of interaction among groups within and across social
contexts, serve to create and maintain social stratification, patterned group relationships,
and institutional organization. These systems are hierarchical, and access to influence and
resources differ according to one’s individual and group position in society.
The work of French philosopher and sociologist Pierre Bourdieu offers a bridge between
our understanding of family structure and societal structure, family rules in relation to social
rules, and the material world in relationship to the social world. Above all, Bourdieu viewed
reality as relational, making many of his ideas helpful in linking family systems and social
theory. Bourdieu’s concepts of habitus, field, capital, and symbolic violence are particularly
applicable to practicing socioculturally attuned SFT.

Enduring Patterns Across Contexts

Bourdieu (1986) argued that it is within social space, or habitus, that we learn, internalize,
and embody shared ways of thinking and doing, values, and beliefs. Habitus is a concept that
expands our thinking beyond dichotomies to consider relationships between dualistic con­
cepts; internal/external, objective/subjective, agency/structure, and personal/social. For
example, a family may be concerned that a child is too shy. They attribute the behavior to an
intrinsic quality of the child (internal). A family therapist is likely to look at the behaviors the
family identifies as shyness, watching for patterns of communication and interaction that help
make sense of these behaviors (external). At the same time, a family therapist may attribute
the problem of identifying the child as shy (internal to the individual) to family dynamics
alone (internal to the family) rather than considering how social dynamics including gender,
class, sexual orientation, race, and specific contexts influence behavior and patterns of in­
teraction (external to the individual and family). In effect, family therapists must hold what
is commonly described as internal and external in the same space, being most interested in
the relationship between these conceptual frameworks.
Habitus refers to a combination of history and disposition within time and space that
shapes our thinking and guides our behavior in relationships. In effect, societal norms and
expectations as expressed through social class, culture, and family contexts, together with
our unique qualities, create dispositions. Dispositions are lasting but also changeable over
time and transferable across settings (Bourdieu, 1986). This includes how we tend to think,
feel, and act in various situations or relational fields. Take humor, for example, which is
 Socioculturally Attuned Structural Family Therapy 83
assigned to some people as an individual characteristic. They tend to make people laugh
across many (but not all) settings. Humor is developed in habitus. Most “funny people”
know how to read contexts well enough to predict what those around them might find
amusing. In effect, humor is a relational dynamic at the crossroads of habitus and dis­
position within relational fields.
According to Maton (2014), “Habitus links the social and the individual because the
experiences of one’s life course may be unique in their particular contents but are shared in
terms of the structure with others of the same social class, gender, ethnicity, sexuality, oc­
cupation, nationality, region and so forth” (p.52). In other words, while individuals and
families are unique, they are also inseparable from the contexts in which they exist. Habitus,
or enduring patterned ways of being and doing, include family upbringing, past choices,
social class, education, cultural norms, spatial setting, and much more; the sum of what makes
us “who we are.” This is both structured and structuring. In other words, our social context,
history, and social location structure our thinking, attitudes, beliefs, emotions, and actions. At
the same time, our patterned participation in society furthers the very structures that influ­
ence us. In fact, social structures become embodied through identity-based constructions
such as gender, race, social class, ethnicity, and sexual orientation.
Let’s consider Jim and Lacey from the example above as a case in point. Lacey embodies
her social identity as a cishet (cisgender heterosexual), White, upper-middle class female in
many ways, including the way she thinks about her body and performs her social role. Her
relationship to self and others is deeply influenced by her perception of a broader social gaze.
She “watches her weight,” gets her hair cut at an expensive salon, shops for clothes that
enhance her “figure,” participates in make-up consultations, and carries a designer purse. Jim
does the same. He “keeps in shape” by participating in individual athletics, dresses in business
casual sportswear when not at work, keeps his hair trimmed and face clean shaven, and wears
designer eyeglasses. Jim’s affair at work reassured him that he is still vital and attractive. The
same affair leaves Lacey believing she has “lost her looks” (and the privilege her looks have
afforded her). Both Jim and Lacey inadvertently maintain their White privilege by adhering
to the belief, and teaching their children, that race doesn’t matter. Their attempts to conform
to social expectations inadvertently contribute to social inequity by serving to maintain the
status quo.

Group Relational Systems

Relational systems develop as groups differentiate from each other developing semi-
autonomous spheres of action that over time become increasingly specialized. Power rela­
tions within and among what Bourdieu called “fields” serve to structure and shape patterns of
interaction. Bourdieu (1977) used the term “doxa” to refer to the “rules of the game” within
a field. These rules are typically not spoken or overt but assumed as if natural and inevitable.
The rules limit the actions of agents within the field while benefiting those who know how
the game is played. The positions we take in these fields, or relational systems, serve to
maintain or disrupt power relationships; to keep the rules and power dynamics the same or
change them. Agents in these fields use their positions, or power, to establish and enforce the
rules that benefit them/their group. Take for example the highly contested ban on bilingual
education in the US state of California. Native English speakers have the advantage in the
field of education and professional positions over those for whom Spanish is their dominant
language in childhood. This advantage is secured from preschool forward. Bilingual edu­
cation threatens this advantage by creating a more equal playing field; a change in the rules
that would redistribute power.
84 Socioculturally Attuned Structural Family Therapy
Power and Capital
⤝⤞

Family hierarchy and boundaries are directly reflective and impacted by power
dynamics in society.

⤝⤞

From a structural perspective, power can be seen as connected to capital. According to

Bourdieu (1986), economic, social, cultural, and symbolic capital all play a role in de­
termining our degree of social influence and access to resources (Garcia & McDowell, 2010).
Economic capital refers to money as well as capital that can be used to secure money without
relying on one’s own labor (e.g., investment capital). Social capital refers to social networks;
relationships that provide opportunities to share resources and/or secure resources (e.g.,
insider knowledge of a job, reference letters for court or school). Symbolic capital is earned
and unearned prestige (e.g., the title of “doctor,” a high status family name, place of birth).
These are all closely linked to cultural capital, which refers to that which can be used to gain
upward mobility (e.g., language and speech patterns, specific looks, dominant culture rela­
tional styles). Cultural capital is an important concept relative to power and equity as those
whose cultural practices are centered and dominant have an advantage. Those with the most
influence and greatest resources tend to reproduce their group’s advantage by privileging
their own cultural practices. This creates lateral advantage for those most closely resembling
and affiliated with dominant groups and vertical advantage through inheritance.
This social dynamic affects family dynamics. Consider a White family in which parents
have transitioned from lower class childhoods to the middle class by working hard, taking out
student loans, adopting middle class language and relational styles, and making sure they
made connections that would provide them with as much advantage as possible. Now that
they are stable in the middle class, they expect their children to enjoy and benefit from their
work to secure economic and social resources. Let’s imagine now that their teenager is
spending her time with lower class friends, not doing homework, and abusing substances.
This is likely to be a problem for the family for many reasons, among them her squandering
of the family’s social and cultural capital.
Bourdieu’s (1986) term symbolic violence refers to when social rules or practices (including
family rules and practices) that support the superiority of one group (or family member) over
another are misunderstood as inevitable. That is, when the superiority of one group over
another is viewed as the natural order of things rather than socially constructed. This view is
widely accepted and internalized by members of both groups. Bourdieu (1986) offered many
examples of this including social class and gender relations. Relative to social class, those in
the upper classes are often seen by all classes as smarter, more diligent, and superior to those in
lower classes. This creates the illusion that social class largely depends on the character and
effort of individuals. Now let’s consider this dynamic relative to gender in family structure
using Lacey and Jim as a case in point. The idea that Jim’s career should come first and that
his needs and comfort are more important reflects pervasive symbolic violence in most so­
cieties in which men are routinely privileged.
Symbolic violence occurs when constructions of male superiority are internalized by both
males and females; when heterosexual relationships are seen as “normal” and homophobia is
internalized; when industrialized societies are seen as “advanced”; when those who don’t
identify as male or female are seen as “other”; when whiteness is centered; and so on. This is
not to say that resistance to these constructions doesn’t exist or that those who are oppressed
 Socioculturally Attuned Structural Family Therapy 85
routinely don’t realize inequity is not the natural order of things. In fact, family members
who are marginalized or oppressed are often acutely aware of their experience even when
uncertain of the broader social dynamics that inform family power dynamics.
Continuing with our example of Jim and Lacey’s family, Laura is likely to feel conflicted;
being pleased that her parents bought her a car while feeling slighted by her brothers’ needs
being prioritized over her own. The therapist would make covert rules overt, in this case
bringing to light and challenging symbolic violence. This process would allow Laura and her
family to identify the dynamics in which they are caught, make sense of their experience, and
have more choices about what to do.

Third Order Change

Socioculturally attuned structural family therapists target third order change by engaging
families in ways that raise awareness and question the impact of societal context on presenting
problems. For example, a therapist might ask couples to speak directly to each other about
what they learned about gender/race/social class/sexual orientation when growing up. This
would include messages from parents, extended family, peers, and the media. As clients are
coached to talk directly to each other about these influences, the therapist asks probing
questions and offers opportunities for reflection that increase collective social awareness in
the therapeutic system.

⤝⤞

The therapist is active and intentional, creating space where assumptions can
be inspected––taken apart and disrupted––to reveal multiple perspectives and
possibilities.

⤝⤞

This critical meta-perspective is in itself a paradigm shift; a shift in how we think and how we
know what we know.
Structural interventions are not limited to families and are often integral to transforming
larger systems such as organizations, institutions, and communities. Consider the example
William Turner offers in Text Box 4.1 in which he describes a community-level intervention
that promoted structural change. In this example, Turner and his colleague were invited to
promote racial integration by engaging community members across physical and social
barriers to envision change and take steps toward transformation.

Text Box 4.1 William Turner, PhD, LMFT

William Turner serves as Distinguished Professor of Leadership and Public Policy

and Special Counsel to the President for Equity, Diversity and Inclusion at
Lipscomb University, Nashville, TN. His teaching and research interests are
focused on African American family strengths and the intersections of hope,
justice, policy and faith.
There is a history of civil rights advocacy in Nashville, but the city has remained
relatively segregated. Not only had it been segregated, but the government had
actually built physical structures as barriers to integration. A new mayor in
86 Socioculturally Attuned Structural Family Therapy

Nashville was interested in tearing down physical and social barriers and in an
effort to do so, began visiting the many local colleges and universities. I happen to
have two good friends at my university who are professors of conflict management
and are African American attorneys. The three of us approached the mayor about
doing something to help deal with social structure differences and barriers. She
invited and funded our proposal to have table-talks where we brought people
together from different backgrounds to have meaningful conversations for a few
hours. The conversations were structured using conflict management rules. There
could be no yelling at each other and facilitators at each table guided the
conversation using a set of questions. The facilitators could deviate from the
questions, but the conversations needed to remain civil. We began doing this in
various communities around Nashville with great success.
The mayor then wanted to do something big and bold. Nashville had just built a
beautiful new convention center. The mayor suggested having a day in which we
invited the community to the convention center where multiple tables would be set
up for conversations. We expected 300-400 people, but on the morning of the
event, there were over 1000 who showed up from all walks of life–those from the
wealthiest sections of Nashville to those who lived in the projects. It was a
beautiful thing. We had meaningful talks followed by debriefing. We then devel­
oped a list of things we could actually do, and came up with a plan for how we
would implement changes in the city.

Practice Guidelines
There are a number of important steps for practicing socioculturally attuned Structural
Family Therapy including, 1) expanding the family map to connect the family to societal
structures; 2) identifying societal influences on family power dynamics, rules, and roles;
3) encouraging families to explore and commit to equity-based relationships, and 4) helping
families restructure to support developmentally appropriate relational equity.

1 Connecting Family and Societal Structures

Socioculturally attuned structural family therapists are familiar with the impact of world­
view, family history, intergenerational dynamics, and social context on family functioning
and the importance of attending to these in therapy. When they join with clients, they are
exploring, attending to, and in some ways entering, a family’s habitus. They are aware of
the need to continually join throughout the process of therapy to ensure a deep under­
standing of each family’s world. Socioculturally attuned structural family therapists map
families within societal context, recognizing that family members go in and out of various
social fields, which further influences their relationships with each other.
In our example of Jim and Lacey, Jim functioned daily in a medical field in which
doctors are highly privileged and assigned significant relational power over patients and
other staff. This, in combination with male privilege, affected the course of his affair with
a nurse in his workplace. Belonging to the medical field provides economic, social,
symbolic, and cultural capital that places Jim at an advantage in his relationship with the
nurse at work and with Lacey. A socioculturally attuned structural family therapist would
include these fields in the family map and understanding of family habitus. She would
invite family members to explore how their individual positions in these social contexts
 Socioculturally Attuned Structural Family Therapy 87
affect their relationships, including the rules they live by as a family, as well as the un­
equal consequences members of the family, suffer when they break a family rule.

2 Identifying Societal Influences on Family Power Dynamics

Socioculturally attuned structural family therapists look beyond the overt and covert rules of
the family to understand their relationship to “rules” of various fields families inhabit.
Consider our example of John and Emanuel who were raised in very different fields or
contexts. Emanuel understood the intricacies of relational dynamics within lower class,
Mexican American communities. He knew the rules. When John entered this field, he was
somewhat lost about what to do and how to be. Likewise, John grew up in upper class fields
that supported White privilege and dominance of White upper class values, attitudes, and
behaviors. When Emanuel entered John’s world, he also didn’t know all of the rules. This
created complex and problematic dynamics for the couple. Their therapist would need to
explore not only broad societal themes related to social class, race, and ethnicity, but also
work with the couple to help them identify the “rules of the game” in each field they enter.
This would ensure they can work together to navigate very different social situations in ways
that they both feel supported as a couple. Rules within fields tend to support existing societal
structures (e.g., taboos against talking about race support White privilege; believing those
who have more are worth more supports existing class systems). Therapy is a place where
these rules can be broken by making them overt, discussing their impact, and establishing
greater agency over their influence.

3 Exploring and Committing to Equity-Based Relationships

By connecting family to societal structures and identifying societal influences on family

power dynamics, socioculturally attuned structural family therapists are poised to explore the
impact and cost of relational inequity on individual and family well-being. Family members
become increasingly aware of how societal dynamics affect their most intimate relationships
as therapists initiate conversations that raise social awareness and expose power dynamics.
These conversations include exploring the relational costs of power imbalances. Back to Jim
and Lacey, Jim enjoyed disproportionate power, which allowed him to be more influential in
setting the emotional climate in the home, meet more of his individual needs, and enjoy
being accommodated by the rest of the family. When the costs of this power were carefully
explored, it became clear to all (including Jim) that the children were closer to their mother
and often resented their father. Jim had lost the respect of his wife and children, and the
females in the family were routinely disempowered. This was very likely not what Jim and
Lacey hoped for and may be in contrast to their stated values of raising strong children,
supporting equal opportunity for their daughter, and Jim’s desire to be close and revered by
the family.

4 Restructure to Support Developmentally Appropriate Relational Equity

Socioculturally attuned structural family therapists share the assumption that families should
be structured in ways that support optimal development for all members. Oppressive re­
lationships and societal structures block equal opportunity for health and well-being, in­
cluding individual and relational development. Influence and accountability must be
balanced. For example, as children gain autonomy and influence, they are expected to be­
come increasingly accountable for their actions and to consider the impact of their decisions
on others. Parents may be in charge of most decisions but are expected to make decisions that
88 Socioculturally Attuned Structural Family Therapy
benefit their children and consider the needs of the group. When one adult overpowers
another, when the needs of one become routinely privileged over another, it is likely to
create an imbalance that creates and maintains presenting problems. Addressing these im­
balances and encouraging structural equity is central, rather than auxiliary, to treatment.

Case Illustration
Let’s continue with our example of Emanuel, John, and Max. Emanuel was born in the US
to parents who had migrated from Mexico without documentation. His early life was spent
in the state of Arizona. When Emanuel was four his father was stopped for a traffic citation
and deported when it was discovered that he did not have proper documents. From the
time Emanuel was four until he was twelve, his father was deported to Mexico and re­
turned to Arizona four times. The family finally made the decision that Emanuel and his
mother would go to the state of New Mexico to live with his mother’s sister. Emanuel’s
older siblings stayed behind as US citizens with jobs in Arizona. Emanuel rarely saw his
father after that time.
John grew up in the state of Texas. His family owned a large, successful business. His father
inherited the business from John’s grandfather and succession of the business to John as the
son and only child was carefully planned and executed. Emanuel and John met in college in
New Mexico. After college, they moved back to Texas so John could run his family business.
After John’s father died, John liquidated the family business to start something new with
Emanuel. This was an opportunity for the couple to move to Massachusetts where they
would marry and begin the process of Emanuel legally adopting Max. Max was born in
Texas. Max’s biological father was White and in the military and his mother was Mexican,
and the young daughter of John’s family’s housekeeper. John’s family’s influence cleared
the way for him to privately adopt Max as an infant.
The couple made the decision to be openly out as a married gay couple when they moved
to Massachusetts. The business was put in both of their names and they bought a home
together. They were able to openly father together and developed a supportive community
of friends and colleagues. Things went smoothly with John taking the lead in the business and
Emanuel taking the lead in parenting until Max became a teenager.

Connecting Family and Societal Structures

The therapist working with John and Emanuel’s family asked questions that raise social
awareness in the therapeutic system. As the therapist analyzed the connections between
societal and family dynamics, the family developed critical social awareness of the systems in
which they were embedded. These conversations provided information that informed the
process of mapping the family in societal context, which in turn provided direction for
restructuring interventions. Following is an example of therapeutic dialogue between the
therapist, Lisa, and the couple, John and Emanuel, that served to raise critical consciousness
while assessing family in societal structure.
Lisa identified as a White, middle class, bi-sexual, gender queer family therapist who
had lived in Boston since childhood. Lisa had personal experience with homophobia,
sexism, and cisgenderism. Lisa’s own, self-of-the-therapist work included critically ex­
amining how their interconnected identities provided privilege in some ways (White,
middle-class, and living in a progressive city) and marginalization or oppression in others
(bi-sexual, gender fluid). Understanding how societal systems and power dynamics impact
their own life helped prepare Lisa to engage in critical consciousness with John, Emanuel,
and Max.
 Socioculturally Attuned Structural Family Therapy 89
Lisa: So John, you mentioned that when you and Emanuel first moved to the family
property in Texas the two of you lived as friends. Can you talk more about that
decision … how the decision was made?
John: My family is really conservative. By the time I met Emanuel, my parents knew I
was gay, but I promised not to tell anyone in our hometown because of the family
business.
Lisa: Who was most concerned about someone finding out and what were they
worried might happen if others knew?
John: Mostly my dad. He had worked really hard to build the business. I think he
assumed we would lose business if the community knew I was gay.
Lisa: What was that like for you and how did you approach Emanuel about your
father’s wishes?
John: I didn’t like it, but my dad always called the shots. I told Emanuel it was
something we just had to do if we eventually wanted the family business.
Lisa: Emanuel, can you tell John directly what it was like for you to be told to stay
closeted in John’s world? To have John and his father make this decision for you?
Emanuel: I felt so uncomfortable with your family anyway, John. They knew I didn’t come
from money. I’m not White. Plus, my being around seemed to just remind
everyone that you are gay. I agreed because I love you, but I never felt like I fit.
I still don’t.
John: Well you fit as far as I am concerned. I wish you just wouldn’t worry about my
family. We left Texas, started a new life, sold the family business … .
Lisa: So it sounds like the two of you are trying to talk about your differences in social
class and race, how racism and classism have affected your relationship.
Emanuel: It is hard for us to talk about, but it has a big effect on us.
John: Really? I think we have done pretty well to overcome those kinds of prejudices.
Lisa: You have overcome a lot just to be a couple. At the same time, it makes sense to
me that you, Emanuel, would notice the effects more. John, I know I am usually
most unaware of the impact of my own privileges. This is much bigger than the
two of you, but can we start by giving you some time, Emanuel, to really talk to
you, John, about your experience?

This line of questioning eventually led John and Emanuel to better attune to each other and
how their relationship was affected by broader societal structures. Increased social awareness
prepared them to depersonalize differences and begin to work together to support each other
and their son within an unjust society.

Identifying Societal Influences on Family Power Dynamics

By talking openly about racism, classism, patriarchy, and homophobia, Emanuel and John
were better able to understand the dynamics in their own family. John tended to take the
lead in major decisions, to be more demanding of Max, and to dismiss Emanuel’s ex­
perience. Many therapists would connect this pattern to intergenerational dynamics and
the socialization of males, but a socioculturally attuned structural family therapist would
also identify this pattern as an inheritance of White, male, upper class privilege. The
process of raising critical consciousness through dialog and reflection would guide action
toward liberatory change (Freire, 1970/2000, Korin, 1994). Following, Lisa names the
inequities stemming from families of origin and John and Emanuel’s social locations in the
broader society.
90 Socioculturally Attuned Structural Family Therapy
Lisa: John, you mentioned that your dad made all the big decisions in your family. He
even made the decision for you and Emanuel to live closeted in Texas. How do
you make sense of this?
John: He was just the head of the household. I think men back then ran everything.
Lisa: Do you remember what that was like for you and your mom?
John: I hated it. He was always on me. I think my mom just checked out.
Lisa: Always on you?
John: He expected a lot. He put me in charge of running a whole section of the
business when I was 15! If I complained he would tell me to “be a man.” I
thought he was going to have a heart attack when I told him I was gay!
Lisa: So being gay was not being a man?
John: I guess not.
Lisa: Working hard, not complaining, excelling at your job … what else does being a
man mean? Being in charge of your family?
John: Yeah. He was just trying to help me grow up and be successful.
Lisa: Passing the baton? So you could be successful and in charge of your own family?
John: When you put it that way … .
Lisa: How about you, Emanuel? What did your family pass down to you about being a
man? Being in a family?
Emanuel: For us, family was everything. I learned you do what you have to for the family.
My dad had to keep his head down … keep a low profile when he was in the
states. My mom was strong and independent when he was gone but did whatever
he said when he was around. It was confusing. I guess I sort of resented him.
Lisa: So even though your fathers both learned men should be in charge of the family,
they had real differences in their power and privilege in the world. How do the
differences in what you learned and the differences in race and social class impact
the power dynamic in your relationship with each other? What messages do these
dynamics send to Max?

A socioculturally attuned structural family map might look something like Figure 4.3.

PATRIARCHY
CAPITALISM

Male Privilege
White Privilege
Entrepreneur/Capitalist
John Class Privilege
US Privilege
Male Privilege
Homophobia
Class/Economic
Heterosexism
Dependence
Nationism Emanuel
Homophobia
Heterosexism Male Privilege
Racism Homophobia
Max
Heterosexism
Racism

COLONIZATION
HETERONORMATIVITY

Figure 4.3 Example of a socioculturally attuned structural family map.

 Socioculturally Attuned Structural Family Therapy 91
Exploring and Committing to Equity-Based Relationships
Lisa valued all voices in the family as they helped the couple identify their egalitarian values.
Emanuel and John described their ideal relationship as one in which they equally shared the
responsibilities of running their business and parenting their son. They were committed to a
fair and just relationship. At first, they saw the issues in their family being about personalities.
Max was drawn to Emanuel because he was more patient and “laid back.” John was a driven
perfectionist who liked to be in control. Over time, what they viewed as internal dispositions
were exposed as existing between the internal and external—between individuals and re­
lationships, relationships, and societal context.
As Max grew up, he expected to enter adulthood in a family that prided itself on being
democratic. This mirrored not only the values of the democratic society in which they lived,
but the value John and Emanuel both placed on having a fair and egalitarian marriage.
Emanuel and John wanted Max to become increasingly autonomous yet accountable to
others. Their own fathers were in more powerful positions in the family and lacked the
emotional and relational attunement they wanted in their intimate relationship as well as in
their parenting. They also wanted Max to be socially aware and know how to challenge
racism, sexism, classism, and homophobia. All three family members readily engaged in
visioning changes in their relationships that promoted equity and closeness. This family had a
multitude of strengths and experiences facing and overcoming oppression that could be
jointly mobilized.

Restructure to Support Developmentally Appropriate Relational Equity

John and Emanuel were committed to dismantling the effects of patriarchy in their re­
lationship. This included rethinking how to help Max “become a man.” One of the ways
Lisa intervened was by helping John find ways to connect with Max that did not rely
on giving him advice or demanding performance. For example, Lisa asked John and Max
to spend a session together in which they were guided in talking directly to each other
and coached to communicate in ways that increased understanding between them. This
included expression of feelings. John was also asked to spend time with Max between
sessions. John had to learn to deal with anxiety surrounding letting go of control and
to trust Emanuel as a co-parent and business partner. Lisa engaged John and Emanuel
in discussions about power dynamics, social class, gender, and race to raise their social
awareness and help them envision change. Lisa also worked directly with the couple
to encourage them in direct communication, making certain Emanuel’s voice was heard
in the therapy process. John learned to listen more carefully and attune to his partner’s
needs and feelings. John also learned to seek out Emanuel’s input on decisions after
realizing that while he thought the relationship was equal, he often made unilateral
decisions. Emanuel became more outspoken, disagreeing with John directly when needed
rather than seeking the comfort of Max when he felt misunderstood by John. Lisa
assigned homework in which John and Emanuel were to regularly meet to discuss
the business.
Over time these structural interventions helped them transform from a patriarchal
business model (typically supported in capitalist economies) to a more collaborative, team-
driven model. They also began routinely checking with each other about parenting deci­
sions. They both enjoyed individual relationships with Max that did not undermine Max’s
relationship with their co-parent. Lisa openly talked about race, class, and culture with the
couple and helped them talk with Max to better prepare him to resist racism and classism.
Their increasing awareness prompted an interest in Max to engage in community activism.
92 Socioculturally Attuned Structural Family Therapy
Overall, the family became increasingly feminist and collaborative, valuing relationships over
tasks; mutual involvement over control.

Summary: Third Order Change

Max, Emanuel, and John engaged in first, second, and third order change throughout the
process of being in family therapy. In this case, first order change included things like asking
Emanuel and John to spend one night a week on a “no-problems date.” The therapist did not
expect this type of common sense solution to change the relationship dynamics per se, but
saw it as a step toward second order change in which the couple redefined their relationship
as one that was closer and more equal. Second order change included Emanuel and John
becoming more equal as parents and business partners and Max developing more balanced
relationships with both of his parents. Third order change included an active decision by
Emanuel and John to resist patriarchy in their relationships with their fathers and each other.
This included challenging gender stereotypes that pressure men to be competitive versus
cooperative, to be autonomous versus collaborative, and stoic rather than vulnerable. In the
end, they were able to structure their family in a more egalitarian and loving way. This
included becoming more aware and committed to dismantling multiple dynamics of op­
pression, including racism, sexism, heterosexism, and classism within their family and be­
yond. The family became fluent in discourses of liberation by taking a meta-view of their
relationships within a societal context. This expansion of relational options was liberating
while holding each member accountable for unearned privilege and misuse of power in
intimate relationships.

Text Box 4.2 Salvador Minuchin, MD

Salvador Minuchin (2017, p. 37), legendary family therapist, teacher, and social
justice advocate argued that the person of the therapist is an instrument of
change:
as I got more experience it became clear that the techniques by themselves
weren’t all that useful. It was therapists themselves who were the instruments of
change, and to be effective, they had to recognize the way they were part of the
system and the process in the therapy room, not just a neutral observer.

Many therapists today draw on multiple family therapy models and/or practice evidence-
based approaches. Minuchin’s words in Text Box 4.2 above do not negate the value of these
models; they remind us that any clinical encounter is more than a set of skills and what we do
is never neutral.

Reflexive Questions
• Consider a time when it was difficult for you to join with a client. What made it difficult
to “attune to them and respond to the way they moved you,” and Minuchin suggested?
• Describe the ways in which economic, social, cultural, and symbolic capital play a role in
determining your degree of social influence and access to resources? How does this help
or hinder you in your life and professional practice?
 Socioculturally Attuned Structural Family Therapy 93
• If you were to expand your family maps (the one you grew up in and your current family
now) to connect your family to societal structures, contexts, and spaces, what would the
maps look like?
• When you think of the optimal structure for a well-functioning family, what comes
to mind? How might a socioculturally attuned lens inform your perspective?
• How can you work with families to help them restructure in ways that address power
imbalances and support developmentally appropriate relational equity?
• How can you help clients move from mutual blame or narrowly defining their problem,
to expanding their lens to view their problems as existing between the internal and
external—between individuals and relationships and relationships and societal context?

References
Bourdieu, P. (1977). Outline of a theory of practice (R. Nice, Trans). Cambridge University Press. (Original
work published 1972).
Bourdieu, P. (1986). The forms of capital. In J. G. Richardson (Ed.). Handbook of theory and research for the
sociology of education (pp. 241–258). Greenwood Press.
Butler, M., & Gardner, B. (2007). Adapting enactments to couple reactivity: Five developmental stages.
Journal of Marital and Family Therapy, 29(3), 311–327.
Chappelle, N., & Tadros, E. (2021). Using structural family therapy to understand the impact of poverty and
trauma on African American adolescents. The Family Journal, 29(2), 237–244.
Freire, P. (2000). Pedagogy of the oppressed. Bloomsbury. (Original work published in 1970).
Garcia, M., & McDowell, T. (2010). Mapping social capital: A critical contextual approach for working with
low-status families. Journal of Marital Family Therapy, 36(1), 96–107.
Jackson, J. B., & Landers, A. L. (2020). Structural and strategic approaches. In K. S. Wampler, R. B. Miller,
& R. B. Seedall (Eds.). The handbook of systemic family therapy (Vol 1, pp. 339–364).
Korin, E. C. (1994). Social inequalities and therapeutic relationships: Applying Freire’s ideas to clinical
practice. Journal of Feminist Family Therapy, 5, 75–98.
Maton, K. (2014). Habitus. In M. J. Grenfell (Ed.). Pierre Bourdieu: Key concepts (2nd ed., pp. 48–65).
Routledge.
Minuchin, S. (1974). Families and family therapy. Harvard College.
Minuchin, S. (2017, January). Systems therapy: The art of creating uncertainty. In Psychotherapy Networker
(pp. 37–38).
Minuchin, S., Montalvo, B., Guerney, B., Rosman, B., & Schumer, F. (1967). Families of the slums: An
exploration of their structure and treatment. Basic Books.
Minuchin, S., & Nichols, M. P. (1993). Family healing: Tales of hope and renewal from family therapy. Free Press.
Minuchin, S., Reiter, M., & Borda, C. (2014). The craft of family therapy: Challenging certainties. Routledge.
Williams, N. D., Foye, A., & Lewis, F. (2016). Applying structural family therapy in the changing context of
the modern African American single mother. Journal of Feminist Family Therapy, 28(1), 30–47.
5 Socioculturally Attuned Brief and
Strategic Family Therapies

Brief and strategic family therapists introduced the idea that change can happen quickly.
Change in one part of the system can create change in another part of the system and small
changes can lead to more substantial, lasting change. Families are often viewed as trying
to solve problems in ways that make sense but don’t work, requiring therapists to think
counterintuitively to intervene in family dynamics. Therapists using these approaches focus
on the here and now, helping families change interactional patterns that often maintain the
very problems they often wish to eliminate.
A number of important approaches to working with families fall under the broad heading
of brief family therapy. These include the work of leading figures at the Mental Research
Institute (e.g., Watzlawick et al., 1967), the Milan group (e.g., Palazzoli Selvini et al., 1980),
and Strategic Family Therapists (e.g., Haley, 1973; Madanes, 1984). As with many family
therapy models developed in the second half of the 20th century, brief models were based on
Bateson’s concept of families as systems (Jackson & Landers, 2020). The focus was on the
family unit and tailoring interventions to specifically meet the needs of each family.
Relatively little attention was paid to the broader social context. These approaches were
originally influenced by Milton Erickson’s counterintuitive approach to change (de Shazer,
1982; Haley, 1973) and have endured many rounds of influential thought including social
constructionism. New approaches have emerged from these frameworks over time including
Post-Milan (Brown, 2010), advances in Milan (Barbetta & Telfener, 2020), and brief strategic
family therapy (Szapocznik & Williams, 2000).

⤝⤞

Socioculturally attuned brief and strategic family therapists promote third

order change by factoring broad societal dynamics into possible hypotheses
and interventions.

⤝⤞

In this chapter, we describe enduring concepts and practices related to brief and strategic
family therapy. We illustrate how therapists can integrate principles of sociocultural attu-
nement and offer practice guidelines. We then share a case illustration to demonstrate how
integrating societal systems and attention to power can lead to third order change.

Primary Enduring Brief and Strategic Family Therapy Concepts

There are a number of tenets common across brief models, including a focus on the here and
now, the assumption that change doesn’t require insight and can happen quickly, and the
DOI: 10.4324/9781003216520-5
 Socioculturally Attuned Brief 95
idea that small change can lead to bigger change (Nardone & Watzlawick, 2005). Early brief
therapists highlighted that we cannot not communicate (Watzlawick et al., 1967). Even
silence is a form of communication and communication may have more than one referent.
Symptoms are sometimes viewed as metaphoric communication with interactional patterns
around one problem representing patterns around another, less approachable problem
(Madanes, 1984). For example, a family may complain of an adolescent repeatedly running
away when in fact their unspoken concern is that one of the parents wants to leave the
marriage. Strategic family therapists consider how families are organized using the metaphor
of family hierarchy, but focus on power dynamics in ways that differ from structural family
therapists.
In strategic therapy, problems are viewed as metaphors and/or resulting from incongruent
hierarchies, or imbalances of power (Madanes, 1981). Those who carry the symptom are
often resisting power dynamics that family members are unable to address. Interventions
share the expectation that therapists will be active and carefully target directives to disrupt
problematic relational patterns (Nardone & Watzlawick, 2005). While less common now
in community agencies and private practice, therapeutic teams were sometimes used to form
hypotheses, observe live sessions, and carefully design interventions for therapists to deliver
during and/or at the end of sessions.
In this section, we offer enduring core concepts in the practice of brief and strategic
family therapies, including circularity and circular questioning, viewing problems as at-
tempted solutions, thinking counterintuitively, and assessing power imbalances. We describe
what makes an intervention strategic, and emphasize the expectation that therapists be active
agents of change.

Circularity
Patterns of interaction and thinking non-linearly remain hallmarks of the practice of family
therapy. Brief and strategic family therapists used the term circular causality to refer to the
idea that it is not necessary to discover where a problem started to find a solution. Each part
of a pattern, or each action, is also a reaction, affecting and being affected by all surrounding
actions (Watzlawick et al., 1967). Patterns can therefore be interrupted anywhere to create
change. Later in this chapter, we will advocate for integrating analysis of societal-based power
into circular thinking, arguing that therapists must be careful not to assume that family
members have equal influence over the formation or resolution of problems or that families
are solely responsible for symptoms.
Circular questioning, introduced by the Milan team, provides a means of feedback while
continually opening new possible explanations and views of the problem (Palazzoli Selvini
et al., 1980). The therapist asks questions to check out hypotheses about what is creating and
maintaining problems. At the same time, family members are asked to share how they view
relationships between other family members, as well as what they think others might think,
say, or feel. This adds new information to their understanding of each other and the problems
they face. The family not only hears about each member’s views and experiences but about
what each assumes are the views and experiences of others. All questions reflect assumptions
and answers confirm or deny hypotheses.
For example, if the therapist asks a family member, “When would your brother say this
problem started?” they are sharing their assumption that there was a time when the problem
did not exist and inferring that knowing the circumstances and timing of the problem’s origin
will help solve it. By asking one family member to assume the position of another, the
therapist is adding information to the system (i.e., what one brother thinks the other thinks)
while forming a hypothesis about why the problem is occurring. When the family member
96 Socioculturally Attuned Brief
answers, “He would say it started soon after our mother died,” the therapist begins to build a
hypothesis that the problem is associated with the death of the mother. They then ask, “Who
was closest to your mother?” hypothesizing that the problem is connected to the loss of a
close relationship. When the client answers “None of us. In fact, we never felt we could live
up to her expectations,” the new information leads the therapist to rethink the hypothesis. It
also leads the family and therapist to shift how they are making meaning of the situation
together.
Hypothesizing is seen as suppositional, providing direction and making sense of problems
relationally. Rather than seeking truth, therapists use hypotheses to guide treatment. Family
members are invited to metacommunicate, which in turn, contributes to new ways of
thinking and doing. Let’s consider the example of the Bernadine’s, a White, middle
class couple (Lily and Tom), who entered problem gambling treatment with their adult
daughter, Mavis.

Therapist: So Lily, I am wondering who you think is most concerned about Mavis’s
gambling?
Lily: Well I think Mavis is.
Mavis: Really?!
Therapist: If I were to ask you that same question, Mavis, what would you say? Who do you
think is most concerned about the gambling?
Mavis: Mom is––definitely! She’s the one who calls me worrying all the time. She gets
dad all worked up about it too.
Therapist: So how would you describe their relationship? Mom and Dad’s?
Mavis: I don’t know … I guess happy. Dad seems happy with their relationship. I’m not
sure Mom is. Maybe she wants him to be around more––pay more attention to
what is going on.
Therapist: And how do you think your mom would describe her relationship with
your dad?
Mavis: She would probably say they love each other, that all couples have to deal with
differences, you know … the usual. She might say he is a grump no matter what
she tries to do to make him happy (laughs and smiles at dad).
Therapist: If your brother Mark were here, what would he say about your parent’s
relationship?
Mavis: He would take Mom’s side. I think he would say Dad is kind of in his own
world. Besides, Mark thinks I am a total loser!
Therapist: So your brother would say Mom is most concerned about the gambling and that
Dad is not as involved with things? How about your Dad, who would he say is
most concerned about the gambling?
Mavis: Well you can ask him, but he will say Mom is.
Therapist: Dad?
Tom: I suppose Mavis is right. It really bothers her Mom.
Therapist: If Mom were bothered less by the gambling would it still be a problem?
Tom: Well of course. It’s not like I don’t care! Lily is just the most tuned in to it.
Therapist: So Mom, maybe they are saying you carry most of the worry? Is that how you
see it?
Lily: I suppose so.

In this brief exchange, the therapist was able to help the family identify a number of
patterns including how the family might be organized around the problem. Lily receives
new information, i.e., that her husband and daughter believe she is most concerned
 Socioculturally Attuned Brief 97
about the problem. The family is offered a new idea, i.e., Mom is carrying most of the
burden of the problem.

Problems as Attempted Solutions

Families are viewed as having the competence and strengths necessary to solve problems,
however, there are times when solutions don’t work and may become or exacerbate pro-
blems (Jackson & Landers, 2020). According to Watzlawick et al. (1974), there are three
primary ways attempted solutions become, or contribute to, problems. The first is when
families underestimate the need to take action. For example, a wife may complain that she
does not have equal influence in her relationship with her husband, who in turn uses his
power in the relationship to dismiss her concerns. This pattern continues until the wife leaves
the relationship. The husband may then realize the need to respond, but responds too late.
The second type of attempted solution is when families overestimate the action needed
to solve a problem. For example, a newly blended family comes into therapy because a
stepfather is concerned that his adolescent stepson is not doing as he is told. When the
therapist investigates, they discover that the son is doing well in school, observes curfews,
does the majority of his chores, and is generally respectful to his parents. The stepfather is
focused on the son’s failure to pick up his room and to complete chores on demand, such
as folding the laundry when asked. The stepfather’s focus on minor non-compliance is
inadvertently creating a problem as the mother feels the need to defend her son and the
son is withdrawing from both parents. This overreaction to a minor issue adds to the
tension in emerging stepparent-child relationships and exacerbates the power imbalance
between the couple by highlighting the mother’s lack of influence over the stepfather’s
unrealistic expectations.
The third type of attempted solution is when families repeat common sense solutions even
when they exacerbate problems. Let’s go back to the example of the Bernadine’s. Mavis (age
28) was having difficulty living on her own without the financial help of her parents. She
worked at a minimum wage job and spent most of her free time in diners playing on
electronic gambling machines. Tom and Lily worried about their daughter being evicted
from her apartment, not having food, or being able to pay her phone bill. They were
dedicated, as most parents are, to helping their daughter be successful and happy. They
refused to give Mavis money to gamble, but when she needed money for rent or food, they
felt compelled to help. They took over her phone bill to make sure they could always reach
her and she could call on them when she needed support. Providing financial support to
encourage their daughter to be on her own is a common sense solution that is effective in
some situations. In this case, parents were being held hostage by the gambling. They knew
their daughter lost the money she needed but didn’t want her to face difficult consequences.
Lily and Tom trying to help their daughter succeed, and Mavis relying on financial support,
(which inadvertently supported gambling), became a pattern of attempted solutions that
made the problem worse.

Counter-Intuitive Thinking
Brief and strategic therapies were influenced by Milton Erikson’s counter-intuitive approach
(de Shazer, 1982; Haley, 1973). Viewing problems from a counterintuitive lens can lead to
creative solutions. How the family is thinking about and defining the problem may be part
of the problem or at least keep them stuck and unable to discover a solution. In de Shazer’s
words (1982), “the therapist’s worldview must help him [sic] see beyond the client’s
worldview. The therapist must see the client’s problem from a different angle” (p. 21).
98 Socioculturally Attuned Brief
In essence, the therapist reframes how the problem is understood, helping clients see it
differently to lead to different sets of solutions. According to Nardone and Watzlawick
(2005), non-ordinary logic is key to unlocking the self-maintaining logic of most problems.
They argued that “The strategic approach to therapy, linked directly to the contemporary
philosophy of constructivism knowledge … is based on the assertion of the impossibility …
of offering an absolutely true and definitive explanation of reality” (p. 38). It is precisely these
many possible realities that open space for counterintuitive thinking.
Rather than being concerned over the cause of a problem, brief and strategic family
therapists are interested in uncovering and disrupting what is maintaining the problem.
The therapist must help families view problems differently to inspire greater options for
change. Take for example a couple who entered therapy because a wife, who had the
majority of power in the relationship, was unhappy about a husband who consistently
acquiesced to her wishes. During the first session, the wife told the therapist they had come
in so the therapist could get the husband to stand up to her. This couple was stuck in a self-
defeating logic loop. The only way the husband was able to stand up to the wife was by
refusing her demand that he do so. If the therapist accepted the client’s position on the
problem, they would worsen the problem by ineffectively trying to get the husband to
be more assertive.
Therapists may find differences in family members’ views to be part of the problem (de
Shazer, 1982). For example, one partner may insist that sharing emotion is primary, while the
other views emotion as counterproductive. Joining with one view over the other typically
leaves the therapist stuck as part of the system attempting to use the same logic. A therapist
would need to shift into a new level or type of solution. This might involve suggesting that it
is not that one approach is better than the other, but the judgmental attitude each partner
takes of the other that is problematic (Atkinson, 2005). This requires therapists to think
beyond their own worldview about how problems should be solved. There are many ways of
looking at what is true. A strategic therapist is most concerned with what works and what
inspires hope for change (Haley, 1976). Haley was convinced that therapists need to help
families construct problems that could be solved.

Incongruent Hierarchies
Like structural family therapists, strategic family therapists consider power dynamics and
family hierarchy as central to presenting problems. According to Cloé Madanes (1981),
“when one is dealing with a family … there is inevitably an issue of hierarchy because the
participants are not all equal. They have status differences based on such issues as age, control
of funds, and community-vested authority and responsibility” (p. 5). Madanes argued that all
couples deal with issues of power and control as they typically divide areas of responsibility.
She noted that family members have the potential to overpower each other, along with the
potential to nurture and care for each other. Incongruent hierarchies occur when family
members’ influence does not match expectations for their roles. Consider a child who
worries over and takes care of a parent with a drinking problem. Not only is the parent
unable to consistently fulfill the role of caretaker and protector, but the child is placed in a
position of taking charge of the parent. Unequal relationships between parents are sometimes
balanced by one or more children siding with a one-down parent, but may also be balanced
through symptomatic behavior (Madanes, 1981).
Take for example a cishet (cisgender heterosexual) couple in which the husband has more
power to influence major decisions and sets the mood in everyday interactions. The wife
accommodates him for the most part, but from time to time goes on spending sprees. She
apologizes profusely when bills come in, but can’t seem to stop. The husband is rendered
 Socioculturally Attuned Brief 99
helpless over his wife’s spending which he is unable to control. In this way, the symptom of
overspending might be seen as serving to balance power in an unequal relationship. This
perspective of power does not clearly differentiate overt power from acts of resistance to
power. When therapists view the most symptomatic person in the family as the most
powerful due to the symptom, they often overlook the symptom as a form of resistance to the
non-negotiable power of another family member.

Therapist as Agent of Change

Brief and strategic models focus on the value of well-placed interventions that create
change. Strategic interventions have become almost synonymous with the use of paradox,
which has largely fallen out of favor. This is in spite of paradox being only one type of
non-transparent intervention. Nardone & Watzlawick (2005) argued that there is no
ethical dilemma when delivering non-transparent interventions because therapy is not a
zero-sum game––the therapist has the best interest of the client in mind and the therapist
and clients win or lose together. There have also always been clear guidelines including the
imperative that interventions should never cause harm (Haley, 1980). Furthermore,
paradoxical interventions must be win/win, i.e., helpful whether or not the family follows
the directive.
What makes an intervention strategic, is not that it is paradoxical or delivered in a non-
transparent way, but the fact that it is specifically tailored to target and interrupt a problematic
interactional pattern. The therapist is responsible to be active and direct the family, supplying
interventions that create change within unique family and societal contexts. According to
Haley (1980, p. 10), a useful theory “should guide a therapist to action rather than to re-
flection. It should suggest what to do.” In fact, Haley placed the responsibility to create
change squarely on the shoulders of the therapist. This mandate has changed over time to a
greater reliance on collaboration between therapists and clients, however, the importance of
therapists being active and accountable for intervening in problematic dynamics has endured.
Descriptions of the wide variety of strategic interventions are beyond the scope of this
work and have been described in depth elsewhere. These include the Milan group’s use of
invariant prescription, paradox and counterparadox, therapy teams, and family rituals
(Boscolo et al., 1987; Selvini-Palazzoli & Viaro, 1988); Haley’s (1984) ordeal therapy and
reframing techniques; and prescribing the symptom, pretending, seeing symptoms as meta-
phors and replacing their function (Madanes, 1981). The following examples are intended to
give the reader the flavor of typical strategic interventions.
Interventions range from direct and transparent to indirect with relatively hidden
agendas. The obvious logic of some strategic interventions is apparent to the therapist and
the family, or at least the adults in the family. Take for example a common pattern be-
tween siblings and a parent. Joe (age 7) and Walter (age 5) fluctuate between playing well
together and arguing. When the arguing gets loud and they start calling each other names,
their custodial grandmother, Mary, enters the room to tell them to stop. If they don’t stop,
Mary raises her voice and sends them to their rooms. Mary is tired of the fighting and
wants a new solution. The therapist asks Joe and Walter what they most enjoy and learns
they especially love going with their grandmother to the dollar store, where they are
allowed to spend a dollar each on anything they like. Mary agrees with the therapist to
offer the money to each of them in a new way. Each week she will exchange two dollars
for 40 nickels. Mary is directed to place 20 nickels in each of the two jars. Whenever she
hears Joe call Walter a name, she simply goes to Joe’s jar, takes out a nickel, and places it in
Walter’s jar. She does likewise when she hears Walter call Joe a name. If either child
protests, they lose an additional nickel. This intervention interrupts the pattern of Mary
100 Socioculturally Attuned Brief
intervening in sibling arguments while maintaining her rule as a parent that there will
be no name-calling. Both children have control over keeping their money and when they
choose to spend it on name-calling, it benefits the sibling whom they intend to insult.
The therapist might also offer a family an explanation without fully disclosing the
reasoning behind an intervention. This doesn’t necessarily mean the reason given isn’t
true, but the truth of the explanation is less relevant than the change in pattern. For
example, a family enters therapy because their four-year-old is throwing fits several times a
day. When she does this, her parents get upset with her and try to get her to stop, which
seems to escalate the behavior. The therapist, after exploring all other potential causes for
sudden disruptive behavior, discovers that the child did not throw tantrums until recently
and shows concern that the child may have missed the important developmental stage in
which young children learn they cannot control everything around them (i.e., “the terrible
twos”). The therapist reassures the family that it is better for a four-year-old to go through
the terrible twos than to go through them as a teen and encourages parents to make sure
their daughter has at least one tantrum a day to get through this developmental stage as
quickly as possible.
The therapist and family carefully lay out exactly what is to happen when the child has a
tantrum and how to insist on a tantrum if she hasn’t had one all day. They rehearse
prompting a tantrum during the session. When they have to resort to prompting a tantrum,
they are asked to sit together and have a cup of hot cocoa once it is all over. Prescribing the
symptom creates change in how the symptom is viewed, as well as each family member’s
action/reaction. Once you have voluntarily done something that you assumed was out of
control, you are more likely to take a metaview that makes repeating the same behavior in
the same old way nearly impossible.
Haley (1984) proposed therapists help families abandon problems by creating ordeals that
made problems too troublesome to maintain. For example, a family entered therapy after
seeing a physician and learned that there was no medical cause for their 13-year-old’s
headaches, which had kept him out of school for several weeks. It was imperative that he
return to school as soon as possible, but the family was uncertain what to do as the headaches
persisted. The therapist explored developmental issues, problems at school, family dynamics,
and so on, only to find that the boy’s headaches seemed to center around some mild anxiety,
which the solution of avoiding school exacerbated. The longer he was out, the more anxious
he became about returning. In this case, the therapist elicited the help of parents and
grandparents who were eager to see the problem resolved. Each of the adults agreed to be on
call to spend one or two days a week in the school nurse’s office. The school agreed that a
parent or grandparent could sit with the student when he wasn’t feeling well. This way he
would at least be at school, but never without someone to nurture him when he wasn’t
feeling well. The boy returned to school, but not to the nurse’s office, releasing his headaches
to avoid the social embarrassment of having a parent or grandparent with him at school.

Integrating Principles of Sociocultural Attunement

Sociocultural attunement requires expanding practice beyond family systems to consider the
relationship between families and society. The idea of circularity or that interactions occur in
repetitive patterns, remains useful in challenging linear cause and effect thinking, however,
the relative power family members have to create and maintain patterns must be taken into
account. Likewise, it is important to understand parallel societal processes that promote
imbalances of power and their effects on incongruent hierarchies on presenting problems.
Socioculturally attuned brief and strategic therapists are called on to not only think coun-
terintuitively but to think in ways that counter-hegemony.
 Socioculturally Attuned Brief 101
⤝⤞

From a socioculturally attuned perspective, symptoms are carefully considered

to determine if and how they may serve as acts of resistance to unjust systems.

⤝⤞

Societal Context
Socioculturally attuned brief and strategic therapists are tasked with understanding how
family interactions and the meaning of problems are impacted by culture and societal
dynamics––the context beyond the individual family. Conceptualizing circularity and pro-
blem formation on a societal level can help therapists develop contextually informed strategic
hypotheses.

Circularity in Context
Circular causality has been heavily criticized as promoting an assumption that problems are self-
perpetuating and that all family members have equal opportunity to create change. Feminist
family therapists challenged the assumption that family members have equal influence and that
problems reside solely within families rather than reflecting power dynamics in the broader
society (James & McIntyre, 1983). According to Goodrich and colleagues, (1988),

Circularity is another systemic construct that operates in women’s disfavor. The idea that
people are involved in recursive patterns of behavior, reactively instigated and mutually
reinforced results either in making everyone equally responsible for everything or no one
accountable for anything. (p. 17)

Haley (1980) actually voiced a related concern when he argued that “Systems theory, as it
was applied to families, tended to describe participants as equals … a primary problem … is
the way systems theory takes away individual responsibility” (p. 15).
Perhaps the metaphor of patterns as circular is itself a problem as it elicits a sense of equality
and equidistance, like sitting at a round table at standard intervals. There is no one at the head
of the table and everyone has the same amount of space. You can see and hear everyone
equally. While the practice of continuing to track interactions until they loopback or “circle
around” to the starting point remains helpful, in reality, patterns of interactions are more
likely uneven, unequal and asymmetrical; actions more or less voluntary, with participants
having various levels of influence and choice across situations. Interactions are influenced by
societal dynamics that afford some greater power and influence in families than others.
Likewise, choices are often narrowed by social constraints, cultural norms, and power dy-
namics that limit actions and reactions.
Consider an Egyptian Muslim family in which an adult son, Mohamed, is unable to earn
enough money to marry due to the country’s long-term economic depression. He begins
to stray from family and religious values in favor of hanging out and drinking alcohol with
a group of peers who are in the same situation. He and his father, Achmed, engage
in verbal conflict when he arrives home. His mother, Magda, attempts to intervene but is
quickly dismissed by both males. The conflict escalates until Mohamed angrily leaves the
house. Magda and Achmed then argue about how the situation was handled until Magda
withdraws. Call to prayer calms and centers both Achmed and Magda who then come
together in a loving embrace.
102 Socioculturally Attuned Brief
Culturally, Mohamed is expected to be a capable provider before he marries. Global
economic disparities leave him caught between childhood and adulthood. He acts out in an
adult way (e.g., drinking with friends) that leaves him paradoxically stuck in childhood (e.g.,
being scolded by his father). As a female, Magda enjoys economic rights and protection under
Egyptian law, which interprets the Qur’an as guaranteeing those rights (Al-Mannai, 2010),
yet like most women in the world, she has less power to influence men in a patriarchal
society. Their religious beliefs and common cultural experience of being called to prayer
five times a day serve as a source of resilience that helps them maintain connection in spite
of conflict. This circular pattern is shaped by economic, religious, and cultural constraints
and opportunities.

Problem Formation at a Societal Level

We must understand how societal dynamics contribute to problem formation and how
some social problems are exacerbated by attempted solutions on a societal level. Consider
financial aid from high resource countries to low resource to countries. This makes
good common sense to most of us. This aid ensures a positive political alliance and often
enhances military strength that supports multiple government agendas. The countries
receiving aid are hopefully in better positions to defend themselves through military force,
build infrastructures, encourage trade, and lessen poverty. The dynamics of national
lending and debt, however, create new problems. Those in power to disburse funds can
do so in ways that benefit themselves, maintain their power, and/or support reforms
that eventually fail. Low resource countries can become increasingly indebted to powerful
international lenders. This reinforces existing international imbalances of power
(Soederberg, 2013). These common sense solutions can have unintended effects at local
levels. In this case, poverty, and the many emotional, relational, and health problems
associated with poverty, may become increasingly difficult for families to overcome as
governments must pay back their loans even when it means depriving families of basic
needs such as safety, food security, health care and education.
It is not uncommon for societies to under respond or over respond in ways that contribute
to large-scale formation of social problems. For example, many societies significantly under
respond to intimate partner violence, poverty, racism, homophobia, and other social pro-
blems. Failure to adequately respond leaves vulnerable family members and families most
marginalized in society without protection and/or equal access to resources. The effect on
families is widespread, contributing to many of the problems family therapists are only too
aware of (e.g., medical problems, depression, anxiety, interpersonal conflict).
The work of Kabura described in Text Box 5.1 is an example of a brief, targeted in-
tervention into a societal system. The intervention was tailored to fit a Ugandan cultural
context by working closely with clan elders and religious leaders. The wisdom of clan
elders and religious leaders is highly respected in the community. They are the first
responders–one of the first to hear a complaint–when domestic violence occurs. These
leaders integrated new knowledge of domestic violence into their traditional, cultural, and
natural wisdom, which in turn informs their decisions on behalf of clan members. This
intervention targeted a specific point in the pattern of interaction in the larger system to
create change.
Kabura (McDowell & Kabura, 2016) sought to increase awareness of community leaders and
accountability of those who commit domestic violence. This intervention did not directly
address gender inequity per se but made an important change that supported just responses to
the outcroppings of inequity. Staff at Bishop Magambo Counselor Training Institute (BMCTI)
in Fort Portal, Uganda reached out to local authorities and community leaders to raise
 Socioculturally Attuned Brief 103
awareness of domestic violence (e.g., signs of abuse, reporting abuse-associated crimes, safety
issues, the abuse cycle, procedures for referring for counseling). In Text Box 5.1 Kabura
describes the impact of this strategic move.

Text Box 5.1 Paschal Kabura, Ph.D.

Paschal Kabura is a Catholic priest and founder/director of the Bishop Magambo

Counselor Training Institute in the Kabarole District of Uganda. According to
Kabura ( McDowell & Kabura, 2016, p. 33):
if a husband beats his wife, the wife will likely go to her parent’s home.
Traditionally when a wife has gone to her parents, her husband has an obligation
to appeal to her family and the clan elder in order to seek reconciliation. The
husband is typically given a punishment and the wife returns to the marriage. Clan
elders are now beginning to enter these situations with a better understanding of
the abuse cycle. They are less likely to be deceived by the husband’s show of
remorse or promises to change. They realize all might not be well when a couple is
in a “honeymoon stage.” They are slower to move toward reconciliation and more
likely to say things like “you tell us now that everything is o.k., but we need to go
deeper into the cycle to get to the root of the problem.” They are better able to
recognize their own limits in solving this problem and are aware of how to refer
clan members for help. Clan elders and religious leaders have significant leverage
in referring families for counseling, helping to overcome the stigma associated
with mental health issues. When sent by a clan elder or religious leader people are
more likely to accept help. It is not unusual for someone to come to the counseling
center at BMCTI saying “I did not think I would come here, but my elder told me
this is what I need to do” or “My clan leader told me if I don’t come here, he won’t
listen to me again.” Clan elders and religious leaders sometimes consult directly
with faculty and staff at BMCTI. In this way, these informal helpers are getting
consultation for their work as well as opportunities to develop their skills without
pursuing a degree. They can seek support when situations get complex. They are
also empowered by borrowing the expertise of the center. For example, it is not
uncommon for a community leader to say, “This is what Dr. Kabura has said.”

Families are also influenced by cultural and societal contexts in their attempts to solve
problems. Consider parents over-responding to children earning poor grades. Poor academic
performance may result in fear, anger, and family conflict. These reactions are informed in
part by economic systems that rely on education as a means of securing middle and/or
professional class status. At some level, a second grader’s poor academic performance
threatens the family’s and child’s long term economic security.

Power
Strategic therapists carefully analyze power imbalances; however, symptom removal remains
the primary goal (Madanes, 1981), rather than necessarily promoting relational equity. This
may lead therapists to intervene in ways that mirror power dynamics and fail to help families
consider more equitable and just alternatives. For example, many years ago Teresa saw a
family in which a teenage daughter and her mother got into chronic arguments. The father
sometimes took the side of his wife and sometimes took the side of his daughter, typically
104 Socioculturally Attuned Brief
being the one to make any necessary final decisions. As a then strategic therapist, Teresa asked
the family to reenact the arguments in session and assigned the father the task between
sessions of flipping a coin each time mother and daughter fought to decide whose side he
would take. This intervention eliminated the pattern of mother and daughter fighting and
father stepping in, but failed to address the societal dynamic of male dominance that
maintained the father’s one-up position in the family.
Post-Milan practice (Brown, 2010) emerged in response to the critique of the Milan
group’s lack of attention to power (e.g., Goldner, 1985, 1993; Hoffman, 1985) and the
introduction of social constructionism. Therapists began being thought of as engaging with
families to mutually understand problems within societal context. Hypothesizing broadened
to include social influences and analysis of power dynamics. Recent advances in the Milan
approach (Barbetta & Telfener, 2020) include “the ontological turn,” such as using lenses
from different angles and positionalities to realize different points of view (epistemology),
while maintaining awareness of realities that are beyond how we look at and talk about things
(ontology); and “the corporeal turn,” focusing on embodiment and embodied knowledge in
a way that goes beyond biology, neurology, and psychology toward a gestalt that includes
bodies and movement in relationship to social and political realities. See Text Box 5.2.

Text Box 5.2 Pietro Barbetta and Umberta Telfener

Pietro Barbetta and Umberta Telfener work at the Milan Center for Family Therapy
in Milan Italy. In the following excerpts, they ( Barbetta & Telfener, 2020) described
important aspects of the ontological turn that embrace social constructivist thinking
and acknowledge the very real consequences of inequity:
What is new in the Milan approach is a needed different attention to discrimina-
tion, poverty, social issues, and human rights. We are dealing with social issues
such as marginalization, that is, what we systemics call out of order, and what the
psychiatric discourse calls disorder. Our curiosity focuses on the social aspects
that create discrimination and pathology, we are curious about the link between
the institutional violation of human rights and new forms of pathology. (p. 11)
Systemic perspectivism moves people to exchange actions, discussing differ-
ences without disqualifying each other … We are interested in creating the
conditions whereby the world outside is observed as a multiverse reality, with
its own terms of engagement. It means that there are social ontologies: moralistic
communities where a woman has to watch the way she dresses; oppressive
institutions where a child can be psychologically abused; big companies where
workers are forced to contribute to pollution under the threat of losing their job;
criminal societies and terrorists who buy weapons from “regular” arms factories;
criminal families (mafia) where loyalty is necessary to maintain appearances of
normality; refugees who do not receive asylum in Europe, even though they come
from camps and war. How can such realities be considered linguistic “construc-
tions”? (p. 10)

Societal Impact on Power Imbalances

In the earlier example, it didn’t occur to Teresa that the symptom or pattern in which the family
was stuck reflected an incongruent hierarchy on a societal level. Patriarchy promotes the as-
sumption that sex and gender are conflated, dichotomous, and natural. Men and masculinity are
 Socioculturally Attuned Brief 105
more greatly valued and assume a one-up position in relation to women and femininity, even in
societies such as the US that tout democracy and equality. At a societal level, men are more
often the decision makers as was true in this family. By asking the husband/father to make an
arbitrary decision about supporting either his wife or teenage daughter, Teresa was reinforcing
the problem even while eliminating the symptom. She was also ignoring what may have been a
form of resistance to male dominance by the mother and daughter.

Culture and Power

Family therapists often view culture as a matter of difference. Cultural competence is vital
to ethical, effective practice and therapists support cultural democracy by viewing all cultures
as equally legitimate. There is a tendency, however, even among culturally competent therapists,
to overlook the centering and dominance of some cultures over others, which potentially offers
those in the majority culture greater social influence and access to resources (See Chapters 2 & 4;
Bourdieu, 1986).

⤝⤞

Culture affects how we attempt to solve problems, and what we consider

intuitive or logical is often unexamined dominant cultural logic.

⤝⤞

For example, European Americans in the US tend to value independence and individuality.
When a family enters treatment with a three-year-old who is having trouble sleeping on her
own, it can be easy to follow the family’s common sense logic of the importance of toddlers
sleeping separately from parents. Common sense solutions (e.g., night light, door ajar, reward
system) attempt to resolve what has been culturally framed as a problem. Family therapists
might believe they are thinking “outside the box” when hypothesizing that the child’s refusal to
sleep alone is a function of family interactions (perhaps a problem in the couple’s relationship)
while failing to examine the expectation that healthy toddlers sleep alone privileges European
American cultural dominance. The therapist in this situation would not necessarily discourage
the parents from their goal, but could help parents put their decision in a cultural perspective.

Symptoms as Forms of Everyday Resistance

Everyday resistance is often overlooked as a response to oppressive power dynamics in fa-
milies and societies. According to Afuape (2011), aspects of everyday resistance include the
ways people always resist oppression; the ways we all struggle with contradictory positions
and ways of responding to oppression that can coexist; the back and forward movement
toward liberation that is forever shifting and changing; the place of our relationships and
social circumstances in supporting or constraining movements in our preferred direction; and
the possibility of being both oppressor and oppressed. (p. 72)

⤝⤞

What we identify as problems might also be sites of everyday resistance, better

understood as symptoms of power imbalances in society.

⤝⤞
106 Socioculturally Attuned Brief
For example, demonstrating depression may be both a genuine physical and emotional
struggle and a way to resist an oppressive marriage or job. Strategic therapists notice this
dynamic and hypothesize symptoms as exerting a type of power that can balance incongruent
hierarchies. Practicing from a socioculturally attuned framework extends this idea beyond the
family to link oppression to broader societal contexts. Women who are displaying depression
as a form of resistance to a male partner’s dominance are also resisting a much broader force of
male dominance, which maintains this power dynamic in intimate relationships. A client
showing depression or panic attacks in response to a workplace may also be resisting much
larger issues (e.g., class privilege, racism, sexism) that promote and maintain unjust working
conditions.
Resistance in the form of symptoms is also frequently overlooked as a site of resilience
(McDowell, 2015). Consider a set of twins in a family in which a socially powerful parent
is verbally and emotionally abusive. One twin argues back continuously and is labeled as a
problem because she disrupts the family on a daily basis. The other withdraws, eventually
relying on drug use to resist oppression. The first twin’s behavior contributes to her
resilience by helping her learn not to give up and to stand up even when under attack.
The second twin resists by engaging in drug abuse, which is temporarily empowering
within drug using contexts, but disempowering in the larger society (Stanton & Todd,
1982).

Third Order Change

Third order change occurs when there are shifts in how families see the world, allowing them
to consider more possibilities for how to understand and negotiate their relationships.
Socioculturally attuned brief and strategic therapists co-construct hypotheses with clients that
include awareness of the impact of societal context on presenting problems. Raising social
awareness helps families realize the impact of these broad social arrangements on their most
intimate relationships and more directly and knowingly participate in dismantling incon-
gruent hierarchies and relational patterns. This deeply impacts family rules and collective
meaning making.

⤝⤞

Third order change occurs in socioculturally attuned brief and strategic family
therapy when families unlock incongruent societal hierarchies in favor of
adopting equity-based relational systems.

⤝⤞

Practice Guidelines
Practicing socioculturally attuned brief and strategic family therapy requires thinking beyond
the family, broadening the circle of interactions and hypotheses to include power dynamics
in societal context. Symptoms are viewed through a lens that considers their value as forms of
resistance and symptom free resistance is supported. Rather than being neutral observers who
intervene to remove symptoms, therapists take a number of steps including broadening the
circle, thinking counterintuitively to counter hegemony, including societal power im-
balances in hypotheses, affirming symptom free resistance, and intervening to support just
relationships.
 Socioculturally Attuned Brief 107
1 Broadening the Circle

Socioculturally attuned brief and strategic family therapists expand their view to attune to the
interconnection of individual thoughts and behaviors, patterns of interaction, cultural lifeways,
and societal dynamics. Consider the Bernadine’s mentioned above who presented with a
gambling problem. Treatment for problem gambling is likely to include attention to biological
(e.g., chemical changes in the brain, neuro-pathways), psychological (e.g., magical thinking,
fantasies of the future), behavioral (e.g., gambling rituals), affective (e.g., emotional triggers),
relational (e.g., attachment styles, family patterns around gambling behavior), contextual (e.g.,
financial issues, allure of gambling contexts), cultural/social (e.g., meaning of money, economic
system, definition of success), and existential (e.g., illusion of control, beliefs around chance)
considerations (McDowell & Berman, 2016). These areas are not discrete or dichotomous but
deeply intertwined. For example, it is not possible to understand the meaning of money, the
thought process around gambling, the family’s reaction to problem gambling, or the allure of
gambling contexts without understanding the society’s economic system and cultural definition
of luck and success. Even the dopamine released in the brain when taking a gambling risk is
influenced by the economic system and cultural value of wealth.
Circular questioning with the Bernadines from a socioculturally attuned framework that
includes the larger context might continue as follows:

Therapist: So I am thinking about why so often in families moms seem to carry most of
the worry. Tom, what do you think most people would say if I asked them why
women seem to worry a lot about everyone else?
Tom: I think most people would say that’s just what mothers do.
Therapist: And what do you think they would say about fathers?
Tom: Well I think most people would say fathers care a lot about their families too but
just show it in different ways … working … doing things for the family.
Therapist: Mavis, if I were to ask your brother Mark the same questions, what would
he most likely say?
Mavis: Well Mark just stays out of things.
Therapist: Yes, of course, I notice he didn’t come today (everyone laughs). But if you were
to venture a guess, what might he say if he were here?
Mavis: I think Mark and I both go to Mom when we need things because she is more
likely to understand, so maybe she just knows us better and so worries more.
Therapist: Mavis what do you think your friends would say about the role of women being
caretakers in the family?
Mavis: Most of my friends are not so interested in doing that. They want partners who
will be more equal and to be able to do more of what they want to do.
Therapist: And your mom’s friends? What might they say?
Mavis: I don’t think they like it, but maybe they would say they are stuck being the ones
who hold the family together. Most of them do a lot of making sure everyone
else is O.K.––especially their husbands (laughs).

By broadening questions to include social discourse, the therapist was able to name and
pursue gender and power dynamics within and beyond the family.

2 Think Counterintuitively to Counter Hegemony

According to Brown (2010), circular thinking must include therapists’ awareness of their
own beliefs and values as well as the impact of dominant social discourses on families and
108 Socioculturally Attuned Brief
presenting problems. Being able to take a metaview of dominant social discourses and the
dynamics of broad societal systems allows therapists to develop the critical consciousness
necessary to think counter hegemonically as well as counter intuitively. We use the term
hegemony to refer to mechanisms that maintain the status quo of unequal power distribution
in society through social, political, economic, and ideological control. This includes, but goes
beyond, the concept of dominant discourses to include laws, corporate and educational
practices, social services, and so on. The therapist’s critical awareness contributes significantly
to how problems are framed and consciousness raising takes on a more central role in creating
third order change. The therapist values sources of resilience and previously silenced voices
of resistance. This is exemplified in the case illustration below as the family and therapist
work together to raise critical consciousness to develop a hypothesis that is socioculturally
attuned.

3 Include Societal Power Imbalances in Hypothesis

Socioculturally attuned brief and strategic therapy expand hypotheses to include societal
power dynamics. Children typically have less power and responsibility than their parents.
Power imbalances, however, are not part of the natural order of adult relationships.
Viewing power imbalances as existing solely within the boundaries of families tends to
pathologize individual relationships and limit how we are able to intervene. Consider a
European American family in which there is an aging parent living with an adult child
and two adolescent grandchildren. The rest of the family talks only to each other and
frequently overlooks the grandparent when making plans. The grandparent is expected
to go along with whatever decisions are made. This family is deeply influenced by a youth-
oriented culture that devalues those who are no longer financially producing. If the
grandparent is female and less than fully able-bodied, the power imbalance worsens as
the family is likely to unintentionally act out the ageism, sexism, and ableism of dominant
US society. The family enters treatment because the grandparent is having angry outbursts.
If the therapist non-reflexively shares the worldview that older adults are worth less
than younger adults and children, they are likely to view the grandparent’s outbursts as a
symptom of adjusting to old age rather than societal dynamics impacting the family.

4 Affirm Symptom-Free Resistance

Resistance is a healthy response to oppression. Strategies for resistance may be quite varied,
including withdrawing physically or emotionally, standing up and speaking out, yielding to
get through oppressive situations, and trying to understand to navigate power dynamics
(McDowell 2004). Socioculturally attuned family therapists are in a position to help clients
envision ways to strategize against oppression in ways that don’t cause them further harm.
Consider a firefighter who was the only female in her rural station. Her co-workers re-
ferred to her as an opportunity hire and excluded her from chances to perform. She was in a
relationship with a man who shared the traditional gender role expectations of her family of
origin and most of her community. She was referred to therapy by a physician after ex-
haustive tests could not determine a physical cause for her inability to swallow food. The
therapist gathered information about all of the client’s relationships before hypothesizing that
the symptom was a metaphor of the client’s resistance to being overpowered. The client and
therapist began exploring dynamics in the client’s life that she was “not willing to swallow.”
Identifying the oppression and attempts to resist oppression was a powerful consciousness
raising intervention. The client joined a group for women in male dominated workplaces
that the therapist started after seeing many women in the community dealing with similar
 Socioculturally Attuned Brief 109
dynamics. Over time, the therapist, women in the group, and the client developed alternative
approaches to resisting oppressive situations.

5 Support Just Relationships

It is not possible for a therapist to be neutral in the face of power imbalances (Knudson-
Martin, 2013). If a therapist fails to address relational inequity, he unwittingly contributes to
it by default. On the other hand, if the therapist encourages shared power, he may be cri-
ticized for promoting his own agenda. This would seem to be an impossible ethical bind if it
were not for the fact that power imbalances often create and maintain the very symptoms the
therapist and family are trying to eliminate (McDowell, 2015). From this perspective, the
therapist is obligated to address what is harming the family. As noted above, therapy is not
a zero-sum game (Nardone & Watzlawick, 2005). Shifting the power from the oppressor
to the oppressed is not a successful outcome as it maintains a power-over system that will
continue to be problematic.

⤝⤞

Transformative action requires socioculturally attuned therapists to be aware of

the impact of societal systems on all family members, including those who are
acting in oppressive ways.

⤝⤞

Case Illustration
Tiana (age 16) comes to family therapy with her brother, James (age 10), and parents,
Brandon (age 40) and Kisha (age 42). The family lives in a relatively safe middle-class
neighborhood. All family members identify as Black, cishet (cisgender heterosexual), and
able-bodied. Brandon and Kisha met 20 years prior while in college. Brandon grew up in a
working class family in which most of the men were in the building trades. Kisha’s parents
were upper-middle class and held important positions in the government. Tiana and James
are both doing well in a private, Roman Catholic school. The family entered treatment with
Ladonna, who works for Catholic Community Services. Ladonna identifies as a Black, cishet
woman. She grew up living in poverty, however, her professional career now provides a
stable middle-class income. The family explains to Ladonna that they are experiencing
growing conflict.
During their initial visit, James responds to Ladonna’s question about why the family
came to therapy by resentfully stating, “My SISTER yells all the time.” Brandon glances at
James with a slight grin. Kisha interrupts with “There is too much fighting between ev-
eryone,” glancing at James with a disapproving brow. The family describes a repetitive
pattern of conflict. They offer a typical example in which Brandon makes a demand of
Tiana (e.g., go close the door, fold this laundry), Tiana ignores her father, Brandon repeats
the demand in an angry tone, James offers to do the chore (“I’ll do it dad!”), Brandon tells
him to stay out of it and pursues Tiana repeating his demand in an angry, physically
threatening tone and posture, Kisha intervenes asking him to calm down while Tiana
screams at her father as she withdraws to her room. Kisha tells Brandon that he can’t just
“boss her around! She is almost 17!” Brandon withdraws in anger until James comes and
sits on his lap.
110 Socioculturally Attuned Brief
Broadening the Circle
The pattern of interaction described above seems relatively straightforward. At first glance, it
appears to be a simple case of a teenager acting out and parents needing to agree on how to
parent together as a team. Part of the problem, however, is that parents disagree on how strict
to be with their daughter and Kisha disapproves of Brandon’s approach. Brandon is not easily
influenced by Kisha and in spite of her cautions, continues what Kisha considers overly
aggressive parenting of their daughter. When Ladonna explores other areas of the parents’
relationship, she discovers this is a pattern. Brandon is far more likely to influence Kisha than
Kisha is to influence Brandon. Kisha frequently attempts to persuade Brandon to see her
perspective, but is left feeling she is the one who must accommodate him.
Ladonna broadens the circle by exploring race, gender, and social class dynamics in society
and how these dynamics impact this particular family. Expectations that Kisha will accom-
modate Brandon based on gender overshadow her coming from a higher social class back-
ground and are, in part, a response to the lack of respect Kisha knows Brandon experiences as
a Black man in the broader society. For example, despite his competence, Brandon was not
promoted as quickly from superintendent to project manager as his male counterparts in his
White-dominated construction firm. Internally he is always on guard, careful not to upset
others, knowing that men like him are often viewed as dangerous. At home, he feels more
entitled to relax his guard and expect obedience. Kisha wishes Brandon would treat Tiana less
harshly, yet knowing he is so often denigrated outside the home, she tends to protect his
status in the family (Cowdery et al., 2009). Ladonna also explored differences in societal
expectations, issues of safety, and avenues for success for Tiana and James as young Black
women and men in the current US context.

Thinking Counterintuitively to Counter Hegemony

When family members’ actions didn’t attain the desired result, they repeated them anyway
because they made sense. When Brandon made a demand of Tiana and she didn’t comply,
he continued with more of the same, repeating his demands more forcefully. Kisha re-
peatedly attempted to get Brandon to understand using the same arguments each time she
was frustrated with how he was approaching their daughter. And so on, with each member
of the family repeating the same type of common sense response even though nothing
changes. Thinking counterintuitively includes considering what message this problem
pattern may be communicating and how the problem may be balancing an incongruent
hierarchy.

⤝⤞

Thinking in ways that counter hegemony includes considering how family

communication may reflect imbalances of power on a societal level.

⤝⤞

When Ladonna asks Brandon more about his concern over his daughter not doing as he
asks, he explains that he “only asks her to do a few simple things!”

Ladonna: So you don’t ask much of your daughter.

Brandon: No. Plus, what I tell her to do isn’t difficult. Just keep the house up, help her
mom with the dishes …
 Socioculturally Attuned Brief 111
Ladonna: Really basic stuff.
Brandon: Yes, what I tell her to do is easy.

Ladonna recognizes Brandon’s response as one that perpetuates female dependency and
underachievement. She is especially concerned because she is keenly aware of the myth of
the Black matriarch that can dismiss the ways Black women lack power (Hill, 2005). She goes
on to challenge this societally informed belief.

Ladonna: Actually, that concerns me a little.

Brandon: What, that it’s easy!
Ladonna: Well yes. Mom, what do you think Tiana is capable of doing?
Kisha: She is a pretty competent young woman. She gets good grades, is on the student
council at school, helps me teach preschool on Sundays at our church. He’s right.
What we expect of her at home isn’t much.
Ladonna: Tiana, is your mom right?
Tiana: I guess so. I just don’t like being bossed around all the time!
Ladonna: I am wondering why your parents don’t expect more of you. (Tiana rolls her
eyes.) No, I don’t mean more time or more tasks, but things that are harder to
do … more fitting to your abilities. You are almost 17, right? Next year is your
last year in high school … then what?
Tiana: I am going to college.
Ladonna: So Mom and Dad, what are you hoping she will learn from you in the next year
before she goes to college?
Brandon: To be responsible so she can take care of herself.
Kisha: Well that, yes. And to be confident. She is a good person. I want her to hold onto
herself and her values when she gets out on her own.

Ladonna continues to explore expectations for Tiana to be grown up; to take care of herself,
make good decisions, and “stand up for what she believes in.” Tiana agrees this is what she
wants for herself and for her brother when he grows up. Brandon was stuck in a common
sense, self-perpetuating cycle of asking less and less of his daughter in more and more de-
manding ways. He inadvertently undervalued his daughter’s abilities and dismissed his wife’s
concerns and advice. He also used anger and aggression as a means to get what he wanted.
Ladonna was thinking counterintuitively when suggesting parents ask their daughter to do
more difficult tasks rather than doing less. If Ladonna would have simply encouraged
Brandon to treat his daughter in a more developmentally appropriate way, (e.g., give her
tasks for the week that she completes as she has time) she would be joining mom’s voice and
either be dismissed as another female in the therapeutic system or be demonstrating that she
had more influence over Brandon’s decision than did Kisha.
Ladonna was also setting the stage to counter patriarchy. Expecting too little of a 16-year-
old daughter reflects low expectations for young adult females. Tiana was obviously capable
of more adult contributions to the family. Ladonna engaged the family in discussions about
what they wanted their daughter to be able to do as a Black female in society. Brandon
agreed that he wanted his daughter to have the same rights and say in her life as men. This
opened the door to talking about the couple’s gendered relationships in which Brandon had
more say than anyone else in the family and how this pattern inside the family might be
exacerbated by racism that takes a toll on the whole family. Ladonna led the family in a
discussion about how that came about, the cost to the family relationships, and what they
envisioned instead.
112 Socioculturally Attuned Brief
Including Societal Power Dynamics in Hypothesis
The socioculturally attuned therapist working with this family began by asking questions that
helped the family work with her to hypothesize how what was going on within the family
reflected broader societal dynamics. The family was caught in an incongruent hierarchy
found more generally in society and played out across many specific contexts in their lives.
For example, Kisha and Brandon worked for the same company and had the same educa-
tional background. Both experienced being routinely marginalized by White peers, building
customers, and company owners as the only two Black employees. The company was also
highly organized around gender. The office employed only women and only men worked in
the field. While both Kisha and Brandon held highly skilled leadership positions in the
company, the women in the office were frequently diminished and dismissed by male em-
ployees who (unlike Brandon) put off requests to complete paperwork, referred to getting
“nag mail” from the office, and circulated sexist jokes.
Ladonna and the family worked together to develop a hypothesis that included a gendered
power imbalance shaped by broader societal racial dynamics that left dad making unilateral de-
cisions and exerting power. This dynamic cost dad some of his connection with his wife and
oldest daughter. His use of aggression came at a particularly high price as family members
sometimes accommodated out of fear. James joined dad’s side, which also cost him closeness with
his mother and sister and perpetuated the privilege sons sometimes have in African American
households due to their lack of advantage in the larger society (Hill, 2005). Tiana needed to learn
to stand up for herself in a context in which males continue to have greater privilege and expect
women to accommodate them. Kisha and Brandon needed to learn, and demonstrate for their
children, the ability to share equal influence in a world that marginalized each of them in
somewhat different ways. This is in keeping with Cloé Madanes’ (2006) reference to therapy as a
place where resistance to the status quo can be acknowledged and supported (see Text Box 5.3).

Text Box 5.3 Cloé Madanes

Cloé Madanes is one of the developers of the strategic approach. According to her
( Madanes, 2006),
Within each therapy client stirs a rebellious heart, a desire to challenge the
status quo. Therapy is a forum for thoughts and feelings that are often considered
to be unacceptable, antisocial, unsafe or dangerous to the morality and good
order. (p. 6)

Affirming Symptom-Free Resistance

The therapists in this situation affirmed the parent’s desire to make certain their daughter was
prepared for adulthood. This included among other things being able to take responsibility
and complete difficult tasks independently. Ladonna, Kisha, and Brandon needed to guide
Tiana in how to resist gender and racial oppression, including how to “stand up for what she
believes in” as a young Black woman. She also affirmed Brandon’s desire to be connected,
Kisha’s right to have equal say in what happens in the family, and the need for James to not
have to take sides. Kisha, Brandon, and Tiana agreed on chores that were more challenging,
would help prepare her for adulthood, and that she could fit into her busy schedule. This
included helping her father change the oil in their cars, doing the weekly grocery shopping
for the family, and giving her brother a ride at least three times a week.
 Socioculturally Attuned Brief 113
Ladonna and the parents agreed to help Tiana practice asserting herself in effective and
respectful ways. Dad agreed to make arbitrary demands of Tiana from time to time without
the use of a loud voice or physically aggressive posture. Tiana agreed to respectfully decline
or offer a time when she would be able to accommodate the request. Mom was then to
review Tiana’s efforts, coaching her as needed. Anyone in the family who noticed Brandan
sharing power by thinking about others first, asking instead of demanding, or negotiating
respectfully, was to warmly approach him and give him a kiss on the cheek. This strategic
intervention prescribed the symptom but in ways that supported a shift toward greater
connection and equality in the family.

Supporting Just Relationships

This family presented with a relatively simple problem, but one that reflected a much broader
social and family dynamic. By supporting just relationships, the therapist was able to help the
family remove the symptom, but not without first recognizing the symptom as a form of
resistance. In other words, the symptom revealed the need for third order change, while also
providing strategic leverage for change.

Summary: Third Order Change

The family in the above illustration engaged in first, second, and third order change.
Changing the types of chores Tiana was asked to do was a form of first order change. This
intervention alone would not lead to second order or process level change, which is qua-
litative and discontinuous, altering the system’s rules, structure and/or order (Watzlawick
et al., 1974). Changing the meaning of Tiana’s refusal to comply with doing chores on
demand from a form of rebellion to a necessary skill for adulthood led the way for second
order change. Second order change included Kisha having more equal say in parenting and
Tiana being supported by both parents in more developmentally appropriate ways. Third
order change occurred in this family when there were major shifts in how they saw the
world (Ecker & Hulley, 1996). The family was able to consider more possibilities for how
to organize their relationships when they were able to take a metaview of gender, race, and
power in society. This helped them realize the impact of these broad social arrangements on
their most intimate relationships and to make more conscious choices about how they
wanted to live. The therapist invited the family into third order change by working
with them to develop a hypothesis that included awareness of the impact of societal
context on the family’s presenting problem. This, in turn, led to further second order change
as they altered family rules about the meaning and impact of gender in relationship to in-
fluence and competence. We end this chapter with another quote from Cloé Madanes
in Text Box 5.4.

Text Box 5.4 Cloé Madanes

Cloé Madanes stated the following at the end of a video recorded in 2008:
I have come to see that family injustice is the root cause of pathology and that for
therapy to be effective, it must bring justice to the family. Sometimes injustice
comes from outside the family and then the therapist must work on bringing justice
from society to the family.
114 Socioculturally Attuned Brief
Reflexive Questions
• How can taking a metaview of dominant social discourses and dynamics of broad societal
systems help you develop the critical consciousness necessary to think in counter-
hegemonic ways, as well as counterintuitively?
• If you were to think counterintuitively, how could this help you counter the effects of
hegemony?
• Can you recall a time when you included power imbalances in your hypothesis of a
presenting problem and in your analysis of what sustained it?
• What would it mean for you to encourage symptom-free resistance, for yourself and for
your clients?
• What would it mean for you as a strategic family therapist if you were able to name the
injustices coming from outside the family and work to bring justice from society to
the family, as Madanes suggests?

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6 Socioculturally Attuned Experiential
Family Therapy

Joel, age 16, slouches in a chair in the therapy room with arms folded scowling at the floor.
Joel’s mother is animated as she explains her concerns about her son. Joel’s father looks away,
obviously frustrated with both his son and wife. Their therapist searches for ways to help the
family express their thoughts and feelings to each other, with her own anxiety triggered by
the family’s fear that they cannot withstand hearing each other’s true feelings. An experiential
therapist in this situation moves toward the unexpressed emotion that the family seems to be
avoiding, helping family members explore their inner worlds and express themselves to each
other. Her goal is to make room for growth by encouraging family members to listen and
have empathy for each other—to attune to each other. Discovering and sharing authentic
experience shifts the way the family thinks, feels, and relates to each other. As a result, they
become more connected, genuine, authentic, and flexible as they demonstrate the ability
to tolerate individual desires, fears, anxieties, hopes, and dreams.
Experiential therapy emerged from existential humanism during the 1950s and 1960s
and was developed primarily by Virginia Satir (1967) and Carl Whitaker (Napier &
Whitaker, 1978.) Satir focused on communication and positive human potential while
Whitaker concentrated on the symbolic nature of family interaction. They were both
charismatic, relying on their ability to be fully present to guide families into new and
genuine experiences. Whitaker was well known for sharing stories from his own life and
making playful, even absurd interventions that symbolized what was going on in the family
and/or created temporary chaos to help the family reorganize without symptoms. The
impact of Satir’s use of self—her warmth, intuition, and authenticity—was sometimes
referred to as magic (Banmen & Maki-Banmen, 2014). Many doubted the ability to re­
produce experiential therapy as a model because it seemed to rely so heavily on self-of-the-
therapist rather than theory and technique. Nonetheless, Whitaker and Satir inspired
generations of therapists to be hopeful and positive about human potential; to trust growth
as an inevitable outcome of honest self-exploration and emotional expression; to rely
on the transformative power of therapeutic experiences, and to use self of the therapist
in genuine and authentic ways.
The application of experiential ideas to therapy continues to expand. Today, in part
in response to neurological findings regarding how the body responds to emotional pain,
a growing number of integrative models incorporate an experiential approach to change
(Hargrave & Houltberg, 2020; Johnson, 2019; Knudson-Martin & Kim, 2022;
Zimmerman, 2018). Clinicians are also studying how to creatively utilize experiential
interventions to bring a therapeutic presence to teletherapy (Heiden-Rootes et al., 2021;
Taylor et al., 2021).
Third order change in experiential family therapy involves the family going beyond un­
derstanding each other within an intimate relational framework to awareness of the impact of
societal forces on their experience and the experience of those around them.
DOI: 10.4324/9781003216520-6
 Socioculturally Attuned Experiential Family Therapy 117
⤝⤞

Third order change in socioculturally attuned experiential family therapy

requires identifying, putting into words, sharing, and hearing felt experiences
of marginalization, oppression, and privilege.

⤝⤞

In this chapter, we describe some enduring family therapy concepts and practices related to
experiential family therapy and illustrate how therapists can integrate principles of socio­
cultural attunement into experiential approaches to broaden awareness of self and others
in societal context. We argue that it is not possible to fully understand ourselves—how we
think, feel, and act—without realizing the impact of culture, societal systems, and power
dynamics on our everyday lives. To this end, we offer a set of guidelines for considering
human potential within societal context and explore the role of power dynamics in
emotion and emotional expression. We conclude with a case example that demonstrates
these principles.

Primary, Enduring Family Therapy Concepts

The focus in experiential therapies is on each individual within a family system. Having
multiple members of a family participate in therapy, including more than one generation,
offers the therapist greater leverage for change and provides the family with greater con­
tinuity. The family is seen as blocking or supporting individual desires that drive self-
actualization, which in turn weakens or strengthens the family as a whole. The approach
focuses on the present, expecting change to occur through therapeutic experiences in the
here and now. We have identified four enduring family therapy concepts associated with
experiential therapies: communication, sharing emotions, experiential interventions, and
therapists’ use of self.

Communication
Experiential therapists help family members get in touch with themselves and communicate
with each other in ways that are genuine and congruent. According to Satir (1967, p. 63),
communication “includes all those symbols and clues used by persons in giving and receiving
meaning.” This includes verbal and nonverbal expression. It is not uncommon for people to
communicate more than one message at the same time, prompting confusion in the message
receiver. Accountability for communication is key. Experiential therapists interrupt attempts
to send messages without taking responsibility for meaning. For example, one may say,
“I said I am not angry!” in a tone that clearly sends the message that they are in fact mad.
The receiver is likely to believe the way the message is sent over its content but has no way to
verify meaning. They are thereby stuck, unable to resolve conflict and difference.
Communication traps like this one derail authentic connection. Take John who won’t tell
his partner, Emily, what he wants, but becomes annoyed when Emily chooses a restaurant
with a long line or goes to bed early on a night John feels amorous. When Emily questions
John, he denies that he is unhappy yet remains quiet, withdrawn, and sullen. In a situation
like this, an experiential therapist would encourage Emily and John to identify and accept
their individual desires, hopes, anxieties, and frustrations helping them put their thoughts and
feelings into words. The therapist might ask the couple to demonstrate or communicate
about their relationship through an experiential exercise. For example, she might ask them to
118 Socioculturally Attuned Experiential Family Therapy
sit back-to-back and talk to each other so their facial expressions can’t be used to relay
unclaimed messages. Or she might use a story from her own life, perhaps telling them about
trying to understand what her preverbal toddler needs and how upset he gets when she
guesses incorrectly.
Experiential therapy promotes democratic ideals of all family members deserving their own
yearnings, choices, feelings, and needs, which they have the right and responsibility to clearly
communicate. However, these approaches tend to expect communication and understanding
to lead to agreement and the meeting of all family member’s needs equally, with little at­
tention to the relationship between power dynamics and communication.

Sharing Emotions
Experiential therapists help people identify their emotions and then communicate them
effectively. Consider Lars, a 70-year-old Norwegian American, Vietnam veteran, who is
being cared for by his adult daughter, Vina. They come to therapy because Vina is “at her
wit’s end” with her father being cross and demanding. She agreed that he could move into
her home and she wants to be a good and caring daughter. She reports, however, that no
matter what she does, Lars “refuses to be happy.” During the therapeutic conversation, the
therapist, Greta, notices a moment when Lars becomes quiet and puts his head in his hands.

Greta: Lars, what are you experiencing right now?

Lars: I am just listening. [looks up]
Greta: I noticed for a moment you looked down and put your head in your hands. What
are you feeling as your daughter talks about you being difficult to please?
Lars: I don’t know. Nothing.
Vina: That’s the trouble dad! You don’t care what I have to say.
Greta: Vina, how do you feel when your father turns away from you like that?
Vina: Angry! Hurt! Pissed off!
Greta: Lars, let’s take a moment … I am going to ask you to help me here.
Lars: Okay.
Greta: (stands up, walks over to Lars and sits next to him.) Will you put your head in your
hands and look down like you did a moment ago?

Lars follows the therapist’s instructions and sits quietly.

Greta: (Lowers her tone and moves in close to Lars.) What are you feeling in your body
right now? In your back, legs, stomach, heart, arms … .
Lars: My chest is tight. (pause) Maybe I am having trouble swallowing.
Greta: So you’re tight in your chest and throat. How about your head and hands?
Lars: I just want to disappear.
Greta: Your throat and chest get tight and you want to hide … disappear. What feeling
might that be? Hurt, anger, embarrassment, shame, disappointment, fear … .?
Lars: (With heads still in hands) Maybe shame.
Greta: So shame … anything else (allows a pause)
Lars: Disappointment in myself.
Greta: (in a low and caring tone) That sounds really difficult Lars–those feelings of being
ashamed and disappointed in yourself.

Greta accepted that Lars had trouble accessing and naming his emotions. Vina was quickly
able to identify emotions but not able to effectively share them in part because her father
 Socioculturally Attuned Experiential Family Therapy 119
refused to listen and acknowledge hearing her. Feelings need to be both expressed and va­
lidated. Vina’s frustration came from having to guess what her father thought and felt. She
assumed he did not care when he reported not feeling anything. By slowing down the
interaction, warmly supporting Lars while challenging him to identify and express himself,
Greta was able to create a new experience. This moment of understanding would need to be
followed and expanded over time for there to be the type of change needed for Lars and Vina
to support each other in being fully themselves.
In this illustration, Greta did not address the context or power differences between Lars
and Vina. Vina had a lifetime of being the daughter of a demanding and difficult father. She
was a female and expected to be a caregiver who accommodated her father’s wishes. Lars was
a Vietnam veteran with untreated trauma and shame, which he held tightly inside. As a
White cishet (cisgender heterosexual) male, he expected others to simply deal with his
moods. He had never stopped to really think about his daughter’s experience of him or the
sacrifices she made to assume his care. Lars was a second generation Norwegian American
who was raised to keep his emotions intact and unexpressed. Military training and being
socialized as a male in his generation strongly supported that mandate.
Satir (Banmen & Maki-Banmen, 2014) made the point that it is not just our feelings that
are important but how we feel about our feelings. She argued that we are often disappointed
in ourselves or ashamed of our feelings. We try to dismiss, change, or hide how we feel from
others rather than fully exploring and expressing ourselves. This prevents our growth and
leads to convoluted communication. Let’s go back to the example of John and Vina. John
struggles with telling Vina what he wants and also with how he feels when his needs aren’t
met. This is due, in part, to John wanting to please his daughter. He rejects his own needs to
be the kind of person who puts his family’s needs first. When this leads to his feeling irritated,
frustrated or disappointed, John is displeased with his own emotion and attempts to deny
how he really feels to himself and others. Vina then presses him to share his thoughts and
feelings, eventually becoming frustrated herself. Now John is even more unhappy as his
efforts to be selfless and please Vina has had the opposite effect.
Experiential family therapy highlights emotion without ignoring cognition. In fact,
thinking, acting, and feeling are interconnected determinants of our experience. According
to Connell et al. (1999), “The goal of symbolic-experiential therapy is to provide an ex­
perience that flips the family’s way of thinking. It must contaminate their way of perceiving
reality and project them into a different way of interpreting and embracing life” (p. 2).
Experiential therapists differ in their emphasis on helping clients connect their present
emotions and experiences with the past. For example, Whitaker did not think clients needed
to understand the current or historical cause of a problem to solve it, while Satir encouraged
clients to become increasingly aware of themselves and to explore the lasting impact of
childhood family of origin experiences.

Experiential Interventions
Experiential interventions are part of the process of therapy that unfolds as families talk about
their situations, relationships, and experiences. The therapist takes the lead in structuring and
guiding the therapeutic system toward growth that will resolve symptoms rather than setting
specific goals with the family at the beginning of the encounter. The therapist assumes
positive outcomes will occur as a result of the therapeutic process; that given the right
conditions, humans grow into their full, symptom-free potential.
Experiential family therapists take an active role in ensuring conditions for growth are met
through identifying and sharing feelings and experiences. According to Napier and Whitaker
(1978), the therapist must win “the battle for structure” (p. 10) while ensuring the family
120 Socioculturally Attuned Experiential Family Therapy
takes the initiative for change. The therapist must be able to facilitate what happens in
therapy, but it is the family’s motivation that drives change. In other words, the therapist
must be in charge of the process and engage fully as part of the therapeutic system without
knowing the outcome of interventions.
Experiential therapists guide families through experiences that prompt awareness of self in
relationship to others. Many forms of expression are available, including, but not limited to,
movement, dance, drawing, and sculpting. Demonstrating rather than simply discussing fa­
mily dynamics provides avenues for understanding through embodied experience and felt
memory. Family sculpting is one of the most common experiential techniques (Papp et al.,
2013). The therapist asks a family member to place others and themselves in the room in
relationship to each other. The therapist helps the sculptor decide who is in the middle and
who is outside; who is turned inward and who is turned away; who is up on a stool and who
is lying on the floor; and so on. She also helps the sculptor determine if someone should have
a fist facing up, a hand facing out, or a head facing down, for example. No interpretations are
solicited. Once all are in place the therapist moves from one to another, inviting the felt
experience of being in the position each has been placed.
Sculpting provides a way to begin addressing power, emotional distance, protection,
closeness, and other relational dynamics. Each person is encouraged to share individual
experiences and feelings that result from family dynamics. All are held in place, listening to
others’ experiences from the positions they hold in the family. Family members don’t always
see the dynamics in the same way and more than one sculpt can be completed to explore
other perspectives. For example, consider a family in which the father often became loud,
stood up, and moved toward his wife and children when he wanted his way. The therapist
asked the family to engage in a sculpt of these situations, slowly and carefully exploring each
family member’s experience and emotions during these moments. When the sculpt was
completed, the father sank into his chair in shock stating “I had no idea I was frightening
them!” Even though he consistently relied on creating fear in those around him to get them
to do what he wanted, it became clear through sculpting that he did not fully understand
what their experience was like or the relational cost of his use of power.

Therapist’s Use of Self

According to Roberts (2005), experiential therapy relies heavily on self-disclosure “as a way
to mold shifting boundaries, help subjectivity to emerge, and add effect” (p. 51). This re­
quires therapists to be diligent in dealing with their own self-awareness; their own emotional
and relational health. Therapists must guide the therapeutic process while being open to
experiencing therapeutic encounters. This includes being able to tolerate intense emotions in
self and others. Consider entering a room with parents whose teenager has recently com­
mitted suicide. Most of us are filled with a sense of dread around the emotions we will
encounter. Experiential work requires us to move in close to even the most painful ex­
periences and honor the humanity of all involved. This is possible in part by viewing
emotions as natural, helpful, and potentially healing. As Connell et al. (1998, p. 28) argued,
“pain is not the enemy.” From this perspective, attempting to help others simply feel better
short circuits the growth process.
Experiential therapists are authentic, using themselves in a variety of ways. They might
share a feeling they are having while in the room with a family making a statement like “I am
feeling some anger and I don’t know where it is coming from. Is anyone feeling angry?” In
this situation the therapist points to what is already in the room, using their own experience
and taking the kind of chance they expect clients to take. Experiential therapists might use
images that come to them while sitting with clients to suggest the symbolic nature of family
 Socioculturally Attuned Experiential Family Therapy 121
interactions. For example, a therapist might say “I keep getting this picture popping in my
head. I don’t know if this makes sense or helps us at all, but I am envisioning the two of you
in combat gear, dusty and tired, arm in arm coming out of a combat zone.”
Likewise, they might use hunches to interpret things like family drawings. Consider a
family in which a 9-year-old boy is described by parents as being depressed, even suicidal.
The therapist asks the boy and his 7-year-old brother to draw a picture of the family that
includes each family member doing something while she talks with the mother and father.
When drawings are complete, the therapist notices the 9-year-old’s drawing includes himself
pointing at a rat in the corner while the rest of the family looks away. This prompts the
therapist to turn to the family and ask “who else feels depressed?” The mother looks at the
father who responds “I do.” Once the 9-year-old gets everyone to look at the rat he is free to
feel better leaving the therapist in charge of helping his dad.

Integrating Principles of Socioculturally Attuned Experiential Family

Therapy
Experiential therapy relies on humanist assumptions that given a supportive context, free of
barriers to positive growth, individuals and families can actualize their full potential. Social
equity is paramount, therefore, to individual, family, and group development across all
contexts as it assures the widest access to that which promotes health and well-being (e.g.,
respect, inclusion, opportunity, affirmation of worldview, physical and psychological safety,
access to education and health care, right to love whomever you choose, financial security).

Societal Context
⤝⤞

Awareness of the impact of societal context on perspectives, feelings, and

desires helps individuals and families take initiative to remove and/or better
navigate barriers to growth.

⤝⤞

Regardless of what is accomplished in therapy, many clients still face racism, sexism,
nationism, homophobia, heterosexism, ableism, and poverty. These oppressive and mar­
ginalizing forces deeply affect physical, psychological, emotional, and relational health.
Awareness of the impact of societal systems can, however, help us see which barriers are
movable. This includes internalized “isms,” the negative effects of socially supported rela­
tional power imbalances, and adherence to societal norms and expectations that are contrary
to our well-being.

Experience and Broader Societal Context

Socioculturally attuned experiential family therapists recognize the importance of social
awareness in the use of contextual self-of-the-therapist. Let’s go back to our example in
which the therapist, Greta, worked with Lars and Vina. Greta described herself as a second
generation German American. Greta grew up in a German enclave in Ohio, US. As is true
for most family therapists, Greta worked extensively on understanding her own family
background. For Greta, this included exploring the impact of her German American heri­
tage. She explored her ability to identify, express, and elicit emotions. This included
122 Socioculturally Attuned Experiential Family Therapy
overcoming her initial discomfort in asking others to openly express feelings. Now let’s
imagine that Greta wants to become more socioculturally attuned, so she engages in addi­
tional work on her contextual self-of-the-therapist. This includes learning about the history
of the civil rights movement in the US, exploring the impact of power dynamics on gender
roles, understanding historical and contemporary identity movements, learning about the
politics of war over the past century, and analyzing how societal systems, such as patriarchy,
social class, democracy, and colonization affect intimate family life.
As Greta becomes better able to understand herself in social context, she is able to help
others, like Lars and Vina, explore how context shapes their feelings and experiences in re­
lationship to each other. She recognizes how Lar’s having a lifetime of White male privilege
dovetailed into his stoic masculine, Norwegian attitudes, and wartime experience. Greta is now
able to contrast this with Vina’s challenge of being a respectful and caring daughter while
maintaining her expectation of gender equality in all of her relationships, including her re­
lationship with her father. Greta’s personal and social awareness allows her to help Vina and Lars
navigate the landscape of being a father and daughter in a specific societal and historical context.
In Text Box 6.1 Timothy Baima describes how he approaches this kind of social awareness with
clients while taking into account his own position as a White heterosexual male.

Text Box 6.1 Timothy Baima, PhD, LMFT

Timothy Baima is an Associate Professor at Palo Alto University, with interests in

Whiteness in psychotherapy and relationships, self-of-the-therapist training, and
Family Play Therapy. He is always mindful of how his identity as a White, straight
cis male from a working-class background is part of the clinical process and
incorporates an experiential view of change into his systemic and attachment-
based work (see also chapter 7).
My clients have often been pulled into habitual relational patterns that undermine the very
qualities in relationships they long for. I work to help them disentangle themselves from
problematic patterns of relating and strengthen their bonds to one another by nurturing
authenticity, attunement, responsiveness, and emotional engagement. I believe our
connections to culture, power, and oppression are central to how we structure our lives
and relationships. Therefore, commitments to see, acknowledge, and respond to power and
subjugation both within oneself and in one’s relationships is fundamental to forming bonds
that allow people to be their whole authentic selves, and nurture themselves and one
another. I appeal to my clients’ hopes and dreams for their relationships. Often, they are
misusing and abusing power in a desperate attempt to force the kind of relationships they
long for, and it is only digging them deeper into a pit of isolation and emotional deadness.
So, I crawl into the pit with them and talk with them about climbing out together.
It is tricky work to invite people to be their whole authentic selves when my social
location as a straight White cis man makes it unsafe for so many people. Each
client I work with will present me with new opportunities to grow in and through my
relationship with them. Rather than assuming that I am trustworthy and thinking
about how I “earn” my client’s trust, I strive to become a more trustworthy person
to them. I also discuss with clients how being a White straight cis man informs my
view of the therapy process, and positions me in terms of what I may have a
tendency to focus on in therapy and what I may miss (Watts Jones, 2010). It also
provides an opening for me to ask clients how they identify in terms of race,
ethnicity, gender identity, sexual orientation, social class, and religion. I share my
perspective that culture is important, and that social power and oppression
 Socioculturally Attuned Experiential Family Therapy 123

significantly affect people and relationships––sometimes in ways, we do not even

notice.
When I started addressing sociocultural themes in my work, I was afraid. At that
time in my development, I was highly dependent on approval from others to bolster
my own sense of self-worth. I especially craved affirmation and approval from
clients with marginalized identities. I felt as if their approval affirmed me as being a
good White person, a good man, and a good straight cis gendered person. I
became perfectionistic in my effort to address culture “the right way” and to say
“the right things” during sessions. I was rather self-absorbed and came across as
performative and cerebral regardless of how much I genuinely cared for my
clients. My focus on myself and my anxiety about looking ignorant or causing
offense got in the way of being attuned and emotionally engaged. As I have
learned to be nurturing with myself, I have become less dependent upon praise
and affirmation from others for a sense of worth. I have learned that I can mess up
in relationships and make amends. This has given me the freedom to move through
my own discomfort and be curious, ask questions, return to conversations that
were dismissed in previous sessions, and supportively challenge clients. I believe
that as we allow ourselves to become more fully human and nurture our own
growth with a balance of love and accountability, we are best positioned to guide
our clients into the vulnerable spaces that will support their own transformation.

As described by Baima (Text Box 6.1), socioculturally attuned family therapists can also
use self-disclosure to raise social awareness and support just relationships. For example, a
socioculturally attuned family therapist might, at the right moment, share with a family her
experience of watching her own father work so hard yet never enjoy the relationship
connections he desired or her own struggle as a woman to balance being a mother with
working. Another example might be a therapist disclosing how difficult it was to watch her
brother come out as gay to parents who were confused and afraid of his sexual orientation.
This type of disclosure can help normalize the experience and open conversations about
social and contextual influences on families.

Experience in Community Context

While experiential interventions often attend to relational space within the family, the fa­
mily’s physical context and community are frequently overlooked as impacting experience.
The context of community includes both space and place. Space can be thought of as
the ecosystem, including all that is living and nonliving in a physical environment. Place
refers to how we experience space. It is within a place that we meet our basic human
needs for personal space, privacy, social interaction, and safety (Fitzpatrick & LaGory, 2000;
McDowell, 2015). The spaces we inhabit, our sense of place, and our ability to secure our
basic needs are highly dependent on societal dynamics of privilege, power, and oppression.
Socioculturally attuned experiential family therapists consider where families live, work,
get medical care, shop, receive education, recreate, and so on relative to spatial justice.
They recognize and address the consequences of dynamics of power and privilege on physical
resources and community geography. McDowell (2015) proposed family cartography as a
method for exploring the experience of families within particular space and place. According
to McDowell (2015) this is a way to “capture family life within the spaces family members
124 Socioculturally Attuned Experiential Family Therapy
inhabit in order to better understand the relationship between power, privacy, personal
space, social interactions, safety, and the problems presented in therapy” (p. 61-62). Family
cartographies are maps that do not need to be drawn to scale or use a predetermined legend.
Rather the therapist facilitates drawing a picture of the family’s community, including
neighborhoods, relevant parks and places of worship, shopping and educational resources,
sources of pollution, noise, danger/risk, and so on. Anything relevant to the family’s daily
lives can be included using symbols the family choses. McDowell suggested a number of
questions that might be used to develop a family cartography of any period in a client’s past or
the present (see Figure 6.1).

Sample questions on how to create a family cartograph

1. Describe the setting – physical environment, climate, town and neighborhood in which you live/lived/
grew up. (Map the territory.)

2. What kinds of social interactions are/were available to you in this setting? Where are/were you and
your family able to go and not go in this setting? How safe do/did you feel? What level of privacy and
personal space does/did this setting provide?

3. Describe the power dynamics in this setting. Include race, class, gender, sexual orientation, abilities,
nation of origin, language and any other signifiers that are relevant. (Add these to the map using
symbols.)

4. How do/did these power dynamics affect you and your family? In what ways do/did you and/or your
family members participate in the oppression or marginalization of others? How are/were you and your
family oppressed or marginalized?

5. Describe the home in which you live/lived. (Add to map as an excerpt) What kinds of social
interactions are/were available to you in and around your home? In what areas of the home did
you spend the most time and why? Where are/were you able to go and not go in your home and
why? How safe do/did you feel in various spaces in your home? What level of privacy and
personal space does/did this setting provide?

6. Who is/was in your family? Who has/had the most power? How is/was the power enacted?
(Draw a map excerpt to show family.) How do these power dynamics reflect the broader power
dynamics in your community?

7. What spaces on your map reflect sites of oppression? Describe the relationships in these sites.
(Add oppression symbols to the map.)

8. Where are sites of resistance? Describe the relationships in these sites. (Add resistance symbols to
the map.) How do/did you and/or your family resist oppression? Where, what and how do/did you learn
to resist oppression?

9. What types of resiliency do/did you develop as a result of this geography? (Add resilience symbols to
the map.)

10. What else would you like to add to the map?

Figure 6.1 Creating a family cartograph.

Source: Adapted from Applying critical social theories to family therapy practice (p. 63) by T. McDowell, 2015, Springer.
Copyright 2015. Adapted with permission.
 Socioculturally Attuned Experiential Family Therapy 125
Once the community map is complete, the therapist can ask the family to draw their home
within the community. This can include all rooms and outdoor space, how each room felt,
who had the most influence or impact on the emotional “weather” in the home, and so on.
This provides a physical reference for remembering and sharing experience and emotion.
The exercise helps the therapist understand the experience of clients within a physical
context while raising social awareness and relational insight among family members.

Cultural Attunement and Cultural Democracy

Socioculturally attuned experiential family therapists extend the humanistic value of each
person having worth and deserving voice by striving for cultural democracy. The ideal of
cultural democracy goes beyond acknowledging that many cultures exist within most so­
cieties to supporting the right each group has to its values, beliefs, and practices without
marginalization or oppression by more dominant cultures (Košutić & McDowell, 2008).
That said, all cultures balance individualism and collectivism. Likewise, all cultures generate
and maintain both equity and oppression.

⤝⤞

Practicing socioculturally attuned family therapy requires auditing what we

assume is “good therapy” from a cultural perspective.

⤝⤞

At a meta level, therapists must view each culture as equally valid and work within cultural
frameworks to support the growth and well-being of all family members. This includes
recognizing the tremendous diversity within cultural groups and families, along with
challenging culturally supported power differentials. The practice of socioculturally at­
tuned experiential family therapy includes asking questions such as: How do we under­
stand the cultural context of emotion? How do we find ways for clients to express emotion
to us and each other in culturally supported ways? What might it look like to be vulnerable
within various cultures and groups? Sharing thoughts and emotions directly with family
members is not prized or adaptive in all cultures. For example, in many Asian cultures
expressing one’s own needs is counter to collectivist values that place the well-being of the
group before that of the individual (Quek & Knudson-Martin, 2006.) Sharing one’s
feelings and needs may be viewed as placing a burden on others. According to ChenFeng
and colleagues (2016), Asian Americans often carry “intangible loss” from generations of
migration, loss of homeland, and marginalization in the host country. Each carries this
burden on their own in “quiet fortitude” without leaning on others, not believing “that
they should or could expect or ask for intimate emotional attention” (p. 5). Duty and
loyalty to the family may be implicitly expected, while focusing on oneself may be viewed
as selfish. A socioculturally attuned experiential therapist would need to work within this
cultural framework to slowly acknowledge losses and “scaffold their movement towards
vulnerability so that it did not leave clients feeling raw and unsafe” (ChenFeng et al.,
2016, p. 5).
Consider Neeb, the aging father in a Hmong family who moved to the US after the Vietnam
war. Like many Hmongs, Neeb left his village in the hills of North Vietnam to fight alongside
the US. When the war was over, Neeb, his wife Me, and their daughter Kiab, took refuge in a
midwestern US city. Their daughter, Luv, was born in the US. Luv now cares for her aging
father. Neeb is not overtly demanding of Luv. He carries the burden of his past trauma in quiet
126 Socioculturally Attuned Experiential Family Therapy
fortitude. He is grateful that his children are thriving. Luv and Kiab are deeply grateful to their
father and protect him from any additional burden after all he has lost and suffered. Kiab knows
it is difficult for her sister to be the primary support for their father, but rather than stating this
directly, she invites Neeb to spend more time with her family explaining how this would be
good for her children. A therapist working with this family would need to share the deep
respect for the father and the way the family quietly shares their burdens.
Greta, who has just walked out of a session with Lars and Vina, is now talking with Neeb,
Luv, and Kiab for the first time. Neeb has been reluctant to leave his home for more than
short errands. Greta is helping them renegotiate care for Neeb so Luv can meet her goal of
completing a college degree.

Greta: Neeb, I see your daughters take very good care of you.
Neeb: I am blessed to have such wonderful children.
Kiab: We love him very much.
Luv: We are grateful to have a good father that would do anything for his family.
Greta: Yes, I can see that. Luv, you live with your father, or he lives with you?
Luv: Yes, we live together. My mother is gone so it is just us in the house now.
Greta: And you are in school? College?
Luv: Yes, I am getting a degree in advertising.
Greta: Neeb, now both of your children will have college degrees! Kiab, where do you live?
Kiab: I live close by with my husband and children. We are thinking father might like to
come and stay with us some days when Luv is in school …

Many emotions and needs were expressed in this short exchange. The therapist noted that the
father was well cared for. This complemented Luv as a caretaker and Neeb as a father who
raised a loving daughter. The therapist also complemented the father by acknowledging the
success of his children. Luv and Kiab acknowledged their father’s sacrifice for them; the impact
of war, migration, and loss by showing gratitude and respect. Kiab was able to indirectly tell her
father that it would be helpful to Luv for him to allow her to care for him some of the time
without stating that he was a burden on anyone. The family might move into expression of
more emotion, but it would be done slowly and within the family’s cultural language.

Power
Experiential therapy relies on a relatively democratic view of families. Though parents must
have influence over children, therapy takes on a quality of treating all family members with
equal respect and concern, making room for all voices. While this remains the goal, so­
cioculturally attuned therapists do not assume all voices hold equal power.

⤝⤞

Socioculturally attuned experiential family therapists analyze power dynamics

from the broadest global to the most intimate family relationships.

⤝⤞

Emotion and Power

Socioculturally attuned experiential therapists pay attention to how emotions are in­
trinsically connected to power dynamics and sociocultural context (Turner, 2007; Pease,
 Socioculturally Attuned Experiential Family Therapy 127
2012). For example, negative emotion has been found to be associated with getting less
than one’s fair share (Turner, 2007). Consider a family in which one of three children
routinely feels overlooked compared to siblings who excel in academics or sports. This
child is likely to have negative emotions about parents, siblings, and/or self. Imagine the
sibling who is amply rewarded for good grades gleefully running around the house. Let’s
now say the athletic child unexpectedly won a spot in the state finals—eyes wide and
mouth dropped open, she lets out a shriek of delighted surprise—getting more than we
expect leads to even more positive emotions. At the same time, the child who is routinely
overlooked falls again into the background feeling jealous, hurt, and/or devalued in
comparison. In this case, the social valuing of success in sports during childhood overrides
qualities and potential (e.g., kindness, other orientation, contemplative nature) of the child
who withdraws.
Those with greater influence and power tend to experience more positive emotions,
particularly when they see themselves as getting the respect and rewards they expect and
feel they deserve. Those with less influence and privilege tend to feel more negative
emotions, including hurt, shame, guilt, and/or anger. Shame and embarrassment tend to
follow perceptions that we are at fault for not getting what we expect (Turner, 2007).
Anger can result from viewing others as responsible for not getting what we expect and/or
feel we have earned. Those who have less power may feel less worthy, while those with
greater gender, race, or class privilege expect more and believe at some level that those
who have less deserve less. Holding greater privilege and expecting more can lead to anger
and frustration when others with less social privilege are afforded equal opportunities and
access. Likewise, displays of anger can be used to maintain privilege through fear and/or
threats of using one’s privilege to negatively impact others. As Baima noted in Text
Box 6.1, those with greater privilege may also misuse and abuse power in an attempt to
force the kind of relationships for which they long and, instead, dig them deeper into
isolation and emotional deadness.
Let’s go back to our example of Lars and Vina. Lars has had a lifetime of male
privilege. Even as a child, he experienced higher expectations being placed on him
than on his sisters. These expectations sent him the message that as a male he was worth
more. The deference shown him within the family (e.g., compliments for working
hard, being excused after a meal while his sisters cleaned up) followed him through
adulthood. Vina, on the other hand, received messages throughout her life that she was
to accommodate and attune to other’s needs. Lars uses cross and demanding behavior
to get the attention he feels he deserves, but loses closeness and connection in the
process.

Emotion and Resistance

According to Garcia et al. (2015) “emotions can fuel our social awareness and resistance
to oppression … [and] prompt us to contribute, perhaps unwittingly, to oppression, [or]
… intervene in our ability to see and resist oppression” (p. 3-4). Power is reproduced
in part through emotions that hold in place dominant systems of thinking, doing, and
being. Emotions also contribute to resistance to oppression. Social movements are
often associated with feelings such as anger over social injustice, love, and selfless
solidarity.
⤝⤞
128 Socioculturally Attuned Experiential Family Therapy
Feelings produced through processes of marginalization and oppression, as
well as those that emerge from growing awareness of power structures, can
mobilize us into action.

⤝⤞

This felt resistance is essential for social change, just as it is essential for interpersonal change.
Consider a heterosexual couple who came to therapy with their only child, Laura (age 16).
Laura and her father, David, frequently engaged in verbal conflict. Laura’s mother, Kim,
silently disagreed with David’s strict fathering and experiences her own frustrations with his
attempts to control their marriage. The socioculturally attuned experiential family therapist,
Latisha, engaged the family in a sculpt. The family placed themselves in the room showing
David with his finger wagging at Laura who is standing up to him. Kim was behind Laura
offering her support. As she was helping the family with the sculpt, Latisha asked what
contributed to the father being in such a position of power. Along with personality and
physical size, the family identified that he made most of the money. Latisha slipped one of
the platforms she kept in her office under the father, raising his height in the sculpt as she
continued to explore. Laura blurted out “because he is the man and no one will stand up to
him!” Latisha took out another platform suggesting it represented male privilege. The family
began to see how both women, mother, and daughter, struggled against male privilege and
the valuing of money producing work over other types of work (e.g., running a family,
school work, housework, relational work). This dynamic maintained the father’s power but
kept him from truly connecting with those he loves the most—his wife and daughter. Latisha
continued to engage the family in exploring and expressing how societally supported power
dynamics impacted their relationships and helped them all resist dynamics that were harmful
to their growth as individuals and their connections as a family.

Connection and Equity

Power is highly nuanced and deeply impacts emotional attunement in intimate relationships.
According to Knudson-Martin (2015):

When power is not equal, the more powerful partner will be less aware of the other’s
experience. What makes it more complicated is that people in higher power positions
generally are not aware of their power; they may not even realize that others are attentive
to their needs or that their interests are dominating the agenda. On the other hand,
people in less powerful positions are likely to automatically take into account the desires
or expectations of the more powerful. People in powerful roles (i.e., teacher, employer,
physician, husband) may take for granted that others accommodate them—or become
distressed when they do not. (p. 16)

For example, children with an abusive parent often become highly attuned to the parent’s
feelings, reading footsteps, facial expressions, and voice tone for indications of mood. Those
in power often lack awareness of the damage their power causes relationships. It is not
uncommon for people of color to point out how they must be knowledgeable and attuned to
White people and the dominant culture to be able to successfully navigate US society. White
people, on the other hand, may choose to go their whole lives without listening to the
experience of people of color or learning about another culture.
Imagine how paying attention to connection and equity might change the therapeutic
process. For example, women often present as more emotionally expressive. In heterosexual
 Socioculturally Attuned Experiential Family Therapy 129
relationships, emotional descriptions of needs are often repeated to male partners, who in
turn dismiss or pay cursory attention to requests. Experiential therapists work to help both
partners understand and empathize with the other’s feelings and needs. Consider viewing a
female partner’s emotional escalation as an attempt to influence a more powerful partner. She
is bidding for connection and relying on empathy as a pathway to influence and/or as a way
to prevent her partner from becoming upset. A socioculturally attuned experiential therapist
would notice this and encourage shared power by helping the male partner learn to listen and
attune to his female partner.

Third Order Change

⤝⤞

Third order change involves going beyond understanding each other, to

understanding the impact of societal contexts on our relationships, including
how societal structures support the voice and welfare of some at the expense
of others.

⤝⤞

Let’s go back to Lars and Vina one more time. First order change might result if the therapist,
Greta, were to help Vina explore her needs and set limits as a caretaker. Second order change
might include Greta helping Lars and Vina understand their own and each other’s frustra­
tions, emotions, and experiences. Greater understanding and improved communication
would help them both meet individual needs while negotiating a more satisfying relationship.
Third order change would target understanding the broader societal context in which caring
for an elder occurs. They would be able to name how caretaking and emotion work is
devalued in US society and most often relegated to women. They would become more
overtly aware of how their relationship is affected by societal power dynamics; the power
difference between an older male father and younger female daughter. Lars and Vina would
begin to recognize how male privilege and power erode the possibility for harmony and
closeness in their relationship. Lars could become softer and more emotionally available in his
later years while Vina could become more empowered in her adulthood.

Practice Guidelines
Understanding the impact of societal systems on presenting problems increases therapists’
ability to attune to client experience and tailor experiential interventions. Following are four
guidelines important to practicing socioculturally attuned experiential family therapy.

1 Honoring Culturally Relevant Experience and Expression

Every culture has rituals, traditions, and ceremonies that promote resilience and demonstrate
collective values and beliefs. These serve many societal functions, including punctuating life
cycle transitions, enhancing cultural norms, and/or solidifying religious beliefs. Most cultures
have specific ceremonies for a person’s birth, marriage, school graduation, initiation, coming
of age, marriage, and death. These rituals offer insight into culturally informed beliefs about
what is appropriate at a given age, for a specific gender, or a specific religion. Spiritual and
religious beliefs and practices may be empowering and healing, and may also be harmful and
sources of pain (Esmiol Wilson, 2018). Rites of passages may be formal (e.g., quinceanera,
130 Socioculturally Attuned Experiential Family Therapy
sweet sixteen party, or a debutante ball), or informal (e.g., such as rites for boys like joining a
gang, fraternity, drinking alcohol, having sex, driving a car, getting into a fight, or registering
for Selective Services). There are also countless healing and cleansing rituals, meditation
practices, and prayer rituals.
There are ample opportunities for therapists to attune to cultural rituals and traditions to
help clients work through difficult transitions, problems, or merely connect with traditions
they may have lost or forgotten. Asking clients if they have cultural, personal, family, and/or
religious rituals, traditions, or ceremonies may help therapists have greater insight as to other
ways of “being” in the therapy room that expands action oriented, creative, and sometimes
non-verbal forms of expression.
It is also important for therapists to attune to the cultural nuances of nonverbal ex­
pression and communication and to honor those forms of expression in therapy. There are
many ways in which our actions express culturally ascribed ways of being. How we use
silence, touch, facial expressions, movements, embodiment, and physical closeness and
distance all influence our gender and cultural expression. So often, therapists unknowingly
adhere to androcentric, Eurocentric, and/or Westernized beliefs about what forms of
communication and expression are privileged. Being open to learning and honoring
multiple forms of expression is especially important for socioculturally attuned experiential
family therapists. For many, connection and understanding can be best accessed with a
glance, touch, or embrace. Clients need permission and the space to use all forms of
expression that honor multiple ways of knowing, being, and relating to each other across
cultural and relational contexts.

2 Encouraging Awareness of Self and Other in Context

Familiarity with societal systems and power dynamics is necessary to guide therapy in ways
that attend to how the most intimate experience is affected by individual, relational, and
societal systems.

⤝⤞

Socioculturally attuned experiential family therapists pay close attention to the

impact of societal systems and the nuances of power that block the potential for
growth in any and all family members.

⤝⤞

Those with greater societally assigned power are often unaware of the negative impact their
power has on others. This creates pockets of stagnation for everyone involved. Consider
David, a conservative Christian in a patriarchal family in which the husband/father is reg­
ularly accommodated by the wife/mother and children. While family members and the
church expect him to be a spiritual leader, the father confuses this role with a power over stance
in which he expects to make all final decisions and have his needs met first. He is unaware of
the full impact of his actions as he experiences the positive effects of being accommodated
without always knowing others are yielding or bending to his will. His wife and children feel
routinely dismissed and forgo many of their own needs to meet his. It is relatively simple to
see how the needs of the wife and children take a back seat, potentially limiting their growth
and potential.
It is less clear that this dynamic also harms David, who is unaware of the increasing
emotional gap or the growth limiting effects of being consistently accommodated by
 Socioculturally Attuned Experiential Family Therapy 131
others. He is not challenged to put others first or to expand his faith by learning to truly
serve, rather than control and “lead” the ones he loves. As he ages and turns toward his
relationships for support and meaning, he is likely to be stunned and disappointed by the
distance and resentment his behavior caused. Socioculturally attuned experiential therapists
name inequities to help free all family members, including those in dominant positions,
from the constraints of power imbalances, keeping in mind the well-being of all. In ex­
periential therapy, naming arises out of the clinical process. Fatma Arıcı Şahin (Text
Box 6.2) describes how using art can help clients recognize and name the sociocultural
nature of vulnerable emotions.

Text Box 6.2 Fatma Arıcı Şahin, PhD

Fatma Arıcı Şahin, a family counselor in Turkey, uses experiential approaches with
a critical, social-contextual and feminist perspective and incorporates various fields
of art (music, dance, literature, photography, cinema, etc.) as tools/techniques that
enable the expression of emotions. (see more of her work in Chapter 14)
Using art in therapy is a powerful method that makes it easier for me to deal with
sociocultural experiences. It helps create a safe and protective environment that enables
people to share experiences through symbols that they would have difficulty expressing
directly. Artistic expression often unwittingly and quickly reveals the implicit. In this safe
environment, I can ask questions that help them give meaning to their sociocultural
experiences through the symbols, and reach their vulnerable emotions underlying these
experiences. Since the silenced and marginalized are often associated with counselees’
most vulnerable emotions, I care about these emotions surfacing in a safe context. I create
this safe space by reframing each partner’s response to life challenges, both personally
and in the broader context, as “a coping strategy,” validating this way of coping while
also making power processes visible by expanding counselees’ interpretations of their
revealed experiences with questions and reflections. Interpreting the here and now
processes, which are also related to cultural issues, creates a fertile ground for change.

3 Exploring Relationships between Power, Emotion, and Expression

⤝⤞

Societal and interpersonal power dynamics may result in some family members
being heard more loudly and/or accommodated by others both in and out of
the family. Those with less power may be emotionally demonstrative or shut
down completely, preoccupied, or guarded.

⤝⤞

As therapists work to bring forth emotional experience in the room, they need to attend to
power imbalances by helping more powerful persons attune and value the experience of
those who are less powerful, working to avoid eliciting even more vulnerability from less
powerful persons. When powerful persons become more attuned, they are also better able to
132 Socioculturally Attuned Experiential Family Therapy
respond in caring and relationally accountable ways. Understanding self and other in societal
context increases the willingness of more powerful family members to step down from their
positions and connect with others. Facing one’s own privilege opens opportunities to be
more accountable to loved ones, maintaining healthier interpersonal relationships.
Families must also be able to explore and support each other’s experiences relative to
power dynamics outside the family. Consider Sarah who routinely experienced harassment
from a male colleague at work. She and her husband, Nathan, entered therapy to find a way
to deal with her growing anxiety and depression. Nathan told the therapist he had “tried
everything short of beating [Sarah’s colleague] up!” Sarah often came home distraught from
being yelled at by her colleague or being the recipient of his unreasonable demands. Nathan
responded to Sarah’s emotional upset by becoming angry himself or telling Sarah what she
should do. The therapist in this situation helped Nathan become more aware of societal
dynamics around gender and to emotionally attune to Sarah. The situation at work and home
were both embedded in gendered power dynamics leaving Sarah with nowhere to turn
where her experience and emotions could be validated. As Sarah and Nathan became more
aware of gender and power, Sarah could take the lead (with Nathan’s support) in reporting
her colleague’s behavior to Human Resources.

4 Promoting Equity-Based Attunement and Connection

As the choreographer of the session, socioculturally attuned family therapists use themselves and
their experience in the room to promote equity-based attunement among family members.

⤝⤞

Mutual attunement includes willingness on the part of everyone to pay close

attention to each others’ experiences, not only understanding but responding
in ways that prioritize connection.

⤝⤞

Children may not feel heard or even have words for what they are experiencing. Less
powerful persons with differing views may feel shut down in conversations and family de­
cisions or not even be able to articulate their experience as there is no common language to
legitimize their perspectives (Fricker, 2007). Socioculturally attuned experiential therapists
notice when those in centered, dominant positions subtly dismiss the experiences of those
with less power or those on the edges of family belonging, and create experiences that name
their realities and value their voices.
Attunement infers attempting to be with others, bear witness to their testimony, help them
make meaning of their experience, and walk next to them in their journey. In effect, we are
intervening by inviting family members to socioculturally attune to each other. To do this,
family members must be aware of the societal contexts that shape their lives and the impact of
power dynamics on their relationships.

⤝⤞

Awareness must go hand-in-hand with the willingness and ability to tune in

and effectively respond to each other.

⤝⤞
 Socioculturally Attuned Experiential Family Therapy 133
Consider a family living in the rural Midwest US in which Lou, age 14, who was assigned
male at birth, is perceiving and experiencing himself as female. When Lou’s family is out of
the house she tries on her sister’s clothes and experiments with makeup. She shares this
with no one, prays for her urges to go away, and is terrified of being found out. There is
no one who talks about gender in her family or community; Lou just knows not to speak.
When Lou is able to get access to the internet at school, she discovers she is not alone. She
is not wrong because she has been assigned the wrong sex and gender. She now grows
emotionally and intellectually alongside this liberating information, reaching out to others
through the internet. Later, when she begins transitioning and decides to tell her family,
they will need to socioculturally attune to her for the family to continue into the future
together. Parents and siblings will need socioeducation about transgender identity and
rights (Giammattei, 2015). They will need to be able to listen to and empathize with Lou’s
silenced and marginalized experience. Her family will need to share emotion in ways that
bring them together.
A socioculturally attuned experiential family therapist would facilitate this type of un­
derstanding and attunement within societal context. The therapist would interrupt mi­
croaggressions such as parents asking what they did wrong. They would help the family
challenge power dynamics that insinuate cisgender children are “normal” and envision
acceptance and support for all children. As the family moves through this process, the
therapist might encourage them to engage in a type of renaming ritual (Brown et al.,
2010). Brown and colleagues (2010) described engaging in renaming rituals with African
American youth who are “given a name at birth, and how during the struggles of
childhood and young adulthood … may lose his/her way and need to be reminded of the
name’s significance to the community he/she belongs to” (p. 334). The ritual involves
family and community sitting in concentric circles around the youth and stating aloud the
meaning of the youth’s name along with poems, songs, or other meaningful readings. Lou
has an opportunity to reflect before the community stands to affirm a new name that
describes her journey and future. In our case, the therapist encourages transformation by
asking supportive family and friends to gather to witness her journey by telling stories of
her strength, affirming her identity through prepared statements, poems, and music; and
standing to verbally and symbolically pledge their support.

Case Illustration
Emilio presented in therapy with sadness and confusion about his marriage. He and his
wife, Mandy, had been married for 14 years. Many of those years had been difficult. He
loved his wife, but she often got angry at him. He felt as though Mandy did not understand
him or appreciate the efforts he made for her and their family and reported that most of
their important discussions ended in heated arguments. He was a practicing Catholic, 32
years old, from the Dominican Republic. Mandy, who was European American, was from
Dallas, Texas, and grew up Baptist. Both were college educated and wanted to raise their
children as Christians. They shared values around family and education. Their therapist,
Leah, was of bicultural descent. Her mother was from the Northeast US and her father was
Puerto Rican. Leah grew up in Puerto Rico and was fluent in Spanish and English. She
shared her clients’ experience of being from a mixed cultural family. Leah asked Emilio if
he would consider inviting his wife to couples therapy given that most of his concerns
centered around his marriage.
The therapist began by helping Mandy feel welcome. She focused on joining with her,
asking about her life and background, and her hopes for the therapy. Mandy was forth­
coming, but it became apparent that both Mandy and Emilio had difficulties expressing
134 Socioculturally Attuned Experiential Family Therapy
their emotions and did not openly discuss their thoughts or feelings. Mandy often re­
sponded with “I don’t know,” or “I’m not sure” and Emilio responded non-verbally, by
just shaking his head yes or no or lifting his shoulders. Leah saw that they were not able to
fully express themselves in session. They seemed to be stifling their responses and emo­
tions. Neither of them reported a history of violence, substance abuse, addiction, infidelity,
financial distress, personal health problems, or any other individual and contextual issue
compounding their marriage. Both had jobs they enjoyed and their children, ages 4 and 6,
seemed to be doing well. After the fourth conjoint session, the therapist asked if they were
interested in trying an experiential and creative approach.

Honoring Culturally Relevant Experience and Expression

Given that both the therapist and Emilio were from a Latin/Caribbean culture, Leah asked if
they would be interested in making a series of altars or shadow boxes for themselves as
individuals and for themselves as a couple. “Altares,” as they are called in Spanish, are per­
sonally handmade or assembled shrines or spaces that serve many functions, not only to
spiritually honor deceased family members, but also as a way to express one’s culture, re­
lationships, and the things a person, couple, or family may value (Bermúdez & Bermúdez,
2002). Altares can be small movable shadow boxes, temporary shrines, such as those created
for the Day of the Dead in Mexico, or more permanent shrines, such as those that occupy a
small nook in homes to memorialize someone or something. Deeply rooted in Latino,
Indigenous, Catholic, and Afro-Caribbean cultures, altar-making invites people to honor
what they believe to be sacred, important, and meaningful, offering an opportunity to openly
and publicly express those sentiments to others. In therapy, the process enables clients to
express emotions and have an experience that engenders a deeper experiential level of in­
dividual and relational growth.
Emilio and Mandy brought three large shadow boxes that they made from wood at
home––one for each of them and one for them as a couple. They gathered things that were
significant to them as individuals and as a couple and family (e.g., pictures, prayers, figurines,
small objects such as a needle and thread, pictures from magazine clippings, small action
figures, a perfume bottle, family pictures, candles, flags, small patches and awards, silk flowers,
jewelry).

Encouraging Awareness of Self and Other in Context

Emilio and Mandy were able to talk about their shadow boxes as they created them. As
they talked, the therapist was open and transparent with her experiences growing up in a
bi-cultural home. She also explained that she was going to assume multiple stances in
their process, such as catalyst, witness, coach, investigator, supporter, etc. Leah asked
questions and made comments such as, “Tell me about the objects you brought in.”
“What does this mean to you?” “Where did it come from?” “What are your greatest
memories about this?” “When did you become aware that this person/thing was im­
portant to you?” “As you look at your shared shrine/altar, what does this mean for you?
Is there anything missing?” “What would you add or change?” “What do you want your
spouse to know about this?” “What would others think if they saw this?” Asking
questions helped Mandy and Emilio discuss the meaning surrounding what they were
doing. Having a creative and culturally relevant process helped them talk about issues
such as culture, values, traditions, wishes, and fears in ways they had not been able to
experience before.
 Socioculturally Attuned Experiential Family Therapy 135
Exploring Relationships Between Power, Emotion, and Expression
The process began by placing all of the pictures and objects on the table. They had a large
grouping of matches, a wine cork and label, coins, rocks, plastic wedding bands, softball
pictures, images of the beach, college memorabilia, concert stubs, and pictures of their
children when they were born. They discussed the objects and pictures, then began to
work together to place the images in the shadow box. As they worked, Leah asked about
the influences that have been instrumental in helping them remain strong as a couple, as
well as the social forces that were negatively affecting their connection. These questions
were difficult to answer, however, having the physical representation to reference helped
Mandy and Emilio discuss what had caused them to drift apart and experience distance
and isolation.
As Mandy and Emilio looked at their own personal altares and shared them with each
other, they began to notice important differences and similarities in what they valued. Mandy
began to cry when she noticed that Emilio had a cross with flowers at the center of his altar
along with images of his family and his country. Her images and objects reflected more about
her hobbies and interests. When the therapist asked Mandy about the meaning of her tears,
she said that she realized that he missed his family and country of origin and that she was sad
that she had not been able to help him stay more connected to his culture and family back
home. He reassured her that it was not her fault, and although it was true he felt isolated and
lonely and missed his family, he loved her very much and that she and their children were his
main priority.
Seeing their individual altares and being able to talk about them in an accepting and
non-judgmental manner helped Mandy and Emilio express their emotions in new ways.
With Leah’s prompts, they were able to openly talk about the gender and cultural scripts,
including how being a man had paralyzed Emilio, preventing him from talking about the
helplessness he felt or his need to connect with his wife and family of origin more
often and in meaningful ways. He missed sharing celebrations and honoring his cultural
traditions. Although Emilio felt powerful in his day-to-day life, he felt as though
Mandy held most of the power in their relationship because she spoke English with an
American accent, was not an immigrant, and understood many more things about
American culture.
Although Mandy spoke Spanish and greatly appreciated Emilio’s culture, she admitted that
she honored her traditions more with their children and often compared him to “American”
friends that “seemed to have it more together.” She also was able to talk about how she felt
the need to “give” him more power by “letting him” make important decisions, manage
their finances, and “let him” win fights so that he would not feel like less of a man. The
process of having honesty, trust, and vulnerability enabled them to position themselves to
begin to make the “couple altar” together. This shrine was a symbolic representation of who
they are and who they aspired to be together as a couple and family.
The couple began to identify the many social forces blocking their potential. For
Emilio, it was his pride and his inability to admit that he was fearful and worried about
losing Mandy. For Mandy, it was primarily the social comparisons and not honoring
Emilio’s culture and his values. She realized that his values centered around his faith and
family and her values centered around material possessions and shared experiences and
traditions from her culture. They were able to talk about power dynamics between the
Dominican Republic and the US that privileged Mandy’s culture. Mandy’s White privi­
lege was a salient factor in their daily lives and relationship, which they had not found ways
to openly acknowledge before therapy.
136 Socioculturally Attuned Experiential Family Therapy
Promote Equity Based Attunement and Connection
After seeing all three altares side by side, and having the experience of making them and
discussing their multiple meanings, Emilio and Mandy were able to experience themselves-
in-relationship in a different way. They became more attuned to one another, bearing
witness to their testimony of pain, loss, regret, and their hopes for the future. The therapist
guided them on this journey of self and mutual exploration and contemplation. By dis­
cussing social forces that were working against them, such as narrowly defined masculi­
nity/machismo, immigration status, and rigid gender and cultural scripts, they were able to
see how their different societal contexts shaped their lives and the expectations for their
marriage and life together. Upon the completion of therapy, the couple was able to keep
their altares as a reminder of their process of growth.

Summary: Third Order Change

In this case, Emilio and Mandy were able to engage in third order change by going beyond
understanding each other to understanding the impact of their societal contexts. The global
power dynamics and resource disparity between the US and the Dominican Republic
shaped many aspects of their lives, including who had greater societal privilege, whose
cultural practices were centered, and how they negotiated power dynamics relative to
gender, language/accent, and race. Societal structures in the US supported the voice and
welfare of Mandy at the expense of Emilio in some ways, and Emilio’s male privilege
supported his welfare over Mandy’s in other ways. When they were unaware of how these
dynamics shaped their relationship, they were more inclined to assign their problems to
themselves and blame each other as individuals. By the end of therapy, they not only
understood and appreciated each other’s experiences more, but were able to come together
to challenge oppressive societal forces on behalf of themselves, each other and their
children.

Reflexive Questions
• When thinking about your own family cartography as a method for exploring the effects of
space and place on your family, what are the main things that come to mind? What
would the map say about your context and how that influenced you?
• Experiential therapists make room for all voices, however, not all voices hold equal
power. What helps you take into account broader sociocultural context in analyzing
what gives or takes away your sense of power?
• What are some ways in which you have attuned to cultural rituals and traditions to help
clients work through difficult transitions, problems, or connect with traditions they may
have lost or forgotten? What were some emotional responses?
• When powerful persons become more attuned, they are also better able to respond
in caring and relationally accountable ways. How does your social location help
or hinder your ability to help others attune to those with less socially sanctioned
power?
• Describe the ways in which you have, or would like to, give meaning to the client’s
sociocultural experiences though symbolic, artistic, and creative interventions?
• If you were to make your own altar/shrine, what things would you include that would
reflect a symbolic representation of your life? Once you made it, who would you show it
to? What would they learn about you in the process?
 Socioculturally Attuned Experiential Family Therapy 137
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7 Socioculturally Attuned Attachment
Based Family Therapies

An infant makes soft baby sounds, gesturing excitedly with her hands. The child’s father
looks into her eyes, makes similar cooing sounds, and mirrors his daughter’s gestures. The
baby smiles and joins her father in their shared experience. This synchronous and reciprocal
engagement is the essence of attachment. Attachment is an interpersonal neurobiological
system that draws infants and caregivers together and serves to organize motivational,
emotional, and memory processes (Siegel, 2012).
Attachment’s importance was first identified by John Bowlby (1952) in a report to the
World Health Organization on the effects of maternal deprivation on British children or-
phaned during World War II. At that time, the application of the theory tended to reify
heteronormative and sexist assumptions that mothers are naturally bonded with their children
and that care for children should be their primary role (Franzblau, 1999). The value of bonds
with other caregivers or the multitude of contextual factors that influence caregiving pro-
cesses received little attention (Birns, 1999; Minuchin, 2002). Since then, attachment theory
has been more broadly studied and applied across the lifespan, elucidating the complex bonds
between biology, relationship, and social context (Cozolino, 2016; Siegel, 2012; Van der
Kolk, 2014) and even applying the theory to the relationships between animals and humans
(Walsh, 2009) and with God (Esmiol Wilson, 2015; Esmiol Wilson et al., 2014).
Supporting relational bonds is particularly important in the current sociocultural context in
the US and much of the world, in which the first decades of the 21st century have widened
divisions among people, and the materialistic, consumer-oriented culture leaves people
isolated, anxious and polarized (Doherty, 2020). In this societal context, Doherty (p. 43)
argued, there is a need for “gluing” interventions that help people not only connect, but
invest in each other, both at the intimate couple/family level and with larger communities.
Demonstrating responsiveness to others is core to healthy families and communities. Toward
this end, some view attachment theory as a unifying theory that can be used as an underlying
framework to inform clinical intervention (Johnson, 2019; Seedahl & Sandberg, 2020).
Whether working with adults, children, or larger systems, attachment based family
therapies (ABFTs) focus on strengthening the emotional connections that build and maintain
relational bonds. They begin with the premise that “needing and receiving closeness and
support is the essence of being human” (Greenberg & Goldman, 2008, p. 84). There are a
number of attachment based approaches to couple and family therapy. Among the best
known are Emotionally Focused Therapy (Johnson, 2004; 2019), Emotionally Focused
Family Therapy (Johnson & Lee, 2000; Willis et al., 2016), Attachment Focused Family
Therapy (Hughes, 2011), Attachment Based Family Therapy (Diamond et al., 2014), and
Emotion-Focused Couples Therapy (Greenberg & Goldman, 2008). Family therapists also
draw widely on related approaches that emphasize interpersonal neurobiology (i.e.,
Cozolino, 2016; Fishbane, 2013; Van der Kolk, 2014) and the social construction of identity
and emotion (Knudson-Martin & Huenergardt, 2010; Knudson-Martin & Kim, 2022).
DOI: 10.4324/9781003216520-7
140 Socioculturally Attuned Attachment Based Family Therapies

Text Box 7.1 Fred Piercy, PhD.

Fred Piercy has over 40 years of experience in the field. He has directed several
marriage and family therapy programs and is a former editor of the Journal of
Marital and Family Therapy.
Interventions based on the power of relationships can be applied at various
systems levels: friends, couples, families, communities, workplaces, environ-
ments, and even cultures … Such thinking is important, particularly in a world
that is becoming increasingly individualistic, fragmented, and isolated. ( Piercy,
2020, p. 754).

As noted by Fred Piercy in Text Box 7.1., current societal pulls toward individualism
and division make the need for approaches that strengthen relational bonds particularly
important.
⤝⤞

Families engage in third order change when they are able to overcome
sociocultural processes that inhibit attachment and enhance a sense of safety
and belonging in complex webs of individual, relational, and societal contexts.

⤝⤞

Primary, Enduring Family Therapy Concepts

Sometimes people think of attachment primarily as a personal internalized model of relating.
If early caregivers were responsive, we engage with others from a secure base that enables
autonomy and optimism (e.g., Ainsworth et al., 1978). If not, we approach life with caution
or uncertainty. Individuals are assessed as securely attached, avoidantly attached, anxiously/
ambivalently attached, or disorganized. While these categorizations can be useful, family
therapists focus on attachment as a systemic relational process across the lifespan, rather than a
static individual state (Johnson, 2003).
In contrast to dominant Western culture that privileges autonomy, independence, and
competition, attachment perspectives value relational needs and focus on processes around
nurturing and giving care. The enduring family therapy concepts that follow help clarify the
systemic, interactive nature of attachment: focus on relational process, intersubjective
emotional regulation, interdependence and responsiveness, relational security and trust, and
change through emotional connection.

Focus on Relational Process

The above example of father and daughter illustrated the interactive nature of attachment.
Let’s call the child Mayuri. Attachment occurs between Mayuri and her significant caregivers.
Mayuri has multiple caregivers. Her parents are divorced and share physical custody. They
have arranged their work schedules so that each parent serves as the primary caregiver three
days a week. On the days they are the primary parent, each drop Mayuri off at a daycare well-
staffed to care for infants. How long she is at the daycare varies, but since each parent has
some control over their work schedules, they seldom leave her for more than five or six
 Socioculturally Attuned Attachment Based Family Therapies 141
hours. Both parents report confidence in the daycare providers, but experience a pull to get
home to their child as soon as possible. They long to touch and hold her. Since family is
important to them, they alternate Sundays with grandparents, sometimes leaving Mayuri
with them and sometimes spending the time in gatherings with their large extended families.
The relational processes among Mayuri and her primary caregivers create shared meaning
and experience from the moment of birth. Ed Tronick (2009), who studied the psycho-
physiology of emotional communication between infants and caregivers, emphasized that
children are not passive recipients of adult action; rather, each actively changes the other.
Staying with Mayuri and her father, let’s imagine a situation similar to what Tronick’s ob-
servational studies showed. As her father tries to put her to bed, Mayuri squirms and grasps
his hair. She detects her father’s fleeting angry facial expression and loud “Hey!” (even
though it lasted less than a second). Mayuri grabs his hands and looks away. Almost im-
mediately father recognizes that Mayuri is distressed. He changes what he was doing and
begins to soothe her, stroking her hair and speaking in a soft voice. At first, Mayuri remains
turned away from him, but over the next 30 seconds, she begins to smile and look at him.
When Tronick measured biopsychological changes in similar interactions, child and caregiver
impacted the physiology of the other.
Whether working with parents and young children or adolescents or with adult re-
lationships in family or community settings, attachment based therapists (ABTs) focus on the
processes by which participants are emotionally accessible and responsive to each other. They
look for how people handle their inherent relational needs. When attachment processes are
working well, as with Mayuri, children learn that they can depend on others to be there for
them, to notice their needs and respond in ways that affirm their experience. Parents will not
always give children everything they want and there will be conflict and disagreement in all
relationships, but communication will be “contingent.” This means there is two-way dia-
logue in which “the receiver of the message listens with an open mind and all of his or her
senses” (Siegel & Hartzell, 2014, p. 82). The response is contingent on what was actually
communicated, rather than automatic, predetermined, or disengaged.
When communication is contingent, “the quality, intensity, and timing of the other’s
signals clearly reflect the signals that we have sent” (Siegel & Hartzell, 2014, p. 84). When
this happens, we feel “felt” or attuned to, that we are not alone. This interpersonal process
shapes the neural processes by which our internal models of self-in-relation are encoded.
When responses of significant others affirm our experience, we feel grounded and our sense
of “self” is connected to something larger than ourselves. As with Mayuri, when there are
ruptures to the immediate connection, they can be repaired. Adult experience is also
emotionally present and appropriately available to children. Even at this very young age,
Mayuri is learning that she has an impact upon and can influence her father and the other
caregivers in her life. She learns to trust that she is safe and the world predictable, and also
learns to reciprocally attune to the needs and experiences of others (Tuttle et al., 2012).
From an attachment perspective, seeking and maintaining emotional contact is at the heart
of healthy development. Isolation and loss are traumatizing. The need for responsive
security-enhancing relationships continues throughout life (Knudson-Martin, 2012;
Mikulincer & Shaver, 2012). The ability to move toward others in times of stress and crisis
improves health and resilience (Taylor, 2002). Though adults are expected to set the tone
with children, adult partners expect responsibility for the relationship to be shared (Johnson,
2019; Knudson-Martin & Huenergardt, 2010). While early relational experiences shape an
initial working model of attachment, new experiences continue to modify and elaborate
internal attachment models (Johnson, 2004). Hurtful experiences of trauma, loss, and betrayal
can move people from security to insecurity, while attuned mutually supportive relationships
can help heal old wounds.
142 Socioculturally Attuned Attachment Based Family Therapies
Intersubjective Emotional Regulation
Human neural systems are designed to be interdependent (Cozolino, 2016; Fishbane,
2013). To develop, we must exchange emotion and information through what Cozolino
called “the social synapse” (p. 19). Through the sharing of emotion, “we participate in
the way each other’s brains are built, how they develop, and how they function”
(Cozolino, 2016, p. 87). The interactions between Mayuri and her father are not simply
behavioral events; they are also emotional processes that connect daughter and father
neurologically.
Mirror neurons enable people to share affective states (Siegel, 2012). They are specialized
cells in the frontal lobes that permit us to viscerally apprehend another’s emotional state and
intentions. They let Mayuri’s father register her distress and revise his response to her almost
instantaneously. Attuned interaction between parent and child allows the parent’s more
mature brain to shape the child’s developing one. The parent tracks the child’s state and
temporarily aligns with it. The child feels felt and her aroused state is calmed. Over time, a
healthy pattern of arousal and inhibition not excessive in either direction is established
(Siegel, 2012).
Clinical issues often relate to how people try to manage painful emotion without adequate
emotional support. Efforts to regulate tender emotions such as isolation or worthlessness can
be destructive. When a parent or partner (or therapist) is not attuned to our primary emo-
tional states, words can seem empty, reinforcing a sense of being alone. In contrast, persons
with secure attachment histories are more able to regulate how they express emotion and
respond to another with an attitude of acceptance, curiosity, and empathy (Hughes, 2009).
“Coregulation, rather than solo self-regulation, is the baseline, normal, and most-efficient
strategy for us as social animals … we are better together, sharing the load and the stress”
(Johnson, 2019, p. 38).

Interdependence and Responsiveness

When attunement and responsiveness are not present, the innate interdependence of re-
lationships can be unsafe. Although Mayuri’s parents, Rajan and Lakshmi, are able to
provide a secure base for their daughter, they were not able to do so for each other. It was
not until after the separation and discovering that he needed to orient himself toward his
daughter’s needs, that Rajan realized how out of touch he had been with Lakshmi’s re-
lational needs and experience. He had felt secure and independent in the world, but did
not attune to his wife and did not know how to respond to her fear, sadness, and anxiety
during their marriage and pregnancy. Lakshmi described feeling alone and misunderstood.
She could not trust that Rajan cared about her or what she needed, and after a while
disengaged from him.
The neuroemotional process of shared affect requires symmetrical power positions
(Hughes, 2009). When roles are unequal, as between parent and child (or therapist and
client), the more powerful persons (parents) must follow the child’s lead and intentionally
open themselves to taking in the experience of other (children). When parents com-
municate acceptance of their child’s emotion, the child experiences mutual respect and
love rather than shame or disgust (Trevarthen, 2009). As children experience their parents
being sensitive and responsive to them, they develop reflective functioning that helps
them make sense of their own experience and that of others (Hughes, 2011). When
parents also communicate the impact of the child’s behavior on them, this mutual in-
tersubjective experience promotes relational security and trust that guides the child’s life
with others.
 Socioculturally Attuned Attachment Based Family Therapies 143
Relational Security and Trust
“Simply holding the hand of a loving partner can affect us profoundly, literally calming jittery
neurons in the brain” (Johnson, 2008, p. 26). If one’s working model of self and other does
not anticipate safety, people develop other adaptive responses. It is a matter of survival.
Porges’ (2009) Polyvagel theory helps explain the internal process. The vagus nerve connects
the brain with other organs such as the heart, stomach, and facial muscles. It has multiple
pathways. The usual instinctual response to a threat is to draw on the branch of the nerve that
seeks engagement and connection to others. But when others are not expected to be safe, the
other side takes over, shutting down these human connections. We may put up our guard,
fight, or withdraw.
In our example, Lakshmi had originally felt safe with Rajan. However, because she had
not always experienced safety with others, she was selective in whom she trusted and had
learned to withdraw when people did not meet her needs. Rajan had been well-tended as a
child but had spent many years depending on himself in a new culture where he felt
somewhat an outsider. He had not learned to tune into or depend on another. Their three-
year marriage did not provide Lakshmi and Rajan a secure base. They were able to suc-
cessfully co-parent, but depending on each other for emotional support was more difficult.
Had either of them experienced physical or sexual abuse or other trauma, their dependence
on each other might have felt even riskier. If one of them had been unfaithful, their sense of
betrayal would likely have compounded the lack of safety and trust.

Change through Emotional Connection

Attachment based family therapists (ABFTs) work by creating a safe environment in which
people are able to experience new responses to vulnerable emotions. “As families learn to
respond to one another in ways that are supportive and nurturing … attachment to other
family members can gradually become more secure” (Willis et al., 2016, p. 1). ABFTs are
active, present-oriented approaches in which experience is heightened through inter-
subjective dialogue, enactments, and/or play. This enables couples and family members to
experience positive physical and emotional connections that literally rewire the brain.
The therapeutic relationship must demonstrate secure attachment qualities (Hughes, 2011;
Johnson, 2019). Before couples or families can safely experience vulnerable emotions such as
shame, loss, fear, sadness, desire, and longing for each other, the therapist must first attune to
each person, seeking to understand and resonate with their underlying emotion. Therapists
need to be open and genuinely engaged, including their experience of what clients present.
They need to receive emotion openly and accept each person’s experience. Even young
children can learn to recognize how they affect others (Siegel & Hartzell, 2014) and use play
to generate solutions that connect one another and develop empathy, intimacy, and self-
worth (Willis et al., 2016). Throughout the process, therapists recognize and attune to clients’
affective desires and help them safely experience positive connections with each other.

Integrating Principles of Sociocultural Attunement

Attachment theory is often used within Western psychology to promote autonomy and goal
achievement, e.g., that a strong attachment bond decreases a child’s need to stay physically
close and enables exploration (Cassidy, 2008) or that an adult can “continue pursuing other
goals without having to interrupt them to engage in actual bids for proximity and protection”
(Mikulincer & Shaver, 2012, p. 260). The value of the relational bonds themselves can get
lost. Attachment based family therapies focus on relationships but typically remain
144 Socioculturally Attuned Attachment Based Family Therapies
decontextualized. AFBTs tend not to address societal influences or examine inequities in
whose interests and values are being advanced. Therapists may also miss contextual factors
contributing to clients’ problems (Vatcher & Bongo, 2001). In this section, we consider the
connections between attachment processes and sociocultural contexts, explore how societal
power dynamics create disparities in whose experience is attuned to and understood, and
consider third order change from an attachment point of view.

Societal Context
The ability to nurture attachment bonds is not just an individual or family problem. Like
many family and child advocates (e.g., Edelman, 1980; 1987), Bowlby (1988) critiqued the
dominant societal system as not organized to support relational bonds:

[In the] world’s richest societies … man and woman power devoted to the production of
material goods counts as a plus in all our economic indices. Man and woman power
devoted to the production of happy, healthy, and self-reliant children in their own
homes does not count at all.
(Bowlby, 1988, p. 2)

A socioculturally attuned approach expands the lens to include the societal processes and
contexts in which attachment processes occur.

Dominant Culture Assumptions and Contexts

Dominant cultural assumptions and contexts affect how theory is interpreted and applied.
Attachment is likely to be viewed as a dyadic process without considering the role of other
family members and social networks. We might assume that a child needs one primary
caregiver. In fact, nonparental caregiving is either the norm or frequent in most societies (van
Ijzendoorn & Sagi-Schwartz, 2008). In our example, Mayuri, whose grandparents im-
migrated to the US from India, is benefitting from access to multiple caregivers.

⤝⤞

Attachment processes between two people are always connected to what is

happening with other family members, as well as friends, community
members, social institutions, and societal norms.

⤝⤞

For example, Rajan’s parents had at first been very angry with Lakshmi. They insisted he sue
her for full custody and were willing to use their considerable financial resources to carry
the cost of a prolonged legal battle. Confused, Rajan turned to the pastor of his family’s
Christian church. The pastor was able to prevail upon the grandparents to take a different
approach. His support enabled Rajan and Lakshmi to overcome anger and cordially share
primary parenting. Focusing too narrowly on the parent-child relationship or the couple
dyad can overlook the need for support within the larger community, and may sometimes
hold individuals responsible for conditions out of their control.
We may also unintentionally hold women responsible for relational change. For example,
in a demonstration of emotionally focused therapy, the therapist helped a man get in touch
with vulnerable emotions that he did not usually express. The therapist ended by suggesting
 Socioculturally Attuned Attachment Based Family Therapies 145
that his wife could help him manage these feelings. Though significant attachment figures
should reciprocally play this role for each other, research shows that clinicians regularly put the
burden of change on women and expect them to calm men (ChenFeng & Galick, 2015;
Loscocco & Walzer, 2013). Socioculturally attuned therapists could have interrupted this
inequitable societal gender pattern by using the therapeutic relationship to encourage the
husband to consider how his emotions might impact his wife and work with him to take
responsibility for his emotion and response (Knudson-Martin & Huenergardt, 2010; see also
SERT, Chapter 14 in this volume).
Warm personal styles might also be confused with attachment (Greenberg & Goldman,
2008). There are many ways loving and caring emotions can be expressed and experienced.
For example, in Asian cultures expectations of “quiet fortitude” sometimes limit the direct
expression of worries or concerns so as not to burden others (ChenFeng et al., 2016). If Asian
partners or family members demonstrate restrained emotional style, this does not necessarily
mean less emotional attachment. Helping them share emotional vulnerabilities would still be
part of an attachment based approach, but therapists would first attune to each person’s
sociocultural experience around expressing emotion and work slowly and gently with them,
appreciating and demonstrating respect for less demonstrative styles while helping intimate
partners find a process that works for them.
For example, Jessica ChenFeng drew on her shared heritage with a second generation
Taiwanese American couple to help husband Brian emotionally engage with his wife
Michelle (ChenFeng et al., 2016, p. 12):

Therapist: Brian, what did you notice that led you to initiate the conversation?
Brian: We got into an argument earlier that day and I noticed that I was upset about it. I
kept thinking about it at work and wondered if it was impacting Michelle also …
I guess … [looking down] I felt bad about my tone of voice since I know now
how much that affects her.
Therapist: … And I also hear you acknowledging feeling bad. I know it’s not typical for
Asian American men to say things like that, especially with the experience you’ve
shared about being put down in our American society; it’s not easy to be open
about what you’re feeling … you’re breaking out of gender expectations that our
culture holds about being tough.
Michelle: Yeah quite honestly, I’m still having a hard time believing this happened, but I’m
so happy. I feel really connected to Brian for the first time in a long time.

Ideals regarding appropriate enactments of autonomy and dependence vary widely across
cultures and contexts. If parents in Japan complete a child’s sentence, that might be con-
sidered a sign of positive attunement linked to a secure attachment style; the same behavior in
the US would likely be viewed as intrusive and associated with an ambivalent attachment
style (Rothbaum et al., 2002). In collectivist cultures, the hoped-for outcome of secure
attachment would be a willingness to coordinate one’s needs with others; nondisruptive
actions that “keep the peace” might be a sign of trust and security. In Western societies, a
secure person is typically viewed as one able to venture outward and take on independent
tasks or roles.
Socioculturally attuned therapists would not be so quick to go along with cultural ste-
reotypes or taken-for-granted expectations. They would, instead, help clients explore the
relational consequences of cultural patterns. They would help parents consider what they
would like their children to learn about engaging with others (e.g., Tuttle et al., 2012). For
example, a Korean American couple brought their five-year-old daughter, June, to therapy
because they were concerned that she was “disobedient and argumentative.” As the therapist
146 Socioculturally Attuned Attachment Based Family Therapies
helped the parents attune to June’s experience, they began to imaginatively take in what June
was discovering about herself. Then the therapist helped the couple consider what “dis-
covering herself” meant to them and how this fit with Korean and American ideas of how
they wanted their child to relate. The therapist also attuned to the parents’ shame around a
“disobedient and argumentative” child, their sense that they were not good parents. After
considering the sociocultural origins of their shame, the parents were more able to accept
their daughter and take some pride in her independence while also clarifying which aspects of
other-oriented behavior were important in their parenting.

Social Construction of Emotion

Neurobiological attachment processes are intricately intertwined with culture and context.
From birth, the human brain is both internal and interpersonal, equipped to identify and feel
the sensibilities of those around us (Trevarthen, 2009). What we feel is invited by particular
social contexts. Rather than residing within an individual, emotions “link persons in the life of
family and community” (Trevarthen, p. 56). When the Korean American couple above felt
shame as parents, they were directly connected to a community of shared values and ex-
pectations that invited and gave meaning to their experience. Recognizing the contextual
salience of emotion helps bring the larger societal context into the moment by moment of
communication and interaction. As we’ll discuss in more detail in Chapter 14, our body’s
emotional read includes the power context; what we feel is always related to our place in the
social hierarchy (Cozolino, 2016; Wetherell, 2012).

Gender and Relational Needs

The need to feel “felt,” and the security and validation that comes from feeling connected to
significant others is human. The creation of a gender binary that assigns people “male” or
“female” at birth interferes with how relational needs are experienced, expressed, and heard
(Davies et al., 2016; Fricker, 2007; Knudson-Martin, 2013). In most societies, attachment
needs and behaviors are considered feminine. Characteristics associated with females are
typically disvalued. Female experience is given less credibility and is less likely to be
understood and validated (Fricker, 2007).
Many quickly learn that demonstrating relational qualities is not masculine. Boys and men
must either disown major parts of themselves or manage the conflict between their relational
selves and societal gender discourse. Masculine stereotypes encourage them to externalize
vulnerable emotions and blame and objectify others. Many men come to parenting and
intimate relationships without practice intentionally focusing on others. Acknowledging
dependency needs can be difficult. As in the example of Brian and Michelle above, socio-
culturally attuned therapists counteract these societal gender patterns by helping men own
vulnerable emotions. They expect that men can and do nurture, and actively facilitate their
efforts to do so. This requires therapists to be in touch with their own socialized emotions
and the gendered power context of their experiences both within the therapy room and
in their personal lives (see Tim Baima’s description of his experience later in this chapter in
Text Box 7.3).
Similarly, touch is a vital human need for everyone. It is connected to brain development and
the ability to organize emotion (Johnson, 2008). Societal messages about sex and touch may
limit this aspect of attachment. Sue Johnson, who along with Les Greenberg developed
Emotionally Focused Therapy (EFT), noted that “North Americans are among the world’s
least tactile people (p. 191).” Males, in particular, are culturally conditioned to not seek touch.
Boys are held and caressed less. In adulthood, they may “funnel all of [their] attachment needs
 Socioculturally Attuned Attachment Based Family Therapies 147
for physical and emotional connection into the bedroom” (Johnson, p. 192). People who do
not feel safe to be emotionally vulnerable may seek what Johnson calls “sealed-off” sex that is
focused on physical release rather than the relational bond. Their partners may feel used and
objectified. Others may use sex as a way to find “solace,” a way to feel reassured about at-
tachment needs, especially when partners are not emotionally available. When sex is part of
secure reciprocally attuned and responsive relationships, physical synchrony and emotional
safety reinforce each other and partners can relax into mutual pleasuring (Johnson, 2008).
Cultural gender stereotypes and objectifying discourse around sex interfere with indispensable
non-sexual touching as well as emotionally safe and loving sexual relationships. See Text
Box 7.2 for an example of a socioculturally attuned approach to sexual issues.

Text Box 7.2 Elisabeth Esmiol Wilson, PhD, LMFT

Elisabeth Esmiol Wilson is an AASECT certified sex therapist, and trained Spiritual
Director. She describes herself as a White, cisgender, AFAB (assigned female at
birth), heterosexual, middle-aged mom and stepmom whose upbringing was rooted
in an LGBTQ affirming, multi-racial, multi-cultural, Episcopal church she attended
with her single mother and younger sister in Kailua, Hawaii. Elisabeth’s clinical and
research interests focus on socially just approaches to integrating couple therapy,
sex therapy, and spirituality. She carefully takes into account larger societal
discourses and power structures and how religion, in particular, can be a factor
that helps and hurts our mental, relational, and sexual health. Here she illustrates
her socioculturally attuned attachment approach.
Mark, who identified as White and Protestant, was sexually abused as a
teenager by his youth pastor. Jose, who identified as Latino and Catholic,
experienced nonconsensual touch from a priest as he was considering entering
the priesthood. Both had higher education degrees in psychology and religion and
had experiences of disaffiliating from their non-affirming family of origin religious
communities and finding an affirming, progressive Christian church they attended
together. In therapy, I stayed aware of the complexity and variety of different faith,
race, culture, gender, and sexuality messages the couple had received through
their families of origin as well as religious upbringings. I also attended to how
power impacted mutuality in their relationship and the impact of larger societal
and religious messages on their current attachment issues. Finally, I explored how
religious systems of inequity continued to impact their current faith and varying
degrees of freedom they experienced in their expressions of sexuality and shared
sexual pleasure.
I tend to name issues directly, using curiosity and open-ended questions to help
hold the complexities, while attuning to the underlying emotions and power
disparities and how these impact relational mutuality and secure attachment.
We discovered that their differing theologies of atonement (reconciliation of God
and humankind through Christ) deeply impacted their sexual pleasure. We
explored questions such as, “What is the impact of believing in an atonement
through death and torture on how you show up with each other emotionally and
sexually?” We explored ways Jose had coped with his attraction to men,
visualizing Christ’s brutal suffering while masturbating to appease his guilt. We
explored the impact of their sexual and religious abuse on their image of God and
on how both continued to view the role of sexual pleasure in their relationship.
148 Socioculturally Attuned Attachment Based Family Therapies

“What differences do you notice in yourself as you move to understanding

reconciliation as a relational process?”
I name not only the social injustice but the impact of the injustice, giving space
for emotional processing and space to feel the impact of being silenced and
marginalized. We explored Jose’s deep desire and sense of calling to enter the
Catholic priesthood, and the splitting and hiding that was necessary to even
pursue that path. We explored how to honor his grief without further silencing the
beauty of living in the fullness of his religious, relational, and sexual identities.
Sometimes my work includes challenging the messages of unjust systems that
clients may already have physically departed from but which nevertheless still
remain psychologically present. We slowed down their sexual scripts, exploring in
detail the thoughts, images, and feelings that emerged in them as they moved
through early, middle, and late stages of arousal. I encouraged Jose and Mark to
interrupt these oppressive messages in the moment, sometimes in their own head,
sometimes verbally with each other, slowing down their sexual experiences to
create more space for congruent, accepting, pleasurable connection.
Part of my work with Jose and Mark included inviting them to envision a
relationship model that they had never seen actualized. As I supported them in
dreaming together, the process itself was transformative. Together they envi-
sioned a spiritually connected, equitable, mutually attuned relationship, in which
they were connected together to a larger religious community. While not all the
folks they cared about supported their vision, Mark and Jose remained committed
to modeling a kind of love that would support others like them to more easily
envision a path toward relational equity and love.

Class and Attachment

The ways attachment processes are theoretically described and researched tend to reflect
Western middle class values (Birns, 1999; Franzblau, 1999). Yet how people approach car-
egiving and receiving varies considerably depending on social structure and the futures they
are preparing their children to enter (Lareau, 2003; Tuttle et al., 2012). Working class parents
have less control over their schedules and less income for quality daycare than the example of
Mayuri above. The dispositions and values any of us bring to parenting and intimate re-
lationships reflect the structured social arrangements we inhabit (Lareau, 2003).
For example, Luellen and her children were referred to therapy after her oldest son,
Darnell (aged 11) told a school counselor that his mother locked him in his room when he
came home after curfew. Resonating with Luellen, a low income, African American woman
raising her boys in a neighborhood where many young men join gangs or become victims of
violence, required that the therapist attune to her emotional sense of how important it is that
her sons be obedient, follow the rules. This would be necessary for them to safely negotiate
racism and be successful in school. Independence and assertiveness, qualities often valued by
White middle class parents, would be risky in a world where Darnell could easily be judged as
delinquent, defiant, or dangerous.
People nurture securely attached relationships across all socioeconomic strata (Birns, 1999).
Members of economically disadvantaged groups often demonstrate considerable emotional
resilience. For example, studies of children of Latino immigrants in the US show high levels
of emotional well-being and social skills (Fuller & Coll, 2010). Nonetheless, stresses such as
limited economic resources, space, and time affect the structure and organization of family
 Socioculturally Attuned Attachment Based Family Therapies 149
life (McDowell, 2015). Differences in measures of attachment security between socio-
economic contexts can usually be explained by the degree to which social environments
support attachment processes (Bliwise, 1999).

Hermeneutical Justice
A core premise of attachment theory is that people develop a coherent self-narrative when
their experience is attuned to and relationally validated (Siegel, 2012).

⤝⤞

The ability to make sense of one’s experience may be disadvantaged when

dominant cultural meanings systematically limit who can express themselves
and be understood.

⤝⤞

For example, incongruence and resulting sense of isolation are likely for those who
identify as gay and lesbian, transgender persons, and people who identify outside the
gender binary (Davies et al., 2016; Devor, 2004). This is not simply a matter of parental
criticism or rejection; it is part of the larger context in which the meanings of gender and
sexuality are constructed. For example, Michael, who had transitioned from female to male
about ten years prior, sought therapy because he was anxious about a forthcoming career
change. He described positive relationships with his family and a stable marriage with a
woman. Yet in this situation in which he would be developing another aspect of his
identity and new kinds of collaborative work relationships, he was faced afresh with what
Miranda Fricker (2007) called hermeneutical injustice, inequities in whose experiences are
understood and given social credibility. This means that the dominant culture offered little
shared understanding as a resource to support Michael’s experience. According to Fricker
(2007, p. 163), “it tends to knock your faith in your own ability to make sense of the
world.” At the start of therapy, Michael was confused by his anxiety because he anticipated
his new colleagues would be accepting. But acceptance is different than being known. Over
the years, Michael had adapted to unremitting hermeneutic isolation by disengaging from
his own emotional experience. His family, partner, and friends tried to understand but
lacked collective meanings to activate mirror neurons to attune to him. Systemic obfus-
cation encouraged him to opt out of shared meaning-making that constitutes the self
(Fricker, 2007). While outwardly friendly and socially involved, he kept an emotional
distance, even from himself. Naming this as a societal problem rather than a personal
deficiency helped Michael overcome some of the isolation and slowly experiment with
steps he could safely take to attune to himself and others.
In another case illustration, Lannie and Kent sought couple therapy to resolve trust issues
before they got married. They told the therapist that neither was “a monogamous person,”
and they wanted an “open” marriage. Collective understandings of monogamy made it
difficult for the therapist to resonate with their experience, even though on a cognitive level
she accepted that partners define for themselves what marriage means. Regardless of a
therapist’s willingness to understand, it is important to reflect upon how we respond to the
effects of mononormativity (Jordan et al., 2017). The therapist had to practice “socially aware
listening” (Fricker, 2007, p. 171) that pro-actively recognized the likelihood that her internal
experience of Lannie and Kent was based on social meanings that obscured her ability to take
in their issues.
150 Socioculturally Attuned Attachment Based Family Therapies
Hermeneutic injustice creates a lack of credibility (Fricker, 2007). People do not take in
your experience as possible or as making sense. Patricia Hill Collins (2000), described how
Black women in academia and other institutions learn to survive in a system that only re-
cognizes knowledge and experience consistent with dominant White male culture. From an
attachment perspective, the isolation and assault to self are substantial.

Power
⤝⤞

Attachment is highly contextual and impacted by power dynamics, inclusion,

and a sense of belonging at intimate, family, community, and societal levels.

⤝⤞

Expanding our lens beyond family puts relational bonds within systemic communication
patterns that reflect and maintain societal power inequities (Knudson-Martin, 2012, 2013;
Medina, 2013). What we feel, who is noticed and attended to, and the likelihood that we
benefit from attuned support, depends on social power processes that govern communication
(Fricker, 2007).

Effect of Power on Emotion

Neural circuitry always registers our place in the social hierarchy (Cozolino, 2016; see also
SERT, chapter 14). The unfolding of emotion is interactive, taking into account both at-
tachment and power contexts (Greenberg & Goldman, 2008). For example, Ben and Liz, a
White cisgender couple in their 20 s, with recent college degrees, sought therapy because of
escalating anger and verbal assaults. Just looking at behavior, it would appear each contributes
equally to the escalation. Each was using anger to protect relational vulnerabilities. But their
gender and social class locations placed them in different power positions, with very different
emotional consequences.
As a male from an affluent family with parents he described as warm and loving, Ben
believed himself to be “open” and “giving.” He valued his relationship with Liz but was
blind to the ways he perpetuated systemic ignorance of, and inattention to, the experience of
those with less social power (hermeneutic injustice). He expected to be taken seriously and
have agency over his own life. When Liz questioned him about his activities or expenditures,
anger––inseparable from his power and identity positions––just seemed to erupt. He would
lash out at Liz, blaming her for not trusting him, questioning her judgment and knowledge,
(i.e., “testimonial injustice” in which he does not take her voice or experience seriously)
(Fricker, 2007).
Liz, also from a loving family, but one with limited economic resources tried to be sen-
sitive to Ben’s interests. Her roots lower in the social hierarchy taught her that silence was
often safest in new settings (Medina, 2013). Her safety depended on gathering information
about her environment. Like others in one-down social positions, she was almost always
aware of what Ben was likely to be thinking and feeling (Knudson-Martin, 2013). She not
only wanted to understand his actions and choices, in her one-down position, she needed to
understand. When Ben lashed out at her, she felt hurt and even more vulnerable. Her sense
of dismissal and injustice motivated angry retorts.
The emotions Ben and Liz experienced are not just personal power dynamics between
them; they reflect and maintain societal power imbalances. These persistent patterns
 Socioculturally Attuned Attachment Based Family Therapies 151
are built into social structure and are usually not obvious to participants (Wetherell,
2012). Therapists need a guiding lens that seeks to understand how a particular emotion
is linked to larger societal power contexts (Pandit et al., 2014). Attending to power
imbalances, such as between Liz and Ben, is important to creating safety in the ther-
apeutic encounter. Socioculturally attuned attachment therapists will not ask Liz to
express vulnerable emotions without first creating a context in which Ben is able to
listen to her.

Effect of Power on Who Attunes

Supportive attachment requires reciprocal attunement; however, those with higher power
statuses tend not to notice or attune to those with less social power unless they intentionally
seek to understand and connect (Knudson-Martin, 2013). This usually is a question of will
(Medina, 2013). Attunement requires a willingness to temporarily let go of one’s own
perspective and take in another’s. Instead, power processes invite persons in dominant po-
sitions to expect subordinates to soothe and regulate their uncomfortable emotions. Ben
takes Liz’s attunement to him for granted until her questions seem to challenge his identity,
autonomy, and/or authority.

Third Order Change

Third order change from an attachment perspective includes awareness of the sociocultural
context of one’s attachment responses. Persons in powerful positions tend to focus outward
rather than inward, blaming others rather than self-reflecting (Greenberg & Goldman, 2008).
Their anger, intimidation, or silence becomes a way to regulate others.

⤝⤞

Third order change is facilitated when powerful persons become aware of their
social location and intentionally attune themselves to others.

⤝⤞

As in Ben’s case, powerful persons need to experience their own vulnerabilities and open
themselves to the experience of others rather than resort to control. People in one-down
positions are likely to be silenced as they adapt to maintain safety and security. From an
attachment perspective, Liz’s eventual anger, rather than withdrawing, is an invitation or
plea for Ben to engage. Instead of viewing her retorts as dysfunctional, it is helpful to
recognize them as resistance to power. Tuning into the power context of her anger
can raise useful awareness and self reflection regarding how one wants to respond to
unjust circumstances (Garcia et al., 2015; Medina, 2013). As Ben and Liz become more
contextually aware, his willingness to hear her anger and learn from it would be an
important step.

Community and Empowerment

The impact of power on well-being extends to the community, the workplace, and the larger
society. People do well when their social contexts affirm their identities and connections.
Prejudice, discrimination, and structural inequalities have an insidious effect, perpetuating
objectification, commodification, and exploitation in the routine ways people treat each
152 Socioculturally Attuned Attachment Based Family Therapies
other (Collins, 2000). Countering these injustices through third order change is more pos-
sible when people build relationships with others who understand and support them
(Almeida, 2019).
The Latino Health Access (LHA) in Orange County, California (Bracho et al., 2016) is an
impressive example of collective empowerment. Participants in vulnerable low-income
communities battle addiction, manage diabetes, stop violence, or improve children’s health
by building relational bonds. Their philosophy resists oppressive societal power processes
“with a heart that feels love for our community and expresses that love through acts of
solidarity” (p. xv). Grounded in science about the effects of societal inequities on health, and
prioritizing the wisdom of the community, the project works through strengthening bonds
and networks among neighbors. Everyone gives and everyone receives. Sarai, a promotora
(community health worker and expert) who struggled with parenting and an abusive re-
lationship summed up the positive impact of community bonds:

When fear comes to me, I take a few steps back. Then I talk to others in the community
and stop being afraid … We belong to each other. Every day we work to create and
invite people to safe, protected spaces where they can be themselves, feel stronger,
overcome their fears, and be part of the solutions.
(Bracho et al., 2016, p. 67)

Models like LHA support family bonds within wider webs of relationships and use those
bonds to construct new knowledge, resist injustice, and create transformative change (e.g.,
Collins, 2000).

Practice Guidelines
⤝⤞

The goal of socioculturally attuned attachment based therapy is to develop

relational connections that enable couples and families to equitably support
each other in the face of life’s stresses and concerns in order to engage in
transformative action.

⤝⤞

The following guidelines help attachment based therapies incorporate a socioculturally at-
tuned approach that attends to power and societal context.

1 Recognize Power’s Effects on Relational Safety

When first engaging with individuals, couples, or families, socioculturally attuned thera-
pists seek to understand how social power, the capacity to “influence how things go in the
social world,” (Fricker, p. 9) is reflected in how participants orient to each other and
the larger environment. How likely is each to feel felt? Who attends to whom? How do
gender and other power contexts affect responses to vulnerability? How do these patterned
responses create safety for some at the expense of others? To create an equitable foundation
for therapy, therapists act to balance power in ways that support emotional safety for
everyone. They take in each person’s perspective without unintentionally allowing more
powerfully situated members to define the direction of therapy.
 Socioculturally Attuned Attachment Based Family Therapies 153
2 Attune to the Sociocultural Nature of Emotion

Safety is enhanced as therapists actively attune to the sociocultural nature of each person’s
emotional experience (Pandit et al., 2014). Socially aware listening is facilitated as therapists
attune to client emotion through a lens curious about how personal experience connects to
larger societal discourses and power processes such as the idea that women should not
question men:

Therapist: It’s so distressing when Liz questions you, almost as though she is questioning
your judgment.
Ben: Yeah! Like she’s putting me down. Like she doesn’t trust me.
Therapist: What’s that like for you? What does it seem to say about you as a man?

Therapists reflect an understanding and name client’s sociocultural experiences, explicitly

linking emotions, experiences, and processes with sociocultural context:

Ben: Nobody ever questioned my dad. I don’t know why she is always questioning
me! Who does she think I am?
Therapist: So, when Liz questions you, you feel like you’re not much of a man in her eyes.
You want her to look up to you. Am I getting that right? [David nods]. It makes
sense to me that if you learned that men are supposed to be right, to be looked up
to, it might be pretty uncomfortable if it feels your authority is questioned.
Ben: I’m not really like that you know—not one of those men who has to be the
authority.

As clients identify the social contextual nature of their emotions and feel understood, like
Ben, they are more able to reflect on themselves and others, which enables more connection
and accountability to self and others. In Text Box 7.3 Tim Baima describes how he raises
consciousness of power and intimacy issues, and how demonstrations of power may be tied
to “socially unacceptable” feelings of vulnerability.

Text Box 7.3 Timothy Baima, PhD, LMFT

Attachment theory frames Tim Baima’s understanding of healthy relationships and

healthy autonomous functioning. His work as an Associate professor at Palo Alto
University focuses on Whiteness in psychotherapy and relationships, self-of-the-
therapist training, and Family Play Therapy. Below he describes his approach to
identifying and naming sociocultural issues with his clients, taking into account his
identity as a White, straight cis male from a working-class background.
First, I believe it is my responsibility to take risks with my clients. I initiate
conversations about sociocultural context even when I am uncomfortable and
bound to be clumsy in my effort to do so. I have long abandoned the dream of
phrasing every question with the eloquence of master therapists and have been
pleasantly surprised to find that even a question such as, “Could race have had
something to do with that interaction?” can be very effective as long as I have the
courage to ask it.
Secondly, I use therapeutic self-disclosure to place my questions and com-
ments in context. I might join with a privileged client by sharing ways I have
154 Socioculturally Attuned Attachment Based Family Therapies

similarly misused power related to my own unearned privilege. When I draw

attention to possible manifestations of oppression related to marginalized iden-
tities I do not share, I may lead by acknowledging my position as an outsider.
When I do so, I attempt to communicate that I understand that I am leaning into a
topic I can never truly understand.
Third, I draw heavily upon Kenneth V. Hardy’s (2016) Validation, Challenge,
Request (VCR) intervention. For example, when I want to challenge a White
partner to see how his defensive posture with his Partner of Color shuts his partner
down, I may start by validating his desire to be connected. Perhaps he is even
taking that defensive tone because he fears losing his partner. This type of
validation allows the client to feel understood and cared for and more receptive to
a challenge about how his tone is actually preventing him from getting the very
connection he desires, and to a request to listen to his partner differently.
Finally, people with social privilege often use domination to avoid discomfort,
inconvenience, and vulnerability. We may draw upon the power associated with a
privileged part of self to compensate for the vulnerability and pain we feel in a
subjugated part of the self. I see many clients who use their power to silence and
dismiss important parts of themselves as well as their partners and children. These
clients are often able to suppress their own internal world and control the people
they are in relationship with, and then end up confused about how empty and
alone they feel. When these clients recognize how domination over self and other
restricts intimacy, they tend to become more receptive to learning how to let go of
domination in order to embrace love.
I believe that love and intimacy are characterized by self-reflection and self-nurturance
that facilitates growth. Therefore, reflecting on our relationships with unearned power,
privilege, and oppression is an act of love towards ourselves and towards all those with
whom we are in relationships. It is important to note that those of us with unearned power
and privilege are far more likely to misuse and abuse that power and privilege not when
we feel powerful, but when we feel uncomfortable, afraid, insecure, or vulnerable. Often
it is when hurt, abused, or subjugated aspects of ourselves are triggered that we
compulsively draw upon our unearned power and privilege to navigate the inherent
discomfort of such situations. Therefore, I believe that 3rd order change must involve
attending to both privileged and subjugated aspects of self ( Hardy, 2016). Empowering
ourselves or our clients in areas we have been traumatized, hurt, or oppressed, goes
hand-in-hand with learning to abandon a dependence on domination rooted in our
privileged parts of self.

3 Accentuate Relational Needs

Dominant Western cultures minimize relational needs and, as noted earlier, increasingly leave
people feeling isolated and focused on material concerns. Attachment based therapists look
for and highlight each person’s relational commitments and values. They look for relational
strengths already present, but which may be currently hidden or overlooked. This helps those
in powerful positions be willing to attune to subordinates. A demanding and punitive father
may be guided to express his love and concern for his acting out teenager. Angry teens may
fear they are not loveable and long for acceptance. A couple divided by hurt may need help
recognizing their dreams for love and understanding.
 Socioculturally Attuned Attachment Based Family Therapies 155
Identifying, naming, and focusing on relational needs creates a vision of what clients are
working toward. As the therapist resonates with and gives voice to clients’ relational foun-
dations and dreams, they “feel safe enough to be in touch with their need for emotional
connection and the positive intentions each held for their relationship” (Wells et al., 2017,
p. 21). Therapists can then help clients access and express these hopes and commitments as
they rebuild and develop their bonds. Individuals get perspective on how they want to
engage in relationships and what to expect. Therapists may intervene to help clients consider
how other family members, friends, work, community contexts, and societal discourses
support (or not) their relational values and needs.

4 Initiate Power-Sharing through Engaged Enactments

Socioculturally attuned ABFTs help clients choreograph engaged encounters that interrupt
societal power dynamics and facilitate attuned connection. Similarly to Socio-Emotional
Relationship Therapy (see chapter 14), they intervene by inviting more powerful persons to
listen and respond, express vulnerability, and take initiative in building relational connec-
tions. Therapists work with in-the-moment-process between clients, focusing on how they
relate to each other and exploring the underlying sociocultural nature of emotion. Clients
begin to see how they enact cultural stereotypes and power dynamics, as well as recognize
when they experience connection and mutuality. It may take repeated enactments of attu-
nement before the less powerful feel safe to ease their guard.

5 Consolidate Equitable Relational Patterns

As clients experience relational safety, connection, and reciprocal support, therapists

heighten and expand the moment. They encourage clients to recognize what they did to
build relationship and highlight the positive relational impact of these actions. In the
process, clients are able to articulate ways they have “become more fair and reliable … to
have a sense of shared accountability” (Wells et al., 2017, p. 24). Therapists help con-
solidate experiences of equitable commitment and relational investment and help clients
envision how they will engage with each other and the larger society going forward.
Socioculturally attuned therapists will have been attentive throughout to key persons and
communities that support clients’ transformation through evolving relationship bonds
and identities.

Case Illustration
Jolene (31) was referred by her midwife following the birth of Matthew (5 months). The
therapist, Norma (26), a Black family therapy intern who used female pronouns, invited
Jolene’s wife Lara (33) to the first session. Norma learned that the White, cisgender
female couple had been married for five years, together for nine, and also had a 4-year-
old daughter, Camilla. When Lara, a kindergarten teacher, gave birth to Camilla she took
a year’s [unpaid] maternity leave. Jolene, an advertising account manager, was doing the
same now with Matthew, while Camilla was in preschool in the mornings and with
Lara’s mother in the afternoon. Jolene had looked forward to a special time with
Matthew; instead, she was “losing it.” She felt inadequate, incompetent, and ashamed.
She was especially humiliated that Lara, who was diagnosed with multiple sclerosis (MS)
when she was twenty, was a “natural” mother, despite coping with her MS, which in-
cluded damage to the optic nerve, somewhat unpredictable balance, and occasional
flare-ups.
156 Socioculturally Attuned Attachment Based Family Therapies
Recognize Power’s Effects on Relational Safety
As Norma began to get to know Jolene and Lara, she was interested in who was oriented to
whom. The couple quickly described Lara as a “caregiver.” Lara’s accounts frequently in-
cluded Jolene’s perspective. Jolene appeared much less attentive and attuned, insisting that
Lara focused too much of her time on friends and family that did not deserve her.

Lara: Like last weekend, my cousin needed me to take care of her daughter. Jolene was
mad at me for doing that. I understand how she feels; she thinks I’m being taken
advantage of.
Jolene: It’s stupid! You never learn!

A pattern of unequal attunement continued throughout the session. Jolene was the bene-
ficiary of considerably more relational care from Lara than she returned. Each woman had
suffered childhood abuse and/or neglect and had worked to overcome the effect of these
attachment injuries. Lara trusted that Jolene loved her and minimized the hurt she experi-
enced when Jolene did not tune into her. She was used to soothing Jolene, helping her work
through her stresses. But when she tried to help Jolene in caring for Matthew, Jolene just
seemed to get more depressed.
Jolene also described feeling betrayed when she discovered that Lara had coffee with
Dillon, her “first love.” It had been ten years since Lara had seen Dillon when she ran into
him unexpectedly. They had coffee to “catch up.” She did not tell Jolene about the meeting
fearing that it would upset her. Norma recognized Lara’s secretiveness as a reaction to
Jolene’s “disentitled power,” common among victims of childhood abuse (Wells et al., 2017,
p. 129). Though more likely among men, this kind of power does not come from an overtly
powerful position; it is connected to feeling worthless and unlovable. Yet their self-focus
creates a power imbalance in the relationship.

Attune to Sociocultural Nature of Emotion

Norma conveyed a deep interest in knowing and “getting” each partner’s experience
through a sociocultural lens. Jolene was not stereotypically “feminine,” but she internalized
all the societal messages about “a good mother.” When she did not always feel loving
thoughts toward her baby, she felt like a failure. She could not tell anyone, especially when
she had been so sure she had so much love to give. The more she felt like a failure, the more
isolated and withdrawn she became. Norma reflected and validated the sociocultural nature
of experiences, linking emotion to relational and societal contexts:

Norma: All your life you’ve known you have so much love to give.
Jolene: [When my parents abandoned me] I was on my own. I knew all I needed was a
chance. I knew I would be a good mother … I’ve been a good mother to Camilla.
Norma: Even though your mother couldn’t be there for you, somehow you carried this
idea with you, of a good mother … like a dream. Do you think your dream is
similar to other women’s?
Jolene: I think everyone knows what mothers are supposed to do.
Norma: When I talk with mothers, almost everyone seems to feel like they’re failing in
some kind of way. Women get a lot of messages about all that they’re supposed to
do––and how loving they’re supposed to be.

Jolene and Lara had spoken at length about what good mothers they would be, how they
would arrange donors, how they would manage child care. They did not speak of their fears,
 Socioculturally Attuned Attachment Based Family Therapies 157
doubts, and vulnerabilities. This was not simply because of prior attachment injuries. It was
also because women receive strong societal taboos regarding expressing and sharing these
feelings (Knudson-Martin & Silverstein, 2009; Mauthner, 1999).
Norma also explored the extra pressure Jolene and Lara felt to represent the LGBTQ
community as “good mothers” and how all these intersected with MS disability:

Lara: I have always kept going no matter what. When my uncle molested me, when I
was bullied at school because I looked funny and didn’t have the right clothes,
I never told anyone. I didn’t let myself care. When MS came, more the same.
Norma: You’ve always had to keep going. It was all on you … and from what you’ve said,
you always tried to make it easier for others.
Lara: I didn’t want to make people uncomfortable. Didn’t want to worry my mom. With
MS, people don’t understand. They might think I shouldn’t be a mom. [shrugs and
smiles] I have to keep smiling.

Accentuate Relational Needs

Norma helped the couple begin to see their relationship patterns and provided a relational
framework through which to understand depression and repair power imbalances. She va-
lidated and built upon the positive connections already evident in the relationship.

Norma: I see the love–how much you each value your relationship … You’ve described
patterns in which Lara is really focused on you, Jolene. I’m guessing that you want
to be there for her, too. [Jolene agrees]. What’s happening now and how hard it
is to not feel the way you want with Matthew, it might be a good time to find a
way to make the back and forth more shared, to make the relationship a safe harbor
for each of you. My hunch is that it will help the depression, too.

Positively framing the couple’s commitment to each other and their family helped counter
societal messages that they were “less than” and not entitled to care. Conversations that
connected their family experiences to larger societal contexts helped remove personal blame
and develop empathy for themselves and their caregivers’ situations:

Norma: [to Lara] What do you think it was like for your mother … taking care of you on
her own?
Lara: She was working all the time. She was working for us. If she knew what my uncle
did, what I was going through … I couldn’t do that to her.
Norma: It seems like you had a sense that your mother was carrying a very heavy load. Even
then, it seems you might have known there was injustice there [Lara emphatically
agrees]. Almost like to the rest of the world your family wasn’t very important.

Initiate Power-Sharing through Engaged Enactments

Jolene and Lara adapted differently to emotional insecurity. Lara worked to calm others,
while Jolene kept emotional distance, unaware of how much she depended on Lara for
emotional stability. Jolene had survived by not letting herself feel vulnerable. In the incident
with Dillon, she did not let herself feel what it was like to need someone; instead, she tried to
control Lara’s relationships. She had not developed the practice of taking in what others felt
or reflecting on her own feelings. Jolene loved Camilla’s bubbly 4-year-old laughter and felt
good when she held Camilla close. With Matthew it was different. She was on her own most
158 Socioculturally Attuned Attachment Based Family Therapies
of the day and he didn’t respond the way she expected. The more helpless she felt, the more
unlovable and unworthy she felt. Lara was moved when she witnessed Jolene’s vulnerability,
but neither paid attention to Lara’s relational needs.
Norma developed enactments that interrupted the couple’s power imbalance and ex-
panded attachment beyond a dyad. First, she asked Jolene to reflect on what she thought it
might be like for Lara when she (Jolene) was having such a hard time with Matthew. This
helped Jolene move away from self-focus that not only perpetuated the power imbalance but
also maintained the feedback loop between isolation and depression (Knudson-Martin &
Silverstein, 2009). In setting up the enactment, Norma first validated Jolene’s despair, then
drew on her love for Lara:

Norma: [to Jolene] It’s so hard. You feel like a failure as a mother, as a person … I’m also
wondering what it’s like for Lara. You’ve said so clearly how much she means to
you. What have you noticed? What it’s like for her to see you so down?

Jolene struggled to have a response. She wanted Lara to tell her, but Norma stayed with
Jolene, supporting her to imaginatively take on Jolene’s experience:

Norma: You know her. “Hard for her,” you said. What’s hard?
Jolene: [Pauses. Looks at Lara, then shrugs]. Just hard, you know. I can’t be easy to deal
with!
Norma: You see that it must be hard for Lara. What do you think the hardest part is for her?

Norma gently persisted so that Jolene could have a successful experience of attuning to Lara.
She resisted the temptation to simply ask Lara.
In a second enactment, Norma asked Jolene to share a fear that she had regarding Lara.
Norma asked Lara just to hear it. This was very difficult for both women, but Norma wanted
Jolene to practice vulnerability in the safety of the therapy room. After Jolene took the lead in
expressing vulnerability—her fear that she was not loveable—Norma helped the couple
process the experience, emphasizing both the emotional risk they took and the positive
consequences. This set the stage for mutual sharing of vulnerability:

Norma: This is a hard time for all of you. You both need each other; you’re both
vulnerable. But Jolene’s pain is easier to see. And I can understand, Lara, why you
don’t want to add to Jolene’s plate right now. But I wonder if there is a way you
could check in with each other and each share a vulnerability you’re feeling? Agree
that you don’t need to try to solve it right then, just listen.

Consolidate Equitable Relational Patterns

Norma continued with enactments designed to help the couple risk an expanded level of
emotional engagement, always paying attention to the balance of giving care and highlighting
the positive aspects of their evolving relational bond. Though it can take considerable time to
rework attachment traumas (see Johnson, 2002; Wells et al., 2017), Jolene began to feel
better almost immediately and each week the couple reported a more secure bond. They said
that the depression and incident with Dillon were the best things that happened to their
relationship. Their prior therapy had helped them develop personal responsibility, but they
appreciated that this therapy validated their closeness. Instead of feeling like a set of diagnoses,
they felt affirmed as mothers and partners. Conversations about mutual care and emotional
support included considerable discussion about living with MS. The fact that Jolene wanted
 Socioculturally Attuned Attachment Based Family Therapies 159
to share this part of her life was astounding to Lara. Jolene, who had always been “private,”
joined a support group for mothers and quickly became one of the organizers.

Summary: Third Order Change

First order change is “common sense” but does not change the systemic ways people engage
with each other. Perhaps they learn some new communication skills or how to better manage
symptoms. Jolene might have taken an antidepressant or discussed her experience with a
therapist. Perhaps Lara would have learned more effective strategies to support Jolene
through the depression. These potential steps would have been unlikely to stimulate second
order change given the nature of the couple’s attachment bonds with each other and their
children. Their responses to each other would still reflect different adaptive responses to
earlier attachment injuries. Jolene would still have received more understanding and care
than Lara. Lara would have remained the competent one, able to look after herself and
others, even while dealing with a chronic illness.
Second order change would have resulted in new ways of relating based on increased
security. Their strengthened bonds would have decreased anxiety around parenting and
supported more flexible boundaries outside the nuclear family. They would have been more
able to share responses to MS, but understanding themselves in relation to the larger society
most likely would not have changed. They would have still seen themselves as “survivors”
creating a better life for their children. They would not have questioned societal messages
about mothers. They would have not had a lens through which to see their experiences as
part of societal patterns larger than their family. They would not have experienced trans-
formation through being aware of the effects of injustice in their lives. They would not have
seen how abuse, abandonment, lower socioeconomic status, disability, and “alternative”
sexualities all intersected with limited credibility still accorded women, or how this limited
their ability to know themselves and each other and to recognize their own worth (Fricker,
2007; Medina, 2013).
Third order change for Jolene, Lara, and their children began with the willingness of a
straight, single, African American intern therapist, to step away from her own knowing to as
much as possible take in the sociocultural nature of Jolene and Lara’s emotional experiences.
As she took time to try to truly understand and to link her clients’ experience with their
social locations and societal power, Lara and Jolene began to see themselves and the world
around them through new eyes. They felt validated as never before. Norma’s carefully
choreographed enactments helped them transform an unequal power dynamic that had not
only maintained previous attachment responses but also reproduced underlying societal
messages of unworthiness. Their relatively quick transformation reflected the empowerment
they felt as they began to see their experience similar to others in their positions (Fricker,
2007; Medina, 2013). Jolene’s leadership in a mothers’ support group also enacted third order
change as she and Lara began to see alternative possibilities and choices in their roles as
women, mothers, and community members.

Reflexive Questions
• How can you, as an attachment based family therapist, expand the notion that
attachment is not only a dyadic process, but one that often includes other family
members, social networks, and norms?
• When considering your multiple positions of power within and across certain contexts,
how do they influence who you attune to for emotional connection?
• How can you balance power in ways that support emotional safety for everyone?
160 Socioculturally Attuned Attachment Based Family Therapies
• What are the ways in which you can identify, name, and amplify clients’ relational needs
so that family members and friends can be more in support of them?
• How do you know when your clients are experiencing relational safety, connection, and
reciprocal support? What are the signs?
• How can you as an attachment focused family therapist heighten and expand the
moment and work toward envisioning and consolidating equitable relational patterns?

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8 Socioculturally Attuned Bowenian
Family Therapy

In the 1950’s Murray Bowen made the groundbreaking proposition that symptoms such as
depression, alcoholism, or physical illness need to be understood as a dynamic process in-
volving the family as a unit, rather than the individual. He described human behavior as part
of interlocking emotional systems through which people receive information from the en-
vironment, adapt, and respond (Bowen, 1978; Kerr & Bowen, 1988). Beginning in response
to Freudian theory, Bowen argued that the principles governing emotional connectedness are
“written in nature” and common to all natural systems (Kerr & Bowen, 1988, p. 26). Two
natural life forces are involved: those that promote self-interest and those that promote the
group. These innately affect functioning across all systemic levels from the cellular to the
societal. Over the years, applications of Bowen’s ideas have evolved to incorporate new
findings from neuroscience and integrate more experiential approaches; however, his sys-
temic conceptualization continues to inform the importance of family of origin work
(Hargrave & Houltberg, 2020).

⤝⤞

Third order change is facilitated from a Bowen perspective when clients

see themselves and their concerns not only as part of multigenerational family
systems but also as part of ongoing sociocultural systems.

⤝⤞

In this chapter, we first explore five key aspects of family therapy based on Bowen theory and
then consider how to integrate principles of socioculturally attuned therapy with guidelines
for practice and a case example.

Primary, Enduring Family Therapy Concepts

Emotion is the energy that drives relationships (Bowen, 1978). Like an “emotional magnet,”
family members automatically respond to and influence each other (Titelman, 2014, p. 22).
Differentiation of self is the core developmental process and is at the heart of Bowen therapy.
It is described as the ability to “maintain emotional objectivity while in the midst of an
emotional system … yet at the same time actively relate to key people in the system”
(Bowen, 1978, p. 485). We view the following components of Bowen family therapy as
central to increased differentiation and relationship functioning: differentiation of self,
transgenerational patterns and transmission, the flow of anxiety, maintaining emotional en-
gagement, and therapist’s family of origin work.

DOI: 10.4324/9781003216520-8
164 Socioculturally Attuned Bowenian Family Therapy
Differentiation of Self
A child is born. Her parents named her Arielle. Arielle is born into a web of emotional
connections that predate her and extend across generations. According to Bowen theory,
from the moment of birth—or even prior to birth—Arielle will experience an automatic pull
toward this togetherness (Bowen, 1978; Titelman, 2014). She will also experience a natural
pull toward individuality. Differentiation of self is how the tension between these two
forces is managed. Arielle’s development of self will move along a continuum from low to
(potentially) high differentiation. On the low end is emotional fusion in which individual
responses are highly reactive to others. On the high end, is a solid self that enables reflective
and differentiated response. Arielle’s capacity to move from emotional fusion inherent at
birth to differentiation depends on the level of emotional fusion in her family of origin. It is
an individual and family level process.
Arielle’s African American family values tightly knit family bonds. In a nearby neighbor-
hood, Eric is born. His European American family prefers more personal space and emphasizes
individual achievement. According to Bowen theory, their process of differentiation is the
same. It begins with functioning based on automatic responses similar to emotional reactions
among other life forms. For example, Carmen’s horse demonstrated emotional reactivity when
he would sense danger, tense up, and step around the shadow of a mailbox every time he passed
one. He did not have the capacity to reflect on the current meaning of a shadow. He reacted
not only on his experience but from instinctual “horse” experience across generations. At this
level of differentiation, there is no ability to observe oneself separate from the group or context.
Differentiation increases when intellectual functioning or awareness enables one to distinguish a
sense of self and respond in a less reactive or automatic way.

Transgenerational Patterns and Transmission

Arielle and Eric’s basic levels of differentiation depend primarily on how their families
handle the intrinsic melding of family members’ emotional states, e.g., their degree of
fusion. It is important not to confuse emotional fusion with preferences for physical
closeness and deep caring about one another. Arielle’s African American family enacts
family centered values within a relatively well-differentiated family system. People in her
family like each other’s company and participate in many shared activities. They enjoy
spirited disagreement and have lively family conversations on many topics. When faced
with a crisis, such as the great-grandmother’s recent diagnosis of Alzheimer’s disease, the
extended family discussed many options for how to share her care. Individual family
members felt respected and freely reflected on what they could and could not do to help.
Even though the emotional demands on the family are high, they are able to lovingly and
non-reactively respond to Arielle’s needs as a newborn while also helping care for their
great-grandmother. Growing up in this well-differentiated family environment promotes
Arielle’s individual differentiation.
In contrast, Eric is growing up in a much less differentiated emotional context. Family
members have never been able to tolerate differences among them. People attend family
gatherings as expected and are careful not to upset each other. Eric’s aunt refuses to parti-
cipate. When Eric was born, she brought a gift at a time when no other family members
would be present. The conflict between this aunt and the rest of the family causes Eric’s
mother, Jamie, considerable distress, and she expends significant energy trying to keep the
peace. She is similarly cautious about upsetting her husband (Eric’s father) and often feels
lonely and unappreciated. Though Eric’s parents and extended family genuinely love him,
the low level of differentiation in this family system is accompanied by intense
 Socioculturally Attuned Bowenian Family Therapy 165
intergenerational anxiety. The high level of emotional reactivity will make it difficult for Eric
to differentiate within this system.
By the time Arielle and Eric are born, the emotional functioning of their family systems
has been evolving for many generations. Arielle’s family has historically been able to respond
to important nodal and socio-contextual issues––including the civil rights movement,
job loss, and the death of Arielle’s grandfather in the Vietnam War––with considerable
self-awareness on the part of individual family members and the ability to support each
other without sacrificing autonomy. Arielle is therefore likely to develop a well-regulated
emotional system and approach adult relationships from a non-reactive, intellectually re-
flective position. This will help her sustain a network of supportive relationships (Kerr &
Bowen, 1988).
Eric will probably experience more difficulty forming healthy and satisfying adult re-
lationships. His historical legacy includes multiple generations in which family members re-
sponded to immigration to the US with high anxiety about economic success and fitting into
societal expectations of the dominant culture by which they judged themselves. No deviations
from rigid roles and expectations were allowed. When Eric’s grandparents lost a child to cancer,
they were never able to speak of it. Since she was a child, Eric’s mother, Jamie, responded to
familial distress by trying to make her parents happy. This pattern is repeated in her relationship
with her husband, Robert, who is frequently angry and not attentive to her. This fused
emotional context will inhibit Eric’s movements toward differentiation of self.

Flow of Anxiety
According to Bowen theory, anxiety in response to interpersonal differences or life’s chal-
lenges is a natural response to low levels of differentiation. An important part of the as-
sessment in Bowen therapy is to track the flow of anxiety within the shared emotional
system. Not everyone is equally affected. Some constantly seek relationships and try to please;
others deny their need for relationships and keep their distance. Substance use, eating
disorders, physical symptoms, and traits such as obsessiveness, grandiosity, perfectionism,
aggressiveness, paranoia, hopelessness, etc. can all be ways anxiety is bound in a system, as are
polarizing beliefs (Kerr & Bowen, 1988). “In general, the more anxious people become,
the less constructive their responses to others tend to be” (p. 124).
When tension is high between two persons, they may deflect their anxiety by directing
attention to another person or activity. This is called triangulation. Triangulation happens
quite naturally and may not be intentional. For example, rather than upset Robert, Jamie
directs her attention to her newborn son Eric. This calms her. The connection she ex-
periences with her son makes it possible for her to avoid addressing her unhappiness in the
marriage. Eric absorbs the tension. If this pattern continues, Eric is likely to become a
symptom-bearer. This is an example of what Bowen theory terms the family projection process,
that is, the anxiety of one generation is passed to another through a series of interlocking
emotional triangles.

Maintaining Emotional Engagement

The ability to maintain genuine relationships in the face of stress or turmoil is the outcome
of differentiation. The Bowen clinical approach emphasizes learning to make “inner-
directed” decisions from within the self, rather than “coercion or persuasion from others”
(Kerr & Bowen, 1988, p. 105). The goal is to respond less on the basis of emotional
reactivity and more from a solid self that can tolerate intense feelings and think out re-
sponses to others. Turning to her infant son when there is stress between Jamie and her
166 Socioculturally Attuned Bowenian Family Therapy
husband may be a sign of emotional fusion. Others may respond to emotional fusion by
neglecting or abusing others or by cutting off from them to maintain emotional distance
(Papero, 2014). For example, Robert reactively responds with anger when his wife dis-
agrees with him. When his son Eric cries for long periods, Robert has little ability to
tolerate the intensity. He disengages and puts his focus elsewhere. He might react to
emotion in the system by physically or emotionally abusing Eric or his wife, having a
sexual affair outside the marriage, or directing all his energy and attention to work or some
other activity rather than engaging with his wife and child. Low differentiation perpetuates
this pattern, making it increasingly hard for him to engage.
People can increase basic differentiation by developing awareness of the emotional patterns
in their lives, the social and family contexts that invite these responses, and how their own
emotional reactivity contributes to sustaining the patterns. This enables more choice about
how one responds, reduces the anxiety in the family system, and has an impact on the
emotional transmission process for future generations (Bowen, 1978). It is important to
remember, that in Bowen theory differentiation and connectedness work together. In Text
Box 8.1 Monica McGoldrick extends the idea to include the larger community and world.

Text Box 8.1 Monica McGoldrick, MSW, PhD

Monica McGoldrick is co-founder and director of the Multicultural Family Institute in

Highland Park, NJ., and adjunct faculty at Robert Wood Johnson Medical School.
She is among those who continue to evolve the practice of Bowen theory and is a
well-known author and editor of books related to gender, culture, diversity,
lifecycle, and family therapy. Her words below are from The Genogram Casebook
( McGoldrick, 2016).
In order to make the best choices, we human beings need to appreciate that we
are all connected to each other and to the earth, to the past and to the future of
each other and of our planet. So making the best choices means aiming toward
positive connectedness with family, friends, community, coworkers, and nature
that surround us … Before people can make the best possible choices for their
lives, they must first be centered and able to think clearly where they are and what
their connections mean to them … Assisting clients to view themselves in the
context of their genograms is aimed at helping them figure out how to live in
respectful relationship with others and with nature, to care for and be cared for by
others as appropriate, and without exploitation or disregard for our world or for
future generations. ( McGoldrick, 2016, pp. 2–3)
All systems are interconnected. Thus when a client begins to see his or her own
behavior as related to that of others, [they have] a choice how to participate in
each relationship moving forward. This helps people take back their power to
relate to others according to their own values for relating rather than letting
themselves be defined by other family members or cultural rules they do not
accept … Helping clients work on their genograms means helping them get past
focusing only on the behavior of others, and learning to focus on their own part in
the system, so they can make decisions to take responsibility for how they conduct
their lives, no matter what others do. Recognizing their connections to others can
often give them the courage to do what is required to resolve their issues.
(McGoldrick, p. 5–6)
 Socioculturally Attuned Bowenian Family Therapy 167
Therapist’s Family of Origin Work
Bowen theory suggests that therapists must work from a differentiated sense of self. This
enables them to avoid emotional fusion with clients’ anxiety. It requires developing a clear
sense of self, knowing our place in the world and what matters to us (McGoldrick, 2016).
Like a coach, Bowen therapists are then able to stay outside of the system, asking the kinds of
questions and making observations that help clients in their own process of self-discovery.
The therapist is a “witness on the sidelines … inspiring clients to undertake their own work”
(McGoldrick, 2016, p. 111). Containing anxiety requires a calm presence that can make
it safe for people to engage in the therapeutic process.

Integrating Principles of Sociocultural Attunement

Human systems are both natural (e.g., biological) and sociocultural. Bowen focused on
human behavior as part of natural systems in common with all life forms and biological
evolution. He did not draw on knowledge from social sciences, such as how key processes
like differentiation intersect with sociocultural context or societal power dynamics (Innes,
1996). Yet because Bowen theory emphasizes the reciprocal flow of anxiety between in-
dividuals, families, institutions, and society at large, attention to the impact of sociocultural,
political, and economic systems can enhance the model and increase the potential to
transcend destructive patterns invited by societal inequities.
In this section, we examine differentiation in societal context, why power processes are
important, and how awareness of one’s sociopolitical, cultural, and historical contexts can be
the foundation for empowerment and third order change. We also show how recent findings
from neuroscience support this expanded application of Bowen theory (Damasio, 1999;
Porges, 2009; van der Kolk, 2014).

Differentiation in Societal Context

⤝⤞

Therapists must be cautious regarding judging differentiation. What looks like

low differentiation may sometimes more appropriately be understood as the
effects of discrimination and/or limited power.

⤝⤞

Anxiety in the Macrosystem

Bowen postulated similar emotional processes at the societal level as in organizations and fa-
milies. When anxiety is high, groups within the system are isolated from each other (Bowen,
1978). People tend to take sides on issues without hearing each other (Friedman, 2007). In
times like today when people are socially polarized, we are “constantly bombarded” by other
people’s reactivity (Friedman, 2007, p. 62). Bowen noted that people or groups respond to the
anxiety by scapegoating persons in subordinate positions; e.g., people of color, immigrants,
low-income people, sexual or gender minorities, and those with mental illness, for example.
Unfortunately, the theory also sometimes seemed to itself reflect a scapegoating of disen-
franchised populations, suggesting that their acts of resistance (i.e., protests or divorce) are a sign
of emotional immaturity and that “over-lenient” public officials keep low-income people
“one-down” (Bowen, 1978, p. 445). An approach more informed by critical theories
(McDowell, 2015) would focus on resilience and motivation to claim a self, embedded in
168 Socioculturally Attuned Bowenian Family Therapy
“acting out” behavior (McGoldrick, 2016; Unger, 2015). This approach would challenge those
with more power to be open to hearing from those with less power, making it safe for them to
speak, even when what they have to say makes us uncomfortable.

⤝⤞

Societal projection processes such as discrimination, scapegoating, and en-

trenched power hierarchies are likely to disproportionately affect targeted or
marginalized groups.

⤝⤞

Living on a day-to-day basis at lower levels of the societal power hierarchy increases stress
hormones and poorer health outcomes, even when controlling for access to health care (Lantz
et al., 2005). Societal stressors become embodied in neuroendocrine and immune systems
(Sternberg, 2001). For example, people raised with fewer economic resources are more likely
to get sick when exposed to a cold virus than people raised with more affluence, even when
economic circumstances have improved later in life (Cohen et al., 2010). From a Bowen
perspective, these are examples of the inequitable effects of societal anxiety, in which the well-
being of one group comes at the expense of another. While living with the effects of dis-
crimination and inequities can affect the differentiation process, persons in more privileged
positions are not necessarily more differentiated. Their apparent health may be a facade held in
place by their dependence on others to automatically meet their needs or accommodate to their
positions of power (McGoldrick, 2016). It is important to consider all the intersecting factors.
For example, Julia, a lab technologist who had been working at the same hospital for over 20
years, sought therapy because she was so depressed, she could barely get out of bed. Going to
work produced considerable anxiety. She felt ashamed that she could not cope better and took
people’s teasing personally. The intense, emotional way she spoke, the questioning of her own
competence, and judgmental statements she made about others all lined up to easily think of her
as “poorly differentiated.” But as the therapist expanded the lens to ask about the changes
happening in the hospital as a result of the pandemic, and in medical services more broadly, a
series of interlocking triangles became evident. Anxiety in the larger health care system moved
to multiple levels of managers in this hospital, which increased the pressure on her team to
perform an extraordinary amount of work, with no mistakes, in a very short amount of time.
This chain of events led to others scapegoating Julia for being different in age and ethnicity.
Julia was probably no less differentiated than the others in her workplace. She was targeted
because anxiety in the larger system made it difficult for the workgroup to tolerate differences.
The difference was that she was the only one showing symptoms and was the one most affected.
As Julia reflected on the anxiety in the system and how various people responded to it, she was
able to consider her options and develop a strategy for how to deal with it. Since her managers
seemed unable to respond in ways that changed the work environment, the burden fell on Julia
to change her own response, including the ramifications of possibly deciding not to work in this
setting. Naming the inherent unfairness in the situation was important.

Intersection of Differentiation and Culture

As we saw in the cases of Arielle and Eric, cultural patterns intersect with emotional differ-
entiation processes. Eric’s less well-differentiated family enacted ideals of autonomy and
achievement in ways that limit positive connection and adaptation. Arielle’s better-differentiated
family enacted the cultural ideal of sticking together to face adversity (Cowdery et al., 2009).
 Socioculturally Attuned Bowenian Family Therapy 169
⤝⤞

When differentiation is high, people are able to apply cultural values in

relatively functional ways. When differentiation is low or in times of distress,
cultural values can become exaggerated.

⤝⤞

Takeshi Tamura (2016), a family therapist in Japan, calls this exaggeration “cultural over-
dose.” For example, Japanese culture tells adolescents that they should achieve for the sake of
family honor. According to Tamura, when anxiety is high, Japanese youth are likely to isolate
themselves and avoid social situations, increasing the risk for suicide, depression, and self-
harm. In the US, cultural pulls toward independence are often reflected in acting out and
externalizing behaviors.
In a video presentation to the International Family Therapy Association, Tamura (2016)
cited the example of a family in Korea. When the video opens, two adolescent daughters
are arguing about using the computer. The mother—with some tension in her voice––tells
the older daughter that she needs to shut down the computer and go to bed in a few
minutes, reminding her that she has school tomorrow. When the daughter does not do this
and the two girls begin to scream at each other, the mother also begins to scream and
threaten the older daughter. Tamura explained that the anxiety in this household reflects
societal performance expectations that make going to school highly anxious for the
daughter. The resulting family conflict is triangulated with societal projection processes in
a way that holds the mother responsible for the daughter’s performance.

Societal Transmission of Collective Trauma

Just as past family emotional processes are passed on from generation to generation and
affect current relationship functioning even when people are not aware of these histories,
collective historical traumas continue to perpetuate heightened anxiety and reactivity.
Watson (2013) described collective nervousness that many African American people ex-
perience regarding how they appear to others. For example, she told of her experience as a
Black woman in a restaurant with a White friend. When Black people at a nearby table
were loud and noisy and rude to the waiter, she felt ashamed and embarrassed. It is unlikely
that her White friend would have felt similarly shamed had the rude diners been White.
Watson attributed this emotional response to the history of slavery where “if one slave got
out of line, all slaves might feel the lash, or worse.” She adds that internalized Black
inferiority leaves people “on the edge … obsessed with how we and other blacks look,
talk, and act because we were enslaved and then discriminated against for having black
skin” (p. 50). The feeling of shame says more about the societal power context of the
situation than Dr. Watson’s level of differentiation.

⤝⤞

It is important to recognize, acknowledge, and name realities of collective

trauma and unsafe contexts. The problem may be a history of collective trauma
lived out and repeated in individual lives.

⤝⤞
170 Socioculturally Attuned Bowenian Family Therapy
When a Black mother was referred to therapy because she demonstrated angry and dis-
ruptive behavior at her daughter’s school, she was quickly described by supervision group
members as “paranoid.” Under that label, no one asked about her experience with schools,
especially schools like this one where the teachers, principal, and most of the students were
White. They did not seek to understand her expectation and fear that her daughter would
be treated unfairly. They could only see that her reaction to the school appeared “out
of proportion” to the issue at hand and did not recognize the historical context of systemic
racism.

Value of Belonging
In Bowen theory, the self can never be defined separately from significant relationships and
contexts (Nel, 2011). The goal is to define a “self” while staying in relationship (Walsh &
Scheinkman, 1988). However, dominant Western discourses tend to value individuality and
autonomy over more connected ways of relating. This bias can be seen in how Bowen
theory is often presented and applied (Knudson-Martin, 1994, 1996).

⤝⤞

Socioculturally attuned therapists resist the temptation to view individual

autonomy as more important than relationships.

⤝⤞

For example, therapists may be more likely to support a decision for a wife to move to
advance her husband’s career (an individualistic goal) than for a wife to not move to stay close
to her sisters––a relational goal (McGoldrick, 2016). Socioculturally attuned Bowen thera-
pists will counteract this tendency to prioritize individual goals over relational ones. They
will emphasize that people need community to sustain their well-being and to have the
strength to resist oppressive forces of society. In fact, sources of healing are embedded in
clients’ cultural communities. A clear cultural or racial connection has been associated with
high levels of differentiation (Skowron, 2004).
As another example of the importance of relational connection to the process of differ-
entiation, consider Marie, a 35-year-old European American woman who strongly identified
with her conservative Christian denomination. Marie felt depressed and powerless in her
marriage and told the therapist she wanted a more equal marriage, but also believed in the
principles of her religion, including that the husband was the leader of the family. The feeling
that she needed to choose between equality or her religion distressed and isolated her. With
the therapist’s encouragement, Marie sought a woman in the church she thought would
understand. Marie returned to therapy the next week saying, “all the women in the church
feel the same way I do!” (Silverstein et al., 2006, p. 401). As Marie explored her Christian
identity, she was also better able to connect to her religion in a personal way and more
genuinely engage in her church community. Marie did not need to differentiate from her
faith; she needed to differentiate within it.

Value of Intuition and Feeling

Bowen theory has been criticized for valuing objectivity over intuition, subjectivity, and
emotional expression (Knudson-Martin, 1994, 1996; Luepnitz, 1988). Bowen emphasized
using the intellectual system to mediate responses to the emotional system and advocated
 Socioculturally Attuned Bowenian Family Therapy 171
clinical strategies that stressed cognitive awareness and distinguished thinking from feeling.
Such approaches fail to acknowledge or value self-knowledge that comes through feeling and
affective awareness and discount the experience of many women and cultures. Nouvelle, an
African American nurse in her mid-thirties described her subjective, “gut knowing:”

I think that growing up as a person of color in this society, you develop something
more instinctual and survival-like. It’s a different kind of smart and a different kind of
sense … It’s much more visceral, it’s much more down here [points to stomach].
(Goldberger, 1996, p. 352)

When people experience a disconnect between what their bodies or experience tell them and
what is expected or known in the dominant culture, they are likely to discount or silence their
own knowing (Jack & Ali, 2010). Rather than a solid, unitary self (as Bowen described), people
in subjugated positions may develop a shifting consciousness in which they simultaneously
perceive multiple realities (Hurtado, 1996). The ability to apprehend multiple consciousnesses
enables them to make sense of the complexities in their lives and negotiate multiple and stig-
matized social identities as they move from context to context. For example, Hurtado spoke of
the need for women of color to navigate danger and anger to successfully manage marginality:

There develops an intuitive sense of danger that is primarily kept at bay through anger.
Putting a “bit” on anger is of primary importance for survival … The challenge is to
“know what you know” and be able to circumvent the consequences of that knowledge
while being true to yourself. (p. 378)

⤝⤞

A socioculturally attuned application of Bowen theory appreciates and draws

from many forms of knowing.

⤝⤞

Differentiation and Societal Power Processes

The ways of relating associated with high differentiation such as direct communication, “I”
statements, and the ability to respect differences and deal with conflict presume relatively equal
power positions. But power imbalances are built into social structures and norms (Mahoney &
Knudson-Martin, 2009; Komter, 1989), and have an impact on differentiation processes.

Power Structures, Fear, and Anxiety

Societal inequities based on race, class, gender, sexuality, or other differences require
emotional fusion, whereby the dominant group’s interests are supported at the expense of
subordinate groups (McGoldrick, 2016). Norms of the dominant culture will be privileged.

⤝⤞

Members of more powerful groups are largely unaware that members of less
powerful groups accommodate them.

⤝⤞
172 Socioculturally Attuned Bowenian Family Therapy
Survival for the women of color quoted above required them to be attentive to the po-
tential emotional responses of the powerful. They needed to manage their emotions in re-
lation to the power situation (e.g., put a “bit” on their anger). Without taking power into
consideration this could seem “overly” focused on others (less differentiated). Instead, this
attention to context is important to their well-being.

⤝⤞

Until those in powerful positions develop an awareness of their dependence on

being accommodated by others, they remain emotionally fused with societal
power processes.

⤝⤞

Inequities inspire anxieties. A well-differentiated system would recognize and address fairness
issues openly and directly. In contrast, autocratic/totalitarian leadership styles seek to contain
the anxiety (Friedman, 2007). Those in positions of power maintain power through inciting
fear among the less powerful. This may be unintentional through unquestioned expectations,
such as when a boss expects an employee to be available for shifts any time of the day. They
may also intentionally incite fear through threats, intimidation, or force. The boss may
threaten employees with losing their jobs if they don’t comply.
In less differentiated systems, responsibility for managing the anxiety often falls on the less
powerful. For example, Bryan Stevenson (2014), a Black civil rights attorney, described the
anxiety he experienced early in his career when he was sitting in his car listening to music on
the radio after parking near his apartment. He looked up and saw a White policeman
pointing a gun at him,

My first instinct was to run. I quickly decided that wouldn’t be smart … “Move and I’ll
blow your head off!” The officer shouted the words, but I couldn’t make any sense of
what he meant. I tried to stay calm … I put my hand up and noticed that he seemed
nervous … I don’t remember deciding to speak, I just remember the words coming out:
“It’s all right. It’s okay … I live here.” I hated how afraid I sounded and the way my
voice was shaking. (p. 40)

Stevenson’s relatively high level of contextual awareness helped him defuse the situation, but
the unacknowledged injustice and assault to his dignity continued to impact him. When he
got into his apartment, Stevenson kept saying over and over again, “They never even
apologized” (p. 42). Stevenson attributed his ability to think through the situation—a dif-
ferentiated response—to his years of study and legal training (which his instincts told him not
to disclose), but the fear and humiliation he experienced were related to his subordinate
position and vulnerability because of what the color of his skin represents on a societal level.

Situated Emotion and Power

Emotion occurs at the intersection of sociopolitical life and daily interactions. It is situated in
complex material and relational field never separate from a person’s power position in the
setting (Wetherell, 2012). The feeling of humiliation experienced by Stevenson is an ex-
ample of his body reading and recording the meaning of the racial hierarchy surrounding the
event. Had the same event happened to a White attorney (which in itself seems unlikely), the
 Socioculturally Attuned Bowenian Family Therapy 173
emotional experience of the participants would have been different, with the attorney likely
experiencing indignation rather than humiliation.

⤝⤞

Socioculturally attuned therapists must listen for, and seek to understand, the
societal contexts in which family histories are embedded in order to identify
and name issues of fairness and injustice.

⤝⤞

Relational Justice and Differentiation

Inequitable power processes at the societal level create power imbalances within couples and
families. Relationships with a high level of differentiation are characterized by equality
(Gilbert, 2006). One person does not function at the expense of another. Each is open to
hearing and understanding the other. There is direct, mutual conversation in which partners
freely communicate their own thinking, and each is actively engaged in listening. Power
imbalances inhibit this kind of direct, mutually engaged communication and tend to be
connected to societal-based power differences such as gender, race, and socioeconomic status
(Knudson-Martin, 2013; Mahoney & Knudson-Martin, 2009). On the other hand, relational
equity facilitates increased differentiation.
It is important to consider how power dynamics in a family or relationship affect differ-
entiation. Power imbalances create an unsafe environment in which those in less powerful
positions (often women and children) must constantly be vigilant and on guard. The lines
between emotional fusion and survival become blurred; it is difficult to move toward dif-
ferentiation when one’s social and/or relational contexts are not safe. Importantly, as dis-
cussed above, at first glance, those in powerful positions may appear more differentiated,
especially if their reactive responses appear rational rather than emotional, but they are not.
Whether they are overtly dominating and abusive or maintain power through more subtle
dominance and intimidation, enacting power by disinterest in and lack of empathy for the
experiences and perspectives of others is a sign of low differentiation. To promote differ-
entiation, socioculturally attuned therapists must attend to the relational power context, and
not confuse power with differentiation.

Empowerment and Third Order Change

In a socioculturally attuned approach to Bowen theory, increasing one’s level of differ-
entiation provides a foundation for empowerment and third order change. This approach
takes very seriously Bowen’s proposition that we cannot understand emotion out of context.
Doing so requires intentionally weaving the connections between interpersonal neuro-
biology, relational dynamics, and societal power processes (Fishbane & Wells, 2015; see also
chapter 14, SERT).

The Sociocultural Brain

Bowen emphasized distinguishing thought and feeling as part of the differentiation process.
More recent work shows that these two cannot really be separated. No parts of the brain are
specifically cognitive or specifically emotional (Damasio, 1999). There is no such thing as a
“non-affective thought” (Duncan & Barrett, 2007). This new information actually reinforces
174 Socioculturally Attuned Bowenian Family Therapy
Bowen’s ideas that the individual does not biologically exist and that social processes become
embodied as we interact (Burkitt, 2014; Gilbert et al., 2012). Without awareness of our
context, we are thus likely to remain emotionally fused with social forces, which are largely
invisible to us and limit personal choice.

⤝⤞

Larger societal processes are part of the nearly instantaneous neurological

sequence in which the contextual and situational nature of relationships register
in the body and are felt.

⤝⤞

In an effort to apply Bowen theory to women and less individualistic cultures, Knudson-
Martin (1994, 1996) advocated for the use of visceral feeling-based knowledge and
movements toward healthy togetherness. From this perspective, rather than primarily using
the “higher” brain to overcome the more primitive brain, differentiation would also in-
clude developing awareness of one’s sensory experience and activating social connection.
For example, Julia, the lab technologist described above, was very agitated as she described
what was happening at work. The therapist recognized that the part of her vagus nerve that
impeded social engagement in response to stress/fear was activated (Porges, 2009). Before
trying to expand systemic understanding of the situation or strategize a response to her
hostile work environment, she stayed engaged with Julia, gently reflecting resonance with
her contextually inspired emotion, “It so unfair. You know you’re competent, but you
feel so humiliated … You just want to do your job.” This empathic engagement calmed
Julia’s anxiety and enabled her to move into a more reflective position. The therapist then
invited Julia to take some deep breaths and feel the anxiety in her body. Julia found that
allowing herself to recognize and feel these physical sensations was important to her
empowerment process.

Critical Awareness
As suggested by Paolo Freire (1971/2000), consciousness and critical self reflection are the
first steps toward liberation and playing an active role in the direction of one’s life. Awareness
of the system and one’s role in it makes this possible. Though neglected by Freire, awareness
of one’s emotions and being able to intentionally respond to them is important to developing
critical consciousness (Garcia et al., 2015).

⤝⤞

A socioculturally attuned understanding of Bowen theory encourages critically

examining how personal biographies are interwoven with societal relationships
in the experience of feeling.

⤝⤞

Reflective consciousness always involves attuning to and engaging bodily sensations;

without them, words and the images associated with feelings and emotion are empty and
meaningless (Burkitt, 2014).
 Socioculturally Attuned Bowenian Family Therapy 175
Differentiation from Dominant Cultural Values
Therapists need to be well differentiated and able to invite reflections that go beyond societal
emphasis on autonomy, competition, materialization, goal-directedness, and objectivity.
Because the language used in Bowen theory can obscure values more commonly associated
with women and less individualistic cultures, clinicians need to be aware of the social context
of their own values and experiences (Stone & ChenFeng, 2020).

⤝⤞

Socioculturally attuned therapists consider what values they want to represent

in their work, asking questions that help expose taken-for-granted societal
expectations. They do this while standing aside to enable clients to reflect on
the values they prefer and make informed choices from positions of self and
contextual awareness.

⤝⤞

This is an active, not a passive role. Therapists take a clinical stance that greater equity leads to
differentiation and, as Monica McGoldrick (2016), one of the first family therapists to apply
Bowen theory from a socioculturally attuned perspective described, “come back again and
again … to help clients expand their perspectives on their values” (p. 63).

Practice Guidelines
The goal of socioculturally attuned Bowenian therapy is to increase individual empowerment
so that clients are able to make choices about how to respond to the circumstances of their
lives and create equity-based relationships in which differentiation is possible. The following
guidelines promote critical awareness of the systems within which one is embedded and
differentiation that enables equity, flexibility, and options. They are not discrete steps, and
therapy is likely to move back and forth between them.

1 Expand Presenting Problem to Larger Contexts

When people initially seek therapy, they are likely to be in an emotionally reactive state. The
therapist’s questions, comments, and observations help to deescalate the anxiety. The
therapist builds trust and demonstrates respect through careful attunement that demonstrates
thoughtful interest in the sociocultural and relationship contexts surrounding their concerns.
In doing so, the presenting issues begin to feel more manageable. The therapist expands the
conversation to include clients’ social identities and locations, paying special attention to how
these inform emotions and meaning. In Text Box 8.2 Monica McGoldrick points to
the importance of addressing sociocultural issues from the outset, even though it may feel
uncomfortable.
It is important to recognize and name the power processes in the immediate situation and
validate emotional experiences related to injustices. Therapists promote optimism and hope
by providing information about the process of change, emphasizing that through their work
together, clients will come to understand and gain perspective on their lives and the patterns
and contexts that influence them. This will enable them to expand options and determine
the direction they want to take.
176 Socioculturally Attuned Bowenian Family Therapy

Text Box 8.2 Monica McGoldrick, MSW, PhD

I ask clients about their cultural backgrounds right up front … I try to help clients
identify cultural patterns that were part of their family’s history––values about
education, money, work, religion, family rituals, communication and so forth …
Where there is disparity [between therapist and clients] in race, sexual orientation,
gender, socioeconomic class, or social location … we should assume there will be
a certain level of discomfort … The key is the therapist’s willingness to help clients
explore their cultural background and become comfortable with such conversa-
tion, since it is not generally part of social discourse … It is always relevant to take
account of your own experiences, genogram history, culture, life cycle stage, and
current stresses in thinking about what issues to watch out for in working with a
particular client. ( McGoldrick, 2016, p. 28–29)

2 Stabilize Immediate Situation

The process of thoughtfully discussing the client’s situation and beginning to expand the
context around it calms anxiety. Clients may also need to make decisions about the current
stressors. Anxiety around these issues can easily pressure a therapist to solve the problem for
clients and invite judgments that pathologize clients and undermine equity. Therapists
need to have developed a critical contextual consciousness to help them be aware
and respond justly (Stone & ChenFeng, 2020). Emotions stimulated by clients’ situations—
such as anger, sadness, helplessness, or shame—provide useful information, particularly
regarding the power contexts underlying the presenting issues. Being aware of one’s own
emotional response can help therapists mindfully determine the most appropriate and
helpful action (Garcia et al., 2015).

3 Assess Differentiation Through a Relational Lens

As discussed earlier, thinking and feeling are connected. The ability to be empathic and
connected to others is essential to well-being. In the process of self-discovery and dif-
ferentiation, clients need to draw on and develop all of these. Because Western society
privileges values such as individualism, rationality, and competition, therapists need to
actively value feeling, intuition, empathy, and connectedness. They should encourage
clients to be aware of their emotions, accept them, and use them to help clarify what is
important to them (Garcia et al., 2015). They should also help clients identify and connect
with people and communities that enhance their sense of belonging and support.
According to McGoldrick (2016),

Clinicians and policy makers who do not consider clients’ deep-seated need for
continuity and belonging … are likely to increase the trauma of the original experience
by ignoring the importance of their clients’ connectedness. (p. 12)

4 Develop and Support Critical Consciousness

Bowen therapists often use genograms to map the people, places, contexts, and communities
that are important in clients’ lives (see McGoldrick, 2016; McGoldrick et al., 2008 for
 Socioculturally Attuned Bowenian Family Therapy 177
detailed guides). Questions suggested by McGoldrick, et al. begin with the immediate
household and life cycle changes: Who lives there? What do they know about the problem?
How do they view it? Where do other family members live? What has been happening
recently? Questions expand to the current community, workplace, school settings, and to
wider intergenerational, cultural, and societal contexts: What ethnic, religious, racial, trade,
or professional groups do you feel part of? How was your family perceived in the com-
munity? What experiences have been most stressful for your family in the US? This work
may be done relatively quickly or expanded upon in depth over many sessions. As therapists
help clients track family patterns over time and space, they raise questions that call automatic
cultural assumptions into question and that help clients recognize and resist societal patterns
that reinforce inequity.
For example, in this exchange between Monica McGoldrick (2016, p. 63) and a male
client, she persisted in raising questions about his resistance to needing help:

MM: What do you think about what I am saying, that the strongest man is a collaborator,
not a do-it-yourself guy who never needs anything? Do you believe that?
Client: … I still believe it’s like my father was. You’re the man of the house and take care of
the family. That’s it.
MM: And how did that work for him?
Client: I don’t know. He did his best …
MM: … And you’ve always had the sense, maybe because of the “man thing,” your father
didn’t let himself connect as much as maybe you needed … But my thoughts are
that the rules for men have been very unfair and not worked well …

Socioculturally attuned therapists can also consider using cultural and critical genograms
to acknowledge aspects of clients’ histories that have been influenced by injustice and
marginalization as well as sources of resilience (Hardy & Laszloffy, 1995; Kosutic et al.,
2009). What sources of pride and shame are related to your culture of origin? What
beliefs and dreams did your ancestors have? How have you been wounded by wrongs
done to your people? How have you been complicit in wrongs done by your ancestors?
What values are important now? Questions like these evolve as clients tell their stories.
As the therapist listens through a sociocultural lens, new questions emerge, new stories
are told, and clients develop a contextual understanding of themselves and their life
choices. They may do research to learn more about the sociopolitical context of their
family history.

5 Help Client Observe Own Part in the System

In this phase of therapy, clients hone in on the most troubling or persistent patterns in their
lives. They become observers of themselves in the present, connect current behavior to
sociocultural patterns and family histories, and learn to recognize their own emotional
triggers. Clients need support to tolerate the pain they may feel as they confront their so-
ciocultural contexts and patterns that have been shaping their lives. Attention to emotions
such as fear, anger, or shame arising from contextual experiences may catalyze reflective
action (Garcia et al., 2015). Clients in power positions need to become aware of the con-
sequences of their actions on others (Samman & Knudson-Martin, 2015).
As clients reflect on themselves and realistically assess their contexts, they acknowledge
what they predictably do when anxiety gets high and begin to identify empowering
actions they can take. People in all power positions may also experience “felt resistance”
(Garcia et al., 2015, p. 5) as they consider changes that resist or disrupt established power
178 Socioculturally Attuned Bowenian Family Therapy
systems and the status quo. Being aware of anxiety and reflecting on it enables clients to
shift toward action and balance responsibility for self with responsibility toward others.
They can envision change and develop a plan for how they will respond differently to
familiar patterns.

6 Increase Equity and Flexibility in the System

Clients are now ready to do the work of making choices, trying new responses, and de-
veloping more authentic and genuinely connected ways of relating. Instead of automatically
reacting according to prior family patterns and societal stereotypes or on the basis of one’s
power position, clients use knowledge of their own experiences and situations to respond
more intentionally. Therapists intervene by serving as a coach and mirror, asking questions
about what happens and challenging clients to break through societal patterns that encourage
withdrawing, triangulating, or other forms of reactivity. Therapists serve as an advocate for
equity and flexibility, supporting all participants to expand beyond their comfort level to
resist taken-for-granted pulls back to the status quo. As clients move toward increasing
differentiation, they become more flexible, less bound by fusion with sociocultural stereo-
types and expectations. Transformation occurs as they are able to relate to each other from
more equitable positions and join together to effectively resist discriminatory and margin-
alizing larger systems.

7 Plan Meetings with Family and Community

Bowen therapy may be conducted with individuals, couples, or families or applied in

community settings such as workplaces and churches (e.g., Friedman, 2007; Gilbert, 2006).
Regardless of who is involved in the sessions, the differentiation process involves thought-
fully planning and preparing for meetings with family members and other significant re-
lationships and settings. Meetings may be part of researching information about one’s family,
history, and culture or steps to engaging with significant people and contexts in new ways.
Ultimately, the goal is to be able to connect with one’s own family history and sociocultural
contexts and to build and maintain these continuing relationships from a differentiated sense
of self.

Case Illustration
At the suggestion of their attorney, Cloé (aged 23) first visited Judy, a White 56-year-old
cishet female and a licensed marriage and family therapist, just several weeks after dis-
covering that their boss had installed cameras that enabled him to secretly view Cloé from
under their desk. They reported that apart from a visit to their attorney, this was the first
time they had left their apartment since the discovery. Judy’s intake form asked several
questions that helped her begin to orient to her clients’ sociocultural contexts. She
learned that Cloé identified as “gender queer” and preferred pronouns “they,” “them,”
and “theirs.” They had been married to James (age 23) for three years, held a BA in
English literature, cited Swedish cultural background, and said religion was not important
to them.
Since Judy had a daughter about Cloé’s age and positioned her clinical work to counteract
societal inequities, she was aware that the case raised feelings of both anger and protectiveness
for her. As a socioculturally attuned Bowen therapist, she drew on awareness of these feelings
to take a differentiated stance in relation to Cloé that was clear about the values that guided
her work while allowing Cloé the space to define themselves.
 Socioculturally Attuned Bowenian Family Therapy 179
Expand Presenting Problem to Larger Contexts
Judy began by asking Cloé about what had happened and the nature of the workplace and
their relationships with people who worked there. She learned that it was a small accounting
office consisting only of her employer, a White male in his 50s who appeared to be widely
liked in the community and had long-standing relationships with the clients he served, a
Black female office manager who had worked with him for over 20 years, and a young single
mother who assisted with the accounting on a part-time basis. In exploring the incident, Judy
assessed how the job fit into Cloé’s sociocultural identity.
Cloé had felt lucky to have a full-time job as an office assistant because it provided
benefits and seemed more personal and flexible than larger places. They said that working
for a large corporation would not fit with their values; that they and their partner James
wanted a lifestyle connected to nature and the local community. Learning that their
employer had violated them in this way was not only a betrayal by someone they trusted,
but put into question their own judgment. They had thought of this man and the women
they worked with almost as family. Their fear about leaving the apartment now was in
reaction to the loss of their identity as a confident person who could make their own way
in the world.
Judy named the violation Cloé had experienced; that it made sense that it would call into
question everything they believed about themselves. She shared her experience that when
people are violated in this way, they often feel shame even though they had done nothing to
deserve the assault. Cloé agreed that they were not at fault––that was why they had hired an
attorney. Yet they were paralyzed, not able to trust themselves, while he [perpetrator] went
about his business. Judy reiterated the unfairness and her genuine sadness and anger that this
had happened to Cloé, “You did nothing to deserve this. I am so sad that this happened to
you. I get angry when I hear stories like yours.” This differentiated expression of the
therapist’s own beliefs and response to the injustice helped to set the tone for the critical self
reflection and action that their work together would inspire.
Focusing on the meaning and context of the violation started to expand the presenting
issues within just a few minutes. Judy then further expanded the context by asking how their
husband James reacted to the assault and about their history together. Cloé described James as
“completely supportive,” “angry on their behalf,” and “a good listener.” Cloé and James had
married as young undergraduates at a small liberal arts college. James represented values
different from Cloé’s family of origin, who “were good, loving people who did not un-
derstand them.” Cloé and James had traveled and lived in several different places, looking for
communities that were “more open and accepting” than the small town in Minnesota where
Cloé had grown up. James fully supported Cloé’s queer identity, which they embraced more
fully in recent years. However, Cloé was still cautious about their gender identity and had
“passed” as cisgender at work.
Judy sketched a brief genogram in her notes and used it to raise additional questions
regarding relationships with family of origin and other significant community connections.

Judy: You said your parents are “good people.” What does that mean to you?
Cloé: My dad’s a deacon at church. My mom and dad would do anything for anyone. Dad’s
a teacher; mom’s a nurse. They care about people.
Judy: How was that for you growing up? Would they do anything for you, too?
Cloé: I always knew they loved me. I still talk with them every week. They’re just so
different from me. They can’t understand. They know I don’t go to church, but we
don’t talk about it.
Judy: Have you told them about what happened?
180 Socioculturally Attuned Bowenian Family Therapy
Cloé: Not really. I told them I quit my job. When I call I ask them about their lives. It
makes me feel better to talk with them, but I don’t want to upset them and they’d
want me to come home. Or mom would come out here.
Judy: So you still keep a connection with your parents, even though you feel you have to
keep this big piece of your life to yourself … Are there other people? Friends?
Community here?

As the initial conversation continued, Judy picked up on key sociocultural themes and in-
vited Cloé to expand on them. For example, Judy noted that Cloé described their parents as
religious and that their intake form said religion was not important to them. She asked Cloé
to say more about that. She also asked about their experience of living outside the gender
binary. By the end of the first session, Judy and Cloé had developed a picture of the trauma as
an assault to Cloé’s identity as a queer person and a demonstration of patriarchal societal
patterns that they worked hard to resist.

Stabilize Immediate Situation

Judy was concerned that Cloé had not left the house in almost three weeks and had mostly
been sleeping. She was aware of her impulse to make decisions for Cloé. Instead, she engaged
directly with them about the seriousness of the situation, inviting Cloé to think through how
best to address these concerns,

Judy: I’m wondering what you think about not leaving the house for almost three weeks?
Cloé: I just couldn’t. James is worried about me. He tries to get me to go places with him.
Judy: Are you worried?
Cloé: Not so much worried … I know this isn’t me. I just need some time.

Judy continued the conversation with questions that contrasted Cloé’s current isolation with
their pattern of taking on challenges. Together they used anger at the injustice as a motivator
for planning some steps to break out of the isolation:

Judy: From what you’ve been telling me, I get the sense that it’s not like you to hole up by
yourself. Is that right?
Cloé: I’ve always been so free, so bold. I think maybe I’ve been naive.
Judy: It seems to me more about the injustice––it’s not fair that you’re not able to be
you … How do you respond to that?
Cloé: It makes me mad! I want my life back. I don’t want to be a victim.
Judy: What do you think would be a first step that you could do to take your life back?

Cloé decided that it was too soon to go out on their own, but that they would arrange to go
on a hike with James on the weekend. Judy also suggested that James join them for the next
session.

Assess Differentiation Through a Relational Lens

Given the family of origin history and early marriage that Cloé described, some therapists might
have approached the couple with an assumption that the two were emotionally fused and
needed to individuate. Judy began the couple session with a conversation about how they
supported each other. She reinforced the value of James’s focus on Cloé, his ability to empathize
with them and to temporarily give up some of his needs to help them through this hard time:
 Socioculturally Attuned Bowenian Family Therapy 181
Cloé: [to James] I worry that I’m being unfair to you. You’re so willing to be there for me.
And it just seems like all I can do to focus on me right now.
James: You don’t need to worry about me. I just want you to get better.
Judy: Cloé, you said James is such a good listener, a real support to you. Has this been a
pattern throughout your relationship?
Cloé: I think we’ve always been there for each other, but maybe sometimes I’ve needed
James more than he’s needed me. I think I struggle more than he does.
Judy: James, are you aware of that capacity they say you have to listen and empathize with
them?
James: Well I care about them. And, yeah, [smiles] I think I might be better at empathy than
a lot of guys.
Judy: I know the give and take is a little out of balance right now. But it seems like your
ability to be there for each other when you need it is a real strength.

At this point in the therapy, Judy wanted to focus on the strengths in their relationship, to see
their connectedness as a foundation for healing and further differentiation. Judy also en-
couraged Cloé to be aware of their feelings. Rather than continuing to resist the feelings of
helplessness and unfairness, Cloé decided to journal about them and make drawings based on
them. They and James began to take daily walks together, while Cloé continued with
therapy sessions individually. The more comfortable Cloé was accepting James’s care, the
more able they were to engage in the work of self-discovery.

Develop and Support Critical Consciousness

Cloé had developed considerable critical consciousness related to oppressive societal norms
and structures in their college classes. Together with James, they had taken active steps to
avoid falling into taken-for-granted societal norms and create a life more consistent with their
values. These were moves toward increased awareness, differentiation, and choice. Yet, as
might be expected given their stage of life, these changes also involved some cut-off from
connection to Cloé’s sociocultural roots and family. In the next sessions, Judy guided Cloé in
continuing to explore how their response to the violation inflicted upon them related to key
themes and patterns in their family of origin, culture, religion, and sociopolitical context.
Through questions that challenged assumptions, expanded the focus outward, and invited
reflection and integration, Judy maintained a curious and supportive partnership with Cloé.
“Men are violent and unsafe,” was identified as a family and sociopolitical theme brought
to the surface by Cloé’s assault:

Judy: So now you think that all men are unsafe? How has that been for the women in your
family?
Cloé: My mother is always telling us to be careful. Not to trust men. To be careful where
you go. In her work as a nurse, she has seen so many women who were raped or
beaten.
Judy: How do you think this message that men are unsafe has affected your mother?
Cloé: My mother is very cautious. She doesn’t go to many places by herself. My sister is just
like her.

As the conversation continued, Cloé realized that they didn’t actually know much about
their mother’s experiences with men or the experience of women in previous generations.
Their father and spouse were described as “exceptions,” warm, loving, and nonviolent. Judy
expanded the topic of male dominance from the family to the larger society,
182 Socioculturally Attuned Bowenian Family Therapy
Judy: You said your father is very kind. How does power work between your mother and
father?
Cloé: No one really questions my father … They’re very traditional really.
Judy: But you question male dominance––a lot, it seems to me.
Cloé: Yeah. But it’s everywhere, everywhere I look. That’s why [explicative] like
[employer] gets away with it. Because they can!
Judy: Yeah. That’s how power works, isn’t it? But you’re not letting him get away with it.
You’re taking him to court. You’re holding him accountable. What else do you think
is important to counter the male dominance in our society?

Framing their assault as an example of a larger system of male dominance was an important
step in Cloé’s ability to develop a thoughtful response to it. Several other key themes evolved
as Judy continued to expand genogram work. For example, “doing good” by following a
religious code was a major moral theme across multiple generations. Independence and
stoicism were connected to survival and success for their immigrant great-grandparents from
Sweden and continued to be valued family traits. Holding back from full engagement was a
common “solution” to potentially disruptive disagreements.

Help Client Observe Own Part in the System

Cloé became better able to name the marginalization they experienced as a queer person
living in a world still organized around a gender binary, heteronormativity, and male
dominance. It began to make sense that they hid this identity much of the time, both because
of very real societal discrimination and because family patterns encouraged only partial en-
gagement of the self. Cloé also recognized that their sense that they should cope with the
trauma of the assault primarily on their own was also part of family and cultural patterns that
they had unconsciously continued. Through conversations with Judy, they began to track
how their response to injustice maintained isolation.

Judy: How has the journaling about your feelings been going? What have you noticed?
Cloé: I’ve noticed that I am very lonely. I want to share my feelings, but I can’t.
Judy: What do you think stops you?
Cloé: It just feels wrong.
Judy: Like you’re breaking a rule?
Cloé: Yes! It might seem silly, but it’s scary to think about telling someone what I’m
feeling––even James.
Judy: How do you think people would respond? I’m guessing maybe some people would
be more able to hear you than others?
Cloé: Yeah. Probably. I think I just don’t want to bother people. To upset them. To be a
burden.

Increase Equity and Flexibility in the System

Judy began to coach Cloé in initiating a plan of action with four goals, all related to living out
the family legacy of “doing good” in a differentiated way: (1) to become engaged in col-
lective action to combat male dominance, (2) to expand safe spaces for authentically ex-
pressing their voice and identity, (3) to develop their own spiritual practices, (4) to update
and deepen their bonds with James and their family. One week Cloé came in with an
announcement that they had told their parents about the assault:
 Socioculturally Attuned Bowenian Family Therapy 183
Cloé: I told my parents what happened!
Judy: Wow. That was a big step. Did it go as you expected?
Cloé: They were great! I told them that I had not told them before because I didn’t want to
worry or upset them. They seemed to understand that. They listened really well.
Judy: How do you think you were different in the way you talked to them?
Cloé: I had decided that I didn’t care how they reacted. I just needed to be honest with
them.
Judy: So you wanted them to know what was really going on with you. You wanted to be
you. Were you prepared that they might not be able to handle it well?
Cloé: I thought through all that. I decided that I could handle it. I knew they loved me.

Cloé made similar changes in how they related to James, not only accepting his care, but also
being more able to focus on what he needed. This change promoted more genuine equality
between them:

Judy: It’s interesting that you are more able to focus on James’s needs now. Do you think
this is because the effect of the violation at work is letting up, or do you think
something else is going on?
Cloé: It’s both. I always followed James’s lead. I liked that he wanted to travel and live in
different places. I liked that he accepted me for who I am. But I didn’t feel like I
could disagree with him. I didn’t even let myself have those kinds of thoughts. So I
think I also kept my distance a little bit. If I let his needs be too important, I would
have felt dominated.

Plan Meetings with Family and Community

Much of Judy’s work with Cloé involved expanding their interpersonal connections and
strategizing how to do this. This included being able to connect with the women they
had worked with to tell them what happened and preparing to tell their story in court.
Judy was always careful to recognize and validate the real dangers and stresses involved,
and to support Cloé in working through what responses were right for them. Another
important step was volunteering in two community groups for young people. One
provided support for children and adolescents questioning their gender identity; the other
provided education to teenaged girls regarding sexual violence. Cloé invited James to
several therapy sessions to help them work through the changes in their relationship as
Cloé took a more differentiated position. In these sessions, Judy also helped James be-
come aware of the hidden power he held in their relationship and to be able to receive
disagreement from Cloé.
Cloé and James took a trip to visit their family in Minnesota. One of the issues Cloé
decided they wanted to share with their parents was their newly evolving spirituality. After
the visit, Cloé returned for a final therapy session. They said they were surprised at how
better able they were to be themselves with their family. They realized how much they had
missed being more connected to them. As a result, Cloé and James were discussing using the
settlement Cloé received from [perpetrator] to start a small farm-to-table restaurant in
Minnesota, a few hours away from their family. Cloé had initiated the idea and felt confident
that they could thoughtfully work through this decision on equal par with James. Whether or
not they started this business, Cloé wanted more connection with their family and was better
able to engage with them even though their parents could not fully understand their identity
and lifestyle.
184 Socioculturally Attuned Bowenian Family Therapy
Summary: Third Order Change
Bowen theory promotes systemic thinking. Understanding symptoms or patterns always
requires going larger (McGoldrick, 2016) so that clients can see themselves, their concerns,
and their multigenerational family systems as part of ongoing sociocultural systems. Third
order change involves being able to critically reflect on how societal context and power
processes are part of one’s situation and making choices regarding how to resist these
dominant societal discourses and contexts from a less reactive, more reflective position.
Cloé and James had begun this process. They recognized systems of systems and elected to
live outside the dominant social structure as much as possible. But at their stage of differ-
entiation, their responses demonstrated the tenacity of emotional fusion within both larger
societal and family systems. Much of their resistance to dominant societal values had been
reactive in nature, cut off from bonds that connected them to family and sociopolitical
contexts. Cloé’s differentiation work in response to the sexual assault enabled third order
change; that is, greater ability to recognize and navigate complex social forces while staying
genuinely engaged in their social worlds.
The clarity and sense of self that comes with third order differentiation involves awareness
and respect for one’s interconnectedness with the larger group (e.g., Wiseman & Papero,
2011). It may be compared to Freire’s (1970/2000) idea of liberation through grassroots
consciousness-raising and action. Through critical thinking and awareness of self-in-context,
people discover their situatedness and how their own internalized images have been emo-
tionally fused with dominant social systems, leaving them trapped inside a socioemotional
web rather than able to make freely informed choices about their lives. Reflection on the self
and the systems within which one is embedded enables transformative action. This enables
awareness of community, which in turn supports increased empowerment.

Reflexive Questions
• If societal projection processes such as discrimination, scapegoating, and entrenched
power hierarchies are likely to disproportionately affect targeted or marginalized groups,
which groups do you think are most affected in your community?
• In less differentiated systems, responsibility for managing the anxiety often falls on the
less powerful. What thoughts or reactions do you have to this statement?
• If inequitable power processes at the societal level create power imbalances within
couples and families, and relationships with a high level of differentiation are
characterized by equality, then what would this mean for your intimate partner
relationship, past or present?
• What would this understanding mean for the couples you work with as a Bowen
informed couples therapist?
• Has there been a time when you have mistakenly confused someone’s power with
differentiation? How did you know?

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Walsh, F., & Scheinkman, M. (1988). (Fe)male: The hidden gender dimension in models of family therapy.
In M. McGoldrick, C. M. Anderson, & F. Walsh (Eds.). Women in families: A framework for family therapy.
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Wetherell, M. (2012). Affect and emotion: A new social science understanding. Sage.
9 Socioculturally Attuned Contextual
Family Therapy

Contextual family therapists take the view that humans are fundamentally connected and
responsible to each other. Ivan Boszormenyi-Nagy devised contextual therapy as a so-
cioethical umbrella under which other approaches may be leveraged (Boszormenyi-Nagy,
1987). Its emphasis on our ethical responsibility to care for one another (Boszormenyi-
Nagy & Krasner, 1986; van der Meiden et al., 2019) is unique and counters dominant
Western ideas of utilitarian self-interest. When developed, contextual therapy represented
a shift from an emphasis on intrapsychic change to facilitating change in the ethical
contracts between people.
Nagy framed therapy as encompassing four levels: (1) the facts, e.g., the circumstances
that impact life experience such as where one is born, key life events such as traumas,
losses, and transitions; (2) individual psychology, or the meaning that individuals make of
their experience and how that is internalized; (3) transactional patterns involving family
communication, structures, and interactions; and (4) relational ethics––fairness in what we
give to each other––as the overarching contextual framework for the other dimensions.
This integrative approach invites many styles of practice and focuses on resources rather
than pathology (Dankoski & Deacon, 2000; Hargrave & Pfitzer, 2003). The approach
continues to evolve and is especially helpful in identifying and addressing the relational
impact of unjust social systems and contexts (Rootes, 2013; Sude & Gambrel, 2017; van
der Meiden et al., 2020).

⤝⤞

Socioculturally attuned contextual therapists inspire third order change by

addressing how larger social contexts and societal power inequities affect the
balance of fairness in people’s lives.

⤝⤞

In this chapter, we first highlight five enduring family therapy concepts that guide contextual
therapy: interpersonal consequences, the balance of fairness, entitlement, intergenerational
loyalty, and multidirected partiality. We then show how to apply them from a socioculturally
attuned perspective and illustrate with a case.

Primary Enduring Concepts

In Nagy’s framework, context refers to the ethical connections within which individual
development and interpersonal dynamics occur (van Heusden & van den Eerenbeemt, 1987).
Whether we work with an individual or a family, these ethical considerations are always
DOI: 10.4324/9781003216520-9
188 Socioculturally Attuned Contextual Family Therapy
present. A look at the case of Barbara, a 25-year-old Anishinabe (sometimes referred to as
Chippewa or Ojibwe) woman with a five-year-old daughter, will help us understand the
concepts in contextual family therapy. Barbara sought therapy because she was in a new
relationship with Karl, aged 32, whom she described as a “good” man and did not want to
“lose.” Both the men in her previous relationships were in prison. She said she could afford
one session a month from her job as a waitress and would not accept a reduction in the fee.
From a contextual perspective, this therapy is about what Barbara has a right to expect in the
relational give and take between herself and others (Boszormenyi-Nagy & Krasner, 1986).

Interpersonal Consequences
Nagy was strongly influenced by Martin Buber’s (1958) view that personhood is founded on
relationship rather than self-interest, living with the world rather than in it (Boszormenyi-
Nagy & Sparks, 1973; Fishbane, 1998). He viewed relationships as a dialogical process of an
I-thou process of “receiving through giving, through caring about the other” and grounded
his approach to therapy in “responsibility for all those who will be affected by his or her
work” (van Heusden & van den Eerenbeemt, 1987, p. 4-6). In Barbara’s case, this included
her relationships with her daughter Cora and partner Karl, but also her mother, stepfather,
former foster care parents, former partners, people in her community and at work, and future
grandchildren.
Contextual therapists believe that what we do inevitably has consequences for others.
Symptoms occur when there are violations of this foundational ethical contract (Hargrave &
Pfitzer, 2003). Like many clients, Barbara had a long history of interpersonal wounds and
betrayals. She “inherited” a mother who was addicted to drugs, and engaged in survival sex
work and a stepfather who sexually abused her. She suffered physical abuse from her first
partner and left him when she learned she was pregnant. These relational injustices were
rooted within legacies of historical injustice and trauma suffered by the Anishinabeg (which
means first people), as Euro-Americans systematically took their land and culture from them.
As we will see, the consequences of the trauma inflicted upon her people continued forward
through multiple generations.
Contextual therapy emphasizes that Barbara is entitled to care and respect and helps her
be responsible for the consequences of her responses to prior injustices. Her therapist is
empathic and stresses that Barbara is not responsible for the abuse she endured. She also asks
about how these previous experiences affect the way Barbara parents Cora and her ability to
be a trustworthy partner with Karl. Rather than considering only pathology in her family
history, contextual therapy helps her find resources that she can carry forward (Boszormenyi-
Nagy & Sparks, 1973; Fishbane, 2005). The work is intergenerational and seeks to rebalance
fairness in these relationships, with attention to the consequences for all family members.

Balance of Fairness
Justice is a synthesis of the reciprocity balance among family members (Boszormenyi-Nagy &
Sparks, 1973). This means that people must openly acknowledge the positive contributions
that they have made to others and that others have made to them (Goldenthal, 1996). Nagy
called this due crediting. This is not just a behavioral action. It includes the capacity to be
sensitive to others, to see from their perspective, and “above all give care to others” (p. 19).
When the giving and taking of care is out of balance, the relationship is not just. Therapists
must be able to name and acknowledge the unfairness and play an active role in facilitating a
more equitable and ethical balance of care. Helping family members balance the ledger of
fairness––who owes what to whom––is a core goal in contextual therapy.
 Socioculturally Attuned Contextual Family Therapy 189
Justice is not simply a 50-50 exchange; “I do this for you, and you do this for me.” It is
based on genuine care and giving what is needed in the circumstances. It means providing
care when someone is sick or disabled, but also acknowledges ways those receiving may also
be giving. It involves commitment to the well-being of one another over the long term. In
the case of a parent such as Barbara, reciprocity is not “tit for tat;” as an adult Barbara is
responsible to create a safe and nurturing environment for her daughter. In her relationship
with Karl, Barbara is entitled to mutual support (Knudson-Martin & Huenergardt, 2010).

Entitlement
All persons are entitled to care and nurturance from others. This is especially true of children
from adult caregivers. Boszormenyi-Nagy used the notion of constructive entitlement to de-
scribe the outcome of receiving positive and responsive care. Having received care as chil-
dren, we have the capacity to give care to others as adults and to pass it along. When
entitlement to care during childhood is not met, the person approaches adult relationships
from a position of destructive entitlement. According to Boszormenyi-Nagy and Krasner
(1986), “destructive entitlement is one end result of the parental failure to honor the inherent
entitlement with which each infant is born” (p. 110). Because they feel as though they are
owed a debt, they may lack or deny sensitivity to others and cause pain or harm. As stated by
Boszormenyi-Nagy and Krasner (1986), “credit earned by victimization predisposes people
to repetitive, substitutive claims for restitution … and are disinclined to feel pangs of remorse
or guilt.” (p.111). Or, as in Barbara’s case, destructive entitlement may skew a person’s
perceptions of justice so that they do not feel entitled to care and do not expect to receive it
from others. They may always do for others without receiving care in return. Either way, the
balance of care in current relationships is unfair.
Sometimes destructive entitlement weakens parental boundaries such that the child must
assume the role of a parentified child. Barbara had been expecting five-year-old Cora to show
care and respect for her feelings, something she was entitled to and did not receive as a child
or in prior relationships with men. While a five-year-old can and should learn to respond
sensitively to others (Siegel & Hartzell, 2003), Barbara had been expecting a level of vali-
dation from Cora that a child could not provide. When she understood this, Barbara was
able to respond to Cora from a position of care rather than anger.
On the other hand, Barbara had been uncertain whether she was entitled to the care and
sensitivity Karl demonstrated to her. She began to feel emotionally indebted, fearful that he
would leave her if she asked or expected too much. The therapist facilitated several couple
sessions that helped Karl explicitly credit Barbara with all that she gave to him, reinforced her
entitlement to care, and clarified what mutual care and support would look like for them.

Intergenerational Loyalty
In contextual therapy, Barbara’s current relationships cannot be understood apart from her
loyalty to her family of origin. Loyalty is defined differently than we may usually think of it.
Here, it is an existential bond that connects us to our origins, but may be invisible to us.
According to Boszormenyi-Nagy and Krasner (1986), “it is almost synonymous with the
essential irrefutability of family ties” (p. 15). We may consciously disavow or disconnect from
family members but remain drawn to our indebtedness to them.
Barbara left home at the age of sixteen and had not seen her mother since. The doubt,
uncertainty, and inability to trust Barbara experienced when Karl demonstrated caring and
treated her well are examples of invisible loyalty. She did not want to be obliged to the
therapist by not paying the full fee but was unaware of the ways she unconsciously
190 Socioculturally Attuned Contextual Family Therapy
maintained loyalty/obligation to her mother and prior generations. From a contextual
perspective, finding ways to express healthy filial loyalty to her parents was an important
developmental task (Fishbane, 2005). It would free her to new possibilities in her own life
and help her engage responsibly with Cora and Karl. It meant learning to see her mother in
the broader context and giving her credit for her positive contributions to Barbara’s life. In
contextual therapy, this process is called exoneration, or “lifting the load of culpability of a
person who has previously been blamed for a violation” (Hargrave & Pfitzer, 2003, p. 139).
Ideally, but not necessarily, it is also linked to processes of forgiveness in which love and trust
are reestablished (Hargrave & Pfitzer, 2003).

Multidirected Partiality
Multidirected partiality is at the heart of what contextual family therapists do (Goldenthal,
1996; Roberto, 1992; van der Meiden et al., 2020). Therapists demonstrate empathy to
everyone while highlighting issues of relational ethics (Sibley et al., 2015). They take into
consideration the relational claims of each person, whether or not they are in the room.
Through the technique of due crediting, therapists highlight relational injustices that each
person has experienced and acknowledge their efforts and contributions. For example,
Barbara’s therapist recognized and empathized with the pain and injustice she suffered as a
child and in her prior relationships. However, she also brought the interests and contributions
of her birth and foster parents into the room.
Contextual therapists explore the past but emphasize due crediting as a current process.
The therapist asked Barbara what she learned about relationships from her foster family.
Though Barbara had not previously focused on the resources this family had provided to her,
it was easy for her to identify the stability and love they had offered. The value of these
important contributions had been lost to Barbara due to split loyalty; the invisible pull of
loyalty to her birth family kept her focused on what they owed her, rather than what she had
actually received from the foster family. As a result, she had not maintained a connection
with them. When she contacted her foster parents and thanked them, they were overjoyed
and still available to her.
Rebalancing trust and fairness when there are legacies of injustice such as trauma and
abuse can require many sessions (Wells et al., 2017); but not always (Goldenthal, 1996).
Barbara did not know much of her mother’s story but knew how to find her. The therapist
and Barbara discussed what it would mean to invite her to a therapy session, and the
uncertainty of not knowing what to expect. Barbara was motivated to transform her life
and ready to take this important step. In the intervening time, her mother had done a lot of
her own transformative work and was active in a twelve-step program. She welcomed the
opportunity to revisit her relationship with Barbara. The therapist began the one two-hour
session with an assumption that there were relational resources that could be accessed. She
invited the mother to tell her story, helping them look not only at what Barbara was
entitled to as a child, but to hear and credit the mother’s anguish at willingly giving up her
child because she did not believe she could care for her. The mother recounted how
her desire to get her child back had motivated her to get clean and marry an older man
(now deceased) who could provide economic stability.
The role of the therapist is not neutral (Goldenthal, 1996). Therapists align with different
persons at different times and use their power to help balance relational ledgers or ledgers of
merits. This is an active role based on multidirected caring and empathy (Sibley et al., 2015).
Barbara’s therapist moved back and forth between caring and empathy for Barbara and for
her mother. The therapist used her role to facilitate a conversation about what Barbara and
her mother needed from each other now. She addressed their shared sadness at never
 Socioculturally Attuned Contextual Family Therapy 191
knowing Barbara’s birth father and Barbara’s experience of sexual abuse, which the mother
had not known. Barbara recounted how she had purposely protected her mother from
knowing this because she did not want to hurt her (an example of invisible loyalty).
Exoneration of past injustice occurred as Barbara began to understand why she was not
given her due and began to see her parents as real people (Fishbane, 1998). Barbara and her
mother developed a plan for maintaining limited contact with each other and for Cora
to know her grandmother. This was facilitated by their shared interest in reconnecting
with generational legacies of injustice, community, and pride as members of the Anishinabeg
nation. Following this session, Barbara reported a fundamental transformation in her sense
of self. She felt more comfortable with, and entitled to, a mutually supportive relationship
with Karl and more confident in herself as a loving parent, while also gradually building
a relationship with her mother and claiming her identity as an Anishinaabe woman.
The therapist’s active use of multidirected partiality enabled the family to rebalance the
generational ledger and intentionally redirect their responses to old wounds.

Integrating Principles of Socioculturally Attuned Family Therapy

Though applications and study of contextual therapy are growing (e.g., Gangamma et al.,
2015; Sibley et al., 2015; van der Meiden et al., 2019), the approach has been underutilized
and understudied. In part, this may be because notions such as sensitivity, integrity, and
relational responsibility do not resonate with Western patriarchal culture (Dankoski &
Deacon, 2000). The relational justice focus of contextual therapy can be expanded to clarify
the impact of broader societal systems and power to enable third order change.

⤝⤞

Justice within a family system can never be separate from justice within the
larger societal context.

⤝⤞

Societal Systems
How family members experience what they owe each other and what they are entitled to is
shaped by cultural norms and values, structural inequities, and legacies of sociopolitical in-
justices and traumas.

Justice, Privilege, and Entitlement

Nagy emphasized the need to look beyond the immediate give and take to place relationship
patterns in context of the ledger of indebtedness across generations and the group’s history.
Entitlement is earned through caring about others and goes hand in hand with reciprocal
indebtedness (Boszormenyi-Nagy, 1987). It is both a human right and a human obligation.
This ethical commitment transcends transactional patterns and carries important consequences
for the future.
Privilege, as we use it in this text, refers to unearned benefits (care) that one gains simply
because of their social locations, for being White, for being male, for being straight, etc. It is a
societal level process that contributes to interpersonal processes. From the lens of relational
ethics, unacknowledged social privilege results in “exploitative oppression” (Boszormenyi-
Nagy, 1987, p. 317), which engenders destructive entitlement. When people acknowledge and
192 Socioculturally Attuned Contextual Family Therapy
are accountable for their privilege, they are more able to be responsive to the needs of others
and earn constructive entitlement. Reciprocally, when processes of privilege result in ex-
periences of discrimination and injustice, destructive entitlement accrues, damaging personal
and relational health and potentially expressed in a variety of harmful behaviors or symptoms.

⤝⤞

A socioculturally attuned approach links person-to-person exploitation to

structural exploitation that may be oppressing all participants.

⤝⤞

Values
Unlike dominant economic systems, contextual therapy values the work of caring and
equity. It challenges the myth of the rugged individual (Fishbane, 1998) and views justice as
collaborative rather than competitive. It can be easy for persons raised in Western cultures to
think of ledgers or give and take from a more individualistic exchange perspective. Instead of
helping people negotiate, “I’ll do this for you and you do this for me,” socioculturally
attuned therapists help people approach each other with empathy rather than blame, and
encourage them to attune to each other and the relationship overall.

⤝⤞

When persons genuinely take on the experience of another, they also begin to
demonstrate more responsibility for the effect of their actions on them.

⤝⤞

Knudson-Martin and Huenergardt (2010) described therapy with Damon, a European

American university student who considered himself a “geek” and not people oriented, and
his female partner Ellie. The couple described an incident in which Damon got angry with
his aunt (with whom they lived) and walked out of the room, leaving Ellie to deal with the
aunt. The therapists did not automatically accept the cultural idea that men, especially
computer nerds, are not relational. Instead, they encouraged Damon to imagine what it was
like for Ellie when he walked out. They stayed with Damon until he could take in her
experience. When he did, he began to see the unfairness and was motivated to engage more
equitably with Ellie, which increased her trust in the relationship.
Helping clients identify their relational needs and commitments enables more choice
regarding what cultural values mean to them, which they want to enact, and how they
perform them. In addition to thinking that geeks could not be people persons, Damon also
believed in fairness and genuinely valued and loved Ellie. He needed help enacting these
caring values that male dominant culture discouraged.

Historical Injustices and Trauma

Millions of people suffer from intergenerational effects of historical injustices such as slavery,
religious oppression, genocide, and colonization that systematically destroy the culture, land
ownership, spiritual practices, and humans themselves (Brown, 2008). This kind of historical
trauma weakens traditional cultural coping strategies and creates stress and trauma that affects
 Socioculturally Attuned Contextual Family Therapy 193
present-day circumstances. Because it was not safe for disenfranchised survivors to express
hostility toward oppressors, they often internalized anger, grief, sadness, loss, shame, and
inferiority that is passed on and affects the next generation (Brave Heart & DeBruyn, 1998).
Groups with these historical injustices endure high rates of depression, violence, substance
abuse, and suicide (Brown, 2008). From a contextual therapy point of view, when the reality
of these injustices is acknowledged, it is possible to transform what they mean going forward.
Consider the effect of the attempted cultural genocide of Indigenous people on Barbara.
European colonization of the Anishinabeg homeland forced social changes that disrupted her
ancestors’ balance of life, leaving them facing death, disease, and starvation and increasingly
reliant on foreign commodities (Brave Heart & DeBruyn, 1998; Brownlie, 2008). In the 19th
century, her people were removed from their traditional lands. Those who survived were
consigned to small tracts, reservations with few resources. Women, who had held high status
prior to European encroachment, found their roles and value diminished (Brownlie, 2008).
Barbara’s grandparents grew up in the economically devastated conditions of one of these
reservations. Her grandfather was sent to a boarding school designed to solve the “Indian
problem” by teaching native children dominant cultural values (Brave Heart & DeBruyn,
1998, p. 63). He was beaten for speaking his native language, not allowed to see his family all
year, and labeled as a failure. As a young man, he was sent to an urban relocation center
where he was not prepared to succeed, developed problems with alcohol, and drifted back
and forth between the reservation and the city. Barbara’s mother grew up in this environ-
ment, with a father who was frequently absent and violent when he was present. She did not
see jobs or opportunities for herself and felt ashamed of her heritage. At the age of sixteen, she
left the reservation with an older man. Soon she was alone and drug-addicted, with no way
to support herself.
The effects of sociohistorical and continued injustice upon Indigenous people had been
experienced and passed forward in Barbara’s family and community for many generations.
Barbara had grown up unaware of the strength of women and spiritual resources within
her Anishinabeg roots and with limited awareness of what her ancestors suffered. Naming
the injustice was very important. This freed Barbara and her mother to embrace their
Anishinabe identity, overcome internalized shame, and develop new life patterns that
honor their shared history.

Environmental Justice
The balance of justice extends beyond the family to communities, nations, and social systems
(Boszormenyi-Nagy, 1987). Nagy argued that family therapists have an ethical responsibility
to contribute to the survival of the planet; that this is “therapy’s ultimate mandate for
humanity” (p. 321). Many people today are disconnected from the earth and unaware of
their ethical relationships to it (Hernandez-Wolfe, 2019; Laszloffy, 2019). Dialogue about
environmental issues can help families consider their ethical relationship to the planet, each
other, and future generations (Fraenkel & Cho, 2020).
As described in chapter one, the effects of environmental distress are not equitable. Mental
health is highly correlated to where we live and our access, not only to services but to a safe
and life-sustaining environment (Hudson, 2012; Magistro, 2014). What is the quality of the
air our clients breathe? Do they have access to green space? How crowded are their living
conditions? Many families have limited choices about where they live, the number of hours
they work, or the availability of safe and affordable green places (McDowell, 2015).
Engagement in collective action can help transform the balance of fairness. For example,
when Sarah Delgado (as described in Esmiol et al., 2012) encouraged a group of houseless
immigrant Latina women to reflect on how environmental factors impacted their relational
194 Socioculturally Attuned Contextual Family Therapy
functioning, they began to share their needs [entitlement] and develop their own form of
activism. Rather than turn injustice inward in the form of depression and hopelessness, they
“grieved … their ‘invisible’ status here in America” (Esmiol et al., 2012, p. 583) and de-
veloped strategies for hope and survival based on trustworthy relationships with each other.

⤝⤞

The contributions that people from parts of the world with fewer economic
resources make to the lives of those in more affluent parts of the world is often
overlooked.

⤝⤞

Justice across Cultures and Contexts

Many people leave their families and homelands to provide services such as childcare and farm
labor that promote the well-being of other people’s families. Relational justice requires
crediting these contributions and accountability to those who make them. For example, Rena’s
(heterosexual co-parent living in an upper class neighborhood) therapy focused on her de-
pression and the effects of trauma in her life. When the therapist inquired about how she
attended to her middle-school-aged daughters when she was feeling low and self-focused,
Rena said that Josephina, her housekeeper from the Philippines, was “around.” The therapist
wondered how Josephina’s contributions to the family were recognized. He asked Rena about
the relationship with Josephina, her circumstances, and their agreement about her services. As a
result, Rena acknowledged Josephina and developed a more equitable contract that included
compensation for childcare. This was important because Josephina had been doing extra hours
and shopping to make sure Rena’s daughters were cared for. Her uncompensated work per-
petuated societal and relational injustices. And, like many who care for children of the affluent,
she had to leave her own two young children in the care of a neighbor.

Power
Societal power inequities affect those whose needs and interests are noticed and attended to.
This occurs in the larger society and in interpersonal communication processes. Preemptive
silencing happens when people are never asked and their interests are not included in dis-
cussions (Medina, 2013). Decisions are made to develop a neighborhood, but residents
themselves are not included in the discussion. Or, a family debates whether to go to the
beach (which the children want) or hiking in the mountains (which the father wants). No
one asks what the mother wants.

Recognizing Power Imbalances

Sometimes people participate in communication exchanges, but their credibility and perspec-
tives are minimized. This would happen if in the family above the mother says she has a lot of
things to do and, whatever they do, wants to get an earlier start, but her concern is overlooked
by the father and dropped from the conversation. Latent power (Komter, 1989) happens when
participants automatically focus on the needs of the dominant person, primarily because societal
norms and expectations limit the options. For example, the owner of a home has a right to sell it.
Unless regulations protect renters, they have no legitimated voice. Or, a family moves for the
husband’s job without fully considering the impact on the wife and children.
 Socioculturally Attuned Contextual Family Therapy 195
⤝⤞

In order to facilitate relational justice, therapists need to assess the power

context of communication patterns.

⤝⤞

There are differences in how people see fairness, depending on their power location. Those
in higher power positions tend not to notice that others attune to them and accommodate
their needs. Women are likely to feel more gratitude for the contributions of male partners
than men do for women’s contributions (Coltrane, 1996; Matta & Knudson-Martin, 2006).
Promoting relational ethics requires that therapists’ observations and questions make these
subtle power dynamics and their relational effects visible. For example, Kirstee Williams
(2011) described her work with a female couple in which one, Michelle, had an affair.
Michelle’s partner, Nicole was older, made substantially more money, and judged Michelle’s
“emotional” communication style as “immature” (Williams, 2011, p. 524). Michelle’s affair
was an indirect response to the power imbalance. “Naming the power difference enabled
them to come face to face with the ways their differing societal power positions interfered
with attaining their egalitarian ideals” (p. 524).

Therapist Power
Multidirected partiality does not mean neutrality (Dankoski & Deacon, 2000). Contextual
therapists care equally about all participants, but are prepared to use their power to
temporarily “side with one person” to help create more balanced relationships (Goldenthal,
1996, p. 11).

⤝⤞

From a socioculturally attuned perspective, therapists need to be accountable

for which values they promote and how their actions affect relational justice.

⤝⤞

Third Order Change

Like other family therapy models, contextual therapy draws on systemic understandings and
interventions that include second order change in transactional patterns, e.g., change in the
rules by which the relationship operates. Contextual therapy places this work within a larger
ethical context––how individuals are responsive and accountable to relational connections
beyond themselves (Boszormenyi-Nagy & Krasner, 1986).

⤝⤞

Socioculturally attuned contextual therapy seeks third order change in which

family members see themselves not only as connected and ethically responsible
to each other, but also see their relationships and loyalties in context of their
societal position and are accountable to the wider community.

⤝⤞
196 Socioculturally Attuned Contextual Family Therapy
A third-order shift in consciousness provides family members perspective on their social
situations and ethical responsibilities and increases their ability to make intentional choices
about how their actions contribute to posterity and the systemic balance of fairness. For
Barbara, this meant she saw her own life in the larger scheme of history and actively engaged
with her mother, Karl, and their community in ways that help restore gender and cultural
justice. They were able to intentionally promote the kind of future they want for Cora and
society by balancing the ledger of fairness within their own relationship, in parenting, and in
their relationships with the wider society.
Therapists are also accountable for the impact of their interventions and the values they
reinforce (Melito, 2003). They are answerable for how their clinical actions help undo
societal inequities or reinforce them. In Text Box 9.1 Stephanie Brooks describes her
contextual approach to third order change.

Text Box 9.1 Stephanie Brooks, PhD, LCSW, LMFT

Stephanie Brooks is Senior Associate Dean of Health Professions & Faculty Affairs
at Drexel University. She describes herself as an African American cisgender
woman, parent of two daughters, and educationally privileged with a productive
career in academia and private practice. Her interests include MFT Education and
Training, Supervision, ADHD in Black Couples, Trauma, Depression and Addiction,
and Leadership. Nagy’s contextual therapy provides an overall ethical framework
for her socioculturally attuned integrated approach to practice.
I center how the dominant culture informs clients’ experiences/relationships,
presenting problems, and coping. This approach allows me to explore how power,
privilege and oppressive systems reinforce and shape interactions and under-
stand how our (therapist and clients) identities and experiences will influence the
therapeutic journey with the larger goal of inviting options and possibilities for
change.
I was privileged to be trained in the mid 80’s in the Intersystem Approach
developed by Gerald Weeks. This approach then and now enabled me to honor the
client’s entire self by assessing across individual, interactional, and intergenera-
tional parts embedded in layers of larger systems and to construct appropriate
interventions that consider and fit the client’s worldview. This meta framework
explores the inner dialectics (individual, biological, psychological, and outer
dialectics (system-sociological/cultural/historical). Therefore, I intentionally
weave in and out modern, postmodern and social construction family therapy
constructs with a critical eye on freedom and liberation. As a therapist, I engage in
self-interrogation and inquiry (self-of-the-therapist) while keeping an eye on what
Nagy refers to as the “between”–what happens in the between therapist-client
relationship?
I try to attune to the clients’ sociocultural experience by noting what is said,
seen, and known and by being curious about what is not said, unseen (hidden)
and unknown. I believe systems of power, oppression, and submission are always
present, and as a therapist, I need to understand how they translate to the client
experience as well as serve as a disruptor. I identify and name these issues
through maintaining a curious stance and questioning. I use focused genograms,
ecomaps, and storytelling as tools for amplifying what has been silenced and
marginalized.
 Socioculturally Attuned Contextual Family Therapy 197

Creating space for clients’ agency and value is important. I use Hardy’s
Validation, Challenge, and Request (VCR) intervention to interrupt unjust relation-
ships and systems. I also use my own power and role to facilitate structural and
systemic change. One method is to engage clients to be curious and question how
they became who they are, which includes exploring family origin dynamics,
geographical, economic, gender scripts etc. This exploration and questioning
creates openings to connect the influence on the presenting problem and typically
highlights their perspective and limitations for change. It also opens conversations
about how they respond to power/powerlessness, who defines power, how they
are expected and want to be treated in relationships. My work encourages
transformative 3rd order change by elevating clients’ voices and experiences
and naming what is considered taboo, which facilitates valuing their own
experience and creates space to imagine what their change would look like if
they were seen and heard.

Practice Guidelines
Socioculturally attuned contextual therapy expands the relational ethics lens to include the
sociopolitical context of intergenerational family processes. Goals go beyond symptom relief
or behavioral change to love and trust grounded in a balance of fairness. As noted earlier,
therapists are not neutral; they actively position their interventions to catalyze justice. They
are likely to engage as many family members as possible, including extended family and
family of choice. The seven guidelines below are interconnected and inform clinical deci-
sions and therapist actions throughout the course of therapy.

1 Practice Multidirected Sociocultural Attunement

As therapists seek to understand and attune to each person’s sociocultural experience and
empathize with it, clients feel felt (Pandit et al., 2014; Sibley et al., 2015). This sets the stage
for family members to also experience empathy for one another, to acknowledge the hurts
and injustices each has experienced, and to begin envisioning potential pathways to healing
(Sibley et al., 2015; van der Meiden et al., 2020). Identifying the societal contexts that give
rise to expectations and feelings helps reduce blame and opens family members to each
other’s experiences. They become more willing to be accountable for the effect of their
actions on others.

2 Discuss Sociohistorical Context/Background

Socioculturally attuned contextual family therapy focuses on justice as the bridge between the
past and the future (e.g., Hargrave & Pfitzer, 2003; van der Meiden et al., 2020). Therapists
help clients explore and name the sociopolitical context of their family legacies. They want
to know about the effect of historical events such as war, immigration, and economic
conditions, as well as the family’s ethnic background and position relative to others in the
community. How was the family treated and regarded by others? What messages did prior
generations receive about their value and worth? How might these have been related to
social identities such as gender, sexuality, religion, race, ethnicity, or ability? As therapists and
clients collaboratively create a sense of these sociocultural contexts, it becomes possible to
198 Socioculturally Attuned Contextual Family Therapy
develop empathy and/or understanding of parents and prior generations. People begin to see
themselves as a transformative link in the evolving family and sociocultural history.

3 Identify and Acknowledge Unfairness

Socioculturally attuned contextual therapists assess the balance of fairness within relationships
and social experience. Through observation and questioning, they track the giving and re-
ceiving of care across generations and within intimate relationships. When people have
suffered injustice, in their families and/or as part of societal processes of power, privilege, and
oppression, having the unfairness recognized, valued, and witnessed is empowering
(Weingarten, 2003). Naming the ethical violation is an important aspect of healing.
Socioculturally attuned contextual therapists look for and explore experiences of societal level
violence to the self and to one’s group. We use violence broadly here to refer to direct
physical attack and witnessing death, etc. to the insidious effects of continued disparagement,
invisibility, or limited access to economic and other valued resources.

4 Assume People Want to Give

Societal discourses around autonomy and competitiveness can mask or pathologize people’s
desire to give to and support others. People who have been hurt by injustice and are owed
care sometimes find it difficult to give to others, and people in power positions may not
notice what others need. Contextual therapists know that at our core, people want to give to
others and intervene accordingly. They approach each family member with these ex-
pectations and, without minimizing hurts they may have caused, also ask about ways that
each has been, or would like to be, helpful. Conversely, it is a great gift to know how to
receive, and not just give. By graciously receiving a gift, we are giving a gift in return.
Identified patients/persons, e.g., those who have been defined as the problem, are invited to
give as well as take. If the therapist is attuned to this process between give and take, then
clients will be able to recognize relational goals and name interest in another’s well-being.
These shifts focus away from pathology toward resources each can provide others.
Importantly, the giving of care is validated and honored rather than overlooked or framed as
a problem. This shift toward a relational perspective actively counters models of human
nature, based primarily on self-interest.

5 Encourage Due Crediting

Once naming and validation of harm and injustice have been clearly acknowledged,
therapists encourage due crediting; e.g., giving the other credit for positive contributions to
one’s life and to the relationship. This must never seem to positively connote abusive or
harmful behavior, but it does involve seeking to find genuine contributions (Goldenthal,
1996, p. 68). For example, Ruben had a history of relationships that ended because he was
not able to make a long-term commitment such as marriage. He, his current partner, and
their therapist all agreed that his ongoing experience since childhood of needing to care for
and protect his mother due to the effects of living with bipolar disorder made it hard to
commit to taking emotional risks. The therapist credited his entitlement to care from his
mother, especially as a child:

Therapist: (after Ruben described his childhood anxiety about his mother’s needs) You
were just a child. You needed her to be there for you. All children do.
Ruben: I know. It’s not her fault. She did her best.
 Socioculturally Attuned Contextual Family Therapy 199
Therapist: She did her best, but she wasn’t able to mother you the way I imagine she wanted
to, the way you had a right to be parented.
Ruben: She tells me she’s sorry. But it’s still a one-way street you know. It’s still about
what she needs from me.

After more dialogue that explored and validated Ruben’s right as a child to have an adult he
could count on to look after his needs and recognized the abandonment from his father, the
therapist moved the conversation to ways his mother had given to him:

Therapist: We know your mother wasn’t able to parent you the way she would have
wanted to … I’m curious, though; I’m guessing there are also things she has given
to you. Do you have any ideas about what those might be?
Ruben: She loved me! I always knew that! I still know that. She tells me all the time.
Partner: You’re so loving. That’s what I love about you. You got that from your mother.
I see that.

Both aspects of due crediting are key to rebalancing Ruben’s relationships going forward:
crediting what he deserved or was entitled to that he didn’t receive, but also acknowledging
what he did get. Since mothers tend not to be credited and are frequently blamed for their
children’s problems (i.e., mother-blaming), helping Ruben acknowledge and credit what his
mother did give him was an important social justice intervention.

6 Encourage Accountability

Contextual family therapists raise issues of responsibility and accountability regarding the
consequences of what clients say and do on others. For example,

Therapist: It makes sense that you would hold yourself back a bit from commitment. How
do you think your holding back affects [partner]?
Ruben: She doesn’t like it. But I tell her I just need time.
Therapist: (persists with effect on partner). What do you think it is like for her?

Socioculturally attuned therapists are also attentive to how relational accountability intersects
with societal power dynamics. Ruben’s sense of destructive entitlement from his family of
origin combined with societal gender entitlement (Wells et al., 2017). The therapist helped
him explore the gendered nature of injustice in his relationship:

7 Focus Forward

Therapist: A lot of men I work with have a hard time staying present when their partners are
upset. They have a hard time really wanting to hear her. Is that something you’re
aware of?
Ruben: ummmm. Yeah!
Therapist: What do you think society teaches men that gets in the way of being there for a
partner?

As clients develop a fuller understanding of the sociopolitical and interpersonal contexts

of their parents and communities, they are freed from invisible loyalty to the past and past
injustices. Socioculturally attuned contextual therapists help people be intentional about
how they want to interrupt the impact of family and societal injustice, what they
200 Socioculturally Attuned Contextual Family Therapy
envision going forward for themselves, their children, and posterity. This opens space
for transformation.

Case Illustration
Let’s return to Rena, the mother with the housekeeper from the Philippines. About a year
prior, Rena (45), a cishet (cisgender heterosexual) woman of Jewish descent, moved to the
Midwest from the East coast when her husband Gideon (age 53) was relocated by the airline
for which he was a pilot. Daughters Anah (age 12) and Ellen (age 11) went to a small private
school. Rena sought therapy with Peter, stating that she battled depression due to a trauma
history and that before the move she had seen a therapist twice a week for seven years. She
had tried several other therapists in the new community but was not satisfied with any of
them. Peter, a 55-year-old European American who earned his LMFT after an earlier career
in pharmaceutical sales, was the single parent of three teenagers following his wife’s death
two years earlier.
Peter approached Rena’s case with the conviction that she would be better able to
manage depression and the effects of trauma if therapy focused on these as part of a larger
set of ethical relationships. He was aware that his wife’s death and his earlier career
change highlighted for him the importance of being accountable to one’s relationships
and deepened his commitment to, and hope for future generations. Though Peter was
careful to distinguish his personal history from Rena’s, as a socioculturally attuned
contextual family therapist, he actively directed his clinical actions to advance relational
and societal justice.

Multidirected Sociocultural Attunement

Although Peter typically invited all involved family members to attend the first session, in this
case, he first met individually with Rena because she was so clear that she was looking for a
therapist that would support her. He wanted to begin to know her and demonstrate mul-
tidirected partiality toward the well-being, interests, and perspectives of other family
members as well. His questions focused on what family members needed from each other and
what they were able to give. He also clarified what Rena needed from him and what each
was willing to give to the therapeutic process. Peter began by letting Rena know that what
she suffered was wrong, that she was entitled to better:

Peter: (after Rena described an overview of the history that brought her to therapy) You
have endured so much! People have hurt you and treated you unjustly. A teacher
who was supposed to support your dignity and growth sexually harassed you. Young
men you thought were friends brutally assaulted you, and your first husband raped
you. And no one seemed to care or notice. No one should be treated like you have
been! You were entitled to teachers and friends who supported you and a husband
that cherished you. You had a right to expect others––your parents, your friends, the
school––to stand up for you. And you didn’t receive that.
Rena: (softly). No one has ever said that to me before.
Peter: You have suffered unfairly. I work from the idea that everyone needs loving and
supportive relationships––in their families and also in their schools and communities.
I see many people who live with the effects of the trauma and injustice they suffered.
I see them turn the impact of these legacies around to create a better future for
themselves and those they love and to make the world a better place. Does this fit
with what you’re looking for?
 Socioculturally Attuned Contextual Family Therapy 201
Rena: Absolutely! You seem to understand how hard it is. I think I could work with you.

In this statement, Rena conveyed that the therapist offered her what she felt she was owed:
understanding and safety. Peter then introduced the idea that Rena also owes others,
especially her children.

Peter: I would like to work with you. I’m wondering also how your girls are doing? How
will the work we are doing here affect them?
Rena: They’re doing OK. The move has been hard for them. Their new school is kind of
hard to break into. You know how kids are.
Peter: I imagine that you want to be there for them, make their transition easier. What do
you think they need from you?

With this line of questioning, Peter established from the very beginning that he sees Rena’s
therapy connected to the give and take between her and others, to what she is entitled to as
well as what she owes others. He also laid the foundation for exploring inequity in her
marriage and extended family relationships:

Peter: How about your relationship with Gideon? How does he attend to what you need?
Rena: (tears) Gideon is gone so much. And he’s under a lot of stress. Pilots in their 50 s have
to prove they’re healthy enough to fly. When he gets home, he needs to relax.
Peter: It sounds like you try to be aware of Gideon’s stress and what he needs. Is he aware
of yours?
Rena: I don’t know. Maybe sometimes. I try to be careful not to upset him.

Peter also learned that Rena had limited connections with her parents, her two brothers, and
their families. She perceived that they did not care about her, except in the most perfunctory
of ways, such as attending family events and observations. Peter’s response also showed
multidirected partiality to them and to the family’s ethical commitments to each other:

Peter: What do you think your family is missing out on by not knowing you better?
Rena: They don’t know me at all really. They never did!
Peter: I imagine there is a lot of you that you wish they could know. I wonder what has
gotten in the way?
Rena: (shrugs). Who knows? They always seemed more concerned about what others
would think than about me.
Peter: That must have been very hard, especially for a child … As an adult now, do you
have any idea what would have made them so concerned about making a good
impression on others?

Discuss Sociohistorical Context/Background

In the next session, Peter began a discussion of the sociohistorical context of Rena’s relational
experience and the traumas she suffered.

Peter: What was it like for you growing up in [East coast city]?
Rena: I was always kind of lonely. Kids teased me about my curly hair. I tried to stay in the
background.
Peter: You said on the intake that you are ethnically Jewish. Were there other Jewish kids?
Do you think they teased you because you were Jewish?
202 Socioculturally Attuned Contextual Family Therapy
Rena: There were only a couple of other Jewish kids in my school. I know there were
other neighborhoods with lots of Jewish people, but not where I lived. I was
embarrassed that I looked different and we didn’t celebrate Christmas like the other
kids.
Peter: How was your family connected to the Jewish community?

As this line of conversation continued, Peter learned that Rena had always felt isolated.
Though her working class family had lived in the same house all her life and were considered
“respectable” by the neighbors, they seldom engaged socially with them. Her family did not
practice Judaism or participate in the large Jewish Center in a nearby community. Peter also
asked about gender:

Peter: What messages about being a girl did you receive from your family and school?
Rena: That I was supposed to be pretty … but I wasn’t. I had a funny nose and unruly hair.
I was skinny. Most people in my school didn’t have expensive clothes, but the girls
dressed cute, you know? I was always plain. My parents didn’t allow short skirts or
makeup.

Peter began to see that Rena found herself alone and in a one-down position at school. He
explored more about this experience and asked where she found support:

Rena: I had a friend, Erin. She didn’t have friends either. Nobody liked her. My parents
didn’t like her; they didn’t like her values and Erin’s mom didn’t care where she
went.
Peter: What did you value about your relationship with Erin?
Rena: I could just be me. She listened to me … sometimes. She made me laugh.

Peter asked about the sexual harassment from a teacher, placing this in context of her social
location:

Peter: Being with Erin must have been a relief. You didn’t have to be on guard. She
accepted you. I can see why Erin was important to you. School was a pretty unsafe
place for you. You were teased. You felt like an outsider and didn’t fit what it
seemed girls were supposed to be like.
Rena: (tears). If it wasn’t for my friend Erin, I don’t know what I would have done.
Peter: You said a teacher sexually harassed you. What happened?

Rena had been surprised when the male music teacher asked if she would like to help him
with the music and instruments. She had never been singled out in a way that felt special
before. When he started making comments about her body and sexual innuendos, she didn’t
know what to do. Erin told her it was nothing to be worried about; it was what men did.
Rena felt uncomfortable but did not dare stop working for him. Her parents had seemed so
pleased that she had been selected for this honor; she never told them how painful it was
being with him. Several years later, when assaulted by multiple teenage boys at a party, she
didn’t tell anyone, not even Erin.
Peter also began to explore what Rena knew about her parents’ history. She knew both
came from families that immigrated to the United States from Poland shortly before World
War II, when it became apparent that it was increasingly dangerous for Jewish people. Since
her family seldom talked about the past, she did not know much about their experience
growing up at this time in history, only that both families scraped by with very limited
 Socioculturally Attuned Contextual Family Therapy 203
economic resources and were grateful to be alive. Peter wondered aloud what it must have
been like for them and how their experiences may continue to affect them:

Peter: I wonder what it was like to grow up in families who left everything they knew and
loved? I wonder how people treated your grandparents when they got here and what
it was like to raise young children in a place where they were considered foreigners?
This must have affected your mother and father and how they parented you.
Rena: I don’t know. I never really thought about it (reflective pause) maybe that’s why my
parents were always so worried about what other people thought, why my dad just
seemed to keep his head down and keep going.
Peter: You’re probably right. I think it might be helpful to know more about this history.

Identify and Acknowledge Unfairness

Rena entered relationships from a position of destructive entitlement. In other words, she
brought a ledger of unfairness from the past with her. The trauma and injustice she ex-
perienced as a result of bullying, harassment, and rape were not separate from, and were
intensified by her marginalized female, economic, and Jewish identities. Her family had
responded to the historical trauma of the Jewish Holocaust by keeping quiet and trying not to
call attention to themselves in their new homeland. Stripped of their economic wealth, living
in a neighborhood with few Jewish people, and not knowing what to expect, they avoided
close affiliation with their neighbors and kept their Jewish identities quiet. As Rena learned
more about her personal and family histories and shared it with Peter, he took care to name
the injustice:

Peter: The injustice done to your family can never be repaid. Your grandparents ran for
their lives and for the lives of their children. They faced discrimination and poverty,
not of their making.

Peter helped Rena recognize how these past injustices contributed to inequity in her re-
lationships with men, including messages she received about her worth:

Peter: All those ideas about how girls are “supposed” to look, how do you think they have
disadvantaged you or put you at risk?
Rena: They made me think I was ugly, that I wasn’t worth much. So I didn’t expect much.
Peter: Do you think this is still true with Gideon? That you don’t expect much?

Peter suggested Gideon join some of their sessions. This enabled both Rena and Gideon to
recognize and name the inequity in their marriage, an inequity perpetuated by differences in
social class and economic and resources, as well as gender. The disparity was present from the
beginning of their relationship:

Gideon: I was attracted to Rena because she seemed so pretty and so vulnerable. Just being
with her made me feel good!
Peter: How did she make you feel good?
Gideon: She was there for me. She liked to be with me and do the things I like to do. She
was a great listener! She still is.

Rena said that she was attracted to Gideon because he was stable; he knew what he liked and
was “mature.” She said she was surprised he would be interested in her. He came from a
204 Socioculturally Attuned Contextual Family Therapy
higher SES family, had economic security, and (in her mind) could have his pick of women.
Recognizing a likely disparity, Peter began to explore their balance of give and take:

Peter: Gideon, you said you were attracted to Rena because she was a good listener and
liked to do things with you. How does this work in your relationship now? Are
you a good listener for her?
Gideon: (pauses). hmm. I’m tired when I get home. She usually asks me what I’d like, how
my trip went.
Rena: I try to focus on him. He deserves it. It would be nice if he listened to me, but my
life isn’t very interesting.

After more fully exploring this imbalance and Rena’s need and right for care and attention,
Peter named the inequity and asked Gideon if he’d be interested in knowing more about
Rena’s life.

Peter: Gideon, you really appreciate the care and attention Rena gives you. It seems like a
pattern has developed where she focuses on you. When you come home, she stops
what she was doing and tries to be there for you. She doesn’t have the sense that
you’re also interested in her. You’ve gotten used to her tending to you. Is this a
pattern that you’d be interested in changing, that you could be there for her as
well?
Gideon: Of course. I love Rena. She just never seems to have anything to say.
Peter: I think Rena has a long history of learning that people, especially men, aren’t very
interested in what she has to say. How do you think you could make it safer for
her, how could you show her that you’re interested?

Note that in this example, accountability for change was directed first toward Gideon, since
he was the beneficiary of the imbalance.

Assume People Want to Give

Peter began with the assumption that Gideon cared about his wife and would want to help
create a fairer balance of give and take. Rather than primarily seeing Rena individually, Peter
encouraged couple sessions. This act of commitment to Rena and their marriage on Gideon’s
part was an important step in rebalancing the ethical ledger. In the past, frequent individual
therapy sessions helped to fill the void in her life, but could not correct the imbalance of
relational fairness that sustained Rena’s depressive symptoms. Both partners began to look
forward to the couple sessions, in large part because Peter recognized and highlighted their
love and concern for the other, even when the going was tough. For example, one day the
couple came in very distressed. Gideon was visibly angry; Rena was pale and silent. She
seemed almost invisible in the room and surely her past injustices had been triggered. Peter
joined with Gideon around his desire to be there for Rena:

Peter: (to Gideon). I don’t know if I’ve ever seen Rena look so scared. I know you’re
angry. I can see that. I also know how much you love Rena, that you don’t want to
hurt her, that you want to be there for her … What do you think happened that
made her so scared right now?

Acknowledging Gideon’s relational resources helped him feel calm and engage in the process
of working through the situation. It helped reassure Rena that she had not lost his love.
 Socioculturally Attuned Contextual Family Therapy 205
Peter also assumed that Rena and Gideon loved their daughters and wanted to provide a
safe and loving environment for them. He regularly asked about their well-being and in-
cluded their concerns in their sessions. He also suggested several family sessions and one with
Rena and the girls. These sessions included the premise that the girls had something to give:

Peter: (to Anah and Ellen) We’ve been talking a lot about what you need from your
parents. That’s important. And I’m guessing you also want to give to them. What do
you think you have to give that might make it easier for your mother?

When asked, the girls showed considerable insight into their mother and seemed energized
to think that they could help her:

Ellen: Mom really loves flowers! I could pick them from the garden and bring them to her.
That would make her feel cared about.
Anah: I think mothers don’t get cared about very often. Mom feels better when I tell her
about my day and I ask her about hers. But I forget to do that. I should do that more
often.

Peter also assumed that Rena’s parents, who were in their late 70 s, also wanted to give and
that Rena would want to give to them.

Encourage Due Crediting

Rena had spent most of her life focusing on what she had missed. Crediting her parents for
what they had already given to her was an important part of her healing. Rena was grateful
that both her parents were still alive and that she could tell them in person. She experienced
an important internal shift when she understood that her parents had always cared deeply
about her and tried to protect her in the ways they knew. She looked forward to visiting
them and her brothers and called them more frequently. Rena acknowledged the courage
and sound judgment her grandparents demonstrated in leaving Europe before it was too late
and how their immigrant experience was an act of love. She was surprised by how willing her
parents were to talk to her about their lives when she asked.

Encourage Accountability
In addition to providing support and validation for what Rena was owed, Peter encouraged
her accountability and responsibility to others from the very first session. He helped Rena
develop strategies to stay engaged with her daughters, even on down days. Rena discovered
that this outward focus often helped her feel better. She learned to be accountable for what
she expected from Gideon, her children, and her parents. As she became clearer that she was
entitled to receive love and care, that she was worthy, Peter also encouraged her to be
intentional in how she wanted to relate to others and what she wanted to contribute, not
only to her own family, but to the future.

Focus Forward
Understanding the effect of past injustices in her life and rebalancing the give and take in
her marriage and with her children helped Rena move from hopelessness to optimism for
the future. She made conscious choices about how to respond to her Jewish legacy and the
isolation her family experienced as a result of the Holocaust and immigration. She became
206 Socioculturally Attuned Contextual Family Therapy
involved in Bend the Arc, which is a Jewish Partnership for Justice, where she learned how
to advocate for the values she cared about. She also joined a knitting group at the Jewish
Community center that provided friendship and conversation in her new community and
she volunteered for a committee at her daughters’ school. She and Gideon took advantage
of the many beautiful parks in their area, hiking as often as they could. Though still on
antidepressant medication, Rena was working with her physician to lower the dosage with
the expectation that she may not need to continue them over the long term.

Summary: Third Order Change

Rena’s case illustrates how contextual therapy can catalyze third-order change that transforms
historical injustice and indebtedness to create an ethical balance in current and future re-
lationships. The therapist positioned his work to be accountable to values of fairness and
responsibility to others, actively engaging with clients in ways that moved away from
dominant culture ideals of self-interest, to our responsibilities toward others. This intentional
shift on the part of the therapist was the result of third order change in how he viewed his
professional role and responsibilities, with a focus on how the effects of his work ultimately
affect the next generation and which societal values are transmitted. He recognized choices in
how systems operate and that his actions were not neutral. This reflective stance served as an
overarching lens through which Rena and her family could see themselves as a transformative
link between the past and the future.
The therapy moved from a focus on individual pathology to the underlying relational
and societal injustice and uncovered family members’ desire to give. As they began to see
their connections to social structures and sociohistorical events, they recognized how these
had limited their responses to each other in ways that perpetuated isolation, loss, and
trauma. Naming the injustice and unfairness while also crediting what family members had
given each other enabled “exoneration,” or starting fresh, so that they could envision an
ethical balance of fairness and transform their ways of relating to each other and the wider
community based on awareness of systemic choices. They moved from isolation to love,
connectedness, and social action.

Reflexive Questions
• How would you describe the sociopolitical context of your family legacies?
• How would you describe the ways in which the giving and receiving of care across
generations are culturally informed and reinforced?
• Did you experience destructive entitlement due to needs and care not being given to
you in childhood? If so, how does that affect your familial relationships and work with
others professionally?
• Do you need to be freed from an invisible loyalty from the past and past injustices? If so,
can you name it and envision a more just and equitable future for yourself?
• “If reciprocity of commitment and earned entitlement are so fundamental to a viable and
balanced life context, why has the ethical dimension in family life so often remained
unaddressed (Boszormenyi-Nagy & Krasner, 1986, p. 211).”

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coronavirus pandemic. Family Process, 59, 825–831.
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10 Socioculturally Attuned Cognitive
Behavioral Family Therapy

Cognitive Behavioral Therapy refers to a range of problem-focused approaches that

address the reciprocal influences between thoughts, feelings, and observable behavior.
With roots in behavioral psychology, early models emphasized stimulus-response patterns,
goal setting, and behavior modification strategies. The addition of the cognitive compo­
nent in the 1970s emphasized how people’s thoughts or ideas about a situation impacted
their responses. In what has been called “the third wave” of behavior-based therapies
(Hayes et al., 2006), a variety of new, more contextually focused approaches, such as
Dialectical Behavior Therapy and Acceptance and Commitment Therapy have emerged.
Recent applications are also more attentive to emotion in both the evolution of problems
and in creating change (Fischer et al., 2016).
Though most CBT approaches still tend to focus primarily on individual experience
(Craske, 2010), cognitive behavioral family therapy (CBFT) (e.g., Dattilio, 2010; Epstein &
Baucom, 2002) and CBT in couples therapy (e.g., Epstein & Baucom, 2002) were developed
to deal with the more complex, systemic ways couples and family members’ underlying belief
systems, emotional responses, and behaviors influence each other. Proponents assert that
CBFT integrates well with other models, and can also take larger societal contexts into
account (Epstein & Dattilio, 2020; Parker & McDowell, 2017).

⤝⤞

Socioculturally attuned cognitive behavioral couple and family therapists

create third order change by attuning to systems of systems that maintain
problematic relational sequences.

⤝⤞

Primary Enduring Family Therapy Concepts

CBT begins with the premise that troublesome behaviors, emotions, and thoughts are
acquired, at least in part, through learning and experience and thus can be changed
(Craske, 2010; Epstein & Dattilio, 2020). The goal is to help people identify problematic
emotional, behavioral, and cognitive sequences and replace them with more adaptive
ones. When applying this process within a systemic framework, five concepts are parti­
cularly foundational: mutual behavioral reinforcement, schemas, cognitive distortion/
incongruent thinking, relational patterns of thought, emotion, and behavior, and therapist
as coach.

DOI: 10.4324/9781003216520-10
210 Socioculturally Attuned Cognitive Behavioral Family Therapy
Mutual Behavioral Reinforcement
According to learning theory, the consequences of an individual’s behavioral response have
an effect on its future occurrence (Craske, 2010). So if a child cries when a mother leaves and
the mother responds by giving the child attention and delaying her leaving, the child may be
more likely to cry the next time the mother leaves. Cognitive behavioral family therapists
focus on these kinds of observable patterns of interaction and the ways in which family
members serve as both stimulus and response for each other (Epstein & Dattilio, 2020).
Integrating Bandura’s (1973) ideas of continual social reinforcement with the systemic notion
of circular causality, one person’s behavior becomes the prompt for another’s. CBF therapists
would not only focus on the mother’s impact on the child’s behavior, they would be in­
terested in how the child’s behavior impacts the mother.
CBF therapists are interested in how mutual behavioral reinforcement cycles influence
family communication and problem-solving patterns. Historically, they have not usually
attended to how interlocking patterns within relationships are connected to larger socio­
cultural processes. For example, they might not ask how the mother’s response is related to
sociocultural expectations about mothering or gender inequalities in family life and the
workplace.

Schemas
The notion of schemas is central to how cognition is linked to behavior (Beck, 1967;
Dattilio, 2001). Schemas are “deeply rooted cognitive structures and beliefs that help define a
person’s identity in relation to others” (McKay et al., 2012, p. 9). They are experienced as
taken-for-granted “truth” about the world and our role in it. Schemas are acquired from
repeated messages about the self as we engage in social situations. They organize the huge
quantity of information in the environment into meaningful patterns that help us predict the
future. Schemas are tied to emotion and thus serve as triggers for behavior. Maladaptive
schemas such as the belief that others are unreliable, will harm you, or won’t meet your needs
are often connected to early childhood experience (McKay et al., 2012). From a CBFT
perspective, attachment working models (see chapter 7) are an example of a schema (Epstein
& Dattilio, 2020).
Schemas such as beliefs that one is inferior, unloveable, different, inadequate, or su­
perior and deserving are examples of how core beliefs about the self affect how one
approaches relationships and responds to others. If your internal truth is that you need to
put the needs of others over your own, then when someone is upset you will likely feel
guilty. But if your internal truth is that you are entitled to having your needs met, you
may respond with anger if someone seems to ignore you. These fundamental orientations
to others arise within a person’s web of relationships and societal contexts such as gender,
culture, race, ethnicity, socioeconomic status, sexual orientation, and other relevant social
locations that inform our position relative to others (Parker & McDowell, 2017;
Silverstein et al., 2006).
Though schemas are considered relatively stable over time, they evolve as we travel
through life, go to school, engage in the workforce, move across cultures, and utilize
technology (e.g., video games, television, movies, the internet). For example, children in the
same family may have very different schemas based on their experiences at school. One child
may develop a sense of herself as competent and the world as supportive and responsive;
another may see himself as picked on and view the world as a hostile place where he has to
fight for recognition or respect.
 Socioculturally Attuned Cognitive Behavioral Family Therapy 211
Cognitive Distortion/Incongruent Thinking
An important idea in CBFT is that family members perceive and interpret each other based
on relatively stable internalized schemas that provide roadmaps for how to respond (Dattilio,
2005). The problem is that schemas can be inflexible and create distortions in thinking and
attributions that create distress and conflict. For example, conclusions may be drawn about a
family member’s behavior without knowing all the facts or circumstances. Information about
another may be taken out of context, for example, if a man makes a decision without
consulting his female partner, she may believe he does not care about her. The behavior of a
family member may be overgeneralized, magnified, or minimized as in when a woman raises
a concern and her female partner responds, “I can never do anything right!” Or “I am
worthless.” How family members perceive each other affects their interaction. As they in­
teract, they not only create perceptions but also see what they expect to see, filtering out
information that does not fit.
For example, Frank’s schema suggests that Jenny should be available when he wants her
attention. He does not notice Jenny’s schedule or what her needs are and acts upset or
disappointed when she is not available. In turn, Jenny starts to see Frank as demanding
and self-centered. Given that her schema tells her she must satisfy him and keep the
peace, she accommodates him quickly to avoid conflict and keeps her resentment to
herself. Frank sees their relationship as comfortable and is not aware that she experiences
him as selfish.
After interacting together over many years, couples and families develop shared beliefs, or
family schemas (Dattilio, 2005), e.g., “we can’t upset Dad” or “it’s best to keep our thoughts
to ourselves.” Entrenched ideas about how each member behaves and how a family functions
and solves problems are foundational to the way a family operates. Oftentimes these are
helpful, such as when children learn that sharing their feelings is expected and welcomed or
when partners expect each other to share their concerns and are responsive to them. Schema
can also become rigid, restricting the interpretation of events and limiting choices and
flexibility (Dattilio, 2005). CBF therapists focus on how schemas can create distortions and
omissions in thinking that affect family communication processes (Baucom et al., 1989).

Relational Patterns of Thought, Emotion, and Behavior

Systemic therapists do not believe it is possible to separate one person’s patterns of thought,
emotion, and behavior from the relational systems within which they are embedded. They
are likely to be interested in breaking down or deconstructing the patterns of beliefs, attri­
butions, and experiences that create and perpetuate destructive relationship patterns. In the
case of Frank and Jenny, the CBF therapist would help the couple identify how each person’s
schema connects to their core beliefs about coupling and family life and how these guide
their assumptions about how to behave and what they can expect from the other. Each will
have brought their own schemas about relationships from their families of origin, and these
will have been impacted by their life experiences (Dattilio, 2001).
For example, even though Frank’s mother had a full-time job, she organized her schedule
so that she was always home before her husband. Jenny observed more mutuality between
her parents and had learned to put relationships first. When Frank did not seem to notice her
needs, her schema of self and others was challenged, leaving her hurt and surprised. When
Frank got angry, her idea that she should preserve relationships influenced her to respond in
ways that would calm him and, in the process, silence her concerns.
When people form adult relationships, they also create a union of their beliefs as they
interact and respond to each other. This combination of ideas and life experiences becomes
212 Socioculturally Attuned Cognitive Behavioral Family Therapy
the family of origin schema passed on to their children (Dattilio, 2005). The family schema
includes the beliefs, experiences, and perceptions of all the family members and evolves
over time as circumstances and experiences change and new family members enter (e.g.,
birth or marriage) or leave (e.g., death or divorce). Individual cognitions thus reflect shared
experience across multiple systemic levels. Jenny and Frank (and their children) are now
part of each other’s cognitive, behavioral, and emotional systems. They have unwittingly
enacted a model of male dominance that is now part of their own and their children’s
relational schema.
Shared schemas guide how we derive meaning from interpersonal experience and serve as
important underlying organizational mechanisms for communication and relational/family
interaction. Because societies and cultures are constantly changing, our shared schemas also
continuously evolve. Just the other day Carmen overheard a six-year-old say to his brother,
“When you grow up, do you want to marry a boy or a girl?” This statement reflected
societal-informed schema about himself and others and what he can expect in life that had
clearly been passed on to him by the people around him and legal changes in the US that
made this option possible.

Therapist as Coach
Cognitive behavioral family therapy is described as collaborative (Craske, 2010; Dattilio,
2010). The image of a coach is a good metaphor for the CBF therapist role. CBF therapists
are likely to begin by educating clients about the approach and some of the key concepts,
such as automatic thoughts, core beliefs, etc. They engage clients in the process of observing
repetitive patterns of thought, behavior, and emotion. For example, they might ask Frank
and Jenny to identify and record their automatic thoughts about each other and to note how
each thought influenced their responses to each other. The therapist might then engage with
them in a functional analysis of their interaction, pinpointing problematic schema formations
that are leading to cognitive distortions.
Like a coach, therapists work with clients to identify clear goals with specific objectives
for change. They then work to develop homework assignments and/or communication
and problem-solving exercises that will help clients attain their goals. The therapist is a
facilitator and educator that helps couples and families take new perspectives and try new
approaches to familiar situations. Because CBFT focuses on the complex relationships
between thoughts, emotions, behaviors, and context, treatment plans are flexible, with
therapists sometimes drawing on interventions from other models to help clients reach
their targets (Fischer et al., 2016).
One common CBFT intervention is to highlight and challenge thinking errors. Though
these thinking errors can differ among family members, cognitive distortions are often shared.
Both Jenny and Frank may assume that the burden for regulating emotion in the family falls
on Jenny; that it is her job to keep Frank calm. Or perhaps Frank’s masculinity-informed
schema leads to the idea that if someone loves him, they will always do what he wants and
not question him. Years of shared interaction have confirmed this perception and he and
Jenny may now share aspects of this idea. The therapist may help the couple challenge this
belief, consider alternative cognitions that might produce different responses, and help them
develop a plan to change this interaction.
The CBFT process requires active participation and motivation for change on each par­
ticipant’s part. CBF therapists keep therapy focused on defined goals, help clients create an
agenda for each session, and provide useful information. The therapist may help family
members practice good expressive and listening skills, facilitate conversation about their
interlocking communication patterns, and/or develop contracts with each other. Because
 Socioculturally Attuned Cognitive Behavioral Family Therapy 213
CBF therapists play active educational and structuring roles in the process of therapy, their
actions and input to therapy have a major impact on whether or not clients learn to see their
problems as manifestations of individual deficits or as connected to sociocultural systems and
the associated power processes.

⤝⤞

Therapists help determine whether or not new relational alternatives generated

in therapy replicate and maintain societal inequities or promote equity and
justice.

⤝⤞

Integrating Principles of Sociocultural Attunement

Practicing socioculturally attuned cognitive behavioral family therapy begins by taking stock
of one’s own conceptual frameworks about reality. Therapists must make sense of the vast
and often conflicting ideas, experiences, values, and beliefs that inform how we understand
and work with individuals, couples, and families, i.e., our schema of schemas (Parker &
McDowell, 2017).

⤝⤞

Socioculturally attuned therapists begin with the view that social schemas are
inseparable from personal and family schemas; they organize therapy in ways
that attend to power dynamics inherent in creating and maintaining these
schemas.

⤝⤞

Contextual Nature of Schema

Ideas integral to CBFT such as the value of having goals or that people can and should take
active steps to shape the direction of their lives tend to be linked to Western social schema
prizing individual autonomy and an orientation to the future. If we apply these measures of
clinical outcome non-reflexively, we may neglect cultural practices and resources inherent to
client solutions (Charlés & Bava, 2020). Learning to recognize how our own social schemas
implicitly organize what we see is an ongoing process, with some social schemas are easier to
recognize than others. Changing them requires intentional action (Williams et al., 2022).

⤝⤞

Shared social schemas are deeply embedded into every level of society and tend
to be almost invisible to us; they are so taken for granted that we often don’t see
how they shape and organize us.

⤝⤞

Societal schemas shape the experience of self and relationships from a very young age. A
major error in thinking typically occurs at birth when children are assigned a gender category
214 Socioculturally Attuned Cognitive Behavioral Family Therapy
based on the appearance of their genitals (Welch‐Ross & Schmidt, 1996). This creates and
reinforces the idea that there are two distinct gender groups and that people must fit into one
or the other. This gender schema limits the allowable options for everyone and disregards or/
and renders invisible a much wider range of experience. Parents, caregivers, and other
children believe in these binary differences and relate to children in ways that anticipate and
reinforce them, even though the biological differences between male-identified and female-
identified babies are minimal (Eliot, 2009). For example, when parents expect a male child to
be more active, they are likely to encourage and reinforce energetic behavior while being
more apt to calm a female child.
Societal gender schemas also typically presume heterosexuality as seen in a tee shirt for
a male infant that reads “chick magnet.” The slogan not only implies heterosexuality, but
carries power differences in the construction of gender by characterizing females as di­
minutive. When children do not fit this message, they learn that they are different, inferior,
or incompetent.
Heteronormativity and patriarchal gender systems tend to reinforce each other. Thus,
parents of a young boy whose behavior seems “feminine” (i.e., sensitive, submissive, emo­
tional) might worry that he will “grow up to be gay” and experience the negative effects of
homophobia. Though the parents would be confusing sexual orientation with gender, this is
a societal level error, not just a personal one. Conflating sex and gender is another societal
level cognitive error, assuming that biological sex and gender identities are the same when
they are not. To optimally support their child, the parents may need help distinguishing the
real effects of not conforming to these societal gender schemas and how to advocate for their
child and recognize their own unhelpful fears and beliefs (Malpas, 2011).
The impact of social schemas on families and family therapy involves the broadest levels of
social, economic, and political arrangements. When therapists attune to core beliefs within
clients’ schema, there is nearly always an opportunity to examine how these connect to
societal norms and values that reflect and maintain larger social systems. For example, Tony, a
cishet (cisgender heterosexual) working class father of three, sought therapy to address im­
pulsive behavior that he described as “sabotaging his relationship.” As he and the therapist
detailed the sequence of thinking and feeling surrounding this behavior, his acting out was
connected to core beliefs that “family men had to give up their creativity to keep a job.”
Rather than see this as simply a reflection of Tony’s individual distorted thinking, the
therapist engaged him in examining and naming the values and structure of the workplace,
societal expectations for men around work and family, and how these affected his personal
schema and relational well-being.
The effects of patriarchy, capitalism, and democracy came together in Tony’s schema in
ways that were inherently contradictory. The idea that men have to give up their creativity to
keep a job reflects Tony’s low-status role in the workplace hierarchy. Yet the cultural
measures by which Tony judged himself also included values such as free choice and enti­
tlement to respect that reflect and maintain the privilege of the dominant group (i.e., White,
upper class, able-bodied, heterosexual, cisgender privileged adult males). Patriarchy also
requires males to develop characteristics that will allow them to take power-over gendered
positions congruent with traits valued in capitalism (McDowell, 2015). Men are thus trained
to respond to others within a hierarchical schema of how relationships work (Tannen, 1994).
In Tony’s case, this meant he was supposed to comply with orders and policies delivered in a
top-down fashion while at work and then take a leadership role in his family. These hier­
archical relationship schemas left him feeling disconnected both at home and work. As he
learned to recognize how these societal schemas impacted him, he was able to give more
value to the relational role he wanted with his children and better understand his frustrations
at work and develop strategies for how to respond.
 Socioculturally Attuned Cognitive Behavioral Family Therapy 215
Conflicting societal messages also place women and girls in a cognitive bind. They are
socialized to develop relational schema (Jordan, 2009; Tannen, 1994). They are expected to
be emotionally attuned to others, yet also learn that thoughts and logic are valued over
emotions and intuition. Even though relational skills are institutionally and historically de­
valued, if women do not demonstrate them they are likely to be viewed as shrill, cold,
uncaring, or self-centered. Holding a stereotypic female schema inherently requires accepting
a less valued societal position to be desired or accepted.

Power and Social Schemas

Therapists need to name whose interests are reflected in the social schemas embedded in
their clients’ schemas. For example, African American family therapist and scholar, Marlene
Watson (2013) tells the story of her grandmother who said, “I was never pretty like my sister
Brazolia. She was the pretty one. I was black and ugly” (p. 1). Though a Black woman, her
schema of self and others reflected the societal framework that people with darker skin are
inferior (i.e., colorism). Social schemas generally promote the cultural capital (Bourdieu,
1986) of the dominant group by privileging how they think and what they do, while mar­
ginalizing the cultural capital and schemas of other groups. Like Dr. Watson’s grandmother,
people will unintentionally adhere to schemas that reflect and support unjust social ar­
rangements in their communities, living conditions, work settings, and intimate relationships.

⤝⤞

Power processes in the broader society tend to be reflected in the power

dynamics within intimate and family relationships.

⤝⤞

CBF therapists should not assume that each family member contributes equally to creating
the family schema or that each feels equally free or entitled to express their thoughts. For
example, in the case of Frank and Jenny above, the entire family operated according to
schemas that privileged Frank’s experience and caused everyone else to avoid saying or doing
things that might upset him. Jenny’s relationally oriented schema from her family of origin,
her experience as a woman, and more egalitarian models of marriage were subsumed over
time by Frank’s schema of male power and entitlement, even though he was largely unaware
of his expectations or how Jenny and the children accommodated him. Expecting Jenny to
challenge her schema-driven thoughts before Frank adjusted his, would be difficult given
Frank’s inherent power in the family system (Knudson-Martin, 2015). In some relationships,
encouraging a less powerful voice to express herself could be dangerous.

Prejudice and Discrimination as Cognitive Distortion

Prejudice is a form of cognitive distortion (Parker & McDowell, 2017). As discussed in
chapter one, economic and political systems play a large, and often contradictory, part in
determining which qualities and characteristics are socially valued and which groups are
privileged. Societal messages about the deficits and inadequacies of non-dominant groups are
integrated into our schemas, along with those promoting the superiority of other groups.
Those in marginalized groups are described in negative or less valued terms while positive
attributes are associated with members of the most privileged groups; as when some people
are thought to be smarter, more athletic, and better looking than others.
216 Socioculturally Attuned Cognitive Behavioral Family Therapy
Though based on inaccurate thinking, processes surrounding prejudice maintain existing
systems of power and privilege and support the idea that exceptions to our social schemas
(e.g., the “poor” kid who becomes wealthy) are primarily dependent on individual moti­
vation and hard work. CBF therapists can easily become inducted into promoting these
prejudicial systems (Williams et al., 2022).

⤝⤞

If therapists are not intentional about expanding their lenses beyond individual
and family schemas, they will likely label problematic symptoms as individual
deficits or flaws in thinking.

⤝⤞

For example, imagine a therapist is working with a teen from a low socioeconomic group
who has been identified as a behavior problem. If they help the youth recognize his
belief that “I will fail no matter what I do,” as distorted thinking, without exploring
the societal messages that tell him he is a failure, then the youth will see only himself as
the problem––or he will resist therapy––and the systemic nature of prejudice remains
unchallenged.
Prejudices are collectively enacted and they serve to maintain systematic discrimination
throughout society. Social norms, laws, policies, and precedents result in unequal access
to social influence and material resources (Jones, 1997).

⤝⤞

Those in dominant groups tend to internalize positive messages about

themselves such that their schema of self and others includes little or no
awareness of their privilege due to their group membership.

⤝⤞

In the US, this enables middle-class White males to view their economic success and
achievements as the outcome of individual hard work (i.e., the myth of meritocracy). This is
a cognitive distortion based on a partial truth; while hard work is important, the contribution
of other social supports and access to relevant knowledge and resources is overlooked
(Parker & McDowell, 2017).
Like the African American grandmother we discussed earlier, persons in marginalized
groups frequently internalize negative messages about their group. These destructive ideas
adversely shape beliefs about personal worth and abilities. For example, a woman may view
herself (and be viewed by others) as too emotional to make good decisions. Three social
schemas are involved here: one says that men are more capable leaders than women, another
says men are less emotional than women, and the other privileges intellect over emotion.
Moreover, this kind of systematic distortion (i.e., prejudice and internalized oppression)
results in discrimination that maintains the dominant social structure. That is, leaders of an
organization are more likely to be male and, regardless of who fills the position, expected to
disavow empathy to put the success of the institution over the needs and wellbeing of
workers. These social schemas also tend to denigrate those who receive welfare as unfairly
“living off others,” while viewing upper class wealth, made from the work of those in the
middle and lower classes, as fair.
 Socioculturally Attuned Cognitive Behavioral Family Therapy 217
Social schemas that support established larger systems are reflected in the attitudes, values,
and behavior of individuals and families. For example, in the US the economic system de­
pends on the willingness of people in the middle and lower classes to work hard, which is
reflected in how values play out within families. Family members may be in conflict over
what work counts, whose work is more important, and so on. The tendency to value paid
work over family work is directly linked to societal schema connected to capitalism (Folbre,
2001). These schemas likely contribute to the power Frank holds in his family and Jenny’s
tendency to accommodate his work schedule.

Impact on Equity and Well Being

Socioculturally attuned CBF therapists should be alert to and intervene in the impact of
societal schemas that suggest who is worth more––who deserves what and why. These
schemas contribute to health and well-being in multiple ways, from viewing environmental
and structural inequities as “fair” or “normal,” to the stress of living daily with discrimination,
to treatment protocols that do not fit the reality of one’s experience or cultural values. This
helps explain why the quality of people’s health in the US depends on their race, socio­
economic class, gender, sexual orientation, age, and ability (Centers for Disease Control and
Prevention, 2013; Watson et al., 2020; chapter 1, this volume).

⤝⤞

Client symptoms should always be examined in relation to their location in

larger systems of stratification, power, privilege, and oppression, as well as the
patterns of thinking and doing that perpetuate prejudice and discrimination.

⤝⤞

For example, Deidre, a White single parent, mother of four, was referred to a community
clinic for depressive symptoms. At first, Deidre appeared difficult to engage and somewhat
hostile. When the therapist expanded the assessment of the presenting issues to include the
sociocultural context, Deidre became more engaged. The therapist learned that the family
was living in a homeless shelter, the children needed to get to three different schools, and no
school buses served the shelter. Deidre feared that she was at risk of losing her children if they
were late for school again.
Deidre’s automatic thoughts were that it was hopeless to deal with the school system
and that she was a failure as a mother. Even so, she did not give up. She made an
appointment to see the school official monitoring her case but returned feeling defeated
and even more fearful. Applying third order thinking, the therapist and Diedre could
envision more equitable possibilities by visiting the school together. The therapist’s role
was to work with the school official to identify the patterns of thinking (i.e., prejudices
and oppression) within the larger system that made it difficult for the official and Diedre
to find a more adaptive solution. This enabled a transformative systemic shift in
thinking and the school to help develop a more workable plan. Though Deidre con­
tinued to address her role as a mother, her depressive symptoms improved almost im­
mediately. If the therapist had focused the therapy primarily on developing more positive
thoughts about herself and ways to be more organized in preparing the children for
school, Deidre would have continued to internalize ideas that she alone was responsible
for her children’s success or failure and the school system would continue to see her as a
problem parent.
218 Socioculturally Attuned Cognitive Behavioral Family Therapy
Third Order Change
The possibility of third order change depends on seeing the systems we are embedded in
and envisioning alternative options and choices. It helps to realize most cultures are
complex and people enact cultural models in many different ways. For example, a study of
heterosexual couples in Iran found that they drew on multiple societal schemas when
describing their relationships and there appeared to be considerable diversity in how
Iranian couples integrated and responded to potentially contradictory societal schema
(Moghadam & Knudson-Martin, 2009). Though the powerful impact of male dominant
social norms was evident as women reported ways husbands could use the law to limit
where they went, others spoke of values inherent in Islam that promoted expectations of
mutuality and respect for women and described them manifested in their marriages. The
authors concluded that couple and family therapists should help clients explore religious,
cultural, and legal values and ask what their faiths or cultural norms teach about justice and
respect, rather than assume that these social schemas are not open to reflection or able to be
enacted differently.

⤝⤞

Conflicts inherent in social schemas are common and create openings for third
order change.

⤝⤞

For example, a couple’s power dynamics might be influenced by the deeply embedded
expectations one or both hold about who has the right or is more qualified to make major
decisions (patriarchy), alongside the expectation that each should have equal voice (de­
mocracy). While these contradictions can be the source of cognitive distortion, they are also
potential fertile ground for developing more adaptive relationship patterns. People are usually
not aware of the impact of contradictory societal schemas in their lives. When these are made
visible, they have more choice. If Frank is asked whether he thinks Jenny’s needs should be
important, he is likely to draw on beliefs regarding equality and say they are.
The ability to transform destructive patterns is enhanced when people are aware of the
multiple values inherent in their social schema, the consequences of each, and whose interests
these represent and maintain. In Text Box 10.1 Elizabeth Parker describes how to help
couples break societal gender schemas into the nitty gritty of how they show up in the
division of labor, and how doing so helps couples address conflict and be more intentional
about how they divide family labor.

Text Box 10.1 Elizabeth Parker, PhD

Elizabeth Oshrin Parker (she/her) is a family therapist and researcher. She has
done research on a variety of topics including complex trauma, effects of
discrimination on mental health, and quantitative research methodologies.
Many couples come to therapy citing “communication” as a primary issue in
their relationship. People say if they could communicate better and be “nicer” to
each other, then their relationship would function better. However, after clinical
assessment, we find an imbalance in the relationship, where one person—most
 Socioculturally Attuned Cognitive Behavioral Family Therapy 219

often the woman, in male/female relationships—is carrying more responsibility.

This can include tangible duties such as care tasks and childrearing, and also
intangible requirements of a functioning relationship, such as tending to the
emotional health of the relationship or carrying the mental load (for example,
remembering what and when things need to be done).
What this often looks like is both partners working paid jobs outside of the home,
but with the woman in charge of all the tasks that make a family run smoothly.
Sometimes, this manifests as the female partner doing all the care tasks (cleaning
dishes, washing floors, changing sheets, buying soap, etc.), and sometimes it
looks like both partners are doing care tasks at home, but with the female partner
in charge of carrying the mental load of these tasks. Carrying the mental load
means that the female partner is remembering when the sheets need to be
changed, knowing the preferred soap of each family member, or doing the
logistical work of setting up interviews for a nanny. She might ask her partner to
help, and he might do so willingly, but she is still in charge of remembering each
task and knowing the when, what, and where of these tasks.
The concept of schema can be helpful in examining the greater societal
expectations of husband and wife roles that have been inherited and absorbed
in the relationship, and can also help in breaking down the more concrete and day-
to-day workings of family life. Take meal preparation: Say the woman does the
majority of the cooking, but one night she asks her husband to cook dinner
because she is feeling tired. He agrees and cooks the dinner that she was
planning on cooking. Now, while this might look like sharing the responsibility of
dinner, the cooking of the actual meal is only one part of meal production. The
woman had already decided what to make, learned the ingredients that go into the
meal, gone shopping for those ingredients, and put away the food from the store. If
the man has the schema that “making dinner” is the physical act of preparing the
meal and the wife has the schema that “making dinner” includes all of the
preparation previously mentioned, this mismatch can cause inequity and conflict
within the couple. The man may have in his mind that he has taken a task off of his
partner and could be frustrated that “she’s still not satisfied,” while the female
partner still feels run-down and exhausted by all of the other components that go
into meal preparation.
Schemas are useful for helping couples take unconscious expectations of what
relationships and tasks should look like and turning them into conscious choices
between partners. It is important to spend time with the couple to look closely at how
their relationship functions and then break down all of the components of their family life.
Many have schemas inherited from their families or modeled by society that the woman
is in charge of family life and the man contributes partially to tasks. You can see this
when the couple describes the man as “helping” with laundry or babysitting his kids.
Recall the example of meal preparation and the different understandings of what the
task entails. Helping the couple come together on a mutually agreed definition of what a
task is and who is responsible for it can help them restructure their expectations of each
other in order to have a more equitable distribution of family life and ultimately take the
strain off the couple’s relationship.
220 Socioculturally Attuned Cognitive Behavioral Family Therapy
⤝⤞

Though it is not easy to step outside dominant social schema, practicing from a
socioculturally attuned perspective can lead to more options and third order
change.

⤝⤞

Practice Guidelines
The following five practice guidelines help family members recognize commonly held so­
cietal schema, track their effects on their relationships, and develop alternative relationship
models that work better for them (Parker & McDowell, 2017). It is helpful to note that they
are not always implemented sequentially and may move fluidly back and forth over the
course of the therapy.

1 Identify Problematic Schemas

Socioculturally attuned CBF therapists systematically gather information about how client
families function, identifying the schemas and cognitive distortions that contribute to con­
cerns that brought the family or couple to therapy.

⤝⤞

Socioculturally attuned cognitive behavioral family therapists look to the larger

context to help pinpoint societal schemas that underlie problematic behavior,
provide contextual meaning to family interaction, and affect the way family
members perceive and impact each other.

⤝⤞

Figure 10.1 provides questions that can help guide therapists’ initial assessment of potential
sources of societal schemas that contribute to the problematic schemas affecting each client.

2 Track Patterns at Multiple Levels

CBF therapists help family members track how their thoughts, feelings, and behaviors are
part of circular interactional patterns that include multiple family members. In this process,
they make explicit how problematic schemas underlie the targeted emotions and behaviors.
Tracking patterns provides an opportunity to begin to discuss the beliefs and ways of making
meaning that guide family members’ expectations of each other and makes the thinking
behind the behaviors visible. Socioculturally attuned therapists approach this task with in­
terest in how the patterns they are identifying are part of cultural, historical, and sociopolitical
processes and seek to expand and contextualize them (Pandit et al., 2014). As the therapist
develops questions and hypotheses that clarify the repetitive patterns and cognitive distor­
tions, family members begin to see themselves responding to each other and develop an
interest in the source of the schemas influencing their relationships. Therapists use a variety of
techniques to visualize these patterns of influence, such as the downward arrow technique
(Beck, 1995) (see Figure 10.4).
 Socioculturally Attuned Cognitive Behavioral Family Therapy 221

Source of Societal Schemas Therapist listens for

Place In what kinds of contexts is the client

embedded? How have these contexts changed over
time? How much mobility is possible?

Gender What societal messages about gender has the

client internalized?

Socioeconomic status How do socioeconomic status and economic

situation impact schema of self and other?

Sexual Orientation How have societal messages about sexual

orientation influenced client’s internalized
identity and expectations about the life cycle?

Sociocultural Location How do clients’ culture, religion, age, race,

ethnicity, and disabilities impact their schema of self
and relationships?

Larger Systems How do client relationships with legal structures

(immigration, justice system, and so on) impact
their schema of self worth and agency?

Social Power How much personal, interpersonal, and

institutional power do clients experience as a
result of their societal position?

Societal Position What overall messages about self in relation to

others are perpetuated by client’s position in
societal context?

Figure 10.1 Sources of societal schemas and influence.

Source: Adapted from Silverstein et al. (2006) p. 399.

3 Connect Individual, Family, and Societal Schemas

Therapists must be intentional in helping families become aware of the ways they are en­
acting commonly held societal schemas. When family members see themselves caught in
patterns larger than themselves rather than as simply something wrong with them, their
experience is less pathologized (Pandit et al., 2014). Once thoughts, feelings, and behaviors
are identified, there are many ways therapists can help people explore the underlying as­
sumptions or values that societal schemas impose on them and how these impact their be­
havior. Video clips from movies or psychoeducation groups can be helpful sources of
consciousness-raising conversation. Therapists can recognize societal schemas embedded in
clients’ automatic thoughts and directly identify them and track their consequences in the
222 Socioculturally Attuned Cognitive Behavioral Family Therapy

Sample Questions to Link

Personal, Family, & Societal Schemas

1. The idea that [insert distorted individual thought] is interesting. Where do you
think you learned [insert parallel societal stereotype or expectation]? How did/does
[your family] enact this pattern?

2. I noticed that when [interpersonal trigger] you responded by [insert societally

stereotyped or inequitable behavior]. What thought was going on for you right
then? Is the idea that that [client answer] common among other [relevant social
group] that you know?

3. The idea that [cognitive distortion] is really causing you to [problematic

behavior]. How do you suppose this kind of idea has affected other people [or men,
women, etc] in our society? How do you think this idea has emerged in history?
How does the thought that [distorted societal idea] affect others in your family?

4. When you feel [troubling emotion] what thoughts about yourself as a [relevant
social group/role] pop up for you? What messages in society encourage this
thought? What expectations about [social role] do you take in? What parts of
yourself do you have to keep hidden? How does this impact others?

5. How do others in your community to view [problematic behavior]? What moral

codes or societal expectation are tied to your [distorted thought]. Who in society
benefits when you think this way? How did you learn to think this way? How has
this kind of thinking affected your family/relationship?

Figure 10.2 Questions to link personal, family, & societal schemas.

relationship. For example, when a woman says that her thought was that she didn’t want to
upset her male partner, the societal idea that “women should protect men’s emotions” could
be named as a societal expectation and its consequences on her and the relationship iden­
tified. A column for messages from society can be added to a thought record (See
Figure 10.5). Opportunities to critically reflect on the connection between personal, family,
and societal schemas from a meta-perspective are empowering (Hernández et al., 2005).
Figure 10.2 provides examples of questions that can help make this link.

4 Commit to Alternative Relationship Models

As consequences of destructive societal schemas are linked to the sequence of thoughts,

emotions, and relational patterns, family members become interested in other options. Values
associated with alternative ways of relating can be explored, which enables family members to
take more ownership of the values that they want to guide their life (McKay et al., 2012;
Williams et al., 2022). Recognizing how their reactions to each other have been connected
to restrictive and/or inequitable societal models decreases self-blame and makes it more
possible to label barriers, observe impulses to act with old schema coping behaviors, and
 Socioculturally Attuned Cognitive Behavioral Family Therapy 223
develop values-based strategies to move beyond them. To help overcome the power of
dominant societal schemas, therapists provide leadership in engaging family members in
examining and experimenting with relationship models that support the well-being of all.
They support couples and families in envisioning an agreed-upon plan for change.

5 Create Behavioral Change Based on New Schemas

Core schemas of self and others are very persistent. Clients are now ready to actively
engage in an intentional process of responding to each other based on the new schemas to
which they have committed. This requires activities that help each of them recognize
when problematic emotions and thoughts arise and to do something different. The
therapist may provide education about practices that help enable this kind of behavioral
change. For example, they may teach mindfulness skills to facilitate emotional regulation
(McKay et al., 2007) or strategies to face emotions rather than avoiding them. The
therapist helps family members and partners track their new responses to each other and
identify how they overcame the old emotional cues and thoughts, as well as the pieces
involved in enacting something new. They provide support and guidance that enables
people to persist even when powerful emotions and old thoughts arise. Part of the
coaching role is to remind people of the values and goals they identified and help families
develop homework activities that keep the new relational schemas visible, such as a
communications checklist or values intentions worksheet. Figure 10.3 is an example.
Therapists invite clients to rate themselves and their significant others (usually, sometimes,
seldom), then note where there are discrepancies in perceptions and discuss how their
internalized social schemas may contribute to their differing perceptions. Clients should
identify areas for discussion and/or practice in their therapy sessions.

Case Example
Jared (35) and Pamela (29), a European American cishet working class couple married for
eight years, sat straight, their bodies stiff as they described the concerns that brought them
to the MFT training clinic. They said that about the only time they talked was when
they were “fighting about the boys.” Aaron (aged 13) did not want to go to school, Jason
(aged 12) got into fights, and they feared that Dillon (aged 9) worried too much about
all of them. Pamela reported feeling “depressed” and “exhausted all the time.” Their
therapist, Claudia, a Latina family therapy graduate student, aged 35, was also a married
cishet woman and mother of a toddler. As the session began, Claudia noted that the couple
seemed nervous and approached her as an authority. Jared said that he “wanted to learn
what he was doing wrong.”
Claudia was aware that the couple’s subservient orientation to her was very different
from how she had learned to approach authorities in her relatively affluent home. She was
mindful that her context for parenting was likely to be very different from this family’s.
She checked her own feelings about Pamela having become a mother at such a young age.
While mostly experiencing awe for how anyone could manage this, she was also conscious
of some beneath the surface judgment that Pamela “should have planned her life better”
and recognized this as part of what she had learned was important to be successful. When
she did not plan, Claudia felt inferior, less than. She had been especially careful to avoid
the stereotype that Latinas get pregnant at a young age. This self reflection helped Claudia
orient herself to the couple with respectful curiosity about how they made meaning of
their responses to each other and an interest in how the world around them influenced
their schemas.
224 Socioculturally Attuned Cognitive Behavioral Family Therapy

Perception Perception
Relational Practices
of Self of Other
Attunement to Others
How interested are you in knowing and understanding the
other’s experience and perspective?
Do you listen to your partner? Your children? About what? In
what circumstances?
To what extent do you notice and respond to the other’s
feelings and needs?
Openness to vulnerability
How willing are you to show weakness, uncertainty, or mistakes
in your partner’s presence?
How safe and willing do you feel to share innermost thoughts
and feelings with your partner?
How likely are you to seek relationship repair by expressing a
feeling or concern?
Accepting influence
How able are you to engage the other in addressing issues that
concern you?
How free do you feel to directly express their opinions or make
requests?
How readily do you accommodate your interests/schedule to fit
your partners’/the family’s needs and schedule?

Relational responsibility
To what extent do you focus on what is needed to maintain or
improve your relationship?
To what extent do you keep track of what needs to be done in
the house? For the children? For the relationship?
How responsible are you for doing the emotional work in the
relationship?

Figure 10.3 Relational practices checklist.

Source: Adapted from the Circle of Care. Knudson-Martin & Huenergardt, 2010; Knudson-Martin & Kim 2022
(see chapter 14).

Identifying Problematic Schemas

Claudia wanted to get background information about the family’s context and the factors that
might influence their personal and family schemas. She also wanted to engage the couple in
an exploration of their interaction patterns and begin to develop hypotheses about the se­
quence of thoughts, emotions, and behaviors causing distress. After she gave the couple hope
and a vision of how change could occur by describing the process of therapy, she explained
that problems were often related to living in environments that created toxic and distorted
ideas about ourselves and how we relate to others. She invited the couple to describe the
problem that brought them to therapy.
When Jared said he was frustrated and didn’t know what to do, she asked questions that
helped to detail his view of the problem, “What happens? Who does what? What thoughts
go through your mind? She was especially interested in understanding the context in which
 Socioculturally Attuned Cognitive Behavioral Family Therapy 225
he felt so helpless. Jared described fights between Pamela and the boys. He would raise his
voice and tell the boys to stop arguing with their mother, but this did not help and seemed to
make Pamela even more upset. When Claudia asked him what he did when his efforts didn’t
help, Jared replied that he felt “useless” and usually “gave up.” Using the questions in
Figure 10.1 as a guide, Claudia recognized his feelings as connected to societal schemas that
create the distorted expectation that men must always be competent and in charge.
Turning to Pamela, Claudia was aware that not all voices in a relationship come from
equal positions and made sure to not automatically follow Jared’s definition of the problem
and to instead invite another perspective, “Jared says that it’s upsetting to see you and the
boys fighting and to feel useless in making the fighting stop. That’s his point of view. What
do you see as the problem?” Pamela described being worried about the boys and needing
to protect them. She was quick to praise Jared, who was not the birth father, for being
there for them. Claudia asked questions to detail what happened from Pamela’s point of
view and began to establish a picture of how her responses connected to Jared’s. For
example, Pamela repeatedly spoke of how indebted she and the boys were to Jared. When
Jared would yell at the boys it triggered thoughts that she had no right to expect much of
him. They began to pinpoint Pamela’s underlying schemas about self and others––that it
was not safe to trust anyone and that she was unworthy if she upset a man. Claudia
wondered how these personal schemas connected to larger sociopolitical systems and how
these impacted what happens within this family.
Claudia immediately began to widen the lens to learn more about the societal contexts
surrounding their problems and expanded upon this in the next session. She asked about the
neighborhood they lived in and their experiences with school, economic, and legal systems.
She asked about how others had viewed their families growing up and what they learned
about things like gender, social class, and sexual orientation. She encouraged reflection about
how these affected their expectations and responses. Together, using questions like those
illustrated in Figure 10.2, the therapist and couple began to pinpoint a troublesome sequence
in which the emotions and automatic thoughts generated around parenting resulted in re­
sponses that distanced them from each other and increased arguments with their children.

Tracking Patterns
The boys were invited to several sessions to further track interactional patterns. Claudia
helped the family observe their responses to each other, systematically detailing how each
served as triggers for the others. For example, when Pamela said that 12-year-old Jason was
getting in fights at school and needed to change his behavior, Jason told her to back off.
Nine-year-old Dillon came to Jason’s defense and 13-year-old Aaron rolled his eyes. When
Pamela raised her voice and repeated her concern, telling Jason that fighting was dangerous
and would get him in trouble, Jason directed an angry curse toward her. Jared told him to
respect his mother.
The therapist guided the family in identifying each person’s automatic thoughts and reac­
tions, making visible a behavioral sequence they could all recognize and bringing new
awareness regarding their situation. Underneath Jason’s reaction was the idea that if he did not
fight, he would never be respected at school; that he would not survive. Aaron anticipated
increased distress between his parents that he could do nothing about and squelched his fear that
Jared would leave the family by telling himself he didn’t care. Nine-year-old Dillon broke into
tears, saying that Mom should leave Jason alone; that she was making everyone unhappy.
Pamela became visibly depressed, a reaction supported by the idea that she was worthless
because she failed to keep all members of the family safe and was upsetting them. Jared phy­
sically pushed his chair back saying, “I give up.” The therapist helped clarify the desire for
226 Socioculturally Attuned Cognitive Behavioral Family Therapy
family members to be able to express disagreements and still love each other. All agreed that
helping mom and dad stay connected to each other during times of stress was a primary goal.
In couple sessions, Claudia helped Pamela and Jared create a downward arrow diagram to
visualize the connection between their contexts, core schema, and responses to parenting. As
illustrated (Figure 10.4), parenting was connected to core schemas about self-worth and gender
for both parents. When the boys acted out or were distressed, Pamela experienced an almost
automatic cascade of thoughts connected to the societal idea that “women’s worth is defined by
men.” This led to the irrational thought that “she is worthless if the children upset Jared.” Jared
reacted to underlying societal schema regarding male leadership that in the end translated to the
distorted idea “that for him to be a man, Pamela had to keep the boys in line and doing well.”
The couple readily recognized these thoughts as errors that did not really represent how they
viewed parenting or their relationship with each other but escalated in times of stress.

Connecting Individual, Family, and Social Schemas

Claudia helped the couple develop strategies to observe their own behaviors, recognize when
they were being triggered, and identify their underlying automatic thoughts. They discussed
situations that happened and what they noticed. As they talked in session, they created “thought
logs” that included the triggering event, feeling, thought, response, and associated societal
expectation. An example is illustrated in Figure 10.5. Expanding the pattern to detail how their
environment contributed to the family pattern helped Jared and Pamela feel understood and
validated and more able to approach their problems without blaming themselves or each other.

Pamela: Women’s Worth & Children Jared: Men’s Leadership & Children

Women’s worth is defined by men Men must be in charge

Men’s opinions matter more than women’s To be in charge I must know what to do

People expect me to be competent

When a man treats me badly I am
worthless If others see me as incompetent I am a
failure
It’s my job to learn how to please a man
It is not acceptable to be a failure
It hard to know what will please a man
When I cannot handle the boys I am a
I must be very careful not to upset a man failure

Men are not allowed to be a failure

When Jared yells at me I am worthless
For me to be a man, the boys must
Without Jared my children and I are behave properly
nothing
For me to be a man Wendy must keep
My children must not upset Jared the boys in line.

I am worthless if my children upset Jared

Figure 10.4 Downward Arrow Illustration.

 Triggering Event Thought Feeling Societal Schema Response

Pamela: School calls School is unsafe Guilt Stereotype that Black Call Jared to ask him to
because Aaron is not in kids are violent and hate talk to the school
school. gay kids

Schools judge parents

I’m a bad mother Worthlessness

Jared: Pamela calls me The guys think I’m a Embarrassment Men shouldn’t let Anger at Pamela.
at work. “wus” women “hang on them”

My boss might see Anxiety Work and family should Refusal to call the
be separate. school

Pamela: Asks Jason to Jared’s worked hard; the Guilt Women need to calm Yells at Jason that he
turn down the music and noise will upset him. men. won’t be able to go to
do his homework the party unless he does
I can’t even get Jason to Worthlessness Mothers are responsible his homework.
do his homework

Jared: Jason calls Pamela is too controlling Anger Boys should not be over- Yells at Pamela, “why
Pamela “bitch,” slams protected are you always over-
his door, & turns up the reacting?” and goes out.
music I’m entitled to some Anger Work is a man’s
peace and quiet priority; he should be
able to relax at home.
Socioculturally Attuned Cognitive Behavioral Family Therapy 227

Figure 10.5 Thought log with societal schemas.

228 Socioculturally Attuned Cognitive Behavioral Family Therapy
For example, the high cost of housing in their urban area meant that they could not afford
to own a home near Jared’s work even though he had to drive three to four hours every day.
Claudia asked questions that helped the couple examine taken-for-granted assumptions about
owning a home and how this societal-driven need was related to social schemas about class
and economics that made owning a home a measure of personal worth and success, especially
for Jared.
They discussed how the schools in their neighborhood suffered from limited resources and
Pamela’s fears about violence on the school grounds. When she saw Jason fighting, she feared
that he was taking on male models of violence that triggered her own experience with men.
They also examined the racial composition of schools and how as parents of White children,
their fears might be related to racial stereotypes and biases regarding children of color. They
began to consider how to talk about racial issues with their sons without perpetuating dis­
crimination and irrational racist fears.
Pamela was especially concerned for Aaron’s safety, as he had recently told his parents
that he thought he might be gay. They examined each parent’s responses to these safety
concerns in light of internalized societal ideas about masculinity, sexual orientation, and
appropriate behavior for boys. Though both parents said they accepted Aaron’s sexual
orientation, they needed help examining how internalized homophobia limited their
ability to engage with Aaron and support him. Jared, who already felt unsure and disen­
gaged from his role as a father, was especially at a loss regarding how to develop a re­
lationship with a gay son.
Pamela, who became a mother at sixteen and had lived in a world dominated by poverty
and male violence prior to meeting Jared, felt extraordinarily grateful for his financial sup­
port. They examined how her ideas about herself were influenced by societal schema that
valued people based on their income and limited what people with little money felt entitled
to. Jared, who was brought up in a middle-class family with a physically violent father,
adamantly resisted using physical force. With no positive model for how to engage with the
family, he focused most of his personal identity on work. Jared began to recognize how his
anxiety at work was linked to underlying societal schemas that valued his performance at
work more than his relationships and caused him to resist missing work for family matters but
take time from family to “go out with the guys” after work. Pamela came to see that part of
her depression was internalized anger at the unfairness in their relationship and gendered and
classist ideas that, though she desired more emotional closeness with Jared, said she was not
entitled to it.

Commit to Alternative Schemas

Jared and Pamela began to have a sense of the systems of schemas influencing them. They
saw how the schemas into which they had been socialized, together with their prior life
experiences, generated automatic thoughts and emotions that triggered behaviors that
added to their stress, increased conflict, and created emotional distance. To achieve their
goal of staying connected even in the face of conflict, they not only needed to change the
way they communicated, but they also needed to identify and commit to a new relational
schema. Because societal schemas limit the options people are able to envision, the
therapist gave them a handout illustrating a model of relationship based on equality and
mutual support that she “borrowed” from Socio-Emotional Relationship Therapy (see
chapter 14, Figure 14.1) and used it as a guide to help them examine and identify values
that were important to them. She also engaged them in conversations about ideals they
wanted to model and support for their boys as they form relationships and participate in
social systems outside the family.
 Socioculturally Attuned Cognitive Behavioral Family Therapy 229
With Claudia’s encouragement and support, Pamela and Jared made a list of the values to
which they wanted to commit. For example, they decided they liked the idea of shared
relationship responsibility. This meant they had to resist societal schemas that said women
needed men but men didn’t need women, that women were responsible for raising children,
and that men always had to have the answers and be competent. They wanted to know
Aaron as a person and not just accept him as “gay.” This meant they had to relate outside
gender and sexual binaries and stereotypes. Jared wanted to learn to have a father-son re­
lationship with him and their other sons. Overall, they wanted to organize their family more
around relationships and less around economic measures of success and to equally support
the wellbeing of every family member.

Creating Behavioral Change Based on New Schemas

Though Pamela and Jared did not have the time or comfort with writing to keep regular
thought records at home, they created a special place to keep copies of those made in session
easily accessible. They also found it helpful to tape a copy of the model of mutual support (see
chapter 14, Figure 14.1) where they could see it. Pamela and Jared showed the diagram to the
boys and told them they were trying to model a new way to respond to each other. The
therapist also helped the couple practice letting themselves sit briefly with their stressful
emotions, recognize them, and name the family and societal messages underlying them. This
made it easier to respond differently. When the couple reported triggering events that re­
sulted in the old cycle, Claudia coached them in identifying new responses that would help
them attain their goal of staying connected during times of stress.
One of the most transformative sessions included the boys. Claudia guided a conversation
about masculinity between them and Jared. Jared spoke of what he had learned about the
destructiveness of needing to be “in charge” and how he had not really learned how to focus on
others in the family. He told Aaron that he wanted to not let his fears about homosexuality limit
their relationship. With Claudia’s encouragement, Aaron was able to risk sharing his ideas about
what he’d like from his father. And, following Aaron’s lead, Jason and Dillion described how
they’d like to engage more fully with Jared. Witnessing this event between her husband and
sons helped Pamela solidify a new schema about men, women, parenthood, and her worth.
Claudia asked her to share these ideas with her family. The family examined the list of values
they had previously made in terms of both the progress they had made and the new challenges
they gave themselves. They had learned to take a meta-perspective on societal schemas and
were moving into third order change, intentionally developing a new shared family schema less
constrained by inequitable and limiting societal messages and structures.

Third Order Change: Summary

Socioculturally attuned cognitive behavioral family therapy is well suited to the process of
third order change. The approach encourages people to raise consciousness about societal
influences on their thoughts and how these are connected to their emotions and inter­
actions. Couples and families can recognize the impact of societal inequities in their lives
and decide to create more just relationships and challenge discriminatory social distortions
that maintain them.
In the case of Pamela and Jared, first order change occurred when Pamela learned to pause
and be aware. She was able to recognize that the extent to which she worried about upsetting
Jared was problematic. She began to respond in ways that helped her feel better about herself
and the marriage. Second order change occurred when Pamela and Jared redefined their
shared family schema to include more options for who does what. Family members no longer
230 Socioculturally Attuned Cognitive Behavioral Family Therapy
held Pamela responsible for everyone else’s behavior. Third order change occurred as they
began to develop social awareness, to consider the systems of systems that influenced them,
and began to see how their life was organized around prescribed roles.
Pamela and Jared no longer automatically followed societal norms and expectations. They
still experienced times of conflict and confusion, but their response to the conflict was
different and brought them together as they reminded themselves of the societal schemas they
were resisting. If automatic thoughts from earlier schemas were triggered, they recognized
their oppressive nature and were able to draw on a different view of the world. The ability to
see multiple sets of societal schemas and make choices in relation to them was transformative.

Reflexive Questions
• If you could make a list of 5 societal schemas (schemas that reflect dominant societal
values and beliefs) that have shaped your experience of self and relationships, what would
they be?
• How do you think these societal schemas affect your thoughts, feelings, actions, and
interactions in personal and professional relationships?
• If prejudice is a form of cognitive distortions, what makes them sustain over time? How
can they be disrupted by cognitive behavioral couple and family therapy?
• What are your reactions to this statement? “If therapists are not intentional about
expanding their lenses beyond individual and family schemas, they will likely label
problematic symptoms as individual deficits or flaws in thinking.”
• How can you help families disrupt disempowering societal schemas and transform them
to schemas that reflect their needs, interests, and vision?
• What are the tools, interventions, or means by which you have helped others recognize
the impact of societal inequities in their lives? How did these processes lead to more just
relationships and challenge discriminatory social distortions that maintain them?

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11 Socioculturally Attuned Solution
Focused Family Therapy

Solution focused family therapy (SFFT) evolved from the work of Steve de Shazer, Insoo
Kim Berg, and their colleagues during the early 1980s in the United States (US) at the Brief
Family Therapy Center (BFTC) in Milwaukee, Wisconsin. Those at BFTC developed a
collaborative, ecosystemic approach that assumes families have the solutions they need to
solve problems (Lipchik, 2002). SFFT shares a number of tenets with other brief systemic
models, including a focus on the here and now, the assumption that change can happen
quickly, understanding problems from a relational, interactional perspective, and the idea that
small change can lead to more significant change. Reliance on a social constructionist, post-
structural framework also aligns SFFT with postmodern models such as collaborative and
narrative family therapy (Chenail et al., 2020), and the approach can be integrated into a
variety of other family therapy models (Nelson, 2019).
Solution focused family therapy is more about creating change than about understanding
problems. Consider parents who enter therapy with their four-year-old child who is having
angry outbursts. The therapist acknowledges the problem but assumes the child does not
always have outbursts. They ask parents about places in which outbursts do not occur,
question the family about times when outbursts are less severe, and search for times when the
child starts to have an outburst but quits. As a solution focused brief therapist, they put their
energy into what works. They help the family determine what is different about their
thoughts, feelings, behaviors, and interactions during times when the problem is not oc-
curring, (i.e., when the family is engaging in preferred behaviors and interactions). The
therapist works together with the family to identify and amplify solutions that have been
overlooked, avoiding hypothesizing about the cause of the problem, e.g., that the parents
don’t have enough control, the child is expressing pent up feelings, or the child is caught in
marital conflict. Solution focused family therapy relies on the idea that change is always
happening and there are always times when presenting problems don’t occur or at least are
not as severe (Thomas & Nelson, 2007; Nelson, 2019).

⤝⤞

Socioculturally attuned solution focused family therapists encourage third

order change when they help families choose and amplify solutions that
support equitable and just relationships.

⤝⤞

In this chapter, we describe enduring family therapy concepts and practices related to SFFT
and offer a set of guidelines for socioculturally attuned practice. We share a case illustration to

DOI: 10.4324/9781003216520-11
 Socioculturally Attuned Solution Focused Family Therapy 233
demonstrate how to create third order change by integrating societal systems and attention to
power into solution focused practice.

Primary Enduring Family Therapy Concepts

While no family therapy model is without theoretical underpinnings, SFFT is more about
language than theory; about asking the right questions at the right time. That said, SFFT is often
misinterpreted as simply a set of techniques that are often used with other models. Therapists
who too rigidly and quickly move from one solution focused question to the next often
overlook relevant information, (e.g., undisclosed problems and experience, feelings, meaning-
making, and relational dynamics). Therapists who avoid problem stories can leave clients
feeling like they have not been heard, putting at risk a meaningful collaborative therapeutic
relationship. The focus on what to do may be reassuring and seem rather simple at first.
Without a deeper understanding of the approach, however, it is easy for therapists and clients to
miss opportunities for finding strengths and solutions within the rich tapestry of life that extends
from the most intimate thought and feeling to the broadest and most complex societal systems.
There are many guidelines for working from a solution focused stance that are beyond the
scope of this chapter and published elsewhere (e.g., de Shazer & Dolan, 2007; Nelson, 2019;
Nelson & Thomas, 2007). Following, we share the hallmarks of SFFT, including resolute
attention to the use of language, a collaborative stance in which therapists rely on clients’
strengths and expertise, careful construction of therapeutic goals, and finding and amplifying
exceptions.

Use of Poststructural, Social Constructionist Language

In SFFT, therapists and clients work together to construct meaning in ways that help solve
problems. All therapies rely on language, but SFFT pays particular attention to the use of
language from a social constructionist and poststructural perspective. de Shazer and Berg
drew heavily on Austrian-British philosopher Ludwig Wittgenstein’s understanding of
language games to create change through therapeutic conversations (Bidwell, 2007; de
Shazer and Berg, 1992; de Shazer, 1997). From this perspective, words without specific
referents are fluid, and boundaries around them can become easily blurred. This is helpful in
SFFT because it allows therapists to participate in the co-construction of meaning in ways
that can make problems more solvable. This is particularly important to the process of
moving away from being defined by problems. Take as an example a White middle-class
father, Daniel, who entered therapy after his wife has been incarcerated. His only child,
Maya, is 8 years old. They entered therapy after the school called Daniel to tell him that
Maya had been getting into fights. Their therapist, Aziza, was an upper middle class, Arab
American Muslim, who identified as a cishet (cisgender heterosexual) woman.

Aziza: So tell me about why you came in today.

Daniel: Maya has been having fights at school. She never used to be aggressive but since her
mom went to prison, she hasn’t been herself.
Aziza: I see, so your mom is in prison now?
Maya: Yes, and I hate it! I want her to come home.
Daniel: So do I, but it doesn’t help for you to be aggressive! (Turns to therapist) I know she
is depressed, but she can’t take it out that way.

Aziza recognized Daniel’s description of his daughter as aggressive and depressed as con-
tributing to the stuckness of the problem. She responded to Daniel’s statement in a way that
234 Socioculturally Attuned Solution Focused Family Therapy
began to shift meaning from Maya being defined by characteristics or qualities of aggression
and depression to Maya experiencing those states. She encouraged Daniel to describe specific
observations that lead him to conclusions about his daughter.

Aziza: What tells you Maya is feeling depressed?

Daniel: She is irritable and spends most of her time alone in her room. She also cries a lot.
Aziza: So Maya, your dad has seen you crying a lot and spending a lot of time in your
room. You are feeling sad?
Maya: Of course I am. My mom is in prison and everyone knows it!
Aziza: The kids at school know?
Daniel: Her best friend told a few of the kids and now they all know.
Aziza: That must be difficult and upsetting, Maya.

Aziza began to move away from the father’s description of his daughter as being aggressive
and depressed in favor of moving toward a co-construction of the problem as Maya feeling
upset and sad because she is going through a difficult situation. Aggressive and depressed are
terms with fluid boundaries that give way to the equally fluid but more solvable and transient
problems of upset and sad. Changing the description of the problem affects meaning and
alters future interactions.
It is important not to immediately accept problems as clients understand and present them.
The therapist in this situation worked with the family to contextualize the problem. SFFT
has been critiqued for failing to place problems in social context (Dermer et al., 1998),
however, contextualizing language, meaning, experience, relationships, and roles is a basic
premise of this model (Sundman et al., 2020). As we argue later in this chapter, there is room
to expand the context further without abandoning the core of how language can be used to
co-create solvable problems and well-designed goals.
All questions shape meaning, including what therapists expect by asking them. SFF
therapists carefully use questions to inspire the expectation for change. Questions are open-
ended, often using words like “when” and “will.” A SFF therapist is likely to say “tell me
about a time when … ” rather than “has there ever been a time when … ?” and “what will it
look like when” rather than “what would it look like if … ?” Let’s jump ahead in the
therapeutic conversation with Daniel and Maya.

Aziza: Tell me about times when you feel sad or upset about your mom when you are at
school but you don’t get into a fight?
Maya: I don’t know. I guess when the teacher is looking at me.
Aziza: So when the teacher is looking at you, you decide to do something different? What
do you do?
Maya: I just think “don’t get in trouble” and keep my head down.
Aziza: Really? You are able to keep your head down and remind yourself not to get into
trouble?
Maya: Yeah, I guess.
Aziza: How about other times when you feel sad or upset about your mom at school but
you don’t get into a fight?
Maya: When I am with my friend or I see my dad is there to pick me up.
Aziza: So when you are with your friend or getting ready to be with your dad you don’t
start a fight? I am curious about that. What is it like for you to be with your friend
or your dad? How does that help?
Maya: I don’t know. I guess I know they care about me.
 Socioculturally Attuned Solution Focused Family Therapy 235
These questions demonstrated Aziza’s belief that change is possible and exceptions are already
occurring. Maya’s strengths began to emerge. In time, Aziza and the family discovered that
Maya is someone who cares deeply about others, appreciates close caring relationships, and
has the ability to resist acting out her feelings. This questioning continued until Maya, her
father, and the therapist had a clear plan for how and when to amplify the exceptions they
identified.
The types of questions most frequently used in SFFT include miracle questions, scaling
questions, and coping questions. There are volumes written about why and how to ask these and
other types of questions (e.g., de Shazer & Dolan, 2007; Lipchik, 2002; O’Hanlon & Rowan,
2003; Selekman, 1997; Walter & Peller, 1992). What follows here are some comments about
the foundational role these questions play as interventions in the practice of SFFT.
According to de Shazer & Dolan (2007) the miracle question serves several important
functions. First, it is useful in setting goals. If the therapist asks something like “If you
wake up tomorrow to a miracle, and the problem is solved … ?” or “How will we know
when the problem is solved and we are done with therapy?” they are inviting clients to
imagine solutions. Asking questions like “What will each of you be doing differently?”
“If we had a movie of your family when this problem is resolved … ?” or “What will
each of you notice … ?” help the therapist and family understand the current impact of
the problem and descriptions of solutions. Second, the miracle question provides an
emotional experience. Through imagining, clients can experience some of what it will be
like after they make the desired change. Imagining is a powerful tool that motivates us
and gives us hope in everyday life. Third, the miracle question sets the stage for finding
exceptions. Clients’ descriptions of what will be different provide them and the therapist
with clues––specific feelings, behaviors, thoughts, interactions––that are likely already
occurring to some degree at least in some contexts. Finally, miracle questions help clients
move from digressive stories (i.e., what has or is getting worse) to progressive stories (i.e.,
what has or is getting better).
Once the therapist and clients establish goals, scaling questions may be used to assess
progress toward goals and focus on exceptions (de Shazer & Dolan, 2007). Scaling
questions send the message that the problem is not static; that there are times when the
problem is less present and/or solutions are more accessible. For example, a therapist
might ask a couple questions like, “On a scale of 1-10, with one being not giving each
other the benefit of doubt at all and ten being really giving the other the benefit of doubt
(one of the clients’ goals), where were each of you on the scale when the fight broke out?
How about times when you were getting along? Or when during the week did you
notice you gave the other or they gave you a little more benefit of the doubt (e.g., going
from a 5 to a 6)?” These types of questions imply that clients have control over giving
each other the benefit of doubt and that at times they do just that. They help explore the
connection between giving each other the benefit of the doubt and getting along. Scaling
questions can also be used to help clients describe their inner world of emotions (de
Shazer & Dolan, 2007; Lipchik, 2002) which can then be connected to what is happening
relationally.
Typically, therapists use scaling questions around exceptions that reflect positive goals
(i.e., what is happening rather than what is not happening). The following example
demonstrates a slightly different use––using scaling questions to identify and deal with
emotions. The example also explores one of many ways to scale without the use of a
numeric measure, to which children may have more difficulty relating. While SFFT
relies heavily on moving toward positive goals (i.e., what is rather than what isn’t), it can
be helpful at times to make space for unwanted emotions. Let’s go back to Daniel
and Maya:
236 Socioculturally Attuned Solution Focused Family Therapy
Aziza: So Maya, if I had a big thermometer that went from the floor to the ceiling, and the
bottom is not sad at all and the top is as sad as you can ever imagine (uses hand
gestures to describe the thermometer), how sad are you right now?
Maya: About here (holds her hand up to about the middle of the imaginary thermometer).
Aziza: What do you notice when you are about this sad (uses hand gesture to show the
point in the thermometer Maya indicated)? What do you usually do?
Maya: I just maybe read a book or watch tv.
Aziza: How does your dad know when you are this much (hand gesture to the same
spot) sad?
Daniel: She gets quiet and won’t talk to me.
Aziza: What helps you go from here (on the imaginary thermometer) to here (a little
lower on the thermometer)?
Maya: Maybe when Dad and I play a game or Grandma comes over.
Aziza: So when you and Dad play a game or Grandma comes over you feel a little better.
What do you do differently when you are a little less sad? When you are playing a
game or spending time with grandma?

Aziza was able to assess Maya’s current level of sadness. She would likely want to compare
that to the previous week and carefully investigate what was better when the sadness lessened.
The series of questions helped the family and the therapist identify a solution they are already
using, such as talking to each other and having some fun. In the future, once the family has
had enough time to talk about sadness, Aziza might want to change the scale to one in-
dicating a positive outcome like happiness rather than sadness.
Finally, coping questions (Lipchik, 2002) are used when clients cannot identify exceptions to
a problem. There are times when problems are so overwhelming that it is hard to even imagine
life without them. For example, a client who is devastated over the loss of a child is likely to feel
hopeless about ever feeling anything but sadness and loss. In these situations, SFF therapists ask
coping questions such as “How have you been able to keep breathing?” “How have you
managed to just get from one day to the next?” or “What keeps you going?” This often reveals
rich and meaningful information about strength and resilience (Bolton et al., 2017) that can be
built on over time. Answers such as “I have to keep going for my other children,” “I turn to
God every minute of every day,” or “I know my child would want me to” point to strengths
such as a sense of duty, parental integrity, fierce determination, and unwavering faith, that can
be further explored. At other times when no exceptions can be identified, the therapist might
simply ask the family to “do something different” (de Shazer & Dolan, 2007).

Collaborative Therapeutic Relationships

The therapist may be the expert in the process of therapy, but clients are experts of their own
lives (Anderson & Goolishan, 1992). SFF therapists recognize that each client is unique and
avoid assuming they know what clients need based on theory or clinical experience.
Therapists take a “not knowing” (Anderson & Goolishan, 1992), unassuming, tentative
stance so they are always in the position of learning from clients (Thomas & Nelson, 2007;
Nelson, 2019). Past clinical experience is used as a last resort when clients are stuck and
unable to imagine solutions. At these times, SFF therapists may tentatively contribute
something like “I don’t know if this is helpful, but a lot of people I work with who are in
your situation tell me … ” (Lipchik, 2002). Clients take on an active role in discovering
exceptions through examining thoughts, feelings, behaviors, and interactions along with the
therapist. When clients say “I don’t know”, the therapist believes them and helps them
discover what was previously out of their awareness.
 Socioculturally Attuned Solution Focused Family Therapy 237
Successful SFFT depends on therapists genuinely believing clients have what they need to
solve problems. Therapists need to be authentically hopeful, curious, respectful, and positive
(Nelson, 2019; Thomas & Nelson, 2007). According to Sundman et al (2020), “the prac-
titioner builds on hope, positive emotions, virtues, caring, love, compassion, gratitude, and
sympathy for the clients and their environment” (p. 35-36). SFF therapists are deeply
committed to believing in and finding strengths, which helps them persevere when clients
doubt their own abilities to overcome problems. Therapists who successfully use this model
not only ask poignant questions but listen deeply to clients. They allow clients time and space
to share problematic stories so that they are truly heard. Problem stories also offer therapists
opportunities to explore strengths including how clients got through hard times.
While there is a clear focus on solutions, exceptions are embedded in both problem and
solution patterns (Choi, 2019). SFF therapists can track problem patterns to notice exceptions
in and out of sessions. For example, a common problem pattern for a couple might be to
immediately distance when they start to have conflict. In this case, the therapist would want
to notice times when a couple stayed engaged, regardless if they were aware of these ex-
ceptions. The therapist might say to a couple, “I noticed just now that you stayed in the
room and in the conversation, even though you both became angry. How were you able to
do that?” The couple might respond with, “It is because you are here,” which only speaks to
motivation. The therapist would press further, “I understand you are motivated to do
something different when you are in therapy and I am sitting with you, but I am still really
interested in how you were both able to stay in the conversation.” This is not a simple
question and would most likely take the couple and therapist some time to unravel.
Therapists must enter clients’ worlds—the way clients make meaning—to cooperate with
them on solutions. What other models see as resistance, is viewed as therapists not co-
operating the way clients expect or need. The therapist gently leads from behind. While most
SFF therapists consider customers for change to be those who share a goal for change and are
willing to do something about it, many invite all family members to treatment to recruit as
many customers as possible to help resolve problems.
SFF therapists, having faith in clients’ strengths, connect deeply and authentically with all
members of a family and inspire expectation for change through their own unwavering
optimism (Lipchik, 2002). Therapists join with clients in part through compliments and
seeing the best in clients; however, compliments are genuine rather than paternalistic. For
example, a therapist would be taking a one-up patronizing stance by saying something like,
“That is so amazing, good for you for not giving up!” but would be taking an authentic
stance when saying something like, “I notice that you don’t give up easily on what is im-
portant to you and your family; that you are tenacious and determined.”

Focusing on Client Goals

Goals must be important to clients (Nelson, 2019); however, it is not accurate to assume the
therapist simply accepts the goal as first delivered by clients. The therapist plays a highly
instrumental role by facilitating the process of helping clients develop workable goals that
meet a variety of criteria. This requires exploring clients’ experiences, the meanings they
make of their situation, their opinions of each other, their sometimes conflicting hopes and
dreams, their past struggles, and as we will introduce further along in this chapter, their
sociocultural context.
Well-defined (Walter & Peller, 1992), or well-formed (Nelson, 2019) solution focused
goals are stated in several ways: in positive form (e.g., what will be vs. what won’t be); refer
to process (e.g., We will be backing each other up as parents vs. each making decisions on
how to parent on our own); in the here and now (e.g., get along better vs. get married
238 Socioculturally Attuned Solution Focused Family Therapy
someday); address the right level of specificity (e.g., I want to be more efficient vs. I want to
get my filing done on time); are within the client’s control (e.g., We want to follow through
on rules and consequence vs. We want our son to do his chores); and use the client’s lan-
guage (e.g., you want to get along as a family vs. you want to function better as a family unit).
The goals are designed to be achievable and include a role for all family members who are in
therapy (Nelson, 2019).
To clarify, the therapist attends to client language throughout therapy while actively
engaging in co-constructing new language and meaning. In the example of Daniel and Maya,
Aziza would not accept as a goal the first explanation of what the client wanted to achieve.
Aziza would have made a mistake if she had said:

Aziza: So tell me about why you came in today.

Daniel: Maya has been having fights at school. She never used to be aggressive but since her
mom went to prison, she hasn’t been herself.
Aziza: So fighting at school is a problem? Do you agree with your dad, Maya?
Maya: Yes.
Aziza: What do you want Maya to do instead of fighting, Dad?
Daniel: I just want her to get along with the other kids.
Maya: Duh Dad. Like I don’t want the other kids to like me.
Aziza: So both of you want Maya to get along better with the kids at school? Tell me
about times when you do get along, Maya.

In this scenario, the therapist accepted the definition of the problem too quickly, without
exploring what was going on in the family or hearing Maya’s story about her mother being
incarcerated. This type of goal could be instrumental in finding exceptions to fighting as the
therapist pursues what getting along looks like, what each person is doing, and so on. The
problem with this goal, however, is that it is not at the right level of specificity. It too
narrowly defines the problem. It also includes only one member of the family, inadvertently
implying the child is the problem and missing opportunities for more significant systemic
change. Notice the difference in the type of goal that can be set after exploring the problem
more fully:

Aziza: O.K. So when you are talking to Dad or Grandma and having some fun you are not
quite so sad. Dad, what are you doing differently at these times Maya is talking
about?
Daniel: Well, I guess I am talking more too, having some fun. It is nice when my mom
comes over. It gives me someone to talk to.
Aziza: Helps you feel better too?
Daniel: Yeah. It has been hard on me too and on my mom. Well of course on Maya’s mom
especially. We all worry about her.
Aziza: Sure, it has been hard on everyone––everyone worries. It sounds like it helps
though when you talk to each other and stop every once in a while, and remember
to have fun?
Daniel: Yeah, I guess so.
Aziza: Maya, how about at school, what helps you get along with everybody as often as
you do?
Maya: Sometimes I don’t think about it. Maybe I am having fun with my friends or doing
school work.
Aziza: I will be interested in knowing more about times you start to think about it or start
to worry but decide not to and times when you are thinking about it but manage
 Socioculturally Attuned Solution Focused Family Therapy 239
not to get into fights … but right now I am wondering if you are both saying that it
is important to take a break from thinking and worrying about Mom sometimes.

Here the therapist builds on exceptions that include having some fun and not worrying to ask
the family to consider the idea that they can take a break from the problem. This implies that
the problem is not always occurring and points toward further exceptions.

Daniel: I suppose it doesn’t help any of us to just dwell on it. I know Maya’s mom wouldn’t
want that. We need to start getting back to normal.
Aziza: Maya what does your dad mean when he says “getting back to normal?”

Aziza picks up and repeats Daniel’s statement about getting back to normal. This metaphor
(Zatloukal et al., 2019) uses the client’s words to capture a way of being and has the potential
to meet the criteria required to co-construct a well-defined, solution focused goal.

Maya: I don’t know … maybe doing things we used to do, wrestling, watching tv
together, eating dinner at the table … just normal stuff.
Aziza: So as a family you would like to get back to normal? As normal as you can be given
what’s going on? Maybe at school too?
Maya: Yeah. Everywhere. I just want to get back to normal.
Daniel: I know her mom wants that too.

Aziza didn’t force a goal or accept the first idea that came along. She kept talking with the
family until the right type of goal emerged. This goal is at the right level of specificity. It may
seem broad at first glance, but “back to normal” serves as an umbrella goal under which many
more specific interactional solutions can be identified. This is a goal that has a solution em-
bedded in it because it refers to a time when the problem did not exist while still taking into
account the family’s difficult situation. This goal is also helpful to everyone and includes all of
the family in the solution. Finally, the goal makes sense as the family is identifying what many
families report, such as maintaining family routines during a time of crisis enhances resilience.

Discovering and Amplifying Exceptions

Exceptions to any problem can be found, created, or imagined. Focusing on the positive helps
nudge clients in the direction of the desired change. SFF therapists are continuously oper-
ationalizing goals and identifying anything that clients do that moves them toward desired
outcomes. They encourage doing more of what is working and examine how clients are able to
do things differently when change is spontaneous. Let’s continue with our example of Daniel
and Maya. Aziza would want to identify what is included in “back to normal,” trusting that the
family knows what this will take, even if they can’t immediately describe it. She would believe
that the family has the strength and resilience to accomplish this goal.

Aziza: So Dad and Maya, let’s imagine that we are meeting for the last time because we all
agree that you are as back to as normal as you can be until your mom gets home.
What will we notice? What will each of you be saying? Better yet, let’s say you
bring in a movie to show me how things are back to normal. What will we see you
doing in the movie?
Maya: We will be talking and laughing. Dad would be tickling me.
Daniel: Maya would be coming home saying she had a good day at school.
240 Socioculturally Attuned Solution Focused Family Therapy
Aziza follows these more global statements like a good day at school with specific, observable
behaviors.

Aziza: The two of you will be talking and laughing more. You will be wrestling and tickling
and Maya will have good days at school? [therapist repeats replacing the word
“would” with the word “will” moving from hypothetical to expected change]
Daniel: Yes. And Maya won’t be so sad all of the time.
Aziza: And you, Dad?
Daniel: Well, I suppose I wouldn’t be so sad either.
Aziza: So what will you both be feeling instead of so sad? [looking for the positive vs.
absence of negative].
Daniel: Maybe less worried about Maya’s mom being O.K.
Aziza: So less worried and sad. Tell me about times now when you are a little less worried
and sad [continues to use this language because it still seems most meaningful and
useful to the client]
Daniel: I think when I remind myself that Maya’s mom will be alright. That we will get
through this.
Aziza: You have been through other difficult things in your life? [looking to transfer
solutions from one context to another]
Daniel: Yes. My father died a couple of years ago. Maya was really sick when she was a baby.
Aziza: (lowers voice speaking more slowly) How did you remind yourself that you could
get through those hard times––that things would be alright?
Daniel: (tears up) I just told myself that I could do it. That I wasn’t alone and that
eventually, things would get better.
Aziza: How are you teaching your daughter to have that kind of courage and deep
optimism as she is going through her first really hard time?
Daniel: I think I could do better. [turns softly to daughter] Sweetie, things are going to be
alright. Your mom is safe and will be home by next summer. We can make it. She
wants our lives to be as normal as we can make them while she is gone.
Maya: (quietly) I know Dad. I’ll be alright.

Toward the end of session:

Aziza: So I am wondering if you would be willing to do an experiment this week? It seems

like you both want things to be as normal as possible and that you agree you can get
through this. Would you be willing to do something every day that will reassure the
other that things are going to be OK? You know something normal! [all laugh]

Now we have some exceptions that are related to the goal, can be used across contexts, are
relational, and are within the client’s control. The therapist knows enough about the problem
to notice exceptions when they may be out of the family’s awareness. Aziza would also be
keen to watch for exceptions that occur in session. For example, if Maya, Daniel, and
Daniel’s mother are in a session and the therapist notices them teasing each other, she might
say “Is teasing each other one of those things that you normally do?”

Integrating Principles of Sociocultural Attunement

SFF therapists support social equity by challenging power dynamics between clients and
therapists, seeing clients as experts of their own lives, and taking a collaborative, power-
sharing stance. SFF therapists also serve as activists when they avoid pathologizing clients,
 Socioculturally Attuned Solution Focused Family Therapy 241
refusing to focus on problem-saturated descriptions and labels. Socioculturally attuned SFF
therapists go beyond the family, however, to include the impact of, and potential solutions
within, the broader societal context.

⤝⤞

Socioculturally attuned solution focused family therapists help clients access

personal and contextual strengths and resilience by integrating critical aware-
ness of societal context and power dynamics.

⤝⤞

Solutions in Societal and Cultural Context

SFFT is based on social constructionist and post-structural thought, which centers the re-
lationship between culture, societal context, and meaning. Solutions to problems emerge from
cultural and social frameworks which both expand and limit possibilities. Cultural groups within
societies collectively generate solutions over time. This long list includes things like rituals that
help mark change or deal with loss, acts of resistance through the use of language and song, and
rules that support caring family relationships. Cultural and societal norms are not apolitical,
however; they advantage some over others, and those with greater influence in societies have
greater impact on meaning-making. According to Bidwell (2007), “social constructionist theory
does not necessarily reject an underlying ‘reality’” (p. 73). Uneven influence over meaning-
making has real material consequences, including access to adequate employment, healthcare and
housing, level of food security, safety, influence in the legal system, and so on. While SFFT is well
suited for practice across cultures and societies due to social constructionist underpinnings,
therapists and clients will be limited in imagining and discovering solutions if they fail to realize
the potentially restricting aspect of unexamined cultural frameworks and societal systems. The
question is how we do this without imposing a theoretical framework on clients.
A number of scholars and practitioners have advocated integrating Paulo Freire’s (1970/
2000) approach to raising critical consciousness using dialogue, reflection, and action into the
practice of family therapy (Korin, 1994). There are several points of convergence between
Freirean ideas and SFFT. Chief among these is the belief that people are the experts on their
own lives. Like SFF therapists, Freire viewed emancipatory education as helping people
become aware of what they already know. While SFF therapists focus primarily on clients’
expertise of themselves and each other; what they know works to eliminate their problems.
Freire focused on encouraging people to recognize their expertise on their environment and
societal context. The main difference is that SFFT aims to help people discover what is helpful
on a personal and interpersonal level. Emancipatory education aims to help people uncover
societal realities so they are in a better position to take necessary action to improve their lives.
What they know about themselves and the world is transformed by an understanding of the
reality of broader cultural and societal dynamics.

⤝⤞

Inviting clients to explore societal forces that affect their lives can increase
potential solutions and encourage discovering and amplifying a broader set of
exceptions.

⤝⤞
242 Socioculturally Attuned Solution Focused Family Therapy
SFF therapists are pragmatic—willing to explore what works. They rely on asking nuanced
questions and avoid getting caught in theoretical word games. It is not so difficult to
imagine integrating social and cultural awareness into SFFT practice. Take for example
Janise, an African American single parent living on low income, who is balancing the
demands of motherhood while pursuing a college education. A SFF therapist is likely to
ask Janise questions about where she lives, who is in her life, what social support systems
she has (e.g., church, peers at college), interactions between family members, and so on.
The therapist would work to co-create a goal that is in positive form, for example, “being
the mother I want to be” in spite of her challenging situation. The therapist would then
help Janise operationalize what this means and explore times when she is able to do so;
complete her school work while parenting, act according to her values and beliefs, and
enjoy being with her child.
A socioculturally attuned SFF therapist would extend the context and word questions in
ways that would help Janise and the therapist become more aware of the effect of her societal
context. Questions might include, “You mentioned that most of your peers at school are single,
middle class, White students. What is your experience in that context? How do you make sense
of the racial and social class dynamics?” As Janise and the therapist uncover the impact of
oppressive sexist, racist, and classist educational and other societal systems, Janise would be able
to make new meaning of her situation. This would not alleviate her financial stress or the
“isms” she is faced with on a daily basis but would expand potential solutions and better
acknowledge existing strengths. Solution focused questions that follow might include things
like, “How do you think Black women have historically been able to survive and thrive when
there has been so much working against them?”, and “How have you been able to do this for so
many years?”, How are you able to be successful in school and still be a caring mother, despite
the racism and sexism you experience and with so few financial resources?” These questions
would help Janise move from the broader context, including the strengths Black women in her
situation have historically shared, to her own strengths and solutions.

⤝⤞

Clients and therapists can move from seeing the client as having unique
solutions to a private problem, to being part of a collective with both common
and unique solutions to a shared public problem.

⤝⤞

Language, Meaning, and Power

The relationship between language, meaning, and power in socioculturally attuned SFFT
takes us back to the beginning––to de Shazer’s (1997) reading of Wittgenstein, who pos-
tulated that meaning associated with words emerges only when used and heard in context
(Pitkin, 1972; Sundman et al., 2020).

⤝⤞

Socioculturally attuned solution focused family therapists critically analyze

discourse as it unfolds in therapeutic conversations, attending to words, tone,
body language, and emotion to understand how power shapes meaning.

⤝⤞
 Socioculturally Attuned Solution Focused Family Therapy 243
This includes attention to the role of power and meaning and context in how problems are
understood and goals are identified. We might think of socioculturally attuned SFF therapists
as routinely searching for meaning while engaging in a type of informal critical discourse
analysis to understand how group power dynamics are part of the context in which meaning
is made and social arrangements are reinforced. According to van Dijk (1995), critical dis-
course analysis “focuses on (group) relations of power, dominance and inequality and the ways
these are reproduced or resisted by social group members through text and talk” (p. 18).
Let’s explore how societal context and power dynamics impact meaning embedded in
even the most seemingly simple questions and solutions. Suppose a therapist echoes a remark
by a family that the mother “is a strong woman.” This won’t evoke the same image or
description for all of us, but for many of us it means something like “she can endure a lot” or
“she can stand up for herself and won’t take being put down.” The meaning of the statement
is inseparable from gendered power dynamics. SFF therapists must attend closely to meaning
to ensure questions and solutions support social equity. The therapist might follow with
questions like, “You mention that you see your partner as a strong (woman/man/person).
Can you describe what you mean? What do you and others notice that leads you to describe
them in this way?” These questions open space for discussing gender and other power dy-
namics using specific, here-and-now examples. If being a strong woman includes enduring a
lot or not taking being put down, questions that follow would include identifying how a
client is able to stand up to others as well as what is happening relationally that requires
standing up to others.

Third Order Change

Third order change can occur when the experience of all family members is fully explored
within their sociocultural context. Slowing the process of imagining values, solutions––
expanding what is both possible and preferable to include equitable relationships––
mirrors the model’s expectation of collaboration between therapist and clients. When offered
space to do so, families and therapists can envision, identify, and amplify just solutions. This
requires extra steps to ensure what has been silenced can be named and voiced; that therapists
intervene to encourage families to develop the willingness to respond to each other; and ex-
ceptions are noticed and amplified that encourage transformation toward just relationships
within and beyond the family. In Text Box 11.1, Toni Schindler Zimmerman describes
practicing SFFT from an equity-based framework.

Text Box 11.1 Toni Schindler Zimmerman, PhD, LMFT

Toni Schindler Zimmerman (she/her/hers) is a Professor in the Human Develop-

ment and Family Studies Department at Colorado State University. She identifies
as White, female, cis-gender, upper middle class, heterosexual, unaffiliated
religion, able bodied, Euro-American.
Clients, therapists, and supervisors are embedded in systems of privilege and/
or oppression based on their social location (e.g., race, sexual orientation,
ethnicity, gender and gender expression, socioeconomic status) in their personal
and professional lives. As therapists and supervisors, it is essential that we
understand how these systems were set up, how they continue today and the real
and significant harm that is caused as a result. The mental health system has
participated and contributed to oppression and discrimination and worse.
244 Socioculturally Attuned Solution Focused Family Therapy

In order to dismantle systems of oppression in mental health, we must be fully

committed to examining and changing our policies, practices, and the way we
interact with clients and others in our work. This commitment involves gaining
significant knowledge about the history and current realities and the disparities
and barriers imposed upon those with marginalized identities by those who hold
power. In addition to a commitment to learning and unlearning, we must also be in
a continuous state of self-examination. Systems of oppression and discrimination
are so foundational to everyday life that if we are not vigilant to our implicit bias,
stereotypes, microaggressions, and deficit assumptions that can show up in the
therapy and supervision process, we can do real harm. Systems of oppression in
relationships can show up in the therapy room where power is unjustly distributed
(e.g., couples, parent-child, therapist-client) and in the workplace itself (e.g.,
supervisee-supervisor, a caste system among employees, harassment). In all
areas, we must actively work to create an environment and provide services that
are socially just. This is the foundational value that I strive to work from.
My work is guided by a systems perspective including attunement to systems of
oppression at all levels. I utilize a variety of models including Solution Focused
which I will talk about here. From a Solution Focused model, I focus on strengths
and the remarkable ability to cope, that so many clients and supervisees exhibit.
The lived experience of so many persons with marginalized social location
identities is that of being underestimated, overlooked, single storied, and
attended to from a deficit lens. Connecting some of these experiences in their
personal lives to the way in which this is also happening at the societal level is
useful to provide context for the pain and suffering they are experiencing.
The message can sound like “our societal structures value and reward people
who make more money and even see them as more important and often give them
more of a say. So, it is no wonder in your relationship you have this dynamic. It is
surprising that you have so many areas of your relationship where you are
functioning as equals, without who makes more money having influence in
decision making. How can you do more of that?” “Given the unjust (e.g.,
homophobic, transphobic, misogynistic, racist, etc.) society in which we live,
how have you coped in your work, in your relationships?”
Highlighting exceptions in the therapy room can be a way of identifying and
naming power inequities. For example, a therapist might say something like “the
way you spoke to your partner was not from a place of power over her and shutting
her down; instead you accepted her concerns and listened and validated her. I
wonder if that is why she was able to find the courage to speak up even though she
was worried about your response.”
I might say something like, “The way you listened and didn’t interrupt just now
gave your partner the opportunity to feel valued and heard, how were you able to
do that when you have been taught to win in conflicts?” An example of what
interrupting unjust relationships might look in therapy could be, “I have to stop you
there. It is no wonder given the “father knows best” society we live in that you want
to be in charge. Earlier you were able to listen to your son without judgment and
with an open heart and mind and that is when I saw you being the best father.”
I sometimes use the concept of envisioning a future without the problem. For
example, “when you both approach decisions with equality–valuing both of your
ideas equally–what impact do you think that will have on your feelings of closeness
with each other?” I would add that I believe in providing ongoing opportunities for
 Socioculturally Attuned Solution Focused Family Therapy 245

all voices to be heard in organizations, anonymously or not. Listening to clients,

staff, students, etc. and valuing all voices is essential for transformation. No voice
is too “small” to be heard. No voice is so “big” to drown others out.

Practice Guidelines
Following are four guidelines for practicing socioculturally attuned SFFT. These include
inviting clients to explore the societal context in which they live, considering equity when
setting goals, broadening the search for solutions to the wider societal and historical context,
and discovering and amplifying just solutions.

1 Invite Clients to Explore Societal Context

Socioculturally attuned SFF therapists invite clients to examine the relationship between
societal context and presenting problems to expand possibilities for solutions and support
equitable relationships. Therapists need to have the social awareness to know where to look
and what to ask, but not assume they know the social reality of clients’ lives. Therapists and
clients explore social dynamics together engaging in mutual conscious raising. It is assumed
that each family has a unique relationship to its societal context and therapists must attune to
their specific situation. In other words, societal context plays out differently across families
and the therapist must take a stance of inquiring to help families explore context as integral to
the meaning they make of the world, including how they relate to each other.

2 Consider Equity in Co-constructing Client Goals

Socioculturally attuned SFF therapists work with families to ensure goals include as many
members as possible and support relational equity. Imagine asking a few well-placed ques-
tions in addition to the typical miracle question such as: “So you have described that when
this problem is gone all of you will be communicating more. I am curious about how you
envision each of you being heard by the others. Whose voice will carry the most influence
and be heard the loudest? Who is likely not to be heard or have as much influence in
conversations?” and/or “What will it look like when you all have the influence you need to
feel heard and get your needs met?” As clients answer these questions, they are likely to
negotiate goals that include attention to power dynamics. The therapist might name the
impact of the family’s societal context by asking questions like, “What will be the difference
between how males and females are heard in your family?” “How will this be the same or
different from your experience in the rest of your lives?” Socioculturally attuned SFF
therapists continue to check with clients about the impact of goals relative to their relational
power throughout the course of therapy.

3 Broaden Search for Solutions to Wider Context

SFF therapists listen carefully to clients’ values that may not be directly expressed but are
implicit in conversation (Sundman et al., 2020). Socioculturally attuned SFF therapists also
broaden the search for solutions by valuing the wider social and historical context. This
includes working with clients to identify collective resistance and resilience. Clients are
encouraged to consider the exceptions of their ancestors, those in their social identity groups,
246 Socioculturally Attuned Solution Focused Family Therapy
and those whom they admire. Having ancestors who maintained their humanity even when
enslaved, practicing religion in spite of discrimination, or being part of a group that continues
to practice cultural traditions in spite of colonization and attempted genocide are examples of
the power of the collective. Individuals within these collectives are also important sources of
strength, resilience, and exceptions (e.g., a grandmother who left an abusive relationship to
raise children on her own, a sibling who came out in spite of family disapproval, a leader in
the Civil Rights movement, a parent who went to college later in life). Exploring these
resources often exposes shared characteristics, or solutions, that can be amplified. Questions
might include: “In what ways are you like your grandmother?”, “How have the many
generations of your religion been able to stay faithful in spite of discrimination?”, and “How
have you been active in keeping cultural traditions going?”

4 Identify and Amplify Just Solutions

Therapists and clients work collaboratively to identify and amplify exceptions. They expand
available solutions and then choose from possibilities. Each member of the family is asked to
identify exceptions and prompted to do more of what works. Socioculturally attuned SFF
therapists add a step to this process by intervening to ensure that what works is just; that
exceptions which are amplified are those that all members of the therapeutic system agree to
support, or at least don’t interfere with relational equity, and that equity is supported in all
relationships, such as relationships in the workplace, social groups, and religious commu-
nities. Socioculturally attuned SFF therapists pay constant attention to societal stereotypes and
systems of discrimination and oppression. Consider a male client answering a question such as
“What seems to help the two of you get along better?” with “When she listens to me!” Of
course listening to each other helps most of us get along, yet few therapists would proceed
with “So do you agree that listening to your husband helps the two of you get along better?”
It would not be uncommon, however, for a therapist to say something like “So do you both
agree that you get along better when you listen to each other?” A socioculturally attuned SFF
therapist again takes a few extra steps toward transformation, resisting the temptation to
gloss over the power imbalance indicated in the original statement. The therapist might ask
the husband “So you would like your wife to listen to you. What does that mean for you?,
How do you know when she is listening to you?, How does she know when you listen to
her?”, and then ask the wife, “What do you think he means when he says he wants you to
listen to him?, How do you know when he is listening to you?”, and so on.

⤝⤞

Socioculturally attuned Solution focused family therapists ensure that family

members do not act in ways that oppress or limit each other’s strengths and
solutions. Rather, the therapist works with the family to ensure equitable
relationships that support the wellbeing of all members.

⤝⤞

Case Illustration
Tina, age 40, immigrated from Taiwan to the US when she was 25 and married a European
American man, David, age 39. Most of her family still lives in Taiwan, including her parents
and two siblings, and their children. Her nephew, Eric, did not do as well as the family hoped
on the Taiwanese national Form III exam at the end of junior high and was placed in a less
 Socioculturally Attuned Solution Focused Family Therapy 247
than desirable high school. The likelihood of Eric not passing college entrance exams in
Taiwan loomed over the family. Eric’s parents also wanted Eric to become more fluent in
English than was possible in compulsory English language courses and costly after school
programs. Simply put, like most parents, they wanted their child to have opportunities for a
better life. The extended family collectively decided Eric would live with Tina and David to
attend high school and college in the US.
Within months of arriving, Eric had become isolated, spending most of his time in his
room. Try as they might, Tina and David were not successful in drawing Eric out to be an
active member of their family. David had become irritated with Eric’s seeming unwillingness
to contribute to basic family chores. David complained to Tina about Eric leaving his plate
on the table or having to be asked to gather his dirty laundry week after week. Eric had also
become increasingly unhappy with his aunt, whom he expected would be there to help him
more than she was. Tina was caught in the middle, feeling burdened by her brother’s ex-
pectation that she would take on the responsibility of raising her nephew and worrying she
was burdening David with her family problems.
Eric felt lost in the US, unable to speak the language fluently or understand the culture.
He was not making friends at school, relying on communicating mainly with his aunt, and
playing video games with kids back home whenever he got the chance. Tina and her
sister-in-law talked daily about Eric and how Tina and David might help him adjust.
Things did not improve, however, in spite of their efforts. Eventually, Tina asked Eric’s
parents for permission to take him to therapy. Tina was referred by one of her friends
to a Taiwanese American family therapist, Alice, who worked from a solution focused
framework.

Invite Clients to Explore Societal Context

The therapist explored the relationships between David, Tina, and Eric including how they
saw the problem within their societal and cultural context. Eric described his Aunt Tina as
“not having Chinese thinking.” He expected his aunt to offer him more guidance, help him
more with daily decisions, monitor his homework, and instruct him in what she expected
him to do around the house. Eric respected his aunt as his elder but there had been little
connection between them before he arrived in the US. David wanted Eric to be more
independent and thought by now he should be able to see what needed to be done and take
responsibility for his own schoolwork. David and Eric agreed they expected Tina to be the
bridge between them. Following is an excerpt from their therapy conversation:

Alice: So Tina, you mentioned that you are sort of a bridge between Eric and David.
Also between your family here and your family in Taiwan?
Tina: Yes, I guess I am. I want to support my brother and nephew but also want to make
sure David doesn’t have to take on my whole family.
Alice: So trying to bridge what everybody needs?
David: She is the one everybody goes to. She is the bridge for Eric too.
Alice: Eric, you go to your aunt when you need something, or don’t understand
something about being here?
Eric: Yes. My aunt helps me the most.
Alice: So Tina is the bridge because she knows both countries—knows how to think
Chinese and to think US. How do each of you think gender expectations might
play into this on both ends of the bridge? Is it part of Tina’s role to help everyone
understand each other?
248 Socioculturally Attuned Solution Focused Family Therapy
Alice continued to help the family explore the transnational contexts which were impacting
their daily lives and each of their contributions to helping the family adjust before moving on
to co-construct goals. It was evident that Tina was expected to take on the most responsi-
bility for cultural translation. As a Taiwanese American woman living with a European
American man, she had been the one to culturally accommodate. David did not put equal
effort into bridging the cultures, assuming Tina would take on this burden. Gender dynamics
were also at play as Tina’s husband, brother, and nephew all expected her to solve family
problems.

Consider Equity in Co-constructing Client Goals

After exploring cultural and societal context, Alice was in a better position to co-construct
equitable goals. The family went on to talk about what it will look like when they no longer
need a bridge or a cultural translator. They agreed that one of their goals was for everyone
to learn to live in two cultures at once.

Alice: When you have all adjusted to living together in two cultures, what will we notice?
What will you see each other and yourselves doing differently?
David: Eric will be talking to us more, spending more time trying to make friends …
contributing to the household without always being asked …
Alice: And what will you be doing differently, David?
David: Maybe not going to Tina every time I don’t understand Eric or don’t like what he is
doing? Taking more on myself.
Alice: Tina, what will you be doing differently when you are no longer carrying most of
the burden of being the bridge in the family?

In the excerpt above, David begins answering the miracle question with what he wants from
Eric. Alice continues to ask questions that will co-construct a goal that encourages equal
participation and holds everyone equally accountable for change. The conversation con-
tinued in this way until all members of the family and the therapist co-created the goal of
everyone working together to learn how to live in two cultures at the same time. The goal
was then carefully defined and described. This might include recognizing when cultural
norms and values are at odds, making room for multiple traditions, and learning key words in
both languages. This goal challenged the inequity of those in the most marginalized cultural
positions (i.e., outsiders from the less globally powerful Taiwan) needing to be the ones to
adjust to those in the most centered and dominant cultural positions (those in the most
privileged group in the more powerful host country). Likewise, contributions were expected
to be equal among all genders.

Broaden Search for Solutions to Wider Context

Alice searched for exceptions by identifying ways David and Tina were already able to live
together and adjust to living in two cultures at once. Exceptions included each of them
explaining cultural differences to their families, negotiating different values, beliefs and
cultural practices, and thinking about cultural differences rather than assuming the worst
when differences arose between them. Alice also asked about Eric’s willingness to come to a
new country, his ability to navigate school, and times when he was aware of cultural dif-
ferences. Alice helped the family draw from collective successes. These included drawing
from the rich history of Chinese and Taiwanese people in the US, including how they coped
with discrimination and cultural difference. This included stories of those like Tina who
 Socioculturally Attuned Solution Focused Family Therapy 249
found ways to successfully live in the US without losing connection to core cultural values or
family in her home country.

Identify and Amplify Just Solutions

The therapist in this case was careful not to promote or amplify solutions that worked for
some but were not just solutions for others. For example, asking Tina to continue to work
harder than the rest of the family to bridge the two cultures may have worked and in fact,
had been working to some extent, but was not a just solution. Alice could reasonably
assume that amplifying unjust solutions would lead to further problems later on.
Identifying and amplifying just exceptions and solutions included times when David and
Tina talked together with Eric to help him interpret differences in US and Taiwanese
culture. It also included times when David worked to understand and support Taiwanese
cultural beliefs, values, and practices in ways that matched Tina’s work to learn about
and fit into European American culture. Alice helped the family amplify times when
David and Eric spent time together and when Eric went to David for help and David
advised Eric.

Summary: Third Order Change

Third order change occurred in this family when there were major shifts in how they saw
the world and the problems they were having within this expanded view (Ecker & Hulley,
1996). The family was able to consider more possibilities for how to organize their re-
lationships when they were able to take a metaview of culture and transnational power
dynamics as well as gender across two societies. This helped them realize the impact of
these broad social arrangements on their most intimate relationships and to make more
conscious choices about how they wanted to live. The therapist invited the family into
third order change by asking questions that placed their lives within cultural and societal
context.
The family continued to work on bridging two very different cultures in a single
household, but now did so from a perspective that broadened options. They could more
consciously share the burden of living in two cultures rather than Tina having to do all of
the cultural accommodating. They developed a more critical view of the relationships
between countries and the tendency for one partner’s culture and gender to dominate the
other. Third order change made it impossible to automatically assume the prescribed and
stereotypical roles of a female cultural outsider who must learn to live in the US and a
White US male who married an accommodating Asian female. This arrangement was now
one of many possibilities that Tina and David could choose for their lives together and
with Eric.

Reflexive Questions
• Solution focused family therapy is more about amplifying strengths and creating change
than about understanding or treating problems. How is this stance counter-cultural
within psychotherapy/mental health fields? What values does it represent?
• When considering your work as a solution focused family therapist, how do you see
yourself supporting social equity? What factors enable you to do this?
• If you were to write a list of societal forces that increase solutions, what would they be?
What broader set of exceptions could be amplified?
250 Socioculturally Attuned Solution Focused Family Therapy
• How do you challenge power dynamics between yourself and your clients? What values,
beliefs, and knowledge enable you to see your clients as experts of their own lives and to
work in collaborative and power-sharing ways?
• How is it that choosing to amplify strengths and refusing to focus on problem-saturated
descriptions and labels are forms of activism? What sociocultural forces are being resisted
or challenged?
• How do you determine if what you are asking each member of the family to identify as
solutions or exceptions to the problem is just and equitable?

References
Anderson, H., & Goolishan, H. (1992). The client is the expert: A not-knowing approach to therapy. In
S. McNamee, & K. J. Gergen, (Eds.). Therapy as a social construction, (pp. 25–39). Sage.
Bidwell, D. R. (2007). Miraculous knowing: Epistemology and solution-focused therapy. In T. S. Nelson, &
F. N. Thomas (Eds.). Handbook of solution-focused brief therapy, (pp. 65–88). Haworth Press.
Bolton, K., Hall, J., Blundo, R., & Lehmann, P. (2017). The role of resilience and resilience theory
in solution-focused practice. Journal of Systemic Therapies, 36(3), 1–15.
Chenail, R., Reiter, M., Torres-Gregory, M., & Ilic, D. (2020). Postmodern Family Therapy. In
K. Wampler, R. Miller, & R. Seedall (Eds.). Handbook of systemic family therapy, (Vol. 1, p. 417–442).
Wiley & Sons.
Choi, J. (2019). A microanalytic case study of the utilization of ‘solution-focused problem talk’ in solution-
focused brief therapy. The American Journal of Family Therapy, 47(4), 244–260.
Dermer, S. B., Hemesath, C. W., & Russell, C. S. (1998). A feminist critique of solution-focused therapy.
The American Journal of Family Therapy, 26(3), 239–250.
de Shazer, S. (1997). Some thoughts on language use in therapy. Contemporary Family Therapy, 19(1), 133–141.
de Shazer, S., & Berg, I. K. (1992). Doing therapy: A post-structural re-vision. Journal of Marital and Family
Therapy, 18(1), 71–81.
de Shazer, S., & Dolan, Y. (2007). More than miracles: The state of the art of solution-focused brief therapy.
Hawthorn Press.
Ecker, B., & Hulley, L. (1996). Depth oriented brief therapy: How to be brief when you were trained deep and vice
versa. Jossey Bass.
Freire, P. (2000). Pedagogy of the oppressed. Bloomsbury. (Original work published in 1970).
Korin, E. C. (1994). Social inequalities and therapeutic relationships: Applying Freire’s ideas to clinical
practice. Journal of Feminist Family Therapy, 5(3-4), 75–98.
Lipchik, E. (2002). Beyond technique in solution-focused therapy: Working with emotions and the therapeutic
relationship. Guilford Press.
Nelson, T. (2019). Solution-focused brief therapy with families. Routledge.
Nelson, T., & Thomas, N. (Eds.). (2007). Handbook of solution-focused brief therapy. Haworth Press.
O’Hanlon, B., & Rowan, T. (2003). Solution-oriented therapy. Norton.
Pitkin, H. (1972). Wittgenstein and justice. University of California Press.
Selekman, M. D. (1997). Solution-focused therapy with children: Harnessing family strengths for systemic change.
Guilford Press.
Sundman, P., Schwab, M., Wolf, F., Wheeler, J., Cabie, M-C., van der Hoorn, S., Pakrosmis, R., Dierolf,
K., & Hejerth, M. (2020). Theory of solution focused practice. European Brief Therapy Association, Books on
Demand.
Thomas, F. N., & Nelson, T. (2007). Assumptions and practices within the solution-focused brief therapy
tradition. In T. S. Nelson, & F. N. Thomas (Eds.). Handbook of solution-focused brief therapy, (pp. 3–24).
Haworth Press.
van Dijk, T. A. (1999). Critical discourse analysis and conversation analysis. Discourse & Society, 10(4), 459–460.
Walter, J., & Peller, J. (1992). Becoming solution-focused in brief therapy. Brunner/Mazel.
Zatloukal, L., Ž á kovský , D., & Bezdíč ková , E. (2019). Utilizing metaphors in solution-focused therapy.
Contemporary Family Therapy, 41, 24–36.
12 Socioculturally Attuned Collaborative
Family Therapy

Collaborative practices (Anderson, 1997), also known as the collaborative language systems
approach (Anderson, 1993, 1995) and the postmodern collaborative approach (2012a), at­
tends to the relationship between client and therapist, listening and responding to client’s
narratives through a dialogic process that generates new thought and action (Anderson,
2022). Leaders in the field of family therapy such as Harlene Anderson, Harry Goolishian,
Lynn Hoffman, Tom Anderson, and Peggy Penn were instrumental in developing these
practices; however, they are now applied across many disciplines (Anderson & Gehart, 2022).
Collaborative family therapists are known for taking a humble, unassuming “not-
knowing stance” and examining multiple narratives and perspectives to create new
meanings and possibilities. Those who engage in collaborative practice contend they are
responsible for shaping the dialogic process, but clients are always the experts of their own
lives (Goolishian & Anderson, 1992; Monk & Gehart, 2003). Anderson asserted that
working from this collaborative stance is a philosophy of life in action; “a way of thinking
with, experiencing with, relating with, and responding with the people we meet in
therapy (Anderson, 2007, p. 43).” It is a political and ethical value position that counters
dominance inherent in the therapist role through practices that engage clients as equals
(Anderson, 2022; Bava, 2022a). It is a generative way of being with people, not a typical
model of therapy (Shotter, 2005).

⤝⤞

Collaborative practices encourage third order change through generative

dialogue that expands possibilities for more equitable relationships in families
and society.

⤝⤞

In this chapter, we identify core-enduring concepts of collaborative practices and then in­
tegrate the tenets of socioculturally attuned family therapy into the practice of collaborative
therapy. We illustrate these ideas by sharing a case example of a Latino family in crisis due
to the deportation of their son.

Enduring and Foundational Concepts

Below we describe what we believe are enduring concepts of collaborative practices, in­
cluding social construction of meaning, therapy as a dialogic process between conversational
partners, a therapist’s not-knowing stance, and therapy as a mutual endeavor toward
possibilities.
DOI: 10.4324/9781003216520-12
252 Socioculturally Attuned Collaborative Family Therapy
Social Construction of Meaning
Social constructionists assume that knowledge and meaning evolve through interactions
between people. It is impossible to know outside of context (Rosen, 1996). Words do not
have meaning in and of themselves. They derive their meaning from the contexts in which
they are created and change from one context to another (Bava, 2019a). Language is more
than just the words and gestures that are expressed or performed. Meaning emerges from the
cultural practices that define and shape our interaction. The boundaries between self and
society become blurred (Chenail et al., 2020). Through language, we construct the manner
by which thoughts, feelings, and behaviors are produced, which is historically and culturally
located (McNamee & Gergen, 1992; Monk & Gehart, 2003). Collaborative therapists exude
the belief that those with whom they meet are important and have something worthy to say
and worthy of being heard. They are able to meet clients without judgment of past, present,
or future and the therapist does not have a hidden agenda. The keyword for this way of
practice is with; a process that is participatory and mutual rather than hierarchical and dualistic
(Anderson, 2007; Anderson, 2012b).

Conversational Partners
Before meeting or knowing anything about the clients, therapists assume clients will be
collaborators or co-investigators (Guilfoyle, 2006). At the most basic level, the primary aim
of the therapist is to facilitate a generative conversation in which all persons are fully engaged
and heard by each other (Mills & Sprenkle, 1995). This dialogic process is the primary
“intervention.” The pacing of the conversation is often slower than other conversations to
allow space and time for inner dialogues to shape and take new forms. Through the subtle
shifts of inner and outer dialogue, each person’s perspective and experience of the problem
shifts (Monk & Gehart, 2003). It is not possible to predict how the story will unfold or how it
will end. The dialogical process is an intentional, generative, dynamic mutual activity that feels
distinct from other forms of language, such as a discussion, debate, or simply chatting
(Anderson, 2007).
Therapists facilitate a process that keeps all voices in motion and contributing to the
conversation. The therapist models honesty and sincerity, being receptive to hearing and
being engaged in each other’s story. Each client should feel as though they are equally
important and that their version of the narrative is as important as that of others. Therapists
are intentional about not siding with any one particular person, but being “for” all persons
simultaneously.

Humility and Uncertainty

Taking a not-knowing stance is one of the most important, and also potentially misunderstood,
aspects of collaborative practices (Anderson, 2005). Collaborative therapists walk a tightrope
between understanding and not understanding, knowing and not-knowing. The not-
knowing stance does not mean that the therapist does not know. That would be impossible.
It means that the therapist brackets or suspends what they believe to know, so that new
understandings can emerge (Anderson, 2012b). Attending to clients’ local knowledge and
their lived experience is at the core (Anderson, 2022).
From this stance, participants continuously challenge their assumptions and can be open to
untapped potential and possibilities. This means welcoming multiple and sometimes con­
tradictory narratives. The therapist suspends commitment to a particular outcome or agenda
other than that which has been jointly determined by everyone. Although a therapist is
 Socioculturally Attuned Collaborative Family Therapy 253
always informed, prepared, educated, well-trained, and knowledgeable, the stance of not-
knowing is about having the courage and humility to remain in a respectful, unassuming,
learner position. It also means being willing to experience the discomfort that arises when
venturing into new, often previously marginalized space (Bava, 2019b).

Expanding Possibilities
Possibilities unfold when both clients and the therapist are in the moment and open to being
influenced. The dialogic process invites participants to influence and be influenced, to shape
and be shaped by the interaction, and to mutually co-create meaning. Through this rich
process, the not-yet said or heard meanings can emerge (Guilfoyle, 2003). Being open to
possibilities, instead of dogmatically holding on to predetermined scripts and “shoulds,”
enables participants to explore paths that are better suited for their lives, contexts, and
preferred ways of living and being. Doors can open in ways that were previously limited by
social constraints. Clients might say things like, “I have never thought of that before,” “I
could not have imagined doing something like this before now,” or “No one has ever
mentioned this to me in this way.” These types of comments reflect ways in which clients
experience the opening of spaces for new realities to emerge.

Integrating Principles of Sociocultural Attunement

Hare-Mustin (1994) said a therapy room can be like a mirrored room in which a therapist
and client can only openly discuss what is reflected in the dialogue between them. If the
therapist or clients feel unable to address larger social issues (i.e., racism, classism, xeno­
phobia, homophobia, sexism, etc.) because the client has not brought these discourses into
the room, then third order change is not likely (Ellis & Bermudez, 2021). Hare-Mustin
suggested that it is the responsibility of the therapist to develop consciousness about larger
systemic issues and invite these topics into the room so that these social forces do not
remain silent. Socioculturally attuned collaborative therapists open these dialogues,
knowing that while language can marginalize and constrain, it can also empower and
liberate (Chenail et al., 2020).

Societal Context
Collaborative family therapists view language as not just the way we talk, but as a way we
create and are created by the world. As such, justice is manifested in the way we relate to one
another and in the interplay between larger structural and systemic forces and discursive
processes (Bava & McNamee, 2019). See Text Box 12.1 in which Saliha Bava explains how
she works with this relational discursive loop in therapy.

⤝⤞

Socioculturally attuned collaborative therapists engage in conversations with a

heightened awareness of sociopolitical and contextual issues.

⤝⤞

Socioculturally attuned collaborative therapists acknowledge culture as an important com­

ponent of local meaning-making (Anderson 2022; Bava, 2022a; St. George & Wulff, 2014).
They do not know until they are in the conversation what sociocultural issues will arise.
254 Socioculturally Attuned Collaborative Family Therapy

Text Box 12.1 Saliha Bava, PhD, LMFT

Saliha Bava (she, hers, hers, they) is an Associate Professor at Mercy College in
New York and does private practice and organizational consultation. She orients to
Collaborative Dialogic Practices and draws on Anderson, Gergen, McNamee and
Shotter’s social constructionism, critical theory, communicative action, Bakhtin’s
dialogism, Bateson, Wittgenstein, Boal’s theater of the oppressed, performance
theory, and Milton Erickson’s offerings, among others.
I view all practices and by extension my work, as political. Political is “what
people … do together and what their doing makes” in the world ( McNamee, 2009,
p. 62). I see my “work” as being relationally responsive to how we are shaping this
world even as it shapes our everyday encounters. Such relational responsiveness,
which is a political activity, positions us to see how our somatic experiences, local
knowledge, language, and participation are deeply intertwined discursive pro­
cesses in creating the structural and the systemic processes, which in turn shapes
and is shaped by our storied realities as illustrated in the figure below.
“My work”
It’s a process of living in search for meaning
It’s a play of liberation
It’s a play of imagination
It’s a play of dialectics

Sociocultural context is at the heart of it all; it is the water we swim in and what we
produce from within our everyday engagements. Rather than view social locations
and structures as static entities, my curiosity leans towards how the systemic
structural processes are constructed from within the interactional and discursive,
which in turn are shaped by the systemic structural–what I call the relational
discursive loop ( Figure 12.1, Bava, 2022b).

Figure 12.1 Relational Discursive Loop.

I engage in what I call hyperlinked conversations (interviewing) ( Bava, 2019a,

2019b), where we are listening to what matters to the person and how they are
connecting the dots between the various spaces within the loop (https://www.
youtube.com/watch?v=_X4tavN7l-o). My process includes attending to our pre­
sence, listening with curiosity to what is emerging, how context is shaping and
being shaped while noticing the power of “withness” talk. I call this relational play
 Socioculturally Attuned Collaborative Family Therapy 255

( Bava, 2020); an improvised contextually responsive, emergent play. It is a way of

weaving back and forth with the other in the process of sensemaking between the
broader and local contexts of people’s stories. It is a frame from which to engage
our differences, to listen for and respond to from where someone is speaking,
listening, or participating. It offers us a way to value each person’s unique ways of
participating while also inviting them to notice what their participation is creating
in the world around them.
Working in NYC, where I encounter people from all over the world, it is hard to
say that I will know what is silencing or marginalizing for each couple or family I
meet. I follow the clients’ lead. I assume that each culture has its own way by
which the process of domination, subjugation, and liberation operates. And, it is
by adopting a stance of cultural curiosity while leaning into uncertainty that I
encounter the unspoken or even the unspeakable, but often with a felt presence
that touches us. The felt presence can be a gaze, a gesture, a rush of words,
tension, a sensation, a sudden laughter, discomfort etc. Thus, orienting towards
the embodied, felt presence with cultural curiosity and permission, I seek to
engage that which might be silenced or marginalized while attempting to make
sense of what is emerging with our engagement.
As is clearly illustrated by the present day social and racial equity movements,
as social systems act on us, we act back on these systems. In recognizing this
discursive flow of organizing life forces between the personal and the social, we
can reclaim our agency and voice as participants within the sociocultural political
processes. The transformative quality lies in not only noticing the discursive
process but to see the choice points in our everyday participation––from orienting
to our embodied sensations to the use of language, to the construction of stories/
meanings to the reconstructions of institutional systems. Such a perspective offers
us a range of possibilities, as participants, to not only be consumers but also to be
producers of preferred social organizing.

Given that conversations unfold in unique and collaborative ways, it is impossible to predict
which contextual factors will become meaningful in the dialogue.
Following, we offer an example of what this type of conversation might sound like. We do
this understanding that our collaborative colleagues do not typically rely on conversational
techniques or offer examples of dialogue to describe their philosophical stance. Consider
Morgan, who presented to therapy with an expressed desire to transition from male to female.

Morgan: I always felt different.

Therapist: What do you mean? Would you be willing to tell me more about feeling
different?
Morgan: I guess I just felt different … I was always teased and mocked at school for the
types of clothes I wore, especially my old shoes.
Therapist: (curious about the societal context around the notion of “old shoes”) Old shoes?
Morgan: It was humiliating, especially in middle school. We would mostly shop at the
thrift store and garage sales … (long pause) … I hated going with my mom––I
was embarrassed. I didn’t fit in at school and my parents were struggling too hard
to help me.
Therapist: I am curious about what you said about your parents struggling too hard to help
you. Would it be ok to talk more about that?
256 Socioculturally Attuned Collaborative Family Therapy
Morgan: Sure. Maybe I sometimes resent them, but I get it. They grew up with nothing
and they tried really hard. They never had enough money. They both had crappy
jobs. I wanted nice things but then I also felt bad when they had to work so hard
to get them. Sometimes I kind of felt guilty.
Therapist: Yeah, that seems really hard … growing up without enough money … with your
parents working so hard.

Morgan was struggling financially and felt at risk of being evicted from their apartment. The
therapist may have initially thought that the conversation would focus on Morgan’s feelings
around the desire to transition, however, the therapist realized as the conversation progressed
that Morgan was concerned about their financial situation and struggled with resentment
toward their parents.
The larger social constraints of poverty and classism were influencing Morgan’s current
struggles. As Anderson (2012a) suggested, we are born, live, and are educated within mostly
invisible grand knowledge narratives, universal truths, and dominant discourses in societal
contexts that we take for granted. The grand narratives of meritocracy and the intersection of
gender and poverty affected Morgan’s sense of self and relationship with their parents. It was
essential that the therapist was able to remain “experience near” (D’Arrigo-Patrick et al.,
2016) and engage as a conversational partner, gently examining the larger forces that im­
pacted Morgan’s life.

Therapist: How do you think those “old shoes” and all the struggle you have been through
about not having enough affects you now?
Morgan: Well, I hate to say this, but I feel like I got ripped off somehow. I wasn’t given a
lot to build from like my friends and the kids in college. And I always work so
hard and still feel like I’m broke all the time. I can never seem to just make it.
And I know that people discriminate against me because I’m queer, especially at
work. It just sucks all the way around.
Therapist: Sucks all the way around… hmm … Would it be ok to help me try to understand
what that means for you? Can you say more about that?

The therapist continues to stay with Morgan, walking with them closely through their
experience through the effects of societal context.

⤝⤞

Given that grand narratives have so much power and authority in society, they
seduce us into practices that can distance others and create dissonance for
ourselves and our preferred ways of being.

⤝⤞

In addition to the grand narratives clients have about their lives, as therapists, we also have
grand narratives about ourselves, our work, and our profession. The names we use to de­
scribe the profession of family therapy, as well as the politics and economics of diagnoses, are
also important grand narratives. For example, our field is often referred to as “mental health,”
“behavioral health,” “behavioral medicine,” among others. These names were constructed
by larger social systems and have been used to define the practice of “psychotherapy.”
Socioculturally attuned collaborative family therapists remain vigilant about how these
dominant narratives define us and our work, often constraining possibilities and putting
therapists in positions of imposing these ideas through diagnostic categories. In the example
 Socioculturally Attuned Collaborative Family Therapy 257
with Morgan, the therapist was also in the position of serving as a gatekeeper in Morgan’s
ability to proceed with the transition process.
Grand societal narratives also affect how people know themselves, construct their problems
and solutions, and participate in therapy. For example, a therapist might diagnose Morgan
with Gender Dysphoria to get approval for hormone treatment and insurance coverage.
However, Morgan might be anxious about that, not knowing who would see the diagnosis
and how this could impact their living situation (e.g., housing, insurance coverage, and
employment). A socioculturally attuned collaborative therapist would name injustices em­
bedded in the medical context and engage Morgan in conversations to ensure they have the
opportunity to carefully navigate difficult decisions.
As therapists, we must remain vigilant about how and why we support or reject grand
narratives. These narratives have a direct effect on how we engage as conversational partners.
We must also remain aware of how factors such as racism, classism, sexism, and homophobia
affect the ways clients engage as conversational partners (Ashbourne et al., 2016), and be
transparent in making connections between their experience and ideas about the larger so­
ciocultural context.

⤝⤞

Socioculturally attuned collaborative therapists do not remain neutral about

the ways clients are affected by social inequality; they invite these perspectives
into the dialogue.

⤝⤞

It is important to understand that as conversational partners, therapists have a responsibility to

bring a voice to the dialogue (Cheon & Murphy, 2007). In fact, clients may misinterpret
silence as collusion with larger dominant discourses. Let’s consider a therapist who listens
intentionally, respectfully, and quietly for a long period of time as a client speaks of his
religious beliefs. The client becomes notably anxious as the therapist continues to affirm
minimally, with an “uh huh” and slightly nodding his head. The client is left unsettled
because he feels vulnerable in sharing his experience and feelings and the therapist’s level of
engagement does not match that of the client, exaggerating the therapist’s position of power
by remaining silent. His silence is disconcerting and confusing to the client because he does
not know where the therapist stands in response to what he disclosed. The process needs
engaged equitable conversational partners, each contributing to the dialogue in proportionate
and transparent ways.
Socioculturally attuned collaborative therapists are transparent with their concerns about
the impact of societal structures on dialogical processes and how these realities may limit
possibilities generated in the clinical dialogue. D’Arrigo-Patrick and colleagues (2016) ex­
amined how therapists handle possible tensions between collaborative practices and addres­
sing social justice. They found that therapists brought issues of fairness and larger context to
the clinical conversation by asking questions that bring social justice to the forefront and
staying close to the client experience. For example, a therapist might ask, “Could it be that
racism plays a role in what you are experiencing?” Findings showed that the distinction
between activism and collaboration was a false dichotomy. In varying ways, therapists balance
between raising these issues and maintaining relationships with clients. This balance can be
strengthened when the therapist has a clear picture of the sociocultural context in which their
therapeutic relationship is situated. In Text Box 12.2 Justine D’Arrigo describes how they
attend to social justice issues in a collaborative manner, and how this varies depending on the
power context of their various professional roles.
258 Socioculturally Attuned Collaborative Family Therapy

Text Box 12.2 Justine D’Arrigo, PhD, LMFT

Justine D’Arrigo (they/them) is a White queer Counseling and Therapy Associate

Professor at California State University, San Bernardino. They are interested in the
intersections of relational activism and therapy, navigating critical theory &
poststructuralism, post-oppositional approaches to relationships and change, and
exploring compositionism (Bruno Latour) and curiosity in therapy (moving beyond
critique). Their work illustrates the careful attention to use of power when aligning
with collaborative practices and other postmodern approaches.
As a White therapist and educator, I feel a tremendous responsibility to cultivate
a deep awareness of sociocultural context. Some of what has made me so
sensitized to this is my own queer identity. In many ways, I’m not able to see
through any other lens but a sociocultural/sociopolitical one. I am always
wondering how–not if–various intersecting identities and social, cultural, and
political contexts are shaping and informing story, experience, and meaning in
some way.
I name and identify these issues differently based on the contextual factors at
play. Where there is high risk of harm, I might speak more explicitly about how I am
attuning to issues arising from sociopolitical and sociocultural contexts. Most
other times, I see curiosity as my greatest ally in attending to these issues in a way
that exposes them without imposing them on clients. This might look like asking
“How did you learn that this was expected of you in your marriage?” rather than
asking “What messages have you received as a woman about how you should
respond as a wife?” The first question might open space to expose some of the
taken for granted ways gender structures relationship; whereas the second might
impose gender as a way of making meaning.
My way of amplifying what’s been silenced or marginalized happens differently
in my faculty role than in a therapeutic context. As a faculty member who is White, I
am intentional to explicitly name and speak to the practices that have a silencing
and marginalizing effect. For instance, when a colleague of color is dismissed or
spoken over, or when an older White cis male is taking up space to define for
others, I will name this and call attention to it. In a therapeutic capacity, I rely on
my curiosity. I make sure my curiosity is attentive and intentional in moving close to
the places where people or experiences have been invisibilized.
I feel called to use my power to intentionally interrupt unjust practices at both the
relational and systems level. In the university system over time, I have felt more
compelled to use my power to challenge and hold myself accountable. With
students, I feel compelled to use my power to both challenge and trouble things
while also creating a safe relational context that takes time to learn their
experiences too. In a clinical capacity, I feel compelled to use my power to
intentionally be tentative and curious.
I encourage 3rd order change by always posing questions that work to expose
whatever it is that is operating on our lives in a taken for granted and unquestioned way.
I ask the questions that power wants to divert us from, for instance, Who benefits? Who
might be harmed? What perspective is being privileged here? What perspective is
possibly being overlooked or silenced? I think these questions allow folks to consider
the many contexts within which our decisions, actions, and meaning-making processes
are embedded. They often create a pause long enough for some self-reflexivity and
 Socioculturally Attuned Collaborative Family Therapy 259

cultural reflexivity to take root, which I see as supporting more just and equitable
relationships. It is important to me, as someone who is White, to be thoughtful and
careful with how I do this. I don’t want to colonize others in a counter cultural way,
particularly colleagues, students, and clients with minoritized identities; but I do want to
be active in raising questions that might create even the smallest opening for change or
difference in perspective.

Culture is created through the ways we create language, narratives, and social discourses
(Laird, 2000). These narratives are both private (e.g., internal thoughts and processes) and
public (e.g., as when we are talking to another person). We put our cultures into action
through interactive processes that define ourselves and others.

⤝⤞

Socioculturally attuned collaborative therapists must attend to the relationship

between the nuance of words, meanings, intonation, utterances, pauses,
silences, and dominance.

⤝⤞

Cultural categories and language can justify stereotypes, power-over acts of violence (e.g.,
gay-bashing, victim-blaming), and cultural atrocities (e.g., ethnic cleansing, femicide,
slavery). Conversely, compassionate words and the act of listening are important ways to enter
people’s lives by creating space for them to be heard. Language gains meaning from how we
use it in our relationships, not just what we think our words represent (Strong, 2002).

⤝⤞

It is important to be mindful of the ways in which our social locations and

intersecting identities affect the nuances as conversational partners within a
collaborative relationship.

⤝⤞

How people communicate and participate as conversational partners depends in part on their
cultural values and social location. Laird (2000) asked, for example, “How is this person
performing culture?” (p. 106). We add, how is this person or myself performing the inter­
sections of gender, heteronormativity, middle-class, whiteness, etc.? Dominant discourses
ascribe certain performances based on cultural norms (e.g., masculinity and femininity),
which limit the possibilities generated. Socioculturally attuned therapists bring multiple
possible perspectives or stories into the conversation (Ashbourne et al., 2016; Bava, 2019a;
2022a).
Let’s consider Don, a white Jewish man in his late 60s known in the community for his
collaborative practices with queer couples. He agreed to work with Tony and Gabriel, a gay
Latino couple in their late 20s seeking help for Gabriel’s “low sex drive.” Upon meeting the
260 Socioculturally Attuned Collaborative Family Therapy
couple, Don asked questions not simply to get answers, but in ways that allowed him to
participate in the conversation in a curious way, responding to multiple perspectives, and to
stay close to what has been said.

Don: Thank you for being here. I am eager to learn about what you both hope to
accomplish by the end of our conversation? What would be most helpful for you
to leave with today?
Gabriel: I want to tell Tony something I just discovered about myself. I want him to
understand me and be OK with what I have to say.
Don: Would that be alright with you Tony? Is there something specifically you would
like to see happen today, in addition to what Gabriel is wanting for your first
session?
Tony: No, I’m good. I just really want to focus on what Gabriel wanted to talk to me
about. I know it has been weighing heavy on his mind.

As a consequence, Gabriel disclosed to Tony that he thought he was asexual. He told Tony
that he did not know he was asexual until he began to read more about it. Everything he read
matched his perception of himself.

Don: Thank you for sharing that with us Gabriel. I am curious about what meaning this
new identity has had for you personally, as well as for your relationship?
Gabriel: I feel liberated from my “fake self.” I have always felt like I was playing a part; like I
was performing being a man, which meant being sexual. I want to be loving and
giving with Tony and share my life with him, but I am tired of pretending to be a
man in that way.

Don wanted to contribute to and expand the conversation to include the possibility of
addressing the impact of societal context on the couple.

Don: Could it be that social pressures and notions of masculinity and culture affected
your desire to conform to those expectations?
Gabriel: For sure! No one understands it. All my brothers, my dad, and uncles, and friends
are tough macho guys. They are always gay bashing and saying shit about women
and “faggots” and “culeros” (derogatory and vulgar term in Spanish for gay men).
It’s exhausting and infuriating. I know that Tony is the only one who truly
understands me. That is why I love him so much. I love you enough to be honest
with you Tony. I want to be fair to you.

Gabriel and Tony were able to engage in a generative dialogue that helped them understand
each other and how they needed to redefine their relationship. The societal context in which
they and most of us live, does not support asexuality as an acceptable orientation for an
attractive, Latino man in his late 20s, who is in a monogamous, committed relationship.
Gabriel told Tony that he loved him and was attracted to him and wanted to continue to
share their lives together, but that he did not want to hold him back sexually. His sense of self
as a sexual person was a part of him that did not feel authentic. Don gently invited questions
into the discussion such as “could it be that … .?” and “I am curious about how … .? These
types of questions help examine how the larger societal context influenced Gabriel’s thoughts
and feelings about his sexuality. Both partners identified and talked about their experiences
within multiple societal contexts and grand narratives in ways that helped them navigate and
language their evolving relationship.
 Socioculturally Attuned Collaborative Family Therapy 261
Power
Socioculturally attuned collaborative family therapists are aware of the ways power is rela­
tional and contextual. A person’s power within any given context heavily influences the
ability to engage in specific discourses or have voice to say what we need and want to say or
to make the changes we would like to see

⤝⤞

Thoughtful consideration of any relationship must include how the greater

societal context informs interactions and the power dynamics embedded in
those contexts.

⤝⤞

Socioculturally attuned collaborative therapists position themselves in relation to societally

based power processes to effectively work with clients from their understandings and cul­
turally informed dynamics of power. They ask questions that elicit cultural values of mutual
respect, reciprocity, and shared commitment to relationships (Knudson-Martin, 2013).
Clients also enter therapy with perceptions of themselves that reflect their positionality based
on systems of oppression and/or privilege.
Let’s consider Nasheema, a woman who presented for therapy because her parents were
worried about her increasingly alternative “hippie” lifestyle (i.e., had many tattoos, facial
piercings, wore mismatched old clothes, dyed hair), and was not doing well in college.
Nasheema admitted that she was frustrated with college and not knowing what she wanted to
major in or what she wanted for her future. She enjoyed her job at a coffee bar and worked
20 hours a week. Her parents were both professionals and her siblings were academically and
professionally “successful.” Nasheema was the youngest of three and had never felt as though
she fit into her family. Although she had been afforded many privileges and felt loved, she did
not understand why they pressured her to do well in college and have a career. She claimed
to not feel depressed or concerned about any other area of her life except for school and her
parents’ troubled and concerned reaction to her current situation. Her therapist, Renee, who
was in her fifties appeared to reflect many of the same values and beliefs as Nasheema’s parents.
It would have been easy for both of them to maintain positions that held each other in a
negative light––ones that confirmed societal notions of power and privilege. Instead, Renee
created the space in which Nasheema could authentically express herself.

Renee: You mentioned that you feel as though you don’t measure up to your family’s
expectations of you. What do you think they are worried about?
Nasheema: They worry that I won’t be able to support myself financially. They worked
hard to give us a certain lifestyle with lots of opportunities and I think they see
me as throwing it all away by not taking advantage of the life I have been given.
I feel like they see me as a bum, even though they would never say it. I can feel
it. And it makes it worse that my sister and brother are so perfect. They worry
about me too. They have it all together and all they care about is their jobs, nice
things and expensive vacations. I don’t care if I don’t become something big.
Renee: I see. So to become something big, you have to make a lot of money and live a
certain way? Can you help me understand that better?
Nasheema: That’s right. It is like if I don’t meet their expectations then I am a failure in
their eyes.
262 Socioculturally Attuned Collaborative Family Therapy
As the dialogue unfolded, they began to disentangle how power is embedded in cultural and
societal scripts. Renee asked if Nasheema would be interested in learning more about the
ways they both embraced, rejected, or reinforced certain culturally supported discourses.
They brought up many issues; specifically, those related to social status, education, work,
success, image, alternative lifestyles, familial expectations, youth, and aging. As they did so,
Renee was open about her perspectives and possible biases. For example:

Renee: I imagine I come across as a pretty conventional person to you. I’ve done a lot
of the things “society” defines as “success”––a college degree and all that.
Nasheema: (smiles) Yeah. You do look pretty conventional. I wasn’t sure about you at first.
But you seem interested in me.
Renee: Please let me know when I may not be understanding what matters to you.
Honestly, I’ve always had a hard time understanding why people want tattoos
but I am appreciating it a lot more now.

Nasheema told Renee that it felt reassuring to know where Renee stood on certain issues and
that she was frank about her stereotypes about people with tattoos; a bias and prejudice
Renee was not proud to admit. They discussed how Nasheema began to feel as though
certain possibilities were being blocked due to her appearance and beliefs and that she felt
judged for reasons that did not fit her perception of herself. She perceived herself as a kind,
caring, thoughtful, creative, and helpful person. She said others saw her as a bum, living
aimlessly without purpose. Renee stayed “experience near,” continued to be transparent
about her own thoughts, and asked questions that helped Nasheema make meaning of her
experiences within multiple contexts of power and disempowerment.
Socioculturally attuned collaborative family therapists are keenly aware that we are all
influenced by social forces that directly affect our sense of agency and actual agency to
advocate for ourselves or others, and/or the ability to imagine equitable relationships. Renee
had to position herself in her understanding of power dynamics; that all of us, in varying
degrees, experience possibilities that are blocked due to institutional, structural, systemic
oppression, while others who are members of dominant cultural groups, benefit from the ties
they have with those with sociopolitical and economic power. Nasheema has ties with
people with societal power, such as her family and friends growing up, but their disapproval
of her “lifestyle” did not enable her to fully benefit from her association with them.
Examining these power dynamics also helped Nasheema navigate what she wanted for her
life while remaining connected to her family.
Another point to consider is the therapist’s position of power. Regardless of the therapist’s
aim to “flatten the hierarchy” or have a collaborative relationship, therapists do have power
(Larner, 1995). Larner stated that power, knowledge, and influence are intricately inter­
twined in the very experience of therapy and in the client’s expectations of change. He
challenged therapists to consider the wider social context in which a ‘not-knowing’ or ‘non-
intervening’ conversation takes place, that while power is socially constructed, it is also real.
Therapists may prefer to “flatten the hierarchy,” however this remains their decision in a
social context in which the professional role of therapist holds power.
⤝⤞

In the end, therapists must hold themselves accountable for their own power
and for promoting shared power and equitable relationships among family
members.

⤝⤞
 Socioculturally Attuned Collaborative Family Therapy 263
Power is part of all social relationships (Guilfoyle, 2003). The idea that participants in a
therapeutic dialogue are equal and power-free can obscure our understanding of power
dynamics in therapy. Not all perspectives are equally heard or have the same weight in
shaping conversations and reality claims. Just because multiple people are in conversation,
including in a family therapy session, being in the same space doesn’t grant equal voice or
satisfaction with the process and outcome. We agree with Guilfoyle (2003) who asserted that
mutual construction does not occur in the absence of attention to power. In fact, it is the
ethical obligation of socioculturally attuned collaborative family therapists to promote fairness
among family members.

⤝⤞

A potential trap of the collaborative approach is the belief that we equally co-
construct reality. This stance can be mediated with critical consciousness.

⤝⤞

The ability to manage power varies based on a person’s social location and diverse inter­
sections of their identities. For example, it can be an especially difficult for women, the very
young or the very old, ethnic, racial, or sexual minorities, and others from discriminated or
marginalized groups to experience power in contexts in which they are not part of the
dominant group. It takes being in a powerful position to choose to embrace a not-knowing,
unassuming stance to “flatten the hierarchy,” downplay, or share power. As a Latina professor
who is an immigrant, mother of three, the youngest of six children, and only one to graduate
from college, Maria is keenly aware of how choosing to take a stance of cultural humility
when teaching a doctoral level class, often works against her. Although it is her preferred
stance due to her cultural values of personalismo, and her philosophy of teaching and being
a scholar, her social location within her professional context does not support this approach.
Students and faculty will mistake her resistance to masculinist, hegemonic, and colonizing
stances, as her actually not knowing, instead of recognizing it as her intentional positioning to
be a co-learner, sharing her knowledge and power.
If persons in positions of power, such as therapists, supervisors, and educators are not
members of a dominant group, then they may not have the cultural capital or position of
privilege to minimize or share their power with others. Many may feel as if they need to
amplify their power to have similar influence or respect that people from the dominant group
might take for granted. This aspect of power and privilege may be overlooked by some
collaborative therapists. According to Tatum (1997), there is no equal influence. She asserted,
“Dominant groups, by definition, set the parameters within which the subordinates operate.
The dominant group holds the power and authority in society relative to subordinates and
determines how that power and authority may be acceptably used” (Tatum, 1997, p. 23).

Third Order Change

⤝⤞

Without a consciousness raising, action oriented, socioculturally attuned

perspective, therapists risk replicating larger sociopolitical systems and beliefs
that support social inequity and injustice.

⤝⤞
264 Socioculturally Attuned Collaborative Family Therapy
In socioculturally attuned collaborative family therapy, dialogue generates third order
transformational change, including being able to recognize and navigate the social forces in
one’s life in more empowered ways. For example, if we have benefited and continue to
benefit from cumulative advantage, then it is important that we acknowledge our privilege
and situate our success and our ability to assert ourselves or take action with confidence.
Conversely, it is also important to recognize the material consequences of social inequalities,
cumulative disadvantage, and other barriers due to a person’s social location, as well as in­
stitutional and structural systems of discrimination and oppression.
Third order change includes consciousness and action; a form of transformative praxis
that increases our ability to challenge, navigate, and mitigate systems that impede our
ability to overcome adversity. From a collaborative perspective, such change is created
through a shift in how we relate to one another and involves reflexive critique of everyday
interactions (Bava & McNamee, 2019). Transformative dialogues are not always harmo­
nious. In fact, according to Anderson (2022), sometimes having differences and tensions
can be a resource for deeper dialogue and shared exploration. They also require in­
tentionality in how helping professionals structure and approach their work to create
dialogical space that engages clients from beginning to end, as experts in knowing
what they need, and in which resilience and justice are emergent through the collaborative
relational process (Bava & McNamee, 2019; Fraenkel, 2006, 2020; Palit & Levin, 2016).
Peter Fraenkel describes the application of this stance to program development in
Text Box 12.3.

Text Box 12.3 Peter Fraenkel, PhD, Licensed Psychologist

Peter Fraenkel, PhD (him, his), is a White, third-generation Jewish American upper
middle class cisgender heterosexual man who tries to use his racial and educa­
tional privileges and the positions these privileges have afforded him to serve as a
“White ladder and a White stepping stone” for his mostly students of color and first-
generation immigrant students, and for the marginalized families with whom he
works. His reflections are drawn from 14 years of work with his graduate students at
City College in New York City in which they developed, implemented, and evaluated
a program for families living in homeless shelters. His collaborative, grounded
theory approach to research and program development is described in several
publications (e.g., Fraenkel, 2006, 2020).
I was asked to develop a program to support families that were homeless and
living in shelters. Most of the families were African American, Afro Caribbean, or
Latinx. The majority were single-mother families. Since legislation limited the
length of time persons could receive welfare, shelters and other agencies were
scrambling to provide employment and work readiness programs. I was told that
many of the parents were not attending, dropped out before completion, or did not
follow through with efforts to help them secure employment. This was cast as a
problem of “engagement.”
Given my social location as a White, upper-middle class educationally-
privileged, cisgender heterosexual male, mental health professional and re­
searcher, and as a person who had never struggled with homelessness or
joblessness or any location-based oppression, I created an approach that viewed
the “families as the experts” on their challenges and existing coping approaches.
This approach reversed the usual hierarchy of knowledge creation and program
 Socioculturally Attuned Collaborative Family Therapy 265

development and evaluation, in which persons who inhabit positions of privilege

decide what families’ challenges are and what they need to support them, and
then evaluate the success of the program based on processes that do not include
the voices and opinions of the persons receiving the program.
In introducing the nature of the project to families, we noted both in the Informed
Consent forms and in the initial interviews, that we were “turning to them to learn
from them about their challenges, their coping approaches, and what they wanted
in a program, if they wanted a program at all.” We noted that we were taking this
approach because none of us had the experience of being homeless, and
therefore had no basis for understanding the impact and means of coping with
homelessness.
The program provided the opportunity to offer ideas and advice to one another in
multiple family discussion groups, rather than providing “expert” knowledge on
best ways to parent and to cope with various aspects of adversity. Parents are in a
much better position to advise each other about how to work best with the staff of
the shelter that either assist or impede their movement towards employment and
housing. Kids and teens also advised one another on how to cope with the stigma
of being in a shelter, how to have fun while there, and how to keep their spirits up.
Conversations about how to negotiate their many challenges equipped families
with a new sense of empowerment and specific strategies to get what they need as
best they can within the reality of structural racism, classism, and other structural
constraints. Their feelings of oppression and outrage about being treated unfairly
and unsympathetically were validated.
Both families and staff had a lot of fun in these meetings. Many commented that
it was the sense of fun and pleasure that made them feel not like “clients” and us
staff members as “workers,” but that, in the words of one parent during a six-
month follow-up interview, “You treated us like we were friends, and that’s what
made the difference.” In other words, although the challenges facing families were
many and serious, we encouraged a sense of pleasure and enjoyment as part of
the process of addressing these issues. I hold a strong belief that social justice
work is most sustainable when also pleasurable, and not approached only with a
sense of dire seriousness and outrage, which can lead to burnout and bitterness. I
often feel that our work was mostly about helping to “rehumanize and re-spirit”
people whose spirits and family relationships were nearly crushed under the
weight of these challenges and the larger oppressive forces from which these
challenges flowed.

Practice Guidelines
Below we share guidelines for practicing socioculturally attuned collaborative family therapy.
The five guidelines are partially informed by the study of how social justice based therapists
navigate critical and postmodern theories in their practice (D’Arrigo-Patrick et al., 2016).

1 Assume a Critically Informed Stance

A critically informed stance requires therapists to bring critical consciousness to their work.
On the one hand, socioculturally attuned collaborative therapists must know about the larger
266 Socioculturally Attuned Collaborative Family Therapy
systems and sociopolitical context. On the other, they must remain curious and attuned to
how these larger systems affect each individual in each family. Perils of not critically ex­
amining broader social contexts leave families vulnerable to therapists inadvertently
supporting the status quo, including unequal and damaging family power dynamics.

⤝⤞

The critical knowing stance is every bit as important as taking a not knowing
stance. This allows socioculturally attuned collaborative therapists to engage in
liberatory processes while maintaining deep humility.

⤝⤞

2 Participate with Transparency

Transparency in clinical work requires that socioculturally attuned collaborative therapists be

willing to have an open stance regarding what informs lines of questioning and curiosity, be
intentional about situating our interest in social issues based on our own experience, and
be forthcoming with clients about the lens that shapes our distinctive approach. Therapists
value all client voices and experiences. Clients value this open stance in which socio­
culturally attuned collaborative therapists reveal what informs their questions and curiosities.
A therapist might say things like, “I see you as the expert on your own life because you live
it. I will often share my thoughts and reactions to what you say, but my hope is that our
conversations will help you decide what is best for you and what you want for your lives.”
Socioculturally attuned collaborative therapists might also say things like, “I will often ask
questions and share my thoughts and reactions to what you are saying.
If I notice something that seems unfair or a statement about what you should do that may
be coming from the outside or bigger society, I will ask you about it.”

3 Remain Sociocultural Experience Near

As seen in the examples above, therapists are attuned to the way clients experience and give
voice to the impact of social issues. Therapists remain intentional, ensuring that questions
attend to social issues as they directly relate to clients’ experiences in their daily lives. This
practice is instrumental in naming what is unjust or has been overlooked. It intentionally
shares space and voice as collaborative conversational partners.

⤝⤞

The greater our ability to be curious about what happens for each one of us at
individual, interpersonal, social, economic, and political levels, the greater our
ability will be to walk closely alongside others.

⤝⤞

Broadening our lens increases the possibility of sharing connection with others that is
simultaneously personal and sociopolitical. A socioculturally attuned collaborative thera­
pist’s personal experience is expanded by awareness of the experience of others across
diverse social contexts. For example, Don, the therapist who worked with Gabriel and
Tony, reflected on his own performance of gender within his cultural framework and
 Socioculturally Attuned Collaborative Family Therapy 267
became curious about what an asexual identity and experience might be like in other
cultural and religious contexts and from various economic backgrounds. Don also found
himself able to be more flexible in his own sexuality as a White male.

4 Attend to Culture and Power Differences in Dialogical Processes

⤝⤞

Socioculturally attuned collaborative therapists are acutely aware of how power

shapes dialogic conversations and ensure marginalized and subjugated voices
are valued and responded to in ways that support equity.

⤝⤞

In each of the examples in this chapter, the therapists do not presume equality. They know
that larger societal scripts inform power dynamics. Socioculturally attuned therapists take
their own and each participants’ relative power positions into account to maintain a truly
collaborative stance. They are alert to how space and freedom to speak is more available to
some than others based on their positions within discourses that are culturally and socially,
not individually, constructed (Guilfoyle, 2003; Knudson-Martin, 2013). Creating a colla­
borative dialogue involves responses that create space for marginalized identities and risk
addressing the disconcerting and uncomfortable (Bava, 2019b). Genuinely collaborative
clinical actions cannot be pre-scripted. As described by Justine D’Arrigo in Text Box 12.2,
they depend on attention to how power is at play in what we are creating and on asking
ourselves “what questions power wants to divert us from?”

5 Use Inquiry to Promote Equity

Inquiry as intervention involves asking instead of telling clients about the effects of social
issues, and allowing oneself to be led more by curiosity than by theory. Socioculturally
attuned collaborative therapists bring attention and awareness to larger contextual issues
through the questions they ask. For example, rather than telling clients “This is a gender
issue” they might ask “How might gender be affecting your experience?” Or they may
introduce voices from outside the therapeutic milieu, such as “A lot of women talk about
this …” or “There is some research on gender and equity you might be interested in. Would
you like to hear about it?”
Therapists are free to draw on any and all discourses that are relevant and potentially
helpful. A collaborative, not-knowing stance means being curious and asking questions, and
making statements that support relational equity and, by the very nature of asking the
questions, disrupts oppressive power dynamics embedded in larger sociocultural systems and
social structures. Socioculturally attuned collaborative therapists recognize that questions are
never neutral or without purpose. They are intentionally moving us toward equitable
practices. Conversations are generative as well as agentive, enhancing the ability to envision
new realities. This dialogic process can lead to transformational change in how people
engage with each other within their families and communities.

Case Illustration
In a small community, less than ten miles from a large university in the southern US, families
were awakened early on a Sunday morning by law enforcement loudly yelling and banging at
268 Socioculturally Attuned Collaborative Family Therapy
their doors. Startled and scared, families opened their doors to armed agents from the
Immigration Customs Enforcement (ICE) and Enforcement and Removal Operations
(ERO) team, many of whom had identified themselves as parole officers or police just
minutes before. That morning, fourteen men were handcuffed and taken from their homes
in front of their terrified children, spouses, other family members, and friends. Three days
after the raid, at least five others were detained locally as part of ICE’s “Cross Check”
operation that ultimately arrested 2,059 individuals across the US in five days (Department of
Homeland Security, 2015). Most of those detained following the raid opted for “voluntary
departure,” leaving behind traumatized, disrupted families and communities. In the days that
followed, members of the community responded by providing economic, legal, logistical,
and emotional support to these already marginalized families. Sandra was one of the local
bilingual, licensed family therapists who responded to the community crisis. She was a Latin
American immigrant and a trusted member of the community.
During the months following the raid, Sandra met with several families, including the
Garcia family. Sandra was given the Garcia’s number by a community liaison who lived and
worked in their community. When Sandra called, Mr. Garcia stated that he was requesting
help for his family, especially for his wife who was having an “ataque de nervios” (nervous
breakdown). Ms. Garcia was especially in crisis, crying uncontrollably, unable to sleep or eat,
and completely at a loss as to how to help her son (age 20), who had been deported. Her grief
was immense and her husband did not know how to help her. She was also the primary
provider for their family due to her husband incurring a back injury at work, for which he
could not receive medical attention. Their eldest child, who was 20, was taken from their
home, held at a detention center for months, and eventually deported back to his country
of origin.

Assume a Critically Informed Stance

In a both/and manner, Sandra was intentional about maintaining a not-knowing stance while
simultaneously maintaining an acute awareness of the larger sociocultural issues affecting this
family. First, and rightfully so, there was mistrust of strangers within this community. To be
invited into a home was indeed an honor. Sandra was aware that entering the family’s home
was a stance of embracing uncertainty and humility. This stance would be true for any
therapist working in someone’s home, but especially in the case in which there was an
obvious social class difference; with the family representing an oppressed group and the
therapist holding many privileges. In this case, the home was in a mobile home community
of Latinx people, mostly with mixed-legal status.
Although Sandra grew up in a working class family, her current social status rendered a
visible difference due to her education and assimilation in the US. In Spanish, the literal
translation of someone who is from a lower socioeconomic status is “una persona humilde”
(a humble person) and their home is a “un hogar humilde” (a humble home). Sandra had
critical awareness that she was perceived as someone who represented the dominant societal
group (i.e., white skin, English as her dominant language, highly educated, and a docu­
mented Latina). This self-awareness helped her be mindful of her position of power in
relation to theirs.
Sandra’s stance of humility embedded in critical consciousness helped her acknowledge
and honor their positions of power. For example, she asked them to address her by her first
name, not by doctor. For Latinx culture, this stance would represent awareness of the values
of hierarchy, which are based on social status, age, and gender, among other things. It is
also based on respeto/respect, which is not based on material wealth, but instead, earning
respect due to treating others in a personal and respectful manner (Bermúdez et al., 2010;
 Socioculturally Attuned Collaborative Family Therapy 269
Falicov, 1998; Garcia-Preto, 2005). Honoring a family in their home and accepting their
hospitality was an important way in which Sandra remained socioculturally attuned to how
social class and cultural norms intersect. She was also careful to note how their ways of
expressing themselves reflected larger narratives that were stripping them of their power.
As their time together continued, it became apparent that Mr. Garcia was blaming himself,
instead of larger forces, for what happened to his son. He expressed an intense sense of guilt
because he opened the door for the ICE agents and was later told that he did not have to
open the door. Because he respects authority, he did not know that he could resist the
unlawful entry of the agents if the door was closed. He said, “fue mi culpa; yo les abrir la puerta.”
(It was my fault; I opened the door). Sandra asked questions that helped him consider the
larger forces that led him to believe that he had to open the door. “Could it be that you did
not feel like you had a choice? That you believed you were doing the right thing?” she asked
in Spanish. Mr. Garcia said he was taught to obey authority and when they said “Open the
door!” he did. Because he and his son had the same name, he also thought they were looking
for him. He was confused, and then so upset that they took his son instead of him.
Sandra tried to remain experience near, especially as they discussed the larger contextual
factors affecting the Garcia family. They lived in a southern state in which there is a history of
institutionalized discrimination, racism, and oppression against people of color. Latinos were
the latest target, with White supremacy groups gaining momentum using anti-Latino pro­
paganda. The therapist was able to recognize their pain and struggle and discuss how the
larger sociocultural forces influenced their family disruption (i.e., immigration policy in
the US, anti-immigrant sentiment in the South, hostility, and discrimination toward dark
skinned, low income, and non-English speaking Latinos) (Terrazas et al., 2020; Walsdorf
et al., 2020). Although they were loving parents and providing a stable home for their
children, the effects of poverty, Mr. Garcia’s health problems, and gang culture surrounding
their home negatively affected and limited their access to alternatives. Mr. Garcia told Sandra,
“Queríamos una mejor vida para nuestros hijos, y siento que si estamos mejor aquí, pero nos duele sentir
que en el país que tanto queremos, nos rechazan constantemente. Es dificil vivir asi.” (We wanted a
better life for our children, and I feel like we are better here, but it hurts to feel that in a
country that we love so much, that we feel rejected constantly. It is hard to live this way.)
Both parents were devout Catholics who had religious shrines and candles lit in their home
and prayed for their son’s safety. They struggled with feelings of regret and doubt. They
blamed themselves, but also were angry at their son for actively going against the way in
which he was raised, which was to be a good person and a Christian:

Ms. Garcia: [crying and shaking her head] He knew better than that. We raised him to do
the right thing. He knew he couldn’t put himself and others at risk, but he felt
like he was helping his friends. They drank too much and felt like they couldn’t
drive. He was the one that drank the least. They are all so young and just
weren’t thinking! He should have not been with them. We told him to stay
away from them. They just cause trouble. Now they are free and my son is
gone and we can’t help him!

Both parents were upset that he was near the end of his probation when he was detained.
The mother was also angry at the authorities and felt as though her son was treated unjustly
due to being Latino, undocumented, and from a low socioeconomic status. Before he was
arrested for driving without a license, her son had no prior record or legal problems. The
parents were loving, kind, responsible, and insightful. They were a cohesive family. Their
frustration stemmed, not only from their self-blame and doubt, but from the injustice they
experienced due to their marginalized social status.
270 Socioculturally Attuned Collaborative Family Therapy
Their youngest daughter Evelyn was also able to gain greater consciousness about how her
family was affected by her brother’s detention and deportation. Evelyn, who was 10 years
old, was deeply grieving the separation from her brother and traumatized by the way he was
taken. Sandra had to carefully measure her words, especially given that Evelyn was present for
most of their time together. She wanted to help Evelyn contextualize what happened in a
way she could understand. In Spanish, Sandra told her, while her parents listened:

Evelyn, I’m so sorry this happened to your brother and your family. He didn’t deserve to
be handcuffed and treated like a criminal. He is not a criminal. It wasn’t his fault that he
didn’t have the papers that he needed to be here lawfully. Does that make sense to you?
[Evelyn nodded yes]. For those of us who are not born in the US, we have to have
certain documents that say we can be here legally. Not having the legal papers does not
make someone a bad person or a criminal.

Sandra then turned to the parents and said,

The way I see it is that your son had rights, and like many of us, you didn’t know what
those rights were––like not opening the door to authorities without a warrant for an
arrest. You were not aware of your rights. I can’t see how it’s your fault.

They were able to have a frank dialogue in which the Garcia family felt heard and validated,
while also understanding how their problem was situated within the larger social context.
This critical stance would not mean as much without participating in an authentic and
transparent manner. For many Latinx people, being treated with respect and connecting in an
authentic and transparent manner is a core cultural value that transcends social class and other
forms of hierarchy.

Participate with Transparency

The therapist listened carefully in an open, affirming, collaborative manner as the Garcia’s
described the impact of larger structural, societal, and institutional realities. Sandra was aware
of her power in relation to the Garcia’s. She remained transparent and had an open stance in
terms of what informed her questions and was intentional about situating her interest in social
issues (i.e., her social justice and equity based family therapy approach, especially with
Latinos). She also talked about how her work was situated in her own experience of being
Latina and having undocumented family members.

Sandra: Like many Latinos in the US, I also have family members that are undocumented. I
know it’s hard for them, but life is good for them too; much better than it was for
them back in our home country. They feel so fortunate to be in the US and are
doing OK, but it is hard for them sometimes. They have to work so hard physically
to make ends meet. I sometimes feel guilty for having privileges that they don’t
have, especially for my education and the opportunities it has given me.

Sandra was also open about the reason she was there helping them. She was a family therapist
who has devoted much of her energy to helping Latino families. This was her way of giving
back. It hurt her to see how Latinx people are treated for just wanting to have a better life.
She was living the “American dream” in ways they couldn’t. Sandra worked to remain
honest and transparent. This leveraged her position to work with them as conversational
partners and to share her power.
 Socioculturally Attuned Collaborative Family Therapy 271
Remain Socioculturally Experience Near
As the therapy progressed, Sandra remained socioculturally experience near by being attuned
to each family member’s emotions and the ways they were affected by what happened.
She attended to the specific ways in which they described and felt the impact of the effects
of their son/brother being taken away, held in a detention center for months, and being
deported to his country, where he did not have a strong grasp of the language and felt like
an Americanized outsider. Sandra was also mindful of being experience near when attending
to the child’s (Evelyn’s) narrative and her description of what happened. She asked Evelyn
explain things in her own words and asked questions directly related to what she said and
tried to remain near Evelyn’s lived experience, not just to her parents’ or their experience
in general. When asked what this was like for her, Evelyn responded in English,

Evelyn: I miss my brother. He was so funny and nice.

Sandra: I’m so sorry about what happened to your brother. I can tell that you love him very
much. I believe you when you say he is funny and nice. Is there something that you
have here at home that can help you feel close to him while he is away––something
that can make you smile and remember the things he said and did to make
you laugh?

Evelyn ran to her room and got a stuffed animal. Sandra asked if she thought it was a good
idea to hug her stuffed animal when she wanted to feel him close. She smiled and said “yes”
and hugged it tight with tears in her eyes.

Attend to Culture and Power Differences in Dialogical Processes

Throughout their time together, Sandra remained attentive to how the various intersections
of culture and power affected their communication as dialogical partners. As with many
Latinx families, the father held greater power, but he seemed somewhat unconventional in
that he displayed equal responsibility for the emotion work in the home. He initiated the
therapy sessions, attended to his wife’s needs, and was active in seeking help and being
resourceful for his family. Ms. Garcia was also active, but less so, given her greater
language barrier and the extent of emotional crisis she was experiencing. The parents spoke
little English and did not have the means to hire a lawyer to help them help their son. Sandra
also assessed how their different positions of power affected their sense of agency to mobilize
them out of their crisis state. This was especially true when their son was in the detention
center and they did not know how to help him.
Sandra made every effort to not replicate oppressive practices and aimed to treat the family
as an equal partner, although, from a societal standpoint, she had more power and voice. She
was mindful that this family felt as though their son had been forced to accept a new life; that
their sense of personal agency was taken from them. They felt they had to accept the reality
that their son, who had lived in the US since he was four years old, did not know another
place called home other than the US. His use of Spanish was limited and he hardly re­
membered his life in his country prior to immigrating to the US. His mother did not know
how her son could survive living there, especially in the violent, crime-ridden neighborhood
where his grandmother lived.
After a few meetings, they felt comfortable enough with Sandra to ask if she would be
willing to talk to their son by phone. They were worried about his well-being and wanted
Sandra to offer some comforting words of hope. They also wanted her to encourage him to
see things in a more positive light. They knew it was hard for him, but he was also living with
272 Socioculturally Attuned Collaborative Family Therapy
his grandmother, which had the potential to be positive for them both. He was trying to be a
source of support to her in the midst of his own crisis, but Ms. Garcia said that her son
seemed too depressed and angry to make it more positive. Although they called him daily,
they were very concerned. He had been recently assaulted by young men wanting to steal his
phone and shoes and to hurt him. He was able to escape, but he was injured and strongly
shaken by the experience. He felt as though he had lost all his sense of power, was having a
terrible time adjusting, and missed his life with his family.
Ms. Garcia handed Sandra the phone. Sandra explained who she was and why she was
there. She tried to be encouraging and asked questions about his well-being, what he wanted
to do while he was there, and how he thought his family could help him. His parents were
surprised that he talked as much as he did. They said their son was usually closed off
emotionally and it was unusual for him to talk to others about himself. After talking with the
son, Sandra encouraged his parents to help him keep an open mind about unexpected
possibilities and to consider his strengths that could help him optimize his experience
there––he spoke English well, had a high school education, and a home with his grand­
mother. He had access to resources that others did not have. These resources gave him power
in his new cultural context in ways he could not fully embrace.
Sandra was mindful of how her own power could help them gain access to internal and
external resources during this crisis, while also remaining vigilant about how her position as a
“helper” could potentially replicate exploitative or oppressive practices for the family. The
Garcia’s had asked Sandra to help them, but given that they were not paying for her services,
and they were meeting in their home, the potential for boundaries to be crossed and for
vulnerable persons to feel exploited was an ongoing potential threat. By remaining self-aware
and transparent about her role––including that their work would be short term until the
immediate crisis had subsided––and following the family’s lead about how she could be
helpful, Sandra took steps to avoid unintended harm.

Use Inquiry to Promote Equity

As described above, inquiry involves asking questions that lead people to examine the effects
of social issues, as well as engage in dialogues that promote relational and social equity. Sandra
talked with each family member so as to draw on any and all discourses that were relevant
and potentially helpful. She asked questions about their sources of empowerment––in which
they said church, family, neighborhood, and friends––and disempowerment, such as the legal
system, gangs in their neighborhood, and lack of work due to health problems. Through this
respectful questioning, the family was able to name the specific things that were added
stressors, as well as the things that gave them peace. They repeatedly mentioned their faith, so
Sandra asked them more about it.
Rather than “teaching” the Garcia’s how to cope with stress and loss, Sandra turned to
the family as the source of knowledge. She noticed they had a large image on their wall
of La Virgen de Guadalupe, the Virgin Mary, the patron saint of Mexico. Along with this
large image, they had flowers and a burning prayer candle. They mentioned their church
often and Sandra used their faith-based language in her inquiry. For example, she asked in
Spanish, “Creen que, con el favor de Dios, que van a poder restablecer su equilibrio y sentirse fuerte
de nuevo?” (“Do you think that, with the grace of God, that you will be able to regain
your sense of equilibrium and feel strong again?”) Qué es lo que más urgentemente quieren
pedirle a la Virgen para que puedan salir de esta situation y seguir adelante en paz?” (“What is it
that you most urgently feel like you need to ask the blessed Virgin Mary to help you get
out of this situation and to move forward in peace?” Sandra’s questions about the Virgin
Mary helped the Garcia family rally their faith to disrupt the immense feeling of
 Socioculturally Attuned Collaborative Family Therapy 273
powerlessness that had overtaken them. The process helped them limit the extent to
which the larger system and grand narratives of deportation had power over them in­
dividually and as a family. They had resources, especially in each other and their faith.
Sandra met with the Garcia family six more times. In the larger culture, the Garcia family
had very little power. Sandra intentionally engaged with them as equitable collaborative
partners. By being a guest in their home, she was able to be in a space with the family in
which they held the most power. The volunteer, in-home family work was a unique op­
portunity for the therapist to be there in ways that neither Sandra nor the family could have
predicted. Sandra was able to be with them and to be an important resource to regain their
sense of agency in an oppressive system. She continued to volunteer her time, be a source of
support and encouragement, and connect them to community resources related to health,
finances, and legal aid. With a focus on activism through countering injustice, Sandra was
able to engage with the family to disrupt and challenge dominant ideologies and practices that
kept them immobilized with fear, grief, and despair and generate a greater sense of resilience
and hope for change.

Summary: Third Order Change

From a socioculturally attuned collaborative perspective, third order change for the Garcia
family meant that they were better able to recognize and navigate the social forces creating
crisis in their lives. The therapist integrated a critically conscious approach with a humble,
not-knowing stance, while simultaneously responding to the family’s crisis with knowledge
and resources and continually engaging with the Garcia family in critical inquiry. Through
this dialogic process, the Garcia’s felt more empowered to address their unjust situation by
acknowledging and challenging racism, discrimination, and vulnerability due to lower so­
cioeconomic and undocumented status. The ability of the therapist to respond during a time
of crisis and offer a strong dose of withness and genuine support, helped them regain their
sense of hope and courage to keep moving forward and imagine possibilities.

Reflexive Questions
• What would it mean for you as a therapist if you were to embrace a socioculturally
attuned collaborative stance? Would your current place of practice support this way of
working? Why or why not?
• Have you ever taken an unassuming, not-knowing stance, and were mistaken for
not being informed, capable, or in charge? How did this affect you and your work?
• What grand narratives have seduced you into practices that can distance others and create
dissonance for yourselves and our preferred ways of being?
• When thinking about your work as a socioculturally attuned collaborative therapist, how
do you resist the temptation to remain neutral about the ways clients are affected by
social inequality? How do/can you invite these perspectives into the dialogue?
• Given your social location and particular professional context, what would it mean for
you to be transparent and willing to have an open stance regarding what informs your lines
of questioning and curiosity? Does it require safety and protection from others for you to
work in this way?
• How would you be intentional about situating your interest in social issues, and be
forthcoming with clients about the lenses that shape your distinctive approach?
• How do you welcome sometimes contradictory messages and sustain the courage and
humility to remain in a respectful, unassuming, learner position?
274 Socioculturally Attuned Collaborative Family Therapy
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13 Socioculturally Attuned Narrative
Family Therapy

Narrative family therapy (NFT) follows the poststructural idea that problems are located
in larger societal discourses rather than within the individual psyche (Chenail et al., 2020;
Combs & Freedman, 2016). Therapists take a collaborative, hopeful approach to help
clients discover previously unrecognized possibilities and re-author their lives in ways that
allow them to overcome problems. In their groundbreaking book, Narrative Means to
Therapeutic Ends, Michael White and David Epston (1990) drew on the work of Foucault
and Derrida to outline tenets of NFT. They asserted that as human beings, we story
our experiences and in doing so, ascribe significance to events in our lives as a means
of expression. According to White (1995), we live by the stories we tell about ourselves
and others tell about us. The metaphor of story helps us consider problems as thin de­
scriptions of our lives that have been co-written by social, cultural, and political contexts
(Freedman & Combs, 1996; Chenail et al., 2020). Therapists who do not explore these
dominant discourses with clients before developing preferred stories are readily co-opted
by them (Dumaresque et al., 2018; Gaddis, 2016).
In narrative practice, people are separated from, not defined by, problems. Change is
not focused on solving the problem, but on creating new variations and thickening stories
that no longer support the problem. Therapists assume clients have the abilities, skills,
desire, and competence to overcome problems. Preferred narratives highlight these abilities
and skills in ways that help clients live out their values. A common narrative process
involves deconstructive listening and questioning, externalizing the problem from the
person, making oppressive discourses evident, and reconstructing preferred stories that
allow for well-being in the present and expanded possibilities in the future (Freedman &
Combs, 1996; Morgan, 2000). While narrative therapists typically externalize the cause of
problems, there is movement within NFT to incorporate attention to the affective and
physiological processes involved in opening space for new storylines and embodying new
narratives (e.g., Beaudoin & MacLennan, 2021; Ewing et al., 2017; Zimmerman 2018).

⤝⤞

Third order change in socioculturally attuned narrative family therapy bridges

the gap between critical theories and postmodernism. It involves families
understanding how societal forces serve to create and support narratives,
impact intimate relationships, and affect material realities.

⤝⤞

In this chapter we describe key features of NFT. We illustrate how therapists can integrate
principles of sociocultural attunement and offer practice guidelines. We then share a case
DOI: 10.4324/9781003216520-13
 Socioculturally Attuned Narrative Family Therapy 277
illustration in which a young woman and her family bravely stood up to resist oppressive
forces that fueled feelings of victimization and vulnerability.

Primary Enduring Concepts

There are many aspects of narrative family therapy that are rich and unique. We share here
what we believe to be primary enduring concepts, including the idea that reality and
meaning are socially constructed, therapy is generative and time-oriented, people are not
defined by problems, the life of the problem can be deconstructed, and preferred narratives
can be co-created that positively affect the future.

Reality and Meaning are Socially Constructed

The foundational principle of NFT is that reality is socially constructed, constituted
through language, and organized and maintained through narratives (Combs & Freedman,
2004; Freedman & Combs, 1996). We make meaning based on reflections of our ex­
periences in the contexts of our families, communities, and cultures (Berg, 2009; White,
2002). While we might individually or collectively believe that our reality (or someone
else’s) is most true, narrative therapists assert that there are multiple truths and perspectives
as well as endless ways of organizing and creating meaning in our lives. Narrative therapists
are acutely aware that a person’s context serves to create, maintain, and strengthen the life
of the problem, as well as provide a source of preferred narratives. Narratives are informed
by a plethora of sources, including relational dynamics, culture, contextual influences,
interpersonal or internal conflicts, family of origin patterns, gender scripts, and reactivity,
to name a few.
Consider Ava (age 24) and Rob (age 23) who entered therapy when Ava began to feel
uncertain about their relationship. Ava grew up in a middle-class family with her White
mother and stepfather. She was 6-years old when her mother married her stepfather and
had two sons. Her Haitian father was unaware of her birth and not part of the family’s life.
Her extended family never talked about her race, but treated her with less deference than
her two brothers. This angered her mother who would continually tell Ava how beautiful
she was and remind her that “we are all the same.” Rob grew up in a White middle-class
family that had almost no contact with people of color. His parents assumed a “color
blind” stance, teaching Rob and his brother to treat everyone with respect. Among many
other narratives, the couple shared a White liberal story about race being meaningful
(socially constructed as real) yet not consequential (discoursed in a way that obscures
White privilege).
According to White (2007), “many of the people who seek therapy believe that the
problems in their lives are a reflection of their own identity or the identity of others … a
reflection of certain ‘truths’ about their nature and their character or about the nature and
character of others” (p. 24-25). Dominant and constraining narratives impact how others
see us and become further entrenched as social discourses become part of one’s story (e.g.,
internalized sexism, racism, classism, ageism, homophobia). Continuing our example, Ava
and Rob’s relationship was influenced by narratives of race and gender of which they were
largely unaware. Ava described Rob as good looking, athletic, and smart. Rob stated Ava was
the most amazing woman he had ever known. When they shared the story of how they met
they beamed with hope and excitement. Rob described Ava as being carefree, kind, and
loving. Ava described Rob as being responsible, generous, and protective. Rob’s family told
their friends they were delighted that he had found such a “lovely girl,” and Ava’s family
jokingly commented that now maybe Ava would “settle down.”
278 Socioculturally Attuned Narrative Family Therapy
Narrative family therapists focus on understanding and responding to the lived ex­
perience of each family member within all societal contexts. They intentionally attune to
clients’ words, stances, and responses to the forces that maintain problematic discourses as
well as those that give life to preferred narratives. White (1995) argued the meanings
derived through this interpretative process are not neutral. They have real effects and
consequences in our lives. In our example, Ava’s racial and gendered experience had been
silenced for a lifetime. As a child, she was left trying to make sense on her own to navigate
her identity as a bi-racial female, uncertain and unable to speak about how this social
location affected her daily life in school, church, home and the community. Rob was
unaware of his male privilege and how this along with his identity as a “non-racist” White
person contributed to silencing Ava as an adult. In effect, problems occurred when nar­
ratives too narrowly defined Ava and Rob’s identities and dominant societal narratives
(e.g., race doesn’t matter; nowadays men and women are equal) were at odds with their
lived experience.
Narrative family therapists engage clients in the process of re-authoring their stories
through deconstructive listening and questioning. They ask questions from multiple
viewpoints rather than searching for facts. They open space for considering alternative,
subjugated stories and experiences, acknowledging marginalized stories of survival, re­
sistance, and solidarity (Carr, 1998; Sen, 2021). Narrative family therapists do not re-
author clients’ lives, but they must “be acquainted with many possible stories about
life” (White, 2007, p. 82) to help clients re-author their own lives. To do this, they begin
with the understanding that stories have many possible meanings. They are on the watch
for gaps in the story; moments, experiences, actions, and explanations that are ambiguous
or do not fit into how problems are storied and identity is constructed. They ask clients
to fill in details, inviting the construction of alternative stories and/or amplification of
subjugated stories. Let’s listen in on the conversation between Ava, Rob, and their
therapist, Wanda.

Wanda: So Rob, you said your family is very open and accepting of differences. I am
curious how you know that.
Rob: Well like my parents never objected to our relationship (glancing at Ava). In fact,
they love Ava!
Wanda: Ava I am wondering what you think Rob means?
Ava: That I am not White.
Wanda: And your family? What do they think about you being “not White?”
Ava: I think my mom has been through a lot with my grandparents … but I know they
love me. My mom has been my biggest cheerleader.

The story that was emerging between the lines was one of Ava being “not White” but the
extended families “not minding.” This is a powerfully dominant racist discourse that shaped
their daily lives and relationship. Wanda’s tasks as a narrative therapist included helping Ava
and Rob unearth, examine, deconstruct, and re-author the meaning of race/racism (as well as
gender and other stories) and challenge the effect on their relationship. Wanda recognized
Ava and Rob’s lives as multi-storied and engaged them to create scaffolding that shapes a
context in which people can separate from what is known, and form a foundation upon
which they can envision what might be possible (Chenail et al., 2020). It is through more
complex, detailed, and robust stories––in this case including stories about recognizing, na­
vigating, challenging, and overcoming racism––that we can engage in a process of identity
enhancement through which to be our best selves, generate new possibilities for relation­
ships, and realize better futures (Combs & Freedman, 2004; Blanton, 2005).
 Socioculturally Attuned Narrative Family Therapy 279
Therapy is Time Oriented and Generative
Narrative family therapy is considered generative because it encourages clients to con­
struct preferred narratives that eliminate problems and create positive futures. White
(2007) used the concept of maps to help clients explore parts of their life stories that have
not been previously acknowledged. According to NFT, temporal notions of past, present,
and future can be carefully assessed and mapped to understand the terrain of one’s life;
where we have been and where we are going. Events in our lives are seen as linked across
time by themes, creating plots. Those that are included in our life stories tend to fit
within plotlines while contradictory events are left out. Narrative family therapists listen
to stories with an eye to preferred values and positive understandings about oneself that
have been missed, not thickened or detailed. They ask questions that therapeutically
restructure the re-telling of one’s life story, playing an influential, though de-centered,
role (Gaddis, 2016; White, 2007).
Clients tend to enter therapy when stories about themselves and/or others become
problem saturated. Repeated definitions of who we are over time can create “I am”
discourses or identity stories, that can be particularly resistant to change. Going back to our
example, Ava and Rob had very different stories about belonging in their families. Ava was
constantly aware that her presence in her family of origin was from a chapter that would
have otherwise been closed. Ava’s mother and birth father had a brief affair that would
have become an inconsequential footnote in the plotline of Ava’s mother’s life-before-
marriage, if the affair had not produced a child. Rob’s nativity story was one of two birth
parents waiting anxiously after trying to have a child for several years; his arrival signaling
the start of a family.
The narrative therapist will be interested in how these stories of belonging have taken on
meaning to each of them and affected how they live. They look for entry points to a pre­
ferred story by asking about exceptions to the problematic issue or pattern, or by asking what
clients would rather have done, or by identifying an implicit hope or value and inviting them
to envision what it would look like (White, 2007). For example, the therapist might ask Ava
about a story she has heard her mother recount about her birth that brought smiles or
laughter to her mother’s eyes when she tells it. They would want to know all about that
[seldom told] story and why it was so special to her mother. They would not only ask about
the details and meaning of this story in the past; they would ask what it means to Ava now to
know that this aspect of her birth was special in this way, and what this might mean to her as
she charts her future with Rob.
White (2007) promoted the idea of “experience-near definitions of the problem”
(p. 40) which focuses on the particulars of each client’s experience. This helps the
therapist and clients get to know unique and intimate details of problems and their effects.
By doing so, therapists are in a better position to point out what is absent but implicit,
broadening the story beyond the problem to explore what is important and valuable that
is being overlooked in problem saturated stories. Therapists listen deeply and carefully to
narratives to identify words, expressions, and experiences that do not fit with pejorative,
harmful, or destructive dominant discourses. Through deconstructive listening and at­
tuning to dominant narratives, therapists notice what gives the problem power and search
for unique outcomes that support alternative, preferred narratives. This space allows
clients to notice times when the problem is not present and what or who helped them act
or respond differently. Having an understanding of how to situate oneself within multiple
contexts and in a temporal dimension (past, present, future) is essential to moving toward
preferred narratives.
280 Socioculturally Attuned Narrative Family Therapy
People are not Defined by Problems
Unique to NFT is the idea that the problem is the problem. Instead of viewing a person or a
relationship as pathological, dysfunctional, or defective, narrative therapists contend that
persons are separate from their problems. Although we may feel like a problem such as
depression, anxiety, addiction, stress, or worry lives inside us, narrative therapists contend
that it is the problem-saturated belief or narrative that has become dominant in our lives. For
example, a person may struggle with cancer, diabetes, HIV, bulimia, alcoholism, or schi­
zophrenia, but a person is not those things. The illness, condition, or problem does not and
should not define the person or relationship. When clients see themselves as separate, they are
able to see the life of the problem and their relationship with it from many angles, per­
spectives, and contexts. More importantly, this process helps create the space for new and
preferred narratives to emerge (Freedman & Combs, 1996; Parry & Doan, 1994; White &
Epston, 1990).
Externalizing erodes the problem’s power, allowing clients to enact agency by facing and
defeating or weakening the effects of the problem. For example, by personifying the pro­
blem, clients are able to see how the problem can bully, manipulate, coerce, seduce, or trick
us. These acts of violence, power, and control can be so gripping that they inhibit us from
exercising our own power, free will, and agency. Externalizing enables clients to claim or
reclaim power that has been lost or diminished due to the effects of the problem.
Externalization permeates all aspects of the clinical process, from beginning to end
(Bermúdez et al., 2009). The process is nuanced and can happen in many ways. It can involve
one person, several people within a family, and/or an entire community (White 1988; White
& Epston, 1990). Most commonly, the externalization process happens by naming, objec­
tifying, and personifying a problem through a metaphor.
Beginning clinicians often think of externalization as a technique or an intervention,
however, it is more accurately understood as a way of thinking and talking that invites a
therapeutic process, generative stance, or philosophy (McGuinty et al., 2012; Payne, 2006;
Roth & Epston, 1996). Furthermore, a novice might be tempted to simply accept and ex­
ternalize whatever clients identify as the problem when they enter therapy without fully
exploring narratives. In our example, Ava’s definition of the problem as “uncertainty about
the relationship” could be adopted and externalized as the problem without taking time to
fully explore the situation. This would have inadvertently contributed to Ava being viewed
as the one with the problem and without deconstructing the dominant social narratives in
which this problem is embedded (Gaddis, 2016). On further inspection, Ava’s uncertainty
was guiding the way; shedding light on the problems the family was struggling with, in­
cluding racism and sexism. In fact, Ava’s willingness to question was one of her strengths that
had been repeatedly overlooked. Questioning and uncertainty would go on to take a central
role in the couple’s re-authored preferred narrative. Let’s listen in again.

Wanda: I am curious about this uncertainty and questioning … did you notice that when
you were a kid?
Ava: Sure. I was always uncertain about whether or not I really belonged in the new
family. I kept wondering if it was because I looked different or my stepfather
wished my mother hadn’t been with my birth dad before him, or if it was because I
was the only girl …
Wanda: So lots of exploring what might be going on … what wasn’t being talked about.
Ava: Yeah. I am good at that, right? [glances with a smile at Rob]
Rob: (chuckles) You are. She questions everything! I guess I just always accept things at
face value.
 Socioculturally Attuned Narrative Family Therapy 281
Wanda: So Ava is the one who takes on the job of figuring things out and finding ways to
talk about them?
Ava: I guess so.
Wanda: Makes sense … particularly when you are faced with so many unspeakables.
Ava: That’s a good way to put it.

Wanda now has agreement about how to language the problem and can move on to ex­
ternalize “unspeakables.” Racism, White privilege, gendered power dynamics, and unwanted
pregnancies are all among what is unspeakable. Externalizing questions might include things
like, “What do these unspeakables look like?”, “Where do they mostly live?”, “Who else do
they affect and who is affected the most?”, “How do you know unspeakables are nearby?”,
“Who else notices them?”, and “When did unspeakables begin to interfere with your re­
lationship?”

Deconstruct the Life of the Problem

Another enduring concept in NFT is the notion that problems have power and problem
saturated stories need to be understood well to diminish or dismantle a problem’s power.
Rather than supporting pathologizing, deficit-based, internalized descriptions of problems,
narrative therapists separate people from problems with the firm belief that problems will be
eliminated when stories about our lives and consequent actions no longer support problems.
Julie Tilsen (2021) discusses the importance of queering narrative therapy by dismantling and
deconstructing how we think and work to imagine new realities. Tilsen states that decon­
struction is aligned with queer theory’s skepticism toward essentialist ideas by asking ques­
tions that would not usually be asked because they are taken-advantaged truths. By
decentering dominance, space is created for lived experiences and realities to come forth.
Therapists assume a role or clinical posture as a witness or audience whose goal is to be drawn
into the story in ways that lead to externalizing the problem, uncovering alternative stories,
identifying unique outcomes, and re-authoring preferred life stories and/or relationships with
the problem. Therapists actively engage clients in exploring the meaning of the new behavior
and expanding the new storyline.
Consider how Wanda might engage with Rob and Ava to map the problem “unspeak­
ables.” Wanda might use a whiteboard to draw a diagram of the problem and how it affects
individuals and relationships Figure 13.1.

Unspeakables

Silenced

Uncertain of Awkward
our relationship Afraid the
problem is too big
to solve

Figure 13.1 Diagram of externalized problem.

282 Socioculturally Attuned Narrative Family Therapy
Wanda: How do these unspeakables affect your relationship with your family?
Ava: It just feels awkward sometimes, like we all know something but just can’t talk
about it. Makes me feel like there is something to be ashamed of.
Rob: I guess it is like if we don’t talk then it doesn’t exist. If we ignore differences or stuff
from the past, it will just go away.
Wanda: But it doesn’t?
Rob: No. I think it makes us tense and worried sometimes.
Ava: Definitely uncertain of our relationship.
Wanda: Like if we can’t even talk about these things, they must be big?
Ava: Yes. I feel silenced a lot … maybe even invisible sometimes.

Once the problem is mapped, Wanda can encourage Rob and Ava to fight against its effects,
which in turn are keeping it alive. For example, what is unspeakable leaves Ava feeling
silenced; therefore breaking the silence challenges the problem. Talking about race, gender,
White privilege and other unspeakable dynamics provides avenues for talking about differ­
ence, power, and negotiating their relationship within social context. Not talking about these
dynamics fuels Ava’s uncertainty as she is not able to address “make it or break it” aspects of
her relationship with Rob and their families. In turn uncertainty fuels what is unspeakable as
it increases anxiety over talking about real issues.

Co-Create Preferred Narratives

Narrative family therapists listen deeply as they search for experiences, values, and meaning
that counter problem saturated stories and help co-create preferred narratives. These may be
mere traces in the form of hopes, dreams, and intentions; moments when values and actions
support subordinated stories of strength. Therapists remain committed to being curious,
gathering support to thicken and more richly describe new or previously subjugated pre­
ferred narratives. This shift from the problematic to the preferred narrative happens by
searching for unique outcomes. The concept of unique outcomes is similar to the solution-
focused idea of exceptions to the problem (de Shazer, 1991), however, it differs via an
emphasis on helping clients see when they are able to resist the negative or problematic
influence of the problem (White, 1993).
In our case example, Wanda talked with Rob and Ava about how as a couple they had
already begun to challenge unspeakables of racism that can cause trouble in interracial re­
lationships. This part of their story, the part that was challenging existing social relationships,
that insisted on being uncertain until these issues could be addressed, needed to be thickened
as an alternative plot. They agreed on the ideal of race and gender equality but without being
able to really talk about these things; they succumbed to a White male-privileged liberal
stance of maintaining inequity by acting as if equality already existed. Furthermore, Rob’s
acceptance of things at “face value” may have been, at least in part, a function of his un­
spoken White, male privilege.
Understanding the landscape of identity and the landscape of action are important processes
that lead clients toward preferred narratives and desired outcomes. The landscape of
identity “emphasizes the irreducible fact that any renegotiation of the stories of people’s
lives is also a renegotiation of identity” (White, 2007, p. 82). For example, contrast the
landscape of Ava’s identity if she sees herself as a biracial woman from an unwanted re­
lationship instead of a racially aware feminist. The landscape of action refers to concrete
action that must be taken through intentional thoughts, actions, and interactions to bring
preferred narratives to life in strong, tangible, and lasting ways. Following Ava, this might
include her openly discussing race and gender equity and talking more openly about her
birth father. That said, not all actions are possible in all contexts. People will still respond
 Socioculturally Attuned Narrative Family Therapy 283
to her based on the color of her skin. There are societal and structural limits to action that
can be taken on preferred narratives.
There are many ways to explore and amplify unique outcomes. For example, remembering
conversations call on past relational knowings that contradict clients’ dominant narratives that
help elicit preferred, alternative stories. Those conversations thicken the preferred narrative
and give it a stronger life in the future. According to White (2007),

re-membering conversations provide an opportunity for people to revise the member­

ships of their association of life: to upgrade some memberships and to downgrade others;
to honour some memberships and to revoke others; to grant authority to some voices in
regard to matters of one’s personal identity and to disqualify other voices. (p. 129)

A narrative therapist might ask, “Who in your life would not be surprised that you are now
graduating from college?” This re-membering brings forth those individuals who team up
with the client to thicken the plot of the preferred narrative. Definitional ceremonies (White,
2007), rituals, performances, art, creative expression, dance, letters, ceremonies, certificates,
and the telling and retelling of the preferred narrative are also ways in which we can
strengthen the life of the narrative that supports preferred ways of living, being, and relating
to others. Bruner, as cited by White and Epston (1990), stated that “life experience is richer
than discourse. Narrative structures organize and give meaning to experience, but there are
always feelings and lived experience not fully encompassed by the dominant story. Narratives
tend to be anchored in evocative moments; any experiential way of performing or telling
the new narrative gives it more power, making it more likely that the developing narrative
will translate into action (Zimmerman, 2018).

Integrating Principles of Sociocultural Attunement

The underlying postmodern assumption that reality is socially constructed has been em­
braced by narrative therapists, however, a number of scholars have noted the dialectic
tension and limitations of this framework from a critical lens (Agger, 1991; McDowell,
2015; Miller, 2000; Slott, 2005). Many postmodern, including narrative therapists, ques­
tion critical social theory as relying on a grand theory or singular truth claim. In turn, many
critical social justice oriented therapists argue postmodernism relies too heavily on re­
lativism. This can obscure injustice as a matter of pluralistic, equally valid perspectives,
disregarding the real material consequences of social inequity. While narrative philosophy
and practice are strongly situated in multicultural work (Laird, 1998), narrative therapists
who neglect to attend to systems of power, privilege, and oppression risk maintaining the
status quo by failing to address the power these societal structures have over their clients’
lives and agency (Dumaresque et al., 2018).
In this section, we attempt to bridge these competing discourses by exploring the appli­
cation of critical postmodernism in socioculturally attuned NFT. According to Boje (2001)
“critical postmodern is definable as the nexus of critical theory, postcolonialism, critical
pedagogy, and postmodern theory” (p. 433). Critical postmodernists join social construc­
tionists in acknowledging that language does not reflect an objective reality and is not neutral.
Both postmodernists and critical postmodernists agree that the social construction of
knowledge (i.e., what we believe to be true) impacts and is impacted by power (Slott, 2005).
Family therapists working from postmodern, critical, and critical postmodern perspectives
typically share an ethical stance of promoting social justice, even though they may work
toward this goal in varying ways (D’Arrigo-Patrick et al., 2017). In Text Box 13.1 narrative
family therapist Laurel Salmon describes critically deconstructing how sociocultural contexts
are part of each case she sees or supervises.
284 Socioculturally Attuned Narrative Family Therapy

Text Box 13.1 Laurel Salmon, MS, LMFT

Laurel Salmon (she/her) MS, LMFT is the Executive Director of CANDLE, in New York. Laurel
is dedicated to socially just mental health practice and has worked extensively to integrate
strategies for interrupting oppression and understanding the ways sexism, racism, hetero­
normativity, and religious oppression impact therapy. Her work at CANDLE focuses
on providing community support for youth and families. Laurel identifies as a Black, straight,
cis-gender female of Afro-Caribbean descent.
I tend to see all therapeutic clients through the lens of Narrative therapy blended
with elements of emotionally focused and attachment-based approaches. These
models are about how clients experience relationships and the world through
their lived experience. I always come from a place of stating what exists versus
what we are told is true. I validate the internal resistance oppressed and
marginalized people experience and highlight it. This practice helps people to
identify how they want to be treated.
My work provides a framework for third order thinking around oppression and how it
impacts the people we work with. I developed “Four Questions” to analyze how clients
experience the world through the various systems they interact with and the social
constructs the world applies to them. The Four Questions framework includes:

1 What are the common stereotypes about each of the groups that [the client] falls into?
2 What is the dynamic between us because of oppression?
3 How can I expect to oppress [the client] inadvertently if I am not careful?
4 How are the current presenting problems related to oppression? ( Salmon, 2017, p. 14)

Once those factors are front and center, it pushes the clinician and/ or supervisor to identify
how the therapeutic or supervisory relationship is impacted. I always name the unspoken
context of unjust interactions. I err on the side of possibly overstating in order to balance how
early we are conditioned to leave certain inequities unnamed. I routinely take the time to
express who has the power to silence and marginalize by naming and highlighting the
unspoken and unseen. I think it is our role to identify and examine these dynamics as part of
our therapeutic work.
I spend a lot of time examining larger systems that we involuntarily interact with
like criminal justice, education, medical, social service, and mental health
systems. I make an effort to externalize ideas that people have integrated into
their sense of self that come from the way they experience these systems. I also
spend a lot of time talking about power dynamics and how they give all our
relationships (with people and systems) a context that assigns meaning to all
interactions. For example, if I have power over you–earned or unearned–it will
impact how you feel about my interpretation of your behavior and how you will take
guidance from me. If you feel like I value you as a person and respect your
choices, it will adjust the context of how you experience me.
This perspective on power dynamics can be applied to any relationship, not just
therapeutic relationships. It exists in courts, in schools, between doctors and
patients, and in any other capacity where people interact. My hope is that by
constantly giving voice to this, both marginalized and dominating groups will be
slowly pushed toward more equitable relationships.
 Socioculturally Attuned Narrative Family Therapy 285
Societal Context and Discourses of Resistance
Socioculturally attuned narrative family therapists are keenly aware of how complex, in­
terconnected social, structural, cultural, political, and economic realities contribute to un­
equal division of labor and resources, as well as uneven influence in decision-making and
agency within and across all societies. Language plays a significant role in promoting and/or
resisting societal systems; in how these systems are maintained, justified, challenged, and/or
transformed. The aim of socioculturally attuned NFT includes helping clients deconstruct
dominant discourses that maintain problems, co-create new narratives, and take action in
support of preferred narratives. It also includes exploring with clients’ collective discourses of
resistance to socially unjust dominant discourses.

⤝⤞

Socioculturally attuned narrative family therapists assume dominant discourses

are among many competing and interrelated discourses for which there is
greater or lesser social support.

⤝⤞

Support for discourses is garnered in a number of ways including establishing and protecting
truth claims (e.g., this is how it is) and/or appealing to one’s interests, beliefs, and/or values
(e.g., this is how it should be). When discourses are at odds, hybrids are formed. New stories
emerge in the epistemological borderlands within and between global, societal, and familial
contexts. For example, in the US, dominant discourses of democracy and capitalism are at
times congruent and at times conflicting (McLaren & Farahmandpur, 2001). Contested in­
terpretations of these value-based ideologies inform the broadest (e.g., Supreme Court de­
cisions about same-sex marriage, laws banning hate crimes, gun laws, banking deregulation)
to the most intimate (e.g., our relationships with money, reproductive rights, who we listen
to) public and personal decisions. Spin off discourses that have emerged as a result of the
inherent incongruence of these and other dominant discourses include the myth of mer­
itocracy, prosperity theology, and colonial narratives of eugenics that associate skin color and
phenotype with evolution (e.g., race).
The practice of NFT, with its emphasis on writing one’s preferred narrative, can inad­
vertently support the belief that anyone can “pull themselves by their own bootstraps”
(McNamee & Miller, 2004). Socioculturally attuned NFTs will recognize that the socially
constructed discourse of an equal playing field (democratic ideal) in a system that requires
some to be at the economic bottom (capitalism) draws attention away from the inherent
conflict of these narratives by placing the problem squarely on those who have suffered
lifetimes of cumulative disadvantage (Merton, 1988).

⤝⤞

Just as all discourses are acts of collective meaning-making, dominant

discourses and discourses of resistance are shared narratives.

⤝⤞

These various discourses are not seen simply as a smorgasbord of personal choices, but as
value-driven propositions which we cast our votes for or against. When dominant discourses
286 Socioculturally Attuned Narrative Family Therapy
go unnoticed as natural, inevitable, or assumed right by nature of their widespread support,
we at best inadvertently cast or vote in favor or fail to vote against what may not align with
our values, best interests, experience, or epistemology. Again, therapists must “be acquainted
with many possible stories about life” (White, 2007, p. 82), and we argue this includes
discourses of resistance to which clients can be introduced (Sen, 2021). Consider the impact
discourses of resistance might have on our couple, Ava and Rob. Wanda might introduce
them to websites for multiracial families (e.g., Project RACE), invite Rob into a men’s group
that actively challenges male privilege and patriarchy (e.g., National Organization of Men
Against Sexism), and/or offer titles of books (e.g., bell hooks readers on race and gender). All
of these resources are sites of collective resistance, within which meaning that challenges
oppressive dominant discourses are socially constructed. They are also sites in which col­
lective action is organized.
Dominant discourses may privilege some members of families over others, contributing to
relational inequity. Socioculturally attuned NFT attunes to conflicting narratives within fa­
milies. This includes exploring who is supporting them and why, as well as how narratives
may benefit some over others. Therapists carefully attend to ways in which certain family
members are valued by each other, by society, or by other important people and contexts in
their lives. Again considering Ava and Rob, the narrative of Rob as being a non-racist White
man inadvertently placed the burden of change on Ava by masking Rob’s accountability for
White male privilege.

Culture and (De)Colonization

As described in chapter two, colonialism refers to a process in which dominant group cultural
practices, ideologies, and beliefs are centered as more right and true. The ideologies, beliefs
and cultural practices of non-dominant groups are subjugated and actively interrupted. This
privileges dominant groups by centering their cultural capital (Bourdieu, 1986) to create and
maintain colonizers’ advantage. Socioculturally attuned NFT aligns with decolonizing fra­
meworks. As others have detailed, this requires reflexively considering the Western origins of
narrative therapy and how it is conceptualized and practiced (polanco, 2016), as well as how
narrative therapy is regularly co-opted by mental health delivery systems without considering
how the treatment system itself upholds structural causes of oppression and problematizing
world views (Dumaresque et al., 2018).
Like all models, narrative practices do not directly transfer or adapt to other cultures
(polanco, 2016). An emphasis on space and linear time is in itself a colonizing act as the
temporal epistemology of the West and Global North is privileged in most therapy. For
example, therapists typically consider only one dimension of space over a single lifetime. This
is in stark contrast to many indigenous concepts of space existing simultaneously across
multiple dimensions and time existing in nonlinear fashion. Stories are not always depicted in
spoken or written words, as noted in our case illustration at the end of this chapter. Meaning
is also co-constructed in ways that are non-verbal, expressive, and performative.
For example, marcella polanco (2016) described needing to develop a different way of
practicing when working in her native Colombian Spanish, of having what she termed
“unreasonable conversations” (p. 73):

I had to search for … the making of narrative therapy conversations which … make
possible the made-up-ness of extraordinary, ordinary, unreal real realities not normally
verifiable by the mind of Western reason, logic or sensory perception … I seek to turn
reasonable conversations unreasonable, when displacing reason and logic as the only
 Socioculturally Attuned Narrative Family Therapy 287
legitimate means for conversation––hence dethroning the brain as the only organ of our
bodies that possess the capacity to become knowledged … I ask questions like these
[regarding suicide]: What did your body know about you and your relationships that
although your mind had decided to die, your body proceeded to live? At the moment in
which your mind starts taking charge with its deadly plans, what part or parts of your
body do you remember taking the lead in the execution of such plans, and how was it
like for them to engage in the plan? … I have learned that when given the opportunity,
parts of our poetic, imaginative bodies, may have grown minds of their own. They are
begging us to let them speak their minds, since they are often shrouded in secrecy.
(pp. 74–75)

⤝⤞

It is difficult to make sense of one’s experience when there is no language, no

discourse through which it can be described. Not only are experiences outside
of dominant cultural discourses marginalized by others, they are often
marginalized within us––kept secret and foreign to who we think we should be.

⤝⤞

Socioculturally attuned NFTs are attentive to hermeneutical injustice (Fricker, 2007), re­
ferring to inequities in whose experience is understood and given social credibility. They
recognize how readily dominant culture narratives are imposed or unchallenged in therapy
if therapists do not externalize these normative judgements and invite counter-stories
(Dumaresque et al., 2018; Sen, 2021).
Shelja Sen (2021), a narrative therapist who works with young women in India dealing
with gender-based trauma, uses therapeutic conversations to “develop solidarity against
generations of patriarchy” (p. 61). Shawn Giammattei (Text Box 13.2) details a similarly
decolonizing approach in his work with transgender, non-binary, gender expansive (TGE)
clients and their families.

Power and Subjugation

How we think and talk about power is important. Foucault argued that power produces,
through knowledge claims, what we assume to be real or true. This includes what and who
we think of as normal or not normal. The power problem most NF therapists set out to
solve is that of being subjects of objective, scientific, or modern knowledge that defines
who we are for ourselves and others. This has been revolutionary in the practice of family
therapy. At the same time, there is a risk of creating another grand narrative or truth claim
by too narrowly and certainly defining what power is or is not. For example, when we
make claims such as “power is everywhere,” we run the risk of engaging in the very
definitional process Foucault resisted. That is not to say that power isn’t everywhere, but
that we might be better served by saying something like “when we think of power as being
everywhere … .” This type of statement suggests a view from somewhere (we) and that
there are other perspectives (when we think of power as). This is particularly important in
socioculturally attuned NFT as it provides a congruent theoretical perspective by which to
acknowledge the lived experience of Foucault’s second type of subjugation, such as
dependence and control.
By expanding the notion of subject beyond the limits of definition and identity, we are
better able to acknowledge the material consequences and lived experience of social and
288 Socioculturally Attuned Narrative Family Therapy

Text Box 13.2 Shawn V. Giammattei, PhD, Clinical Family

Psychologist

Shawn Giammattei is a private practitioner in California and founder of the Gender

Health Training Institute and the TransFamily Alliance. He teaches at the California
School of Professional Psychology, is a research consultant to Kaiser Permanente
and Emory University, and a World Professional Association for Transgender
Health (WPATH) certified gender specialist and mentor. While he draws on many
clinical models, Shawn situates his work in a narrative paradigm.
The narrative paradigm keeps me attuned to sociopolitical contexts. It requires
we deconstruct the heteronormative and cisnormative elements of the theories
and techniques we use, and to do so in a culturally conscious way. I am a White
2nd generation American, highly educated, and well resourced. I am also a gay
man who was assigned female at birth and began the journey of authentic
embodiment at the age of 36. I live with an invisible disability and have
experienced the extreme impact of transphobia despite the privileges of the color
of my skin and access to education. I am one personification of the resilience in
this community. I am also keenly aware of how much easier my path has been
compared to my trans siblings, particularly QTBIPOC, due to my levels of
privilege.
Transgender people are often viewed in negative and pathologized ways by the
world, their families, and themselves. Their difficulties are not appropriately seen
as a medical issue but as a cultural one. Parents are blamed for not properly
gendering their children, and trans people are often treated like they don’t have
any family or that no one will ever love them or want to partner with them, so they
aren’t even considered in the context of a family or community other than as a
throwaway human. My whole practice, whether working with clients directly,
training clinicians, or acting as an advocate, is to disrupt these notions so we
move to seeing trans people as humans with families, relationships, and some­
thing amazing to offer this world because of who they are, not in spite of it.
It would be very easy to exploit transgender, non-binary, gender expansive
(TGE) clients and their families and become gatekeepers to their medically
necessary care. We must understand not only the obvious issues impacting these
families, but also the more subtle cultural narratives around gender and sexuality.
It is absolutely necessary for any therapist working with this community regardless
of their social location, to do the self-of-the-therapist work, understand who they
are in relation to their clients, and how that impacts their work, the questions they
ask, and what they think is possible for their clients.
The TGE population is incredibly marginalized. This is exponential when one
holds more than one marginalized identity. On top of that, is the impact of
sociocultural narratives on family acceptance or lack thereof. Clinicians need to
stay very close to our clients and understand these interactions and experiences,
and not place our own lens and expectations on the families with whom we work.
Sometimes a simple question about whether they might be experiencing some­
thing opens up a whole story about what’s happening culturally for them. I also use
many tools, including genograms and cultural maps to get a better sense of their
story and experience. I pay very close attention to my own personal reactions to
what I’m hearing. Once I recognize an issue is present or I’m aware that something
is happening politically, socially, or culturally, I highlight it by asking questions
 Socioculturally Attuned Narrative Family Therapy 289

about the impact of those things, or by exploring the history of behaviors that may
be influenced by those factors or power dynamics.
When I sense a power imbalance of some sort or I know something is happening
that is not being brought forth, I usually call it out in a gentle way. Most common for
me is to say something like “I’m noticing something, but I’m not sure it’s correct,
but I’m wondering about that … does any of that resonate for you?” I help them
explore it, unpack it, make sense out of it, and come to conclusions of their own
about what this means for their relationships and what they should do moving
forward. I am always listening for how heteronormativity, cisgenderism, and
transphobia are internalized and impacting us. I generally externalize all those
isms. We explore how they play out, then take a stand on how to challenge them. I
make sure they’re feeling understood and held enough to step in to the scary
areas, especially around power dynamics and the need to balance those. When it
comes to working with systems outside of the therapy room, I am often writing
letters and speaking and standing up on behalf of my clients in the community.
Transgender people and their families not only need advocacy around medical
interventions, they need us to promote general access to care, safe workspaces
and school settings, and equity in treatment.
Envisioning new stories of resilience is a key part of my work. This is often done
with the whole family, but in certain circumstances, if I’m using, say EMDR for
trauma, I always take it to the place where they can rewrite the story with the
newfound empowered knowledge of themselves and the connections they’ve
created. From that place, we can create plans to move towards change, even in
contexts that may appear hopeless. I’m a bit of a cheerleader towards resilience
and transformative change and tend to hold a very hopeful and positive stance,
sometimes holding it for my clients when they can’t get there yet.

relational processes of oppression. Take, for example, a mother who removes herself and her
children from a physically abusive male partner. Her social label and identity may be that of a
single mother whose children are being raised in a broken home. Family members’ identities
are then deficit-based and determined by divorce. A new narrative might support a family
identity as liberated and whose members fought for their freedom. This is a powerful nar­
rative, however, there are still real material consequences to raising children with one income
(typically 80% lower for females), dealing with restraining orders and custody battles, and
getting calls from the school where teachers now frame the children as having problems
at home.
Foucault assumed that resistance is present wherever there is power. Deconstructive lis­
tening and co-constructing preferred narratives are foundational to resisting the subjugating
effects of defining self-as-problem. Socioculturally attuned narrative family therapists pay
close attention to the effects of definitional power as well as dynamics of dependence and
control. This includes noticing who takes up more space in relational contexts; who gets to
talk, who talks most often, whose words have more influence, and whose role in the re­
lationship is most valued. It also includes actively interrupting power-over in support of just
and equitable relationships.
Let’s consider Marvin and Rose who have been married for nearly 50 years. While they
seem to get along well, Marvin frequently teases Rose about what she eats (policing her body
and food intake), makes jokes when she gets lost or forgets something (storying her as less
290 Socioculturally Attuned Narrative Family Therapy
competent), and refers to her as his “old girl” (diminishes both her gender and age).
Discourses that subjugate women are of course still present and were particularly dominant
during this couple’s lifetime. These intimate performances of power both reflect and support
dominant discourses about gender, yet are performed by specific people within specific re­
lationships and contexts. Their performance of power is shaped not only by social discourse,
but by the couple’s personalities, family of origin backgrounds, independent financial re­
sources, relationships with children and grandchildren, and so on.

Third Order Change

Within the context of the therapeutic relationship, there are varying levels of transformative
change that clients experience. As discussed in chapter two, therapists often challenge their
clients to create second order change rather than first order change, as second order change
focuses on altering systems of interactions. Second order change in narrative therapy occurs
when clients reclaim their lives from dominant stories, which in turn transforms their nar­
ratives and their relationships with those with whom they interact.

⤝⤞

Third order change raises social awareness helping clients view dominant
narratives with a sociopolitical lens. Once clients are able to notice how societal
forces are perpetuating dominant discourses and contributing to problems,
they are better prepared to navigate and resist their effects.

⤝⤞

Through a socioculturally attuned framework, NF therapists are able to name, explore, and
deconstruct the influence of societal structures of oppression, such as racism, heterosexism,
sexism, and ableism with their clients. Questions that aim to deconstruct oppressive societal
discourse might include: “How do you think homophobia is influencing the dominant view
you have of yourself?” “In what ways has racism played a role in what is bringing you to
therapy?,” “How does sexism operate in your life?,” “If ableism could speak to you, what
kind of messages do you think it would be saying about your worth as a person? A partner? A
friend?”––and “If your most empowered, best self were able to stand up to classism, what
would you want it to understand about you?”

Practice Guidelines
The following five practice guidelines help family members recognize the impact of societal
systems of power and oppression on not only how they story their lives, problems, and
preferred narratives, but also on the material realities of their lives. It is helpful to note that
they are not always implemented sequentially and may move fluidly back and forth over the
course of the therapy.

1 Expand the Map to Include Sociopolitical Structures

Socioculturally attuned narrative family therapists attune not only the influence of social
discourse but to the impact of societal structures in their clients’ lives. They expand the map
of the problem to name complex, interconnected social, structural, cultural, political, and
economic realities that contribute to unequal division of labor, resources, influence, and
 Socioculturally Attuned Narrative Family Therapy 291
agency within families and communities. Dominant discourses remain central in the work of
deconstructing problem narratives, and reconstructing preferred narratives. What is often less
clear is the understanding of problems and possibilities within societal contexts and social
structures that constrain agency and afford access to opportunities based on the many in­
tersections of social location/group membership (e.g., race, class, gender, sexual orientation,
nation of origin, abilities, religion, etc.). Expanding the map to examine larger social
structures such as patriarchy, white privilege, and structures that control and maintain wealth
and power, help therapists understand a person’s or family’s sense of agency and mobility
within the larger sociopolitical terrain.

2 Deconstruct Power-Embedded Relational Inequity and Name Injustices

Socioculturally attuned narrative family therapists collaborate with clients to deconstruct

dominant discourses that are at odds with, or limiting of, their lived experience. Therapists
loosen the grip of problematic narratives and help open space to link discourses to relational
dynamics that may give or take away power. This includes identifying how shared nar­
ratives support unjust intimate relationships as well as how divergent narratives within
families serve to create and maintain problematic power dynamics. There is a recognition
that what is “preferred” may be contested across individual, family, and cultural narratives.
For example, a narrative supporting male privilege may be preferred by some members of
the family, while a narrative supporting gender equity may be preferred by other members
of the family or all members some of the time. In other words, narratives, including
preferred narratives serve a role and must be considered relative to negotiating power in
intimate relationships.
Additionally, the therapist would be cognizant of the notion that having a preference is
indeed a privilege. For many, having a preferred narrative is facilitated or constrained by the
effects of cumulative advantage or disadvantage due to living with the effects of intersecting
identities and social location. A socioculturally attuned narrative family therapist is mindful of
bias embedded in the notion of a “preferred narrative,” carefully assessing for conflicts and
compatibility within and across multiple narratives. These narratives, preferred or otherwise,
may reflect contesting societal discourses and/or be sources of individual struggle and family
and community conflict.

3 Explore Values Embedded in Narratives

As problem supporting discourses are challenged, new narratives emerge that are in many
ways, value-driven propositions. Helping individuals and families identify, clarify, and
negotiate values is critical to developing preferred narratives that support the well-being of
all involved. For example, one parent may value autonomy and independence more highly
than collective care. How they narrate their child’s journey through life and problems will
be impacted by these values. A father may complain that his son should have launched and
been on his own by his early 20s, while a mother appreciates his ongoing concern and care
for the family. These are potentially very different storylines to which therapists often add
their own valued position, such as launching in early adulthood is healthy, the mother is
holding the son back to meet her own needs, the couple cannot stand alone, etc.
Additionally, not all values have the same weight and power in society. It may be less
apparent for a narrative therapist to determine which narratives reflect values that are
supported or not supported by the dominant group in a society. These factors may remain
unexamined unless the therapist is carefully attending to the implicit values embedded in
client’s and their own narratives.
292 Socioculturally Attuned Narrative Family Therapy
4 Support Relational Equity and Disrupt Oppressive Power Dynamics

Socioculturally attuned narrative family therapists pay close attention to how power is per­
formed; what people do in relation to others, the types of influence they exert, and the con­
sequences of relational inequity. They are curious about how the performance of power is
permitted, accepted, followed, or applauded based on a person’s social location. The therapist
encourages transparency about these dynamics by asking deconstructive questions, valuing
each person’s voice, and helping clients understand the effects of how power is enacted on each
individual and the family. For example, questions that disrupt patriarchy, colorism, or sexism
would focus on how inequity influences and supports the life of the problem. Clients are invited
to deconstruct social and familial narratives that privilege and story unequal adult relationships as
being natural, inevitable, or preferred. The therapist intentionally introduces possibilities for co-
constructing new narratives that support relational equity, irrespective of culture. In every
society in which systemic and culturally sanctioned injustice toward a particular group or person
is enacted, there is active resistance. When socioculturally attuned therapists intervene by
disrupting narratives that fuel oppression, inequity, and relational injustice, we are able to help
clients strengthen transformative narratives that amplify voice and resistance.

5 Thicken Stories of Resistance and Resilience

A mistake many therapists make is that we often have a generalized and essentialized view of
culture, in which we believe that certain cultures will support gender or race oppression and
inequality more than others. This is a distorted view of culture. Although patriarchy is enacted in
most societies, most would agree that the abuses enacted due to patriarchy, such as, femicide,
torture, bullying, rape, and victimization should not be supported. It is important to create the
space for subjugated narratives of resistance so clients can envision preferred narratives.
In sum, there is no cultural excuse, validation, or support for oppression and inequity. In
every place where it is enacted, there are forms of resistance, small and large, internalized or
externalized, overt or covert. And when resistance is understood by a therapist, couple,
family, or society as problematic, then injustice is likely to be reified in one form or another.
For example, if someone resists oppression by becoming withdrawn or depressed, then the
problem is oppression, feeding the life of the depression. The new narrative will align with
the lived experience of the person enacting resistance. Resistance was there, held in the body
and relationships, but the naming opens one’s experience to begin to address the effects of
oppression on one’s self, body, and relationships.
Sites of power are also sites of resistance. Socioculturally attuned narrative family therapists
will excavate these sites to uncover and amplify resilience. These narratives include moments
when clients find ways to hold on to their values, strengthen their resolve, endure in spite of
oppression, and so on. What is often explored only on this personal level is tied to collective
resistance and resilience. Discourses of resistance such as Black Lives Matter movement,
women’s movements, queer rights and discourses, and fatosphere (an on-line community for
fat acceptance) for example, are introduced as shared narratives that challenge and transform
dominant oppressive discourses. Likewise, collective resilience among those with whom we
identify over time (e.g., black ancestors, Native communities) thickens individual and family
stories of resilience and resistance.

Case Illustration
This case involved family therapy with a mother named Raquel, a father named Aldo, their
adult daughter named Ana, and their advocate named Carla. Ana was referred from a center
 Socioculturally Attuned Narrative Family Therapy 293
for survivors of sexual abuse to Gabriela at Latino Centered Family Services. Gabriela was a
third generation bilingual US citizen of Mexican descent. The family did not speak English,
nor read or write in Spanish, and were undocumented immigrants from Peru. Ana was a
young woman in her early 20s, lived at home with her family, and was deaf/hearing im­
paired. Ana had the support of a loving, cohesive family. She was the oldest of four siblings.
Her family cared for her, but she was also responsible for caring for her family by cooking,
cleaning, taking care of her siblings, and being a good companion to her mother. She
especially had a very close relationship with her mother, who was her translator and “voice.”
Ana had never been in a romantic relationship, had outside friends, or gone anywhere
without her family. Her inability to hear kept her homebound and dependent on her parents.
Carla, who accompanied them to therapy, was a bilingual/bicultural Latina who was ob­
taining her associates degree in social work and served as a strong support and resource for the
family. She would often drive them to the family therapy sessions, women’s shelter, police
station and to court. Carla was in a more powerful social position and the ideal advocate for
the family. Although Ana was facing many challenges, she seemed eager to be in therapy and
was engaged in the clinical process from the start.

Expand the Map to include the Problem in Societal Context

Gabriela worked hard to join with Ana and help her feel comfortable. During the first
session, much of the time was spent talking to her mother to gather information and find
ways to nonverbally connect with Ana, with as much eye contact and signs of empathy as
possible. What became apparent is that Ana and her mother had their own sign language.
Raquel was Ana’s primary support person and translator who effectively relayed the thera­
pist’s messages. The therapist would say things like, “please tell her that I am so glad she is
here and that she is so brave for wanting to tell her story and wanting to move forward in her
life in a positive way.” Then Raquel would tell Ana with a series of signs that were unique to
them.
Ana’s mother told the therapist that Ana was sexually assaulted multiple times when no
one was home, by a family member who lived near them. Ana’s mother Raquel was ex­
periencing secondary trauma and she would uncontrollably cry when she felt Ana’s pain and
her own rage toward the abuser, a close relative. Given that Ana could not verbalize or write
her story, the therapist asked her to draw a picture of anything Ana wanted her to see, as a
way to stay connected with her during the first session. As she drew, Gabriela would look at
Ana and show empathy in response to everything Raquel disclosed about what happened and
why they were referred to therapy. At the end of the session, it became apparent that Ana
could express herself through images. As a consequence, given that Ana was deaf and could
not read or write in Spanish or English, Gabriela decided that experiential narrative therapy,
with the use of drawings and enactments, would be the best means of conducting socio­
culturally attuned narrative family therapy.

Deconstruct Power and Name Injustices

Art and narrative therapy have been used as an experiential means to deconstruct problematic
narratives, increase a client’s sense of agency, and reauthor preferred narratives (Bermúdez &
Bermúdez, 2002; Bermúdez et al., 2009; Carlson, 1997; Keeling & Bermudez, 2006). In this
case, Raquel used a storyboard technique to help Ana tell her story for herself. Before be­
ginning, Gabriela met with Raquel and Aldo, as Ana’s parents, to ask if it was acceptable to
proceed with this way of working. Gabriela told them that she would stop at any point if she
assessed that the process was not helpful or harmful for Ana. They both agreed that it would
294 Socioculturally Attuned Narrative Family Therapy
be a good move forward and gave consent for Gabriela to meet with Ana alone most of the
time. This would afford her privacy and offer support, as they both tried their best to connect
and be understood. Raquel agreed she would be a part of the beginning and end of each
session. Raquel’s presence was important, although Ana did not show any signs of distress
when her mother was not in the room.
The first goal was to attune to Ana and her world by demonstrating an attempt to
understand and by responding to experiences within her societal context. This was done
by learning Ana’s signs for her emotions. For example, Ana and her mother explained the
signs for sadness; which was a sign of a broken heart with her hands; fear, which was her
acting as if she were shivering; joy, which was smiling with her hands on her chest and a
thumbs up; peace, which was her pointing to God with prayerful hands or hands on heart;
and frustrated, overwhelmed and anxious, which was her pointing to her head, shaking it
with a sad face.
This process of intentionally and responsively attuning to Ana, led to her naming the
events that unfolded that were abusive and unjust. Ana’s voice would have been easy to
discount or ignore, as none of them knew how to communicate through American sign
language, but as Grabriela communicated her interest, Ana’s will to be understood was
more powerful than her inability to hear, speak, sign, or write. Through the course of
therapy, Ana described what happened with each drawing. She drew a total of 18
drawings, each one representing the sequence of events. The therapist would motion with
her finger in a forward circle as if saying, “and then what happened?” and she would draw
what happened on a new sheet of paper, which the therapist numbered and kept in her file
in the Clinic. The therapist attempted to honor Ana’s language, her ways of knowing, and
her ability to tell her own story. Although Ana did not know the name for rape, sexual
assault, or abuse, based on the therapist’s, mother’s, and advocate’s empathic responses,
Ana was able to name the abuse and injustice through her images, expression of emotion,
and others’ responses.

Explore Values Embedded in Narratives

In the midst of larger familial, social, and cultural systems that may have minimized or
discounted Ana altogether, the therapist was able to demonstrate how she valued and
acknowledged Ana’s worth, which her parents were also doing. The social worker also
valued Ana and was a witness to her pain and survival, as well as her telling and retelling
of the preferred narrative of strength and courage. The values demonstrated by the
therapist, advocate, and her family communicated to Ana that she was loved and that her
family was doing all that they could to keep her safe. They demonstrated their values of
family cohesion, respect, and resilience by demonstrating strength and bravery by actively
seeking resources for Ana and taking legal action to keep the perpetrator and his wife
away from her. Through the course of therapy, the family narrative of love and cohesion
was strengthened, while simultaneously changing Ana’s narrative from victim to survivor.

Support Relational Equity and Disrupt Oppressive Power Dynamics

The entire clinical process, which only lasted eight sessions over five months, served to
intervene and disrupt oppressive power dynamics and support relational equity. Through
the course of telling and retelling her story with the images, Ana was able to demonstrate
how she claimed her power to disrupt the power dynamics, especially with her family
member/abuser, who had the privileges of being a documented, middle aged man with a
good job and financial stability. He and his wife threatened to have the family deported if
 Socioculturally Attuned Narrative Family Therapy 295
they told the authorities about the sexual assault, which they both denied. With the support
of the advocate and the sexual assault center, Ana and her family did not shrink in the face of
the dominant discourse of threats and intimidation. The disruption of power dynamics was
also reflected in a picture Ana drew of herself when she destroyed the gifts he had given her,
including the plants and flower bushes she pulled up and threw at the front door of their
house. This act of resistance, which she initiated on her own, demonstrated her strength and
her ability to stand up to her abuser/oppressor.
Half way through the storyboarding Ana and her mother were able to co-create a space to
imagine and envision a better way of life for Ana. Her preferred narrative depicted images of
her standing next to her mother with both of them holding hands and both arms in the air, as
if triumphant. As White and Epston asserted (1990), with every performance of the new
narrative, we gain valuable experience at reauthoring our lives. By paying close attention to
the aspects of lived experience that fell outside of the dominant story, Ana and her family
were able to discover important resources for the generation and re-generation of her
preferred narrative to emerge and gain strength and life.

Thicken Stories of Resistance and Resilience

It was moving for Ana, her family, the advocate, and therapist to envision what was possible.
Transformation took place because they all worked together in collaboration to make what
was imagined real. Toward the end of therapy, the therapist asked them to do two family
sculptures; one when they were in the grip of the fear, grief, and despair, and another one
representing how they felt now that Ana and her mother were able to bring to light their
courage and strength. On the day of the last session, the mother stated that she was com­
mitted to helping Ana learn American sign language, which would help her make friends and
open herself to an adult world of connecting with others. Her parents also created an art space
for her at home so that she could create artwork and give it as gifts or to sell it so that she
could earn her own money.
Ana, with the support of her family, was able to unite and stand up to the effects of her
oppression and abuse. Her parents and advocate were committed to renewing the restraining
order so that Ana could feel more protected. The therapy process was empowering for
everyone involved, even for her younger siblings. As a final ritual, the therapist asked Anna
what she wanted to do with the drawings, and with a big smile on her face, she commu­
nicated that she was going to bury them in her backyard. She decided to keep the last image
of her and her mother feeling triumphant. She also ended the therapy by giving the therapist
a gift, which was her very first painting she happened to make with the art supplies her
therapist gave her.

Summary: Third Order Change

In this case, first order change occurred when the therapist found ways for Ana to com­
municate through drawings. This made second and third order change possible. At a second
order change level, Ana moved from an unwanted, disempowering narrative of being a
victim to that of a survivor. Her father also resisted machismo by supporting his daughter
above all else, sharing his feelings, and resisting his desire to cause harm to the abuser. He also
stated he felt as though he failed to protect his daughter, however, his resistance to this
dominant discourse led him to have the courage to handle the matter “with intelligence and
calm,” as he stated. He and his wife were able to unite to best support their daughter. Ana’s
decision to learn sign language would provide ongoing second order change as she was
learning to connect with others outside the family for the first time.
296 Socioculturally Attuned Narrative Family Therapy
Third order change occurred in several ways. Ana had never felt understood by anyone
but her mother. The veil of silence that surrounded her left her particularly vulnerable to
hermeneutic injustice (see Chapter 7). In other words, Ana felt accepted by her family, but not
really known until she had an avenue through which to tell her story. Telling her story also
offered her a way to better know herself as she, for the first time, put into pictures what she
experienced, thought, and felt. Ana and her family were well versed in narratives of vul­
nerability and abuse, however, when her family and advocate offered discourses and sites of
resistance, such as going to the sexual assault center, police station, courthouse, and the
counseling agency, Ana and her family were able to re-narrate their social experience to
one in which allies joined them to help her to reclaim her power and stand up to the effects
of injustice.

Reflexive Questions
• What dominant discourses continue to go unnoticed as natural, inevitable, or assumed
right due to their widespread support?
• When considering a problem that negatively affects your wellbeing and interactions with
others, what name would you give it? What social forces does it join with it to give it
strength to rob you of your joy, health, and wellbeing?
• As a narrative family therapist, how can you create space to interrupt and loosen the grip
of problematic relational dynamics by linking them to larger dominant sociocultural
forces? What creative means could you use to do this?
• How would you respond to or manage the conflict of a couple or family members
disagreeing on what they deem to be a “preferred” narrative? What if someone’s
preferred narrative is unjust or colludes with larger systems of oppression?
• How do we as therapists inadvertently vote in favor, or fail to vote against, what may not
align with our values toward equity and relational justice?

References
Agger, B. (1991). Critical theory, poststructuralism, postmodernism: Their sociological relevance. Annual
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14 Socio-Emotional Relationship
Therapy: An Example of
Socioculturally Attuned Couple
and Family Therapy

Most clinical models treat social justice as an add-on or special issue (Hardy & McGoldrick,
2019). Socio-Emotional Relationship Therapy (SERT) begins with equity at its core.
Building on the work of previous feminist and social constructionist researchers and clin­
icians, Carmen Knudson-Martin and Douglas Huenergardt (2010) with a team of colleagues
(Knudson-Martin et al., 2015a, 2015b, 2021; Wells et al., 2017; Williams et al., 2013)
developed SERT to detail how therapists can position their work to interrupt and transform
the impact of societal inequities in couple and family relationships. Working with the
interplay between social discourse, emotion, and interaction, SERT integrates a critical
social constructionist conceptualization of human behavior with attention to interpersonal
neurobiology and the embodied consequences of societal power processes in personal and
relational health and well-being.
SERT serves as a comprehensive model of socially responsible practice grounded in the
assumption that frames this entire volume––that it is not possible to be clinically “neutral.”
It may also be used as an overarching umbrella through which to integrate socioculturally
attuned principles and ANVIET guidelines with other clinical models and evidence-based
practices.

⤝⤞

In SERT, third order change is facilitated by an engaged therapist whose

clinical decisions take into account how societal power processes impact the
moment-by-moment of clinical work, and orient therapy so clients are able to
experience relational possibilities outside those constructed by dominant social
systems.

⤝⤞

Foundational SERT Concepts

SERT therapists view therapy as a social constructionist process and are intentional about
their part in it. In the first phase, therapists set the stage by asking questions that frame clinical
concerns sociocontextually and invite clients to reflect on their relational ideals. Throughout
the clinical process, therapists actively interrupt and explore power processes as they present
in session. This aspect of the work is experiential as clients begin to encounter themselves in
relation to others and the world differently. As therapy progresses, clients see themselves
through a larger lens and therapists support them to detail and practice the relational values
they claim.

DOI: 10.4324/9781003216520-14
300 Socio-Emotional Relationship Therapy
⤝⤞

While dominant social systems across the Western world tend to emphasize
independence, competition, and personal achievement, people cannot thrive
without mutually supportive relational bonds.

⤝⤞

SERT’s emphasis on shared relational responsibility challenges the individualistic discourse

prominent in Western culture and mental health practices (Mehl-Madrona, 2010; Combs &
Freedman, 2016). Five concepts organize practice: (1) reciprocally responsive social en­
gagement, (2) socioemotional experience, (3) social discourse and felt identities, (4) relational
flow of power, and (5) equitable interaction patterns through the Circle of Care.

Reciprocally Responsive Relational Engagement

Like attachment theory (Johnson, 2019, see also chapter 7), SERT emphasizes the role of
mutuality and reciprocal engagement in healthy development. For example, when Robert
sought therapy because he “felt unhappy and lacked motivation,” the therapist explored his
engagement with others and learned that Robert kept himself emotionally disengaged from
his parents and his partner Raul, and viewed colleagues at work as competitors instrumental
to attaining sales goals. Therapy addressed Robert’s negative affect in light of these relational
encounters and the social contexts that supported his distance from others.
Developmentally, it is critical that one person’s mind links with another’s (Siegel, 2007).
This happens as the neural system of one mutually impacts emotional regulation and the
physiologic state of the other (Porges, 2009). Neurons in one body viscerally mirror the
other’s experience. It is not enough for others to understand and resonate with our ex­
perience; we must also be able to empathically imagine what is going on for them.
Reciprocity and responsiveness are key.
When resonance is shared, each person is changed physiologically, psychically, and re­
lationally. For example, resonance with others activates neuroplasticity needed for flexibility
and change, while inhibiting stress (Cozolino, 2016). As is the case with Robert, when people
are not able to, or will not, participate mutually in this social engagement system, optimal
development is not possible. Neurochemistry is affected. Robert’s body may be experiencing
reduced serotonin (associated with feelings of well-being and happiness) and increased cortisol
(associated with stress), both of which are associated with depression (Hanna, 2014).
As we interact, socially created experience is written into physiology. Mutual attunement
enables neural structuring that integrates external and bodily experiences over time, taking
others and the larger picture into account (Siegel, 2007). Meaning is felt with the body as
much as intellectually understood (Burkitt, 2014; Zimmerman, 2018). Though children are
most impacted as parents/caregivers and children attune to and adjust to each other, the
emotional system and physiology of each evolves (Gerhardt, 2004).
Just, mutually supportive relationships invite neurological “fittedness” that promotes po­
sitive adaptation and growth (Fosha, 2009; Knudson-Martin & Kim, 2022). It is not possible
when power is unequal or when those with more social power (such as parents, teachers,
therapists) are not accountable for their power by attuning to and responding to others
(Knudson-Martin & Huenergardt, 2010, Porges, 2009). In unequal social conditions, the
ability to experience responsiveness from others or influence them is not mutual, and the
fundamental ethical obligation to support one another is compromised (see also Chapter 9,
Contextual Therapy).
 Socio-Emotional Relationship Therapy 301
⤝⤞

Thus, though not discounting the value of autonomy, SERT positions therapy
to counteract societal forces that work against relational engagement and seeks
to promote the conditions through which mutual support is accessible.

⤝⤞

With Robert, this means apprehending how his social location as a relatively affluent, White,
cisgender, gay male in the US informs his experiences of vulnerability, power, and openness
to reciprocal relational engagement (Knudson-Martin & Kim, 2022; Samman & Knudson-
Martin, 2015).

Socioemotional Experience
Socio-Emotional Relationship Therapy emphasizes that emotions connect the individual and
the environment (Knudson-Martin & Huenergardt, 2010; Fosha et al., 2009). People ex­
perience emotion personally and physiologically, but its meaning is sociocontextual (Gergen,
2009). For example, across cultures, sadness is demonstrated by turned down lips and
squinted eyes and anger involves dilated pupils and pursed lips; these internal responses and
the meaning ascribed to them are called forth by interpersonal and sociocultural circum­
stances (Burkitt, 2014; Siegel, 2012). Thinking, feeling, body, relationship, and sociocultural
context are woven into one (Wetherell, 2012).
Emotions are primarily nonconscious. These “gut reactions” offer clues to embodied value
systems. Emotion thus alerts us to and is a marker of what is important. From the first
encounter, SERT therapists seek to know their clients––how they recognize themselves in
the world and what matters and resonates with them––by attuning to their contextual so­
cioemotional experience. As an individual’s experience is felt and recognized, SERT
therapists want to know “in what social contexts does this experience arise?” Awareness,
openness, and curiosity facilitate this process. The therapist’s questions and reflections as they
seek to “get” how emotionally salient words and actions connect with larger societal contexts
also help clients increase contextual awareness of their felt experience.
For example, when the therapist asked Robert to say more about his lack of motivation
and what it was like for him, she noticed that Robert’s body seemed to tighten and his voice
took on an edge when he said that he “wants to do better, to work harder.” The emotional
salience of his response suggested a link to important societal contexts. As she imagined what
it was like for this relatively affluent White man to “want to do better,” she followed this
emotional thread outward, asking what doing better meant to him, listening for societal
expectations and standards in his responses, and asking questions that helped name these
social valuations and make them visible. As she did, the therapist could feel the pressure he
felt to always need to achieve more. She could expand the conversation to dominant culture
definitions of success, which Robert felt pulled to attain and meet, especially since he felt
devalued as a gay man.

⤝⤞

Emotional meaning emerges in the context of power processes and social

power works through emotion (Burkitt, 2014; Wetherell, 2012).

⤝⤞
302 Socio-Emotional Relationship Therapy
Robert’s feeling that he needed to keep pushing to achieve makes sense when considered in
relation to maintaining a position of power and living up to expectations defined by a
dominant social structure. Robert’s experience also illustrates how social valuation colors
emotional experience and is internalized. What and who is socially valued affects how parents
respond to children and what they expect of them. Robert’s parents still have difficulty
attuning to their gay son. Social valuation also affects the emotional capital one brings into
relationships. In part, Robert keeps emotionally distant from Raul because as an affluent
white male, he does not experience himself needing Raul (or anyone). Feeling his relational
needs would challenge his inherent power position. In contrast, Raul feels gratitude that
Robert has chosen him, a man with considerably less social standing.
Though Robert appears rational and not very emotional, recent studies of the relationship
between emotion and cognition suggest there is no such thing as a “non-affective” thought
(Burkitt, 2014, p. 95); that “rational” decision-making requires an internal appraisal based on
emotion that is always socioculturally located (Wetherell, 2012; Zimmerman, 2018). How
experience is remembered depends on what, out of all the various sources of contextual
meaning, is personally salient, emotionally evocative, and relationally named (Mehl-Madrona
& Mainguy, 2015). Helping a client like Robert bring the social context of his emotional
experience into awareness gives him more choice regarding the meaning he embodies and
the decisions he makes.

Societal Discourse and Felt Identities

Discourse refers to collective ways of thinking and talking that give meaning to experience
(Krolokke & Sorensen, 2006). Listening for discourse enables therapists to connect individual
identities and relationship patterns to wider sociocultural contexts (Knudson-Martin et al.,
2021). Like narrative therapy (see chapter 13), SERT takes the stance that identity is not
fixed, and that discourses are not neutral and reflect only part of the potential values and
meanings in any situation (Combs & Freedman, 2012, 2016).
Dominant societal discourses reflect societal power structures. They tend to be so taken for
granted that people are not aware of them or their influence on their lives. These socio­
cultural frameworks and valuations are based on the interests and perspectives of those in
dominant positions but applied to all. This creates injustice on multiple levels. People in­
ternalize standards embedded in the dominant discourse and judge themselves and others by
them (Hardy & McGoldrick, 2019). Shared social meaning to understand their experience is
less available within the larger society to persons in subordinate groups, making neuro-
fittedness and interpersonal attunement less broadly accessible. Persons in oppressed groups
may not have words to fully understand or communicate their own experience unless others
can receive and share it. Therapists may not recognize dominant discourses in client stories
unless they have developed a critical contextual consciousness and apply it in practice (Esmiol
et al., 2012).
Robert’s parents have always loved him. When they learned he was gay they “accepted”
him, but lacked shared socially constructed meanings to connect with him. They also took
dominant cultural constructions of worth and value for granted without knowing they did so.
Robert internalized these social messages as well. His feelings of unhappiness and lack of
motivation reflect larger dominant discourses that prioritize individual achievement and
monetary success as the standard for everyone and support values such as autonomy and
independence associated with cisgender masculinity (Loscocco & Walzer, 2013). His identity
will necessarily be engaged in the clinical change process.
Identity validation is related to power. When Robert conformed to dominant cultural
discourse he experienced validation. In his growing up, virtually wherever he went––in
 Socio-Emotional Relationship Therapy 303
school, at home, in the media––Robert’s competitiveness and personal achievements were
recognized and validated. In these moments he felt a sense of belonging, that he fit and was
valued. He was validated when he hid his differences, doubts, and confusion and, instead,
presented himself with authority, standing tall, and not showing weakness. His felt identity
incorporated these elements of societal success, along with shame regarding those aspects of
his experience that were met with disapproval and disconnection (Cozolino, 2016).
Robert carries many voices and perspectives within his experience. Which societal dis­
courses become woven into his identity and structured into his body depends on which
sociocultural meanings are imbued with emotional salience (Mehl-Madrona, 2010;
Zimmerman, 2018). Emotional salience for Robert was connected to achievement and
“being the best.” Gradually, neurobiological physiologies that correspond to these familiar
understandings about himself were established (Ewing et al., 2017). Developing new patterns
involves activating the connections between societal discourse, emotion, and identity
(Knudson-Martin & Huenergardt, 2010; Knudson-Martin et al., 2021).

Relational Flow of Power

One of the distinctive aspects of SERT is its attention to the flow of power in relationships
and how it affects issues such as trust, intimacy, vulnerability, control and influence, conflict
resolution, and communication (Knudson-Martin, 2013; Morrison et al., 2022). SERT
defines power as a set of relationally created and structurally embedded social processes “that
determine whose experiences, abilities, and interests merit value” (Knudson-Martin et al.,
2021, p. 3). From a relational perspective, power is evidenced by whose interests and
needs are noticed and attended to (Mahoney & Knudson-Martin, 2009). Those with more
social power are usually less aware of or attuned to subordinates (Parker, 2009; Tatum, 1997).
They also tend to be less aware of their power positions and may not notice how others
attend to and accommodate them. They may not feel powerful (Kimmel, 2016). The flow
of power serves as context for emotion and is enacted through social discourses and
relationship patterns.

⤝⤞

Rather than focusing on power as an individual property, SERT focuses on the

flow of power from one person or group to another.

⤝⤞

SERT is interested in how power imbalances occur, what maintains or transforms them, and
how presenting concerns relate to power. Robert’s symptoms of unhappiness and lack of
motivation could occur in the context of a power imbalance in which power accumulates to
him or in one where he holds limited power. Clinical actions will vary depending on this
power context. As the therapist gets to know Robert and his concerns, she also begins to
track the flow of power in the relationships Robert describes. For example, she asks how
Raul responds to him when Robert is feeling low energy. Robert answers with confusion
and a blank stare, then says, “I don’t know … he gets clingy, asks what’s going on––it’s
irritating.” The therapist hears that Robert has limited awareness of Raul’s position. To
further explore, she asks Robert what he thinks Raul is experiencing when he appears clingy.
Robert responds that Raul “needs to get a life” and then says he has enough to worry about
with people at work not getting things done. This is an indicator that Robert probably is not
well-attuned to Raul or his colleagues, a sign of a potential power imbalance.
304 Socio-Emotional Relationship Therapy
Because people need and influence each other, power is part of all relationships.
Multiple power contexts typically intersect in any relationship, including those related to
race, class, gender, sexual orientation, migration status, abilities, as well as experiences
related to trauma, loss, and personal life stories (Knudson-Martin et al., 2021). As part of
the appraisal of any situation, human physiology instantaneously emotionally reads the
social power context (Cozolino, 2016; Wetherell, 2012). This felt sense informs how
people judge themselves and others, whose voice is perceived to be credible, feelings of
safety and belonging, and what one has a right to expect or ought to fear. As an affluent
White male, social power flows to Robert. He likely experiences a taken-for-granted sense
that people around him will accommodate his interests and that he should be able to get or
achieve what he wants. When they don’t, he is frustrated or angry. On the other hand,
when Robert enacts achievement and accomplishment discourses at the expense of his
own mental health, power flows toward larger economic interests that benefit from his
labor and work ethic (Garcia, 2011). As a gay man, his ability to make sense of his own
experience and be understood by others is limited by the imposed silencing he encounters
in this social context (Medina, 2013).

⤝⤞

When SERT therapists talk about powerful or less powerful persons, they are
referring to “the outcome of relational patterns that create and maintain
differences in who notices and attends to the other, whose needs and goals
shape the relationship, and who accommodates or responds to provide care”
(Knudson-Martin et al., 2021, p. 3).

⤝⤞

Equity means that the flow of power in the relationship is relatively balanced across
time. Each person is attentive to the other and to the relationship. When power is
unequal, emotional connection is compromised and it is difficult to positively respond to
conflict and life stresses and changes (Baima & Feldhousen, 2007; Jonathan & Knudson-
Martin, 2012).
While Robert experiences power inequities in some aspects of his life, he appears to be
in a power position in relation to Raul. That is, he controls the relational process and his
responses drive the emotional climate (Greenberg & Goldman, 2008). The power accruing
to him also limits crucial aspects of his emotional and relational well-being, which as
described above, require reciprocity and mutual responsiveness. To help Robert address
his depressive symptoms, the SERT therapist will help Robert shift these power im­
balances and invite Raul to participate in the therapy.
Societal power works through the discourses people enact and how these are embodied
in emotion and interaction patterns. SERT therapists emphasize that power processes are
subtle and not always easily recognized. They observe and track whose gestures get a
response and whose are ignored, who controls the topics of conversation, whose per­
spectives are perceived as legitimate, and who is available to orient to the other. They note
how emotions sustain or disrupt these power processes (Garcia et al., 2015; Wetherell,
2012). SERT therapists are also aware that they are embedded in the same larger societal
power contexts and reflexively question their own assumptions and reactions as they
position their work to interrupt the flow of societal power inequities in interpersonal
relationships (Morrison et al., 2022).
 Socio-Emotional Relationship Therapy 305
Equitable Interaction Patterns and the Circle of Care
Across the globe, people increasingly report egalitarian ideals, but few have an image of how
to apply these practices in their personal lives (Mahoney & Knudson-Martin, 2009; Sullivan,
2005). SERT thus utilizes the Circle of Care (Figure 14.1), four orienting principles that
promote mutually supportive relationships and well-being (Knudson-Martin & Huenergardt,
2010). These include mutual vulnerability, mutual attunement, mutual influence, and shared
relational responsibility. Rather than skills to be taught; they are relational guidelines that
clients apply somewhat differently based on their sociocultural backgrounds, situations, and
desires. Enacting the Circle of Care involves an equitable flow of power and reciprocal
positive impact on one another’s neurophysiological and emotional states, which according
to SERT, is the foundation for other clinical change. SERT therapists use the Circle of Care
to guide assessment and clinical decisions.

Mutual Vulnerability
Being emotionally present and engaged requires mutual vulnerability in which people
approach one another with openness, curiosity, and willingness to admit mistakes and
express needs. Robert has learned not to do this. Like everyone, he experiences vulner­
ability; his inability to express it is shaped by his cultural and gender socialization, as well as
his experiences that as a gay young man it was often not safe to be open (Knudson-Martin
et al., 2021). On the other hand, when Raul joins the therapy, he repeatedly expresses
vulnerability, sharing his worries and asking how he can better approach Robert. To not
further a power imbalance, SERT therapists will be careful to not place additional vul­
nerability on Raul without first helping Robert develop the capacity to take a more
vulnerable position. In some relationships, neither person can approach the other with
vulnerability; however, frequently one is in a more inherently vulnerable position than the
other.

Relational Responsibility
Doing what is necessary to maintain
relationship; focus on other as well
as self; accountability to effect on
other

Influence Vulnerability
Willingness to accommodate and Circle of Spirit of openness, curiosity, and
be changed by other; ability to Care self-honesty; willingness to admit
express opinions and have needs mistakes; safety to express needs
met

Attunement
Noticing needs of other; attentive
to and responsive to other’s
experience

Figure 14.1 Circle of Care.

Source: From Knudson-Martin, C. & Huenergardt, D. (2015). Bridging emotion, societal discourse, and couple inter­
action. In C. Knudson-Martin, M. E. Wells, & S. Samman (Eds.). Socio-Emotional Relationship Therapy: Bridging emotion,
societal context, and couple interaction (p. 6). Springer.
306 Socio-Emotional Relationship Therapy
Mutual Attunement
In healthy relationships, each person attunes to the other. They notice and respond. Each
feels known. When people take in and intuit each other’s experience, it is easier to also
express one’s own interests. People want to understand the other and are interested in and
curious about their varying perspectives. People feel validated whether or not others share
their views. When people are not attuned, or when attunement is not mutual, “rather than
the relationship being an energizing force for growth and change, the relationship may
contribute to stress and symptoms such as depression and anxiety” (Knudson-Martin & Kim,
2022, p. 272). While also valuing direct communication, SERT therapists emphasize the
importance of proactive attuned awareness and responsiveness.
In observing Robert and Raul, the therapist noted that Robert expected Raul to know
his needs and respond to them. When she asked Robert what it might be like for Raul
when he emotionally withdraws, Robert said “he should know I don’t like to talk about
my feelings.” In contrast, Raul responded that he understood that it was especially hard for
Robert to talk when he feels like a failure, and went on to explain how that happens for
Robert. The SERT therapist will acknowledge the value of Raul’s attuned support and
persist in helping Robert attune to Raul. This will not only create a more equitable
balance of support in the relationship, it will also help Robert counteract depression
(Papp, 2003).

Mutual Influence
Being in a relationship always includes influencing one another. In mutually supportive
relationships, each person is disposed to accommodate and be changed. On a physiological
level, the neurons of one change in response to the other. Partners take a reciprocal stance of
receptivity to input. Each is equally able to express their perspectives and have an impact on
the other. When power is imbalanced, those with less power accommodate and those with
power do not. Powerful persons may not even be aware of the changes others make in
response to them. If Robert needs to change his schedule to accommodate Raul, he feels
irritated or controlled. On the other hand, Raul regularly considers what Robert needs and
organizes his schedule and personal choices around this awareness. At work, Robert’s au­
thoritative style leads many of his team members to follow his lead in ways he does not see or
appreciate. The potentially valuable perspectives of other team members get lost. The SERT
therapist will be attentive to these imbalances and help Robert more readily open himself to
influence. This will require developing awareness of the sociocultural discourses that have
framed its meaning.

Shared Relational Responsibility

Shared relational responsibility means that each person attends to what is needed to maintain
the well-being of the relationship and is mindful of how their actions affect the other. Those
with less power typically make more efforts to safeguard the relationship by doing most of the
emotional tending, soothing the other or looking out for their needs, and managing re­
lationship maintenance tasks that more powerful partners may not notice or do not want to
handle. Robert’s focus has been on personal achievement. He is not used to focusing on what
his relationships with others need and is not aware of what Raul and others do to keep his
relationships afloat. In the SERT model, transforming the imbalance in relational respon­
sibility will not only support Robert’s relationships, it is necessary to social engagement that
will support his well-being as well as that of those around him.
 Socio-Emotional Relationship Therapy 307
Summarizing SERT’s Theory of Change
SERT therapists promote mutually supportive interaction patterns that help people over­
come the damaging effects of lack of reciprocity, societal inequities, and dominant societal
discourses that devalue relationality. Change occurs interpersonally and experientially when
something new happens that is viscerally salient and creates and embodies new meaning.
When people enact the Circle of Care, they are reciprocally engaged in relational processes
that promote health affirming emotional connection. They are affectively and physiologically
constituted and reconstituted in a socioculturally attuned interpersonal process that validates,
and potentially modifies or re-stories, the felt identity of each person. Therapists help clients
detail and thicken these transformative new experiences into an on-going awareness of self
and other that takes into account the larger societal contexts they navigate.
As Robert comes to see himself sociocontextually and is supported in developing the
relational aspects of himself that have previously been societally discounted, he will be able to
attune to others and his own emotional experience. He will develop more mutually sup­
portive relationships and have more choice regarding how he responds to societal messages to
“do more,” all of which will promote his personal and relational health and decrease his
depressive symptoms. Raul and others in Robert’s life will also benefit.

Principles of Socioculturally Attuned Family Therapy

As an example of a socioculturally attuned practice model, Socio-Emotional Relationship
Therapy takes into account most of the socioculturally attuned principles discussed
throughout this volume. Here we highlight some that are especially central to the practice
of SERT.

Societal Context
SERT therapists connect personal experiences such as emotion, felt identity, and interaction
patterns to larger sociocultural contexts. When they do, clients are able to have compassion
for themselves and others, prioritize their relational interests, and be less constrained by the
effects of dominant societal discourses that were previously largely invisible to them.

Social Context of Emotion

⤝⤞

Connecting personal experience to larger social forces becomes much easier

when emotions are interpreted as a connection between the personal and the
contextual.

⤝⤞

As suggested by Bateson (1972), our minds, bodies, and relationships are open systems that
both apprehend and have an impact upon our environments. Emotions register the personal
meaning of these interconnected systems. They serve as bridges to trust and safety, as well as
early warning signals to be on alert, and as clues to expectations and guides to action (Siegel,
2019). Larger forces such as capitalism, patriarchy, and caste extend beyond individual fa­
milies to schools, workplaces, communities, and media and are reflected not only in discourse
and thought, but in emotion.
308 Socio-Emotional Relationship Therapy
SERT therapists begin to recognize and socioculturally attune to emotion in the initial
sessions. For example, Lena and Samuel sought help following Samuel’s disclosure that he
had lost $20,000 gambling. The therapist asked Samuel to begin by describing how the
gambling fit into his life and what it meant to him. She was especially interested in the words
or experiences that seemed most emotionally central to him and how these related to larger
societal patterns. Samuel said gambling was a way to “unwind,” to “relax” before coming
home. Knowing he was a 34-year-old African American husband and father starting his own
business, the therapist continued to explore what it meant to unwind and relax in light of
these social contexts. As Samuel responded to her contextually interested questions, the
therapist began to sense the pressure and responsibility he felt to be successful, particularly
since his mother sacrificed so much for him to go to college, and Lena’s more affluent father
was a successful Black businessman in the predominately White technology field.
With gentle, socioculturally attuned probing on the part of the therapist, Samuel shared
the personal autonomy he felt while gambling––being away from all the social demands and
expectations. And until this major loss, he felt competent and empowered when gambling.
Doing something he was good at stimulated him. “You have to work twice as hard as a Black
man,” he told the White therapist.”

Socio-Emotional Expression
Which emotions should be expressed and how they are expressed varies across sociocultural
contexts. As described by ChenFeng and colleagues (2017), emotional disclosure in col­
lectivist Asian cultures may feel like a selfish act that places an undue burden on others.
Therapists need to extend gentle empathy to emotions from which clients were previously
disconnected and/or did not express to others. It is also important to validate the relational
intent of protecting others from distressing emotion and not force a display of emotion
(ChenFeng et al., 2017).
Samuel and Lena illustrate another way that limited emotional expression may make so­
ciocultural sense. The therapist noticed that Lena did not express much emotion in response to
Samuel’s disclosure about the gambling loss, even though he had previously kept his gambling
secret from her. The White therapist wondered why she didn’t express more anger. Lena
responded that she knew Samuel worked very hard and was focused on getting his business
going; she could understand his need for a release from the pressure. To expand the contextual
lens, the therapist shifted the conversation to learning more about Lena’s experience growing
up with professional Black parents in a predominantly White community. She asked how her
parents handled pressure and discrimination. Lena said that she knew her parents faced those
things, but they always kept a positive attitude. They smiled and made home a happy place.
The therapist recognized the pattern that Lena described as similar to one reported in a
study of middle-class Black families, where the emphasis was on “pulling together,” which
often meant putting aside troubling individual emotions to overcome societal injustice
(Cowdery et al., 2009). This contextual understanding helped the therapist respond em­
pathically to Lena’s emotional stance, “It’s really important to you to support Samuel, to be
in this together and not let your upset get in the way–you know that as a Black man he has an
especially hard path to climb.”

Gender, Vulnerability, and Trauma

Which emotions are hard to express often relates to gender and how it intersects with other
social locations and life experiences and traumas. In most cultures, men are allowed, perhaps
even expected, to display anger while women are not. The gendering of how emotions are
 Socio-Emotional Relationship Therapy 309
expressed and used is one way patriarchy dominates and controls women (Baima &
Feldhousen, 2007). Enacting the Circle of Care challenges the societal gender discourse that
men should not express vulnerable emotions such as fear or need for relationship and should
instead use anger and emotional disconnection as a way to maintain a power position.
Before expecting persons socialized to avoid “soft” emotions to relationally engage in the
Circle of Care, SERT therapists identify and attune to the sociocultural nature of vulner­
ability. Research on the practice of SERT identified important connections between gender
socialization, interpersonal trauma, and marginalized experience in how vulnerability is
expressed (Knudson-Martin et al., 2021). According to these researchers,

Socialized expressions of vulnerability tended to reproduce gendered power processes by

prescribing expressions of vulnerability as part of female responsibility to preserve
relationships and expectations that men appear invulnerable. Reactive responses to
vulnerability associated with trauma and/or societal marginalization could further
exacerbate power disparities as some women focused even more strongly on preserving
the relationship by denigrating themselves and men responded with self-protective
stances that further limited their ability to be aware of and accountable for their impact
on their partners … [On the other hand,] some women demonstrated self-protective
reactive expressions of vulnerability that could look like a powerful position on the
surface, with accusations and expressions of anger that also inhibit attunement to their
partners, but more likely were expressions of powerlessness that did not increase their
limited influence in the relationship. (p. 14)

Sociocultural attunement to vulnerability exposes the toll patriarchal masculinity discourses

place on men and helps therapists appreciate the internal conflicts and pain men may ex­
perience when their desire to be relational collides with pressure to fulfill expectations that
they appear invulnerable and all knowing. This is especially complicated when experiences of
trauma and marginalization leave them feeling worthless or disempowered (Wells et al.,
2017). SERT therapists attend to both vulnerability and accountability.
Samuel’s marginalization in the larger society contributed to his unwillingness to express
vulnerability or mutually engage in the Circle of Care. When the therapist asked him what it
would be like to share with Lena some of the pressure and doubts he felt as a Black man from
a low socioeconomic background attempting to “make it” in the dominant culture, he
looked at the therapist and said, “you don’t do that!” As they explored this discourse and the
emotions connected to it, he was able to name his fear that he wasn’t good enough for Lena,
“what’s a poor guy from the farm doing with a woman like her?” Importantly, even though
both partners distanced, the therapist helped the couple see differences in the sociocultural
meaning of each partner’s response, with different relational and power effects.

Social Valuation of Emotion

When Samuel said, “You don’t do that!” he was expressing the dominant message in
Western society that emotions, and those who express them, have less worth than “higher”
cortical functioning and abstract thought. Intentionally valuing emotion and recognizing and
honoring the importance of attending to emotional processes counters heteropatriarchy and
discourse that privileges individualism over relationships. Samuel had never shared his fears of
being less than with Lena or anyone. He did not even let himself think about this fear. In fact,
what he typically expressed was just the opposite—that he is on top of everything. Lena
intuited and attuned to his fears, and gave him a pass from expressing them as a way to protect
and support him. But this left her feeling lonely and on the outside of Samuel’s life.
310 Socio-Emotional Relationship Therapy
What is valued in the eyes of larger culture is related to the important issue of respect.
When people do not feel respected in their context, it is difficult to open oneself to the social
engagement system. Samuel internalized awareness that as a Black man he automatically
receives less respect; earning respect was therefore very important to him. For Samuel, and
for many in capitalist societies, respect equated to financial success. In his internal emotional
experience, this was the key to success not only as a businessman, but also as a husband and
father. As a consequence, he regularly sacrificed time with his wife and daughter to earn
respect. When he shared some of this internal experience with Lena in a therapy session, she
reported feeling closer to him, more connected, and more loving. Experiencing the positive
consequences of this new experience was a step toward moving beyond the limits and
detrimental effects of the dominant culture’s valuation of thought and money over emotion
and relationship.

Power
SERT emphasizes the importance of mutual engagement and socioculturally attuned re­
sponses from others for physical, emotional, and relational health. Persistent powerlessness
and devaluing cultural stories of self elevate stress hormones, compromise the immune
system, and affect genetic expression (Mehl-Madrona, 2010). “Even having memories of
‘power-over’ comments–which are often experienced as a disregarding voice, and a felt sense
of exclusion–can create a nervous system response” (Glaser et al., 2017, p. 3).” In contrast,
attuned mutually supportive relationships increase oxytocin and one’s ability to reflectively
respond to stressful life situations. Simply put, SERT addresses power disparities because they
undermine relational engagement and all other efforts to improve health and well-being.
When power is shared, people do better (Knudson-Martin, 2013).

Assessing the Balance of Power

Learning to recognize and assess for power disparities is a critical SERT clinical competency
(Knudson-Martin et al., 2015a).

⤝⤞

The flow of power in a relationship can be nuanced and is not always apparent
at first.

⤝⤞

Power is also complex because there are multiple sources and aspects of power. For example,
at first glance, Lena looks quite powerful. She sits tall, appears composed, and speaks clearly.
Some of her demeanor represents her upper-middle class background and the cultural capital
this affords her, especially in public spaces (McDowell, 2015). Samuel looks down and ap­
pears ashamed. He speaks softly at first and does not seem powerful. Assessing the flow of
power in this relationship requires looking more deeply and tracking the flow of power in
their moment-by-moment interactions, as well as in the history of their relationship. It also
involves interactions between their various social identities and latent power built into social
roles, as well as how their experiences around power may shift across settings and in public
and private spaces.
Because power disparities in SERT are reflected in how partners attend and respond to
each other, the Circle of Care (Figure 14.1) provides a ready framework for assessing the
 Socio-Emotional Relationship Therapy 311

WHAT IS THE BALANCE OF POWER?

Relative Status
• Whose interests shape what happens in the family?
• To what extent do partners feel equally entitled to express and attain personal goals,
needs, and wishes?
• How are low-status tasks like housework handled?

Attention to Other
• To what extent do both partners notice and attend to the other’s needs and emotions?
• Does attention go back and forth between partners? Does each give and receive?
• When attention is imbalanced do partners express awareness of this and the need to
rebalance?

Accommodation Patterns
• Is one partner more likely to organize his or her daily activities around the other?
• Does accommodation often occur automatically without anything being said?
• Do partners attempt to justify accommodations they make as being “natural” or the result
of personality differences?

Well-Being
• Does one partner seem to be better off psychologically, emotionally, or physically than
the other?
• Does one person’s sense of com petence, optimism, or well-being seem to come at the
expense of the other’s physical or emotional health?
• Does the relationship support the economic viability of each partner?

Figure 14.2 Assessing the balance of power.

Source: From Knudson-Martin, C. (2015). When therapy challenges patriarchy: Undoing gendered power in hetero­
sexual relationships. In C. Knudson-Martin, M. E. Wells, & S. Samman (Eds.). Socio-Emotional Relationship Therapy:
Bridging emotion, societal context, and couple interaction (p. 17). Springer. Used with permission.

relational flow of power. Figure 14.2 offers related guidelines developed by Mahoney and
Knudson-Martin (2009) for assessing the balance of power in a relationship. These dimen­
sions include the relative status of partners, attention to other, accommodation patterns, and
well-being. Lutrell and colleagues (2018) also drew upon the SERT framework to develop
the Relationship Balance Assessment, a quantitative measure of mutuality in relationship
processes. Assessing power is complicated by the ways it is structured into social roles, making
it difficult to recognize or self-report. Power becomes easier to see when tracking relational
processes in session and asking process-oriented questions. The assessment guides noted here
help make hidden inequities among heterosexual couples visible, and also work well with
non-binary and gay persons whose relationships are less likely to include taken-for-granted
social power differences (Jonathan, 2009). These guides may also be used to identify power
patterns when working with youth and individual adults.
When tracking the flow of power between Lena and Samuel, the therapist noted that
although Lena appeared confident and spoke clearly, she tended to stop short of saying what
was on her mind when speaking to Samuel. When the therapist explored this pattern as it
occurred in session, Lena said she did not want to add to Samuel’s pressure—a sign of
accommodation. In contrast, even though Samuel internally doubted his status relative to
Lena, his responses demonstrated limited willingness to accept influence from her, creating a
significant power imbalance in who is open to being influenced by the other. According to
312 Socio-Emotional Relationship Therapy
Loscocco and Walzer (2013), this gender imbalance in relational responsibility accounts for
much of the dissatisfaction in heterosexual relationships in American society.
The flow of power between Samuel and Lena illustrates the complexities involved when
macro power processes outside the relationship affect micro processes between intimate
partners. As targets of racism and discrimination, Black men have often been unable to meet
the gendered expectations of patriarchy and Black women have been portrayed as having
power that is seldom actually accessible to them (Hill, 2005). As women and men com­
pensate for these societal perceptions and experiences, women’s relative lack of power in
relationships is overlooked. Like Lena, women of color often hesitate to push their own
issues or concerns since they are aware of the unfairness their partners face in the larger
society (Cowdery et al., 2009). Across racial groups, earning more money than their partners
or holding a higher status job such as physician seldom translates into a female power im­
balance, as partners consciously or unconsciously compensate by finding ways to augment
male power (Esmiol Wilson et al., 2014; Tichenor, 2005).

Emotional Expression, Power, and Behavior

Whose emotions have value and what can be expressed are highly dependent on who is
doing the emoting (Wetherell, 2012). Emotional expression is one way power imbalances are
maintained. Expressions of anger or disappointment on the part of those in powerful posi­
tions tend to silence subordinates and lead them to accommodate to maintain the relationship
and avoid further disruption. Interrupting these power patterns requires remaining socio­
culturally attuned to the vulnerabilities of both partners while also fostering accountability
and mutuality in the Circle of Care (Knudson-Martin et al., 2021).
In the case of Samuel and Lena, the therapist needed to apprehend the vulnerability Samuel
felt regarding his masculine position while also identifying and recognizing his relational desires
and helping him stay accountable to Lena and the relationship. The therapist had to resist the
power effects of Samuel’s anger, which her body registered, to provide leadership that invited
alternative responses to this compelling gender discourse (Knudson-Martin et al., 2015b).
When she persisted, Samuel was able to recognize that he was responding to masculine voices
that said “don’t be a wus,” and to give those societal messages less control.
When Wells and colleagues (2017) studied the processes that created change among
heterosexual couples with histories of childhood trauma, they found that men’s emotions
drove the relational process, with women’s responses being reactive. This did not mean that
women were always submissive. Some responded with anger and actions that served to
protect their vulnerability. Though Lena responded by silencing herself, other women might
respond aggressively.
SERT therapists understand client behaviors in terms of their power context. Expressions of
rage or disengagement in therapy may follow years in which a partner did not listen, attune, or
accept influence from her. Or, as in the earlier example, Robert’s irritation and depressed mood
helped maintain a power imbalance in which Raul regularly set aside his own needs to soothe
Robert. Williams and colleagues (2013) found that the meaning and appropriate clinical in­
terventions for cases involving infidelity depended on whether a partner was unfaithful from a
position of power or in response to a relatively powerless position.

Distinguishing Power, Authority, and Responsibility

It can be hard to distinguish between power, authority, and responsibility. This challenge is
especially salient in more traditional or hierarchical cultures and in workplace contexts in
general. Just because power imbalances are usual in a culture, it does not mean that they are
 Socio-Emotional Relationship Therapy 313
healthy or not open to reflection and change. At the same time, hierarchy and mutual
support can co-exist (Knudson-Martin & Kim, 2022). People can assign roles hierarchically
and respond to each other with the respect accorded these roles, yet demonstrate mutual
attunement and shared relational responsibility.
Some people believe that because a woman makes most of the household decisions, she
holds the power in the family, when in fact she is usually responsible for these tasks because
they are prescribed by social roles and/or the more powerful partner does not want or need
to bother with them. Therapists need to assess the relational flow of power through the
Circle of Care, rather than make assumptions based on stereotypes or ignore power im­
balances because they fit within cultural norms.
Parenting and intergenerational relationships are inherently hierarchical. Parents are re­
sponsible for the safety and well-being of their children. The Typology of Parent-Child
Relational Orientations (Tuttle et al., 2012) helps therapists and clients consider how power
and relational reciprocity are used in parenting. Like attachment therapists (Siegel & Hartzell,
2004), SERT emphasizes the value of a relational approach to parenting in which “parents
listen and respond to the child and teach their children to also be aware of their influence on
others, including the parent” (Tuttle et al., 2012 p. 81). SERT therapists also consider the
social conditions in which parents are preparing their children to live. Working class parents
are likely to emphasize obedience, since it is necessary for survival in environments where
others have authority, while professional class parents are more likely to teach their children
to speak up and advocate for themselves (Lareau, 2011). Socioculturally attuned practice will
take these contexts into account when working with parents and children.

Third Order Change

Knudson-Martin and Kim (2022, p. 284) identified four mechanisms through which SERT
promotes third order change:

a sociocultural attunement to each partner’s felt identities and experience that promotes
relational engagement,
b a shift in power imbalances that supports mutual engagement in the Circle of Care,
c experience engaging with each other from positions of mutual support, and
d a vision of alternatives to inequitable societal power processes.

These processes enable people to make intentional responses to previously taken-for-granted

societal patterns and discourses.
SERT utilizes neurobiological infrastructure to help clients move from cognitive aware­
ness of larger societal patterns in their lives; what narrative theorists call a new story of self and
other, to embodied action that “our whole body learns and absorbs” (Mehl-Madrona &
Mainguy, 2015, p. 206). This goes beyond talk, to affective engagement and practice that
builds upon new positive experiences (Beaudoin, 2017; Zimmerman, 2018). It is facilitated
by an active and engaged therapist who is aware of societal power issues and uses this to guide
clinical decisions.

Guidelines for Practice

Socio-Emotional Relationship Therapy has a well-developed clinical sequence that works in
three interconnected phases: Positioning, Interrupting, and Practicing (Figure 14.3). These
practices align well with the ANVIET principles described in this text.
314 Socio-Emotional Relationship Therapy
Socio-Emotional Relationship Therapy
Clinical Sequence
Phase 1: Positioning
Attuning to sociocultural emotion and discourse and
exposing relational consequences of power inequities

C A.
Explor Attune to
sociocultural sociocultural
discourses emotion

B.
Expose relational
consequence of
power inequities

A.
C. Help
Shift from powerful
C. personal partner
A.
Reinforce new meaning of increase
Envision new
mutuality power vulnerability,
mutuality
dynamics to a accountability
contextual & attunement
one

B. B.
Enact new options Acknowledge
for shared relational work to
responsibility prevent additional
imbalance of power

Phase 3: Practicing Phase 2: Interrupting

Developing new options and Creating relational safety by shifting
practices for shared responsibility in-the-moment power processes

Figure 14.3 SERT clinical sequence.

Phase I––Positioning
Phase I attunes to sociocultural emotion and discourses and exposes (names) the relational
consequences of power inequities. This phase involves three interconnected processes that
position the therapy to support relational values. These strategies continue throughout the
therapy and can be used in any order. They move concepts regarding societal discourse and
power from the abstract to the personal.
 Socio-Emotional Relationship Therapy 315
Attune to Sociocultural Emotion
Ongoing socioemotional attunement is the foundation for SERT clinical work and
helps form the therapeutic alliance. Therapists begin by seeking to “get” clients’ felt
sociocultural experience. They use a sociocontextual lens to interpret what clients present
and develop questions that facilitate a contextual frame for the therapy from the outset
(Pandit et al., 2015). They know they have successfully attuned when clients resonate
through their physiological responses and by sharing more about their experience
(Pandit et al., 2015). Attunement to sociocultural vulnerability and relational desires
are especially important, and often hidden by dominant societal discourse (Knudson-
Martin et al., 2021).

Expose Relational Consequences of Power Differences

Being able to name power while also relationally engaging powerful partners is critical
to SERT. Therapists track and name power differences (such as in who attends, who
accepts influence, etc.) and explore the impact of these differences on their relationships.
Exposing the power dynamic may feel somewhat uncomfortable at first. Successful efforts
are socioculturally attuned, validate the powerful partner’s relational values and interests,
and also address the consequences of actions that maintain the power imbalance, such as not
listening, minimizing, defining another’s “reality,” etc. (Samman & Knudson-Martin, 2015).
For example, a therapist might say,

I know how much you love [partner] and want to make her happy. You feel that as a
man you are supposed to know what to do. And yet she just said that when you make
decisions without her, she feels discounted, like you don’t really care about her. From
what you have said, I don’t think that’s what you want.

Clients need guidance to see power processes themselves. Focusing on power dynamics as
they arise in session and linking them to their clinical concerns works best. Naming power
while highlighting relational values creates a therapeutic context that makes it possible to
resist dominant societal discourses that perpetuate power inequities. Clients who do not
appear open to work within the Circle of Care and/or demonstrate commitment to overt
dominance, aggression, or violence should work individually or in a group focused on power
issues before considering whether to engage intimate partners or other family members
in session (Knudson-Martin & Kim, 2022).

Explore Sociocultural Discourses

People experience their lives personally and tend not to see the impact of larger societal
contexts. SERT therapists listen for societal discourses as clients describe their concerns.
Messages about what is valuable and important, how one should carry out their roles,
what to expect in relationships, togetherness, and independence, the meaning of family
and work, and ideas about right and wrong are especially important. As described earlier,
knowing that emotions get their meaning from the larger context helps therapists
move the conversation from the personal to the contextual. Giving voice to implicit
social discourses behind emotion is a good starting point from which to expand the
contextual dialogue.
For example, when a mother worries that she should spend more time with her child, a
therapist could voice the hidden social message by empathically reflecting, “Good mothers
316 Socio-Emotional Relationship Therapy
are supposed to prioritize time with their children.” When the client affirms this statement,
the therapist can expand the lens to explore this discourse, “What messages do you think
women get about being a good mother?” This conversation can be developed to more fully
attune to her felt sociocultural experience and consider how socially constructed definitions
regarding motherhood affect her experience and choices.

Phase 2: Interrupting
In phase 2, therapists create relational safety by using interventions that interrupt inequities
in the flow of power.

⤝⤞

Therapists recognize when power imbalances are present and take power
into account when deciding which interventions to make and to whom to
direct them.

⤝⤞

The goal is to shift in-the-moment power processes as they arise in client accounts or in­
teractions. This usually means asking different things of each participant, depending on their
power positions and based on the following three guidelines.

Help Powerful Partners Increase Vulnerability, Accountability, and Attunement

Much of phase 2 work involves helping more powerful persons increase their expressions of
vulnerability, take accountability for relational engagement and the effect of their actions, and
attune to others.

⤝⤞

Rather than asking an already more vulnerable person in a one down position
to express vulnerability or attune to others, it is important to shift the
power dynamic by inviting and supporting those in more powerful positions
to engage in these relational actions.

⤝⤞

This can be surprisingly challenging. Since power processes tend to be invisible to those
holding most power, their initial responses may include confusion, deflection, or expressions
of helplessness, i.e., “I don’t know.” Recall that when the therapist asked Robert what Raul
might be experiencing (an intervention that interrupts the flow of power), Robert resisted
focusing on what Raul might need and instead expressed irritation at his “clinginess.” The
therapist needed to responsively persist (Knudson-Martin et al., 2021; Sutherland et al.,
2013), staying with Robert even when he first declares he doesn’t know and encouraging
him to attune to what he does know about Raul.
Interventions that suggest each person does or feels the same thing can minimize power
differences. For example, saying to a couple, “you both are scared,” or “the two of you are
avoiding conflict” ignores—and thus reinforces—a power imbalance. Statements such as
 Socio-Emotional Relationship Therapy 317
these should be used cautiously and, if used at all, need to be followed by clinical actions that
help distinguish the positions each play. Eventually, each person will be invited to express
vulnerability and attune; however, it is important to first create a context in which less
powerful persons are likely to be heard and not place the expectation of change on the one
already carrying the relational burden.
This principle also applies when working with individuals. If a client is internalizing blame
for societal or relational injustices, the SERT therapist will respond with interventions that
interrupt this flow of power. For example, if a female client says, “I am not confident en­
ough, I don’t express myself well,” a response that interrupts power might be, “what happens
when you speak? Who listens?” If individual clients in powerful positions seem to be
avoiding relational responsibility, the therapist will ask questions that help them attune to
others and take relational initiative.

Acknowledge Relational Work

Relational work tends to be minimized or overlooked in many societies. To interrupt power
imbalances, it is important to recognize, name, and expand upon the contributions of those
carrying the relationship load. When partners or family members are present, SERT
therapists work to increase their awareness of this critical relationship work. In individual
therapy, such as the first sessions with Robert in the earlier example, the therapist could
ask Robert how Raul’s focus on him makes his life better or who in the office is most likely
to notice what needs to be done.

⤝⤞

Explicitly highlighting the value of relational work is an ongoing focus in

SERT.

⤝⤞

Shift from Personal to Contextual Meaning of Power

Previously hidden power differences become visible when using the Circle of Care.
Connecting these interpersonal power processes to larger societal forces reduces blame and
makes it easier to help powerful partners share relational responsibility and be accountable for
outcomes they may not have intended or do not wish to perpetuate. Relating power pro­
cesses to sociocultural vulnerabilities associated with marginalization and/socialization is
especially effective in facilitating a shift away from a power position (Knudson-Martin et al.,
2021). For example, Robert will be better able to attune to Raul if the therapist connects her
intervention to Robert’s socialization:

You’ve learned that people should speak up for what they need––that focusing on others
is a sign of weakness. This socialization can make it hard for you to notice or consider
what Raul needs. What do you think he needs from you right now?

Phase 3: Practicing
As therapy evolves and embodied power dynamics become less entrenched, phase three of
SERT focuses on helping clients develop new options and practices for mutual support.
318 Socio-Emotional Relationship Therapy
⤝⤞

Having a more equitable base makes it more possible to address hard issues.

⤝⤞

The therapist works as coach or facilitator to help clients stay in touch with their third-order
goals and get back on track when old patterns emerge. Therapists may draw upon techniques
from a variety of clinical approaches to accomplish the following three clinical tasks.

Envision A New Mutuality

SERT therapists encourage clients to envision mutual relational possibilities from the be­
ginning of therapy. In order to embody these goals, they need to develop a more fully
detailed, personalized picture of what enacting them would look like. For persons like
Robert and Samuel who have resisted engaging in the Circle of Care, this means seeing
themselves wanting and able to take relational initiative. For those who have been carrying
more of the relational weight, like Raul and Lena, it involves envisioning relationships in
which the load is shared and in which they are safe to more fully express their perspectives.
Narrative (see chapter 13) and solution-focused (see chapter 11) practices are helpful. For
example, the therapist might ask Robert to envision what it would look like if he made
more effort to notice the contributions of his colleagues at work. What would he do? What
would he say? What would his colleagues see that tells them he values them? How would his
relationships with his colleagues be different?

Enact New Options and Practices for Shared Responsibilities

As clients experience new patterns of relational engagement, they begin to neurologically
embody these transformational relational ideals. The therapist watches their process.
When clients fall off track, the therapist “helps them notice and process what happened,
with an eye toward what works” (Knudson-Martin & Kim, 2022, p. 283). For example,
when she notices that Lena stops expressing herself when Samuel disagrees, the therapist
interrupts and says,

I’m curious about what’s happening at this moment. Lena, you seemed to have a lot of
energy behind what you were saying, but when Samuel disagreed you stopped speaking.
I’m wondering what happened to limit your voice?

Then the therapist asks Samuel if he noticed that Lena seemed to be holding back and
encourages him to try what he has learned to do to engage her. Enactment promotes the
emotional engagement necessary to move from abstract ideals to internalized identity and
neurologically accessible felt experience (Zimmerman, 2018). Another example of this is
Fatma Arıcı Şahin’s use of experiential activities with heterosexual couples in Turkey (see
chapter 6 and Text Box 14.1 below).

Reinforce New Mutuality

Third order change that embodies relationality and mutual support needs reinforcement.
SERT therapists notice and amplify examples of these changes, accentuating how they
achieved them and detailing the impact of these changes on their relationships. For example,
 Socio-Emotional Relationship Therapy 319

Text Box 14.1 Fatma Arıcı S¸ahin, PhD

Fatma Arıcı Şahin is an assistant professor at Kastamonu University in northern

Turkey, with interests in couple and family therapy, feminism and gender studies,
art therapy and creativity. She first came across the concepts of “3rd order thinking”
and “sociocultural attunement” while reviewing the literature that would form the
basis of feminist and SERT-informed group work that she developed for married
heterosexual couples as part of her doctoral dissertation.
In my doctoral research, I developed an 8-session relationship enhancement
program based on a feminist perspective. My aim was to address power sharing
and equality issues between partners. I applied this program with a group of six
married couples and examined the effectiveness of the program in terms of power
sharing, self orientations (relational and individualistic orientations), and dyadic
adjustment by using a mixed method approach. Beyond a typical relationship
enhancement process that only focuses on the couple system, I intended to help
partners to critically discuss the sociocultural factors embedded in their relation­
ships and how these affect their interactions, and to develop cooperation with
each other to create a shared ideology based on relationship equality (mainly
in terms of gender). I also used various fields of art (music, dance, literature,
photography, cinema, etc.) as tools/techniques that enable the expression of
emotions, and also incorporated Fishbane’s Relational Empowerment idea and
the Gottman model to address various relational skills (e.g., conflict resolution).
A facilitating and active therapist stance that transforms therapy into a social
intervention process, experiential techniques (especially art therapy for me), and
relational empowerment are the key elements of this transformative work. I begin
to disrupt the unequal flow of power in relationships by inviting the more
autonomous partners (mostly male) into a relational position, as in the SERT
approach. When they start to speak from their vulnerability with a relational
orientation, this can create a basis for cooperation that will enable the partners
to resist unjust systems together. Relational empowerment that enables partners
to be mutually attuned to each other’s vulnerable emotions, to care for each other,
and to take responsibility for the relationship together, allows them to develop
partnership to resist unfair sociocultural patterns.
Before the last session of the program, I gave the couples homework to write an
“Equality Manifesto” in an evening when they could talk about their life ideologies
and values with their partners. In the final session, each couple read their equality
manifesto to the other group members, as if the group itself represented the
society. Other group members reflected their thoughts and feelings to the couple
who read their manifesto. In this regard, I strongly believe that group work
accelerates the transformative change in terms of facilitating the transferability
of what is experienced in the group to social life.
When scores of the experimental group were compared with the control group,
the results showed the program provided a significant increase in power sharing
and dyadic adjustment scores that persisted at the three-month follow-up.
Quantitative effects on internalizing a relational orientation were not significant;
however, qualitative findings showed participants found the program useful by
expanding their perspective from an individual focus to a relational and systemic
one, examining power distribution, conceptualizing relationship equality, and
gaining awareness on the social context.
320 Socio-Emotional Relationship Therapy
when Lena noted in passing that Samuel came home early so she could go out with her
friends, the therapist asked how this happened. Did Lena ask Samuel to come home early?
When Lena said that she didn’t ask, that she had expected she’d need a babysitter, the
therapist helped Samuel reflect on what he did to make this act of relational responsibility.
Note how the therapist provided leadership in this process:

Therapist: How did you decide to come home early?

Samuel: I knew she had this thing planned with her friends and I thought I should
help out.
Therapist: You should help out … this seems different than in the past. How so?
Samuel: (pause) Uhh … I guess I was thinking more about Lena and what it is like for
her to do most of the childcare. And I wanted to spend more time with Izzy.

Samuel’s response showed that he was beginning to internalize the Circle of Care, which the
therapist recognized as a shift in power and challenge to the dominant discourse that had
been shaping his actions. To reinforce this change, she continued to help him take in the
relational impact of his act:

Therapist: You were thinking more about what doing childcare is like for Lena and your
desire to spend time with Izzy. How do you think this focus on Lena and Izzy
affected your relationships with them?
Samuel: Well … I feel closer to them. And like I want them to know I care about them.

The therapist also helped Samuel make his challenge to the dominant discourse intentional:

Therapist: It’s kind of a break from all that social pressure you felt to always focus and
perform at work––that that was the measure of your worth.
Samuel: Yeh. I hadn’t realized how much that “money is success” stuff had a grip on me.

The therapist continued to reinforce the new mutuality by asking Lena what it means to her
that Samuel appreciated the load she carries and wants to be more connected with her and
Izzy.
Over time, clients increasingly relate based on their evolving vision of mutuality and
recognize when they are acting counter to this. They see their issues through an expanded
lens that carries less blame and enables them to be more intentional about how they engage
with each other and the world. An example of this may be found in Text Box 14.1 (above),
in which Fatma Arıcı Şahin describes her research on a group process she developed to help
reinforce couples’ evolving mutuality.

Case Illustration
Julia Keller called for therapy saying she was no longer able to cope and didn’t know what to
do, “Everything is falling to pieces–I just can’t hold it together anymore.” On the intake
form, she checked depressed thoughts, helplessness, and anger. She indicated physical and
emotional abuse in a past relationship and occasional thoughts that she did not want to live.
Julia identifies as a 45-year-old White, straight woman and has been married to her partner,
Michael (55, White) for eighteen years. She and Michael have two sons, Sean (17) and
Braden (16), and a 14-year-old daughter, Aubrey. Nate (25), Julia’s son from an earlier
relationship, is currently in jail. The impetus for her call, Julia said, is that Braden was
 Socio-Emotional Relationship Therapy 321
suspended from his soccer team for coming to practice drunk and Aubrey is at risk of not
passing two classes. Julia feels like a failure and hopes someone at the Family Center can help.
Sydney, a 30-year-old newly licensed LMFT, is assigned the case. Sydney identifies as a
mixed race (Black/White) cisgender gay male who passes as White. Because Julia appears so
distressed, he decides to first meet individually with her to assess safety. He is aware that
mothers receive many societal messages that they are singularly responsible for the behavior
and well-being of family members, and is mindful that seeing her individually could reinforce
this idea. He is curious about her socio-emotional experience and intentional about posi­
tioning their work together to counteract these destructive societal discourses and is sensitive
to potential inequities in the Circle of Care.

Phase I––Positioning
Julia opts for an in-person session (rather than virtual), saying she needs to get away from the
house. Despite her current upset, Julia presents as a “well-put-together” upper-middle class
woman, with stylish clothes, hair, and nails. Sydney welcomes her and begins to attune
based on the intake information:

Therapist: It sounds like there is a lot going on in your family [Julia nods] and you’re feeling
pretty overwhelmed.

Julia begins to cry and describes the relational burden and hopelessness she feels.

Julia: I don’t know what to do. I try so hard, but everything I do is wrong. I’m so worried
about the kids, but they just ignore me. And Michael doesn’t trust me. He says I don’t
know how to relate to them and should get off their back. [she takes a deep gasp]. I
just can’t do it anymore.

Sydney expands the lens to get an initial sociocultural sense of her experience of hopelessness
and potential suicide risk. He does this by responding to the emotion she appears to carry
regarding her roles as wife and mother.

Therapist: (gently) Being a good mother is important to you.

Julia: Yes! That’s all I wanted–something I never had. One of the reasons I married
Michael was because I could be a stay at home mom.

Sydney has a choice here. He could, and eventually will, explore the family history and those
hurts and losses, but at this moment he stays with her experience of societal expectations
around being a mother, wife, and woman. Bringing in the larger context will reduce the
blame Julia appears to be internalizing and help her feel less alone in her struggles.

Therapist: What does it mean to you to be one of the women who could be a stay at
home mom?
Julia: That I’m acceptable. That I’m worth something. That we have the money and
resources to do that.
Therapist: (thoughtfully): Being acceptable. To whom? The community? Society?
Julia: To the world. That I’m not trash. That I can take care of my kids.
Therapist: So in the eyes of the world women who can’t take care of their kids, keep them
out of trouble, aren’t worth much … are trash? Where do you think that idea
comes from?
322 Socio-Emotional Relationship Therapy
Inviting Julia to reflect on the larger context of her pain around her identity as a mother set
the stage for framing the family’s troubles and her own worth through a larger, third order
lens that counters injustice and offers more options.
By the end of the first session, Sydney and Julia determined she was not at risk for suicide.
They had begun to develop a contextual picture of her situation in which Julia, who had
experienced houselessness and foster care as a child, could feel respected and validated.
Sydney helped Julia begin to link her current feelings of worthlessness and failure, not simply
to a “bad” family background, but also to societal discourses that equate personal value with
economic resources and place relational burden on women.
Next Sydney met with the whole family and with Julia and Michael as a couple. He
observed that Michael and the children tended to subtly belittle Julia and discount her
opinion. This included teasing Julia that she was a “prude” regarding Braden’s alcohol use
and suggesting that she was hard on Aubrey because Julia was putting on weight and was
jealous of her daughter’s good looks. Sydney named these power issues and their effect on
Julia and the family.

Therapist: I noticed just now that when Mom spoke about her concerns regarding Aubrey’s
grades, Sean dismissed her concern as “over-reacting” and Dad suggested she was
jealous of Aubrey. When you did that, Mom got angry and you all laughed.
What do you think makes it possible for you to put her down like that?
Braden: We’re just having fun. She’s too sensitive.
Therapist: I’m guessing that’s hurtful to you, Julia. [Julia nods]. (To the family) How do you
think having fun at mom’s expense keeps you from addressing important issues?

In this early phase of therapy, Sydney helped the Keller family begin to consider their
issues with each other in terms of the larger societal context. This consideration began with
attuning to their socioemotional experience, making the power imbalances between Julia
and the rest of the family visible, and naming the relational consequences of this inequity.
He helped the family validate their relational desires, while observing that societal messages
prioritizing money and social appearances seemed to get in the way of their well-being and
the connections they would like to have with each other. He shared that many people who
come to the Center struggle with these concerns, and that these pressures could be
especially challenging for White families. This racial statement, which created curiosity and
additional discussion among the family members, made sense to them since this ob­
servation followed Sydney’s careful attunement to their felt experience and connections to
their sociocultural contexts.

Interrupting
Subsequent sessions alternated between couple sessions with Michael and Julia and sessions
with the whole family. Braden was also referred to a substance abuse group for teens,
which Michael agreed to support only because the coach required it before Braden could
return to the team. As the therapy began to delve more deeply into the family’s issues,
Sydney was attentive to power processes and directed his clinical interventions to in­
terrupt imbalances. For example, in a couple session Julia expressed frustration that
Michael was not taking Braden’s drinking problem seriously. Michael sighed, shook his
head, and looked to Sydney:

Michael: She lives in lah-lah land. What does she want to do, raise a fag! I know for a fact
that all the guys have their beers.
 Socio-Emotional Relationship Therapy 323
Sydney recognized that Michael was discounting Julia while also attempting to recruit him
into societal gender messages that generationally maintain White heterosexual male dom­
inance (Kimmel, 2008). He interrupted that societal power dynamic by challenging it:

Therapist: To be a straight male requires underage beer drinking? This is part of being an
athlete?
Michael: (pause) well you know … that’s how it’s always been. It’s what guys do!

Sydney seeks to attune to Michael’s sociocultural vulnerabilities around masculinity:

Therapist: You’re worried that to be a man Braden has to fit into some kind of beer-
drinking image? What is your worry for him?
Michael: I don’t want people to think he’s a mama’s boy … he can be a little over-sensitive
for a guy.

By interrupting Michael’s replication of heteropatriarchy, Sydney opened space for en­

visioning alternatives:

Therapist: When you say Braden can be sensitive, what do you mean?
Michael: He cares a lot about people’s feelings. He’s always been like that.
Therapist: Braden cares about people’s feelings [Michael and Julia both nod]. How do you
think that will serve him well as he grows into manhood?

To also intervene in the gendered power dynamic between Michael and Julia, Sydney in­
vited Michael to attune to Julia’s frustration:

Therapist: So earlier when Julia said she was frustrated that you haven’t seemed to take
Braden’s alcohol issues seriously, what do you think it is like for her when you
discount her concerns in this way?
Michael: I wasn’t really discounting her; I was just trying to tell her like it is.
Therapist: (persisting) and what do you think it is like for her when you “tell her like it is?”
Michael: I don’t suppose she likes it very much.
Therapist: (supporting and expanding Michael’s move toward Julia’s experience) She
wouldn’t like it because it feels ….
Michael: (pause) diminishing, I suppose. Like what she thinks is not important.
Therapist: I’m guessing you do care about what she thinks. Is that right? [Michael nods.] So
what do you think her concerns for Braden are?

After Michael reflects on Julia’s concerns, Sydney encourages him to recognize and express
his gratitude to Julia for the caring she gives, an intervention that interrupts their power
imbalance and also reinforces relational values typically minimized in individualistic Western
societies:

Therapist: Julia, you focus a lot on the children’s well-being. [Julia nods.] Michael, how
does Julia’s concern for the kids make their lives better?

During this phase of the therapy, Sydney is actively engaged in interrupting power inequities
as they arise in session. This includes helping Michael and the children attune to Julia and
respect her, and is facilitated by connecting their personal issues to larger societal processes.
324 Socio-Emotional Relationship Therapy
For example, Sydney validates Michael’s relational interests and then commiserates with him
regarding the ways male socialization and societal expectations get in the way:

Therapist: Michael, I see how much you care about your kids, and about Julia too. Other
male clients tell us how caring and sensitivity gets washed out of them in our
society. It can make it hard to know how to show and express our caring—or
how to focus on others and still feel like a man. What has been your experience
with this?

Effective intervention required that Sydney make sense of complex intersections of personal
and societal power processes. Julia’s anger sometimes erupted in ways that masked her limited
power and hopelessness. The relationship between Michael and Julia was founded on
multiple power differentials based on gender, age, socio-economic status, and perceived need
for the relationship. Julia was grateful to Michael for “rescuing” her and her young son.
Michael expected her gratitude and subservience and, at the same time, did many things to
take care of her. His power was structured into their identities, and his domination was not
often overtly expressed. Feeling distant from his own harsh father, Michael tried to maintain
a friendship role with the children and left discipline to Julia, rather than being accountable as
a father and partner. As encouraged by the dominant system, he measured himself by higher
socio-economic standards than their current situation and often sacrificed relationships to
demonstrate financial success. The children were unaware of their privilege and social capital
and were learning that they did not need to work hard or conform to institutional rules to be
successful or get what they wanted. In their privileged situation, attunement to others was
not valued.
Interrupting these power dynamics took critical consciousness, self-awareness, and courage
on Sydney’s part. His internal responses to societal power processes told him that as a young,
gay, person-of-color, it may be inappropriate or not safe to actively engage with this relatively
affluent White family, especially since Michael was old enough to be his father and exuded
an air of superiority. To interrupt power processes despite these vulnerable feelings, he em­
pathically connected with the sociocultural experience of each family member and joined to
resist power with them (Knudson-Martin et al., 2015b). His peer supervision group dedicated to
socially responsible practice helped him process his emotional reactions to the family.

Practicing
Over time, the Keller family began to incorporate relational themes into their conversations
and interactions with one another. Neural pathways supporting trust and mutual support
were activated when they experienced each other in emotionally meaningful new ways.
With this more equitable foundation beginning to be established, they are now more able to
safely deal with unresolved issues between them. Sydney’s role is to help the family envision
and develop what shared responsibility in the Circle of Care looks like for them, keeping
them on track when old patterns emerge and reinforcing transformational new ones. For
example, in a session focused on Aubrey’s engagement with school, Aubrey says she isn’t
worried, that she’ll be able to pull it together in the end. When Julia begins to protest, saying
Aubrey has to learn to take things more seriously, Aubrey starts to react and then sighs and
turns to her mother:

Aubrey: I know you worry about me, Mom. I get it. Just trust me on this OK. I know what
it takes to pass.
 Socio-Emotional Relationship Therapy 325
Sydney reinforces and highlights Aubrey’s step toward attuning to her mother, as well
as helping flesh out a picture of personal and shared relational responsibility while validating
caring work.

Therapist: (leaning in) I wonder if I could interrupt for a moment. Aubrey, I noticed that
you began by saying you know your mother worries about you. What did it
mean to you to say that to her?
Aubrey: Well, I do appreciate all she does for me, and I get that she worries.
Therapist: It makes sense to you that she worries?
Aubrey: Yeah. I mean coming here I’ve heard her talk about it enough. And I can see
why parents worry.
Therapist: What would you want your mom to know about your appreciation of her.
Tell her.
Aubrey: (to Julia) I didn’t think before about what it’s like to be a mother. It’s not fair that
you should blame yourself for what I do, but I guess that’s what mothers are [air
quotes] supposed to do. I know I’m lucky to have you to worry about me—even
when I don’t like it.

Sydney reinforces the effect of Aubrey’s demonstrations of caring:

Therapist: (to Julia). What is it like to hear Aubrey say she knows you worry and appreciates
it, even though she doesn’t always like it?
Julia: (tearfully) I’ve tried so hard to be a good mom. [looks at Aubrey] Thank you,
honey. It really helps to hear that.
Therapist: How does it help?
Julia: It makes me feel not so alone … and better about myself. Like someone notices.

Sydney helped the family broaden and nuance the conversation about their responsi­
bilities to each other, including Michael and the boys. They discussed societal expecta­
tions and pressures and how these connect to responsibility for oneself and others.
This invited a discussion of what it means to get good grades. It became clear that
Aubrey’s disengagement from academic expectations was, in part, resistance to auto­
matically falling in line with social standards designed to maintain the dominant socio­
economic structure:

Aubrey: I don’t even know why you care so much that I get into a good college. What’s it
for? What’s it do for you, Dad? Does it make you happy? I don’t think so.

The family was now actively engaged in consciously considering how to enact relational
values and life choices previously hidden to them. Similarly to what might happen in
contextual therapy (see chapter 9), Julia was also able to get a broader picture of the
intergenerational injustices in her life and be more intentional about how she defined
herself and her contributions to others going forward. Michael started to take the lead in
demonstrating respect for Julia’s caring and reflecting with Sean and Braden through an
expanded lens about what it means to be “a guy” and how they want to relate to others.
While all the arguments did not go away, and challenges with each other and the larger
world are on-going and not always easily resolved, they now see themselves through the
Circle of Care and a broader sociocontextual lens. They have a new framework through
which to address old issues such as how Julia’s son Nate fits in the family.
326 Socio-Emotional Relationship Therapy
Summary: Third Order Change
As a White family, the Kellers had been socialized to align their internalized identities and
parenting practices with the dominant heteropatriarchal capitalist system and to expect access to
its perceived rewards. The previously unrecognized costs to each person’s development and
their ability to connect with one another were many. As a consequence, their relationships did
not support Julia’s emotional well-being or relational responsibility among Michael and the
children. As the Keller family began to see their personal struggles in context of larger systems
of systems, they could envision new relational possibilities. Third order change in this case is
represented by this new way of seeing themselves and the world around them.
With the therapists’ active support, the Kellers used the Circle of Care to help expand
upon and begin to enact relational values that mattered to them but had been minimized and
masked by dominant social discourses. Julia no longer solely carried the relational load.
Michael began to experience the rewards of genuine relationships with his wife and children
and obsessed less about financial success. Sean, Braden, and Aubrey also demonstrated more
relational responsibility and approached adulthood with more intentionality about their
values and broader definitions of success. The family still faced many issues but were more
able to support each other through them.
It would have been easy for a therapist working with this case to get caught in Julia’s
history of abuse and focus primarily on how she could be less triggered in the present. This
first order change, while useful in the context of larger third order change, would have
perpetuated the dominant system that put responsibility on her without questioning the
larger systems of systems. Family therapists might also have focused on second order change
in how the Keller family communicated, which while also useful, would have left the un­
derlying individualistic material value system unchallenged or implied blame on the family
without awareness of the societal context around them. To do third-order work, Sydney had
to be intentional about how his clinical interventions reinforced or challenged social systems
that work against relationships and perpetuate inequalities. Whether working with affluent
families like the Keller’s or those in marginalized social locations, Sydney always begins by
attuning to the effect of their social contexts on their presenting symptoms and felt ex­
periences, and directs his interventions to value what is minimized or overlooked and to
counteract social power inequities.

Reflexive Questions
• What is your reaction to this statement- “There is no such thing as a ‘non-affective’
thought; ‘rational’ decision-making requires an internal appraisal based on emotion that
is always socioculturally located”?
• How can you help clients map the ways in which their emotional responses are
connected to contextual social forces? Can you think of this for yourself?
• If identity is how people know themselves in relation to others, then how is your
identity confirmed by a sense of being known, recognized, and validated? How do these
processes give or take away your power?
• SERT defines power as a set of relationally created and structurally embedded social
processes that determine whose experiences, abilities, and interests merit value. How do
these power dynamics affect what and who you attend to in your clinical practice?
• The Circle of Care uses four orienting principles that promote mutually supportive
relationships and well-being: mutual vulnerability, attunement, influence, and shared
relational responsibility. Which one of these relational guidelines is most aligned or
misaligned with your gender and cultural socialization?
 Socio-Emotional Relationship Therapy 327
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15 Socioculturally Attuned Praxis:
Consciousness in Action

We have contended throughout this text that the broader context impacts families and shapes
our practices as we engage in equity-based family therapy. Previous chapters focus on in­
tervening at the level of families and individuals. In this chapter, we focus on the potential
impact of, and processes for, intervening at other levels of societal systems (See Figure 15.1),
including community engagement, research, teaching, supervision, policy work, and orga­
nizational change. These systems are often saturated by the effects of oppression, inequity and
injustice. According to Patricia Hill Collins (1990), the work of racial-ethnic feminisms
illustrates how theory and social action (praxis) are linked. Similarly, Freire (1970, p. 36),
advocated praxis, as “action and reflection upon the world in order to change it.” Praxis is
the resistance expressed by oppressed people and groups to harmful/constraining ideologies
and inequitable institutions. Simply put, praxis is putting consciousness into action. From our
perspective, applying ANVIET across social contexts can provide guidance for praxis.
The work of transformative change is certainly not unique to family therapists; however,
family therapists are uniquely poised to integrate systemic thinking and critical consciousness
across various contexts and are often in positions where we can affect change. So, how can
family therapists––along with professionals from all disciplines––use third order thinking to
envision transformation in communities, organizations, governmental systems, and interna­
tional relationships? How might third order thinking inform knowledge production, shape
public policy, and support a healthy, sustainable environment? How might we design and
carry out interventions that target third order change at all levels of societal systems? In this
chapter, we bring forth the voices of practitioners enacting third order change across various
social systems.
The levels of societal systems shown in Figure 15.1 are not discrete, but overlap and impact
each other in complex ways. For example, international dynamics, including wars, sanctions,
tariffs, and immigration policies impact the most intimate aspects of culture, community, and
family life. Organizations are positioned in particular places at specific times and rely on
governmental and economic systems and policies. All locations or levels present a variety of
constraints and opportunities for relational well-being and equity. For example, judicial
systems are in many ways bound by government laws that prescribe minimum sentences
regardless of individual circumstances or fairness, yet as Andraé Brown describes in Text
Box 15.7, there are also opportunities to influence court decisions to prioritize rehabilitation
over punishment. Public policy and laws are often points of contention as they determine
which organizations and public sectors will thrive at what cost to others (e.g., loosening of
environmental regulations increases profit and global competition, while risking public health
and the survival of the environment). This figure also draws attention to the social de­
terminants of health discussed in chapter one; broader or more “upstream” interventions
(e.g., expanding Medicaid coverage), impact lower “downstream” sites (e.g., agency policies,
community wellbeing, educational systems, the health of those living on low income).
DOI: 10.4324/9781003216520-15
Figure 15.1 Socioculturally attuned praxis across societal systems.
Socioculturally Attuned Praxis 331
332 Socioculturally Attuned Praxis
Using ANVIET as a Guide for Third Order Systemic Change
A number of core principles, which reflect ANVIET guidelines, emerge across the many ex­
amples of transformation shared by change agents throughout this chapter. Our colleagues
describe their work in ways that reflect their abilities to engage in third order systemic thinking
across varied contexts. They consistently keep the bigger picture in mind as they navigate,
instigate, and solidify change. Just as we do when working with families, these experts pay close
attention to the process of change, carefully considering how to engage others, work relationally,
generate buy-in, create collective vision, and thoughtfully intervene one step at a time.

Build and Maintain Attuned Relationships

Family therapy is first and foremost relational. We are able to apprehend the sociocultural
context of others and attune to them, even when we don’t share their worldviews or per­
spectives. Family therapists recognize the importance of engaging all family members, making
sure all feel understood, heard, and valued. Boszormenyi-Nagy (1966) referred to the ability
to take all family members’ views and well-being into account as multidirected partiality.
This allows us to hold multiple perspectives in the same space, even when they are in op­
position, to stay connected, and to assume the best intentions. Systemic family therapists have
long been experts at helping people attune to each other and work diligently toward mutual
understanding, growth, and resolving conflict. When therapeutic relationships are stressed,
we work efficiently and effectively to repair them. We need to rely on these skills to create
change through relationships.
Building and maintaining attuned relationships necessitates collaboration. It is crucial to
develop alliances to collectively engage in change efforts within organizations, agencies,
communities, and societal systems. Alliances may be intentionally initiated through affirming
what is said or named, echoing a remark, a glance of recognition, or a conversation in the
parking lot. They often develop around specific initiatives and evolve as organizations
transform. Attempting to create change on one’s own, without support from others, can lead
to being marginalized or even removed from the system. This is particularly true for those
who are at greater risk of being marginalized––those whose identities represent people from
minoritized groups within society (e.g., people of color, women, differently abled, LGBTQ+
persons). It is also important whenever possible to work across social locations toward a
common purpose. This collaboration allows for the intentional use of working with allies and
accessing others’ experience, insights, and positionality to create change.
An important part of hope and the ability to envision and work toward transformative
change is facilitated by seeing ourselves as part of something larger than ourselves. Building
and maintaining attuned relationships can often involve a spiritual component. In Text
Box 15.1 William Turner, principal investigator of the HOPE Laboratory, a translational
research program that focuses on the application of hope theories, systems theories, and
positive psychology principles in systems and organizations at multiple levels, describes the
connection between hope, spirituality, and movement toward justice.

Text Box 15.1 William Turner, PhD, LMFT

William Turner serves as Distinguished Professor of Leadership and Public Policy and
Special Counsel to the President for Equity, Diversity, and Inclusion at Lipscomb University,
Nashville, TN. His teaching and research interests are focused on African American family
strengths and the intersections of hope, justice, policy, and faith.
 Socioculturally Attuned Praxis 333

I find more and more as I study hope, the doors are opening for me and other
scholars to speak unapologetically about spirituality as a very important ingredient
of hope; frankly, I think it is a driver. That doesn’t mean that you must be connected
to a church, a synagogue, or mosque, or anything like that to experience a greater
fullness of being that enables you to access hope. I think particularly for Black and
Brown people, if we are trying to do something that doesn’t incorporate that sense
of hope, we might just as well be talking to the wall. I would like for scientists and
clinicians to not be afraid of exploring and acknowledging that reality in the lives of
those we are attempting to help.
Clients’ clinical presentations are often compounded by feelings of anger, rage,
and hopelessness. Thus, fostering hope can be complicated, not only because
clients may be subject to one multi-layered, traumatizing experience after another,
but also because of therapists’ well-intended but often misguided actions. In a
nation in which the idea of a ‘just society’ is a vision that we have never really fully
embraced, effective intervention requires us as therapists to assess our own
social positions of power and privilege and their implications for our work with
clients whose everyday lives are colored by inequities in every imaginable way.
Hope cannot truly emerge until there is a confrontation of the truths of one’s
realities and the contexts that have maintained them. Once understood, we can
find meaningful ways of moving forward. That is what hope is all about.

Name without Shame

Shaming rarely, if ever, motivates others to engage (McGoldrick et al., 2021). Yet, we
sometimes expect that simply pointing out what another is doing wrong––including how
they are being oppressive and/or unaware of equity issues––will be transformative. Broadly
speaking, we can see this dynamic unfold in “calling out” and “cancel culture” (Brown &
Devich‐Cyril, 2020; Ross, 2019a, 2019b). As therapists, it is easy to understand that it would
be problematic and most likely counterproductive to simply say to a parent, “The way you
are going about this is harmful.” We would instead make sure we understand and attune to
where everyone in the family is coming from, including the parent. We would likely seek
out underlying values, help the parent attune to the child, and explore other ways of relating
while maintaining a positive relationship with all. We would name the problem from
multiple perspectives, without shaming the parent. We would call the parent and all members
of the family “in” rather than calling them “out.” According to Ross (2019b), calling-in is
like a call-out done with love and respect:

Calling-in engages in debates with words and actions of healing and restoration, and
without the self-indulgence of drama. And we can make productive choices about the
terms of the debate: Conflicts about coalition-building, supporting candidates, or
policies, are a routine and desirable feature of a pluralistic democracy. (p. 2)

Engaging with respect is second nature to those of us who work with families day in and day
out, yet when we enter work systems and organizations we sometimes expect a very different
outcome when we proclaim “This is not OK! You’re being classist/racist/sexist/homo­
phobic, etc.” Direct confrontation surrounding what is just is appropriate, especially when
harm is being done intentionally; however, in most cases, this approach is counterproductive,
putting others back on their heels, feeling rejected or hurt, and often unwilling to further
334 Socioculturally Attuned Praxis
engage. In fact, speaking out and expecting to be heard is often part of unexamined privilege,
i.e., “my voice should and will count.” The question in the classroom, boardroom, and
meeting room is how do we call others into equity-based work?” Naming without shaming is
important, especially when creating or building on collective values.

Identify and Build on Collective Values

Change is most likely to happen when it is in the best interest of all, including those with
the greatest power and influence. Derrick Bell (2002) referred to this as interest con­
vergence. When we work with families, we almost intuitively ensure that the proposed
change is in the best interest of all and that we have buy-in from as many family members
as possible. We work to get family members or community members on board for change,
help them come together to fight the problem, not each other, and help all family
members identify how more equitable relationships will help them realize their values and
goals. Consider the political polarization we are currently experiencing in many parts of
the world. It is common now for families to be divided by their divergent views and
political positions. Exploring collective values can place political differences in perspective
as families prioritize mutual support, loving each other through difficult times, and other
relational values (Fraenkel & Cho, 2020). In other words, identifying and centering core
values creates a context in which it is in everyone’s best interest to prioritize relationships
over political opinions.
Identifying core values in institutions, communities, and organizations provides a cor­
nerstone for equity-based change. Unjust policies and practices often result in moving away
from collective values. For example, if an educational institution values diversity of thought
and inclusion, yet has hiring policies that result in repeatedly hiring conventional thinkers
who represent people from the dominant societal group, this will work against the institu­
tion’s alleged DEI (diversity, equity, and inclusion) values. At times, an institution may be
attempting to meet external requirements that are not explicitly tied to its core values.
Consider a family therapy program that is attempting to accommodate accreditation standards
by increasing the number of students of color in incoming cohorts, without making any
other changes to policies, faculty awareness, and diversity, or curriculum. The challenge then
becomes, “How does increasing racial diversity connect with the program’s existing values?”
and/or “How do we engage in value building around equity, rather than just promote
diversity?” Understanding, co-creating, and building upon collective values will work to­
ward creating change with intention.

Intervene with Intention

The word intervention is complex and has multiple meanings. What does it mean for an
educator, administrator, supervisor, student, community member, or client to intervene?
What does it mean for a family therapist to intervene? We often tell family therapy trainees
that if we spontaneously stop a video of a session, they should be able to explain what they
are doing and why they are doing it; describing their intention. When we practice family
therapy, we are paying close attention to each interaction, making a multitude of decisions
about what to do next and why. Contrast this with being in a professional meeting and
simply saying whatever is on your mind, loudly repeating a point, or saying nothing at all.
When out of the therapeutic context, we can forget to pay attention to relational dynamics
and to intervene with the intention to create (often incremental) change.
Deciding how and when to intervene to support equity-based decision-making could be a
volume in itself. The best mantra we have found is “it depends.” Just as in therapy, there is no
 Socioculturally Attuned Praxis 335
“one size fits all” intervention; rather it depends on carefully reading the situation and ex­
amining what will be helpful at any given time. This requires using a systemic lens to
consider possible outcomes of any intervention. Consider the power dynamics involved
when a colleague with less social influence and institutional status speaks up only to be shut
down by a more powerful person in the group. It is not uncommon for someone with higher
status to jump in to “rescue” the lower status colleague, using their own privilege as a form of
uninvited leverage or “protection.” Contrast this with amplifying what has been margin­
alized by maintaining composure and stating “I’d like to get back to the point [colleague]
made, “I am interested in hearing more,” or “You know, building off what [colleague]
mentioned, I think … [in support of the idea].”
It is vital to consider power dynamics when considering how, when, and where to in­
tervene. This includes analyzing one’s designated role and social location, evaluating the
impact these have on one’s influence, as well as potential costs of attempting to influence.
Role privilege (e.g., positions of organizational leadership, being a teacher or supervisor) may
be diminished or enhanced––challenged or supported––within specific systems based on
interconnected social identities (e.g., gender, race, abilities, looks, age, ethnicity, sexual
orientation, religious affiliation). As we know from therapeutic encounters, the power tied
to the social location of all involved––including the therapist (change agent)––needs to be
factored in when determining how to best intervene.

Create Collective Vision

Most of us who engage in this work have goals or a vision for what we believe will create
greater social equity. A common misstep that many of us have made at some point is to
“show all of our cards” before building a collective vision. This can be to our disadvantage
when engaging in long-term change initiatives; for example, announcing “The first thing
I want to do in my new role as an administrator is to eliminate racism in our organization.”
This open stance, while authentic and transparent, may serve to polarize a group you need to
have working together. Anti-racist initiatives may be on the top of the list, but announcing
the plan without first building relationships, attuning to the needs, values, and attitudes
of all involved, and creating a collective vision may create undue resistance that sets the
initiative back.
Building a collective vision can be painstaking work that requires at least attempting to
involve all stakeholders. It is difficult to move a village until everyone is packed and ready to
go. Except in the most dire of circumstances, this doesn’t occur until (at least most of) those
being asked to move/change are invested in the collective vision of an equitable and better
future.

Engage in and Support Transformation

Family therapists understand change processes and know that transformation is possible. We
recognize the importance of incremental, sequential steps toward change. We persist when
change is slow or temporarily moves backward. We don’t complain or blame families for not
changing. We look for alternatives, try to locate what we have missed, invite greater un­
derstanding, expand our creativity, and keep at it. We are often the holders of hope and
contributors to the expectation for change, both of which have been noted as being central to
client’s success in therapy. Nonetheless, change can be difficult and complex in any human
system, and it rarely works to provide common sense, first order change interventions. For
example, requiring faculty to add readings authored by those in diverse social locations may
change the landscape of an institution’s syllabi and prompt some new conversations in
336 Socioculturally Attuned Praxis
classrooms (i.e., first order change); but it doesn’t transform the curriculum (i.e., second
order change). Likewise, requiring organizational staff to complete online diversity training
may meet legal expectations, but is unlikely to change the organization.
In contrast, being at the table when decisions are made to add diverse voices to
the curriculum or to require diversity training may create opportunities for incremental
movement toward third order change. For example, one might be in a position to ask,
“What are we hoping to change by ….”, “What are some other ways we might …”, “How
can we go beyond …”, “How does this support our values …,” and so on. This requires us
to purposefully move into positions that provide opportunities to create change, watch for
moments when change interventions are likely to be successful, intentionally intervene in
one place to create change in another, and work within one’s sphere of influence. These are
all foundational to transformational third order change.

Third Order Praxis Across Contexts

Third order change involves all levels of societal systems, any of which can be transformed in
ways that create and maintain more equitable circumstances and relational dynamics. Those
who engage in socioculturally attuned praxis (critical consciousness in action) do so within
the contexts they inhabit. In Text Box 15.2, Manijeh Daneshpour describes her work to
support social and relational equity across the many contexts in which she lives and works.

Text Box 15.2 Manijeh Daneshpour, PhD, LMFT

Manijeh Daneshpour (she/her) has been working in academic settings since 1996
and has been a clinician, researcher, presenter, and writer while being an
administrator for the past 25 years. What follows are her thoughts regarding third
order thinking and sociocultural attunement.
I am a cisgender woman from Iran and grew up in an educated middle-class
family that perceived gender as a social construct. My parents believed that
women are as capable, if not more capable, than men and helped us develop a
very strong sense of self and trained us not to see ourselves as gendered women
but as capable and multidimensional human beings. When I came to the US, I
decided to continue to wear hijab, first based on the simply undeniable destiny
that I was indeed born in Iran and my parents were born Muslims and practice
their religion. Years later, I realized that my identity as an educated, capable,
confident, liberal, and intellectually bright woman is usually not as important a part
of my identity to others as my head wrapped in a scarf. I realized that even highly
educated and liberal people could not see me as the whole person beyond the
piece of cloth on my head. None of these intersectional categories of my identity
were intriguing to people, except how someone might have somehow oppressed
me because I was a Muslim woman from Iran. So, when religion was no longer a
salient part of my identity, I consciously decided to politically wrap my head with a
scarf to stand against the cultural hegemony that open minded and intellectually
sophisticated feminists are supposed to look like White women and their hair has
to show to be considered a progressive thinker! So every time I present at a
conference, go to class, attend a leadership meeting at the university, or greet a
new client in my office, I am conscious that just because I wear a hijab I have to
 Socioculturally Attuned Praxis 337

use all aspects of my interconnected identities to make a connection. Thus, I need

to be mindful of my intersectionality and use 3rd order thinking to do my job well.
Through my own, at times painful experiences, I have become sensitive and
attune to everyone else’s intersectionality and social locations. I listen with the ear
of my heart and bring my whole humanity to these conversations. I try to
contextualize people’s experiences and believe in advocacy for the voiceless
and challenging the powerful in any setting and capacity. I am familiar with
sociopolitical theories of gender and understand the impact of structural and
internalized racism. I name and identify these complex issues in every encounter,
even at a party with friends and families and in conversations with my children.
I believe advocating for the most vulnerable is the most ethical part of socially
just family therapy. In my clinical work, I challenge individuals’ unfairness and
unjust actions and advocate for those with less power, even if they are not part of
the therapy process. I interrupt oppressive gendered patterns and challenge the
unfair patriarchal hierarchy. I help people with transformative change by providing
meaningful and relevant information, tapping into their personal resources, and
empowering them to use their sense of agency to challenge themselves and
others. I use my knowledge, expertise, and relational skills to help people change
their perspectives and become their own agents of change.
In my writings and research (e.g., Daneshpour, 2016; Daneshpour & Dadras,
2021), I use topics to directly advocate for those who tend to be more mistreated
and misunderstood (family therapy with Muslims, multicultural couple therapy with
Muslims, family therapy with immigrants and refugees, third wave feminism, etc.).
The topics I chose to write about are culturally, socially, and politically intertwined.
For example, I don’t try to advocate for Muslims as a religious group. I advocate
and write about this group as a misunderstood social group with many relational
and familial issues needing the help of mental health professionals.
In the context of my administrative work, I advocate and amplify marginalized
voices of students, faculty of color, and staff. I personally get involved when a
student of color gets disciplined on any of our campuses. I go to every faculty
meeting, every orientation meeting with students across our multiple campuses,
and invite students to directly contact me with any concerns related to experien­
cing any types of marginalization. I routinely engage in faculty and program
directors’ training to be more conscious of their implicit biases and conduct
culturally sensitive training for our faculty.
I teach alternative ways of thinking and challenge students’ perspectives in
every class. I blend in the latest articles, images, videos, and news relevant to
marginalized people’s lives with any topic I cover. In supervision, I use social
justice, feminist perspectives, and culturally sensitive perspectives and ask my
supervisees to write about their self-of-therapist experiences and bring a tape of a
recorded session about how they incorporate social justice perspectives in their
work. We read articles, watch the news, and discuss the everyday experiences of
people whose lives are impacted by the unfair actions of others.
With the intersections of my identities, my most significant strength is to interrupt
unjust relationships loudly. I have met with the presidents and the provosts of
different institutions to discuss policies and rules when applied to marginalized
students and written letters to other organizations, including AAMFT. I have been
told that my authenticity, passion, and recognition of my intersectional self can be
a source of transformation and modeling for others in multiple settings and
338 Socioculturally Attuned Praxis

positions. I am bold, kind, considerate, not afraid of being wrong, and learn from
my mistakes. I treat every disagreement with my children, spouse, and family
members as a professional learning opportunity and believe in human decency
and love.

In Text Box 15.3, Dana Stone reflects on how in her context as an educator and su­
pervisor, she supports beginning therapists develop the capacity to support clients in third
order change. She further describes her commitment to engaging in critical intention as an
ongoing practice in her professional and personal life.

Text Box 15.3 Dana Stone, PhD, LMFT

Dana Stone (she/her) is an associate professor at California State University in

Northridge. She identifies as a multiracial Black-White, cisgender female, hearing,
temporarily able bodied, heterosexual, and non-religious. Her work focuses on the
multiracial experience and supporting early career therapists with marginalized
aspects of identity in navigating the field of marriage and family therapy and
counseling (see Stone & ChenFeng, 2019).
My application of third order thinking really starts in the classroom with
beginning therapists. In my teaching, I center societal processes such as
inequities, power, privilege, and oppression, and embark on a journey beside
my students as they consider the impact of these factors in their own lives and in
the lives of the people they will serve. As therapists, we can only help our clients
and effect third order change if we start first with ourselves.
I have taken guidance from colleagues on how to identify and name these issues
(social inequities; the impact of power, privilege, and oppression). My process
includes ongoing critical self-reflection. From everything that I read and watch,
and the people I turn to for my own learning (through workshops and conferences,
etc.) I take time to reflect and think about how my own understanding is achieved
and to consider the ways I can integrate the material I am learning. I spend time in
conversation with trusted colleagues (from shared and different social locations)
to deepen my own understandings, and then collaborate to come up with creative
ways to bring the knowledge into the classroom or supervision.
I look for narratives, stories, publications, and media that amplifies the margin­
alized. I have committed, in my ongoing personal and professional development,
to read with critical intention, to watch with critical intention, and to listen with
critical intention. When I engage in this way, I ask: whose voices are telling these
stories, whose voices are missing, and where can I go next to learn more from
“own voices” perspectives?
I work very hard to provide feedback in ways that will encourage deeper self-
reflection when I have observed relational or systemic injustice in the classroom or
supervision. I own my mistakes openly and with transparency to lead by example.
I continuously talk about individual, interpersonal, and collective responsibility to
disrupt inequities and injustice. I often center the conversation in the here and now
to promote action at the micro level, especially when students and supervisees
 Socioculturally Attuned Praxis 339

feel overwhelmed by the vast injustice that surrounds and they wonder how they
can affect change as one person.
I guide students in a personal process of self-transformation by encouraging
engagement in critical self-reflection regarding intersectional aspects of their own
identity. I invite them to name the parts of their identity that are privileged and
parts that are not. As students become more attuned to their own intersectional
identity and increase their understanding of their own power and privilege as well
as their experiences of oppression, they begin to recognize how their own
experiences may mirror that of their clients. It is also through sharing of self and
identity in group spaces that students begin to understand their experiences in
relation to the myriad experiences of their colleagues. This deepens their under­
standing of themselves as cultural beings and promotes cultural democracy in that
it gives voice, value, and respect to diversity and emphasizes the importance of
proactive engagement from everyone to dismantle dominant discourses of what is
“right” or should be centered.
When students and supervisees engage in a process of critical self-reflection
about their intersectional identities and power, privilege, and oppression, it
enables them to consider why the sociocultural context of each of their clients
matters when considering therapeutic interventions that will promote meaningful
change.

Developing Culturally Attuned, Equity-Based Community Interventions

Family therapists sometimes extend their work with families to include members of the larger
community and may target change in the community itself. The Cultural Context Model
(CCM) provides an excellent example of doing so in ways that create third order change (see
also Chapter 2). The CCM includes building therapeutic communities of support and ac­
countability, as well as engaging community members as sponsors and stakeholders in the
therapeutic process. The model challenges the dominant assumption that therapy is, or
should be, a solely private matter by inviting clients and members of the community to join
together to build critical consciousness and provide support for liberatory transformation. In
fact, the CCM routinely goes beyond impacting individuals or families to making a differ­
ence in communities (Almeida, 2018; Almeida et al., 2007).
Socioculturally attuned practice can be applied in multiple contexts. For example, I (Maria
Bermudez) consider my scholarship, clinical skills, teaching, and activism as forms of praxis
that are simultaneously enacted. I recently had the privilege of being involved as a co-
principal investigator in a community-based participatory research project called Lazos
Hispanos (Hispanic Links). This project was formed to address the challenges and health
disparities experienced by members of our Latinx community. Our aim was to enhance the
health and well-being of immigrant Latinx people residing in low-income communities by
helping them gain knowledge and access to local community services. Theoretically, we
aligned with decolonizing and feminist informed research methods. We asked women re­
garded as leaders in our Latinx community to work on our research team as volunteer
community health workers/promotoras. With their support, and that of colleagues and local
community clinics, agencies, and organizations, we formed Lazos Hispanos. Our multicultural
and interdisciplinary research team enriched every aspect of the program and enhanced
culturally responsive community engagement (Matthew et al., 2020).
340 Socioculturally Attuned Praxis
There are several ways in which third order thinking and ANVIET served to guide third
order change with Lazos Hispanos. First, we attuned to the struggles faced by members of the
Latinx community, most of whom are immigrants with mixed legal status. With this
awareness, the colleagues conducted a needs assessment to identify and name problems
within the community (Calva et al., 2020). As scholars invested in equity-based practices,
social justice, and immigrants’ rights, it was important for us to use our positions of power
and social and cultural capital to help members of our community gain access to the com­
munity resources that they identified. Many suffer the effects of blatant institutionalized and
systemic racism and anti-immigrant hostility in our state. We listened to them and valued
what they said was important to them and their families and what they needed as a com­
munity. We invited a small group of women to be part of our research and outreach team as
key stakeholders best positioned to help Latinx families gain access to these resources (en­
vision). The program proved to be transformative for our community and for all of us
who participated in it (Orpinas et al., 2020). We shared knowledge, information, and gained
power from our mutually respectful and beneficial relationships.
Similar to the micro-advocacy work described by Holyoak and colleagues (2020), our pro­
gram aimed to bridge Latinx families to resources and organizations (intervene)––school staff,
teachers, and tutoring, free/affordable medical clinics, legal services, employment opportunities,
transportation and housing information, food sources and nutrition information, crisis services,
financial aid, etc. This community-based work not only helped community members, but our
team also felt empowered and afforded the promotoras and us greater credibility as knowledgeable
and trusted community leaders and advocates (Alvarez-Hernandez et al., 2021). Although our
program only lasted four years and was sadly truncated due to the effects of the COVID-19
pandemic, the program greatly impacted our community and helped Latinx families gain access
to community services via their connections with Lazos Hispanos and our community-based
participatory research team (Orpinas et al., 2020). We are left with the void of not having this
valuable resource in our community. Latinx immigrants continue to be marginalized, deni­
grated, rejected, and live in fear with the real threat of arrest, detention, and deportation
(Walsdorf et al., 2020).
To give perspective, in 2018 the governor of our state had a televised campaign ad in
which he stated, while he was holding his rifle and showing staged weapons in the back­
ground, “I own guns that no one is taking away … I’ve got a big truck just in case I need to
‘round up criminal illegals and take ‘em home myself; yep, I just said that. If you want a
politically incorrect conservative, that’s me.” He also recently addressed the State by declaring
that he was going to protect our schools from the dangers of critical race theory. This is the
sociopolitical context in which we live and work toward relational and systemic equity and
justice. Indeed, the personal is political (Hanisch, 1969).

Creating Third Order Change in Organizations and Institutions

Over twenty-five years ago, Bartunek and Moch (1987) introduced the idea of third order
change in the field of organizational development using a cognitive framework that relies on
the concept of schemata. They posited that first order, incremental change occurs within
organizations when ideas and solutions are developed based on shared and accepted schemata.
Second order change relies on changes or alterations within shared schemata. Third order
change requires a change in schemata themselves. Broadening this definition to include
specific attention to an organization’s collective values, mission, culture, and structure within
the broader sociocultural context clears a path for understanding, intervening in, and sup­
porting equity within organizations.
 Socioculturally Attuned Praxis 341
We must be able to take a metaview of the organizations in which we ourselves are
embedded as well as those that affect the families with whom we work. Some family
therapists engage in systems consultation when invited into organizations to solve problems
and help create organizational change (Boverie, 1991; Matheny & Zimmerman, 2001;
McDowell, 1999). Likewise, we may be tasked with creating change within our own or­
ganizations or institutions, such as improving quality of care, spearheading diversity and
inclusion efforts, and providing organizational leadership. We are often faced with re­
conciling organizational and institutional policies and practices with what we believe is
fair and just to clients. Unjust policies and practices could include culturally dismissive
practices, race and social class bias, lack of awareness, and/or marginalization of LGBTQ+
clients, among others. Our own professional organizations are no exception. Furthermore,
we ourselves, may be privileged and oppressive and/or marginalized, silenced, and/or op­
pressed within agencies, community organizations, educational and other institutions, and/or
professional networks.
The process of change within organizations is not as simple as sharing our (good) ideas
about what is socially and relationally just. In fact, as noted above, directly and (sometimes
loudly and repeatedly) voicing critiques may be counterproductive. In fact, we have wit­
nessed beginning family therapists who are passionate about social justice, demand change
as newly hired practitioners, only to be fired for “lack of fit” with an agency. The common
sense idea that what is right should and will prevail if explained well enough is, in fact,
an example of expecting third order change with a first order intervention. Organizational
transformation toward equitable practice requires third order thinking that includes re­
cognizing one’s own positionality when considering interventions. In Text Box 15.4,
Quentin McDowell shares his work, including how he leverages his leadership position and
social (White male) privilege to create more equitable practices in an educational organi­
zation. Many of his comments are in keeping with McGoldrick et al. (2021) who argued for
the importance of shared values, collective vision, leadership commitment, and collaborative
action to create more culturally aware and just organizations.

Text Box 15.4 Quentin R. McDowell, MA, School Administrator

Quentin McDowell (he/his) is the Head of Mercersburg Academy, an independent

secondary school. He identifies as White, male, heterosexual, and able-bodied.
As a school leader, I approach my work with a strong sense of optimism and
hope. I believe that change is not only necessary but that it is always possible.
Social, cultural, and systemic change at the organizational level requires enga­
ging a wide range of stakeholders, including employees, students, and a
governing board, as well as alumni and a multitude of parents that we count as
key constituents.
Attunement in this context calls for deep listening to those from a wide range of
national, cultural, generational, political, and socioeconomic backgrounds, as
well as a wide spectrum of identities. There is a need to attune to the individual
and collective nature of these many constituencies and to facilitate attunement
amongst and between them. One of the key challenges is understanding such
disparate perspectives and creating opportunities to call all into conversations
that promote equity.
342 Socioculturally Attuned Praxis

I believe it is better to call people into the larger conversation as opposed to

calling them out for an act or exchange that may have diminished the dignity of
another. While imperative to name an issue so that value can be placed on it, it can
be counterproductive to leverage shame as a tool for change. That being said,
there are times when a call out is necessary, most specifically when intervening in
a moment where harm is occurring or being threatened.
The naming of an issue begins the process of placing value on it. By speaking
and acknowledging an issue, it is elevated to a public level where it can then be
more intentionally explored and become part of the organizational agenda.
Naming what is not just allows the organization to more readily assume the
challenge of creating positive cultural change, particularly when tethered to a
school’s collectively affirmed institutional values.
It can be hard to interrupt unjust relationships and systems without first
establishing institutional norms and expectations that are broadly shared and
accepted so that when injustice is brought to light, there is an existing framework
to reference that illustrates what is, and what is not, expected or permissible. This
gives voice, vocabulary, permission, and support necessary to those seeking to
interrupt what is unjust. Part of the process for envisioning change requires those
with different perspectives within the community to come together and work
toward common goals to ensure broader buy-in and support through a sense of
democratic engagement.
Key to all of this is support from the very top of the institution. The position I now
hold allows me to more effectively encourage third-order change because I am in
the center of the organization. The inequities within systems are more visible and
impacting–as well as more difficult to change–at the margins. As a leader, I must
be able to use my social privilege and institutional influence to leverage change,
not by demanding or dictating, but by pulling all stakeholders together to ensure
equity is a core value in our mission and vision and that we collectively create
policies and practices that ensure accountability.
It can be difficult to judge the pace at which we need to move to create lasting
change. We have to go fast enough to show progress and to create greater equity
for those in the margins, yet slow enough to develop allies of those who have
traditional power. At the end of the day, I would rather say we got a long way but
moved too slowly than to say we moved too fast and did not get very far.

Our social locations and roles within organizations largely determine how we go about
generating and supporting third order change. Where do our social identities place us in
organizations? Is our impact minimized in a religious institution if we are not religious or a
member of the same religion? What are the organizational dynamics in relationship to race,
ethnicity, gender, language, sexual orientation, abilities, etc.? Are we insiders in the orga­
nization and an integral part of its mission? Are we outsiders, or seen as nonessential? What
are the various constraints and opportunities for praxis within specific contexts and how do
we strategize accordingly? In Text Box 15.5, Jessica ChenFeng shares some of these dynamics
in relation to her efforts to support social and relational equity in a medical school and
hospital setting.
 Socioculturally Attuned Praxis 343

Text Box 15.5 Jessica ChenFeng, PhD, LMFT

Jessica ChenFeng (she/her) is a second-generation Taiwanese American therapist

and educator who worked in a medical school and hospital setting and is currently
on the faulty of Fuller Seminary in Southern California. She is interested in social
contextual issues such as race, gender, and spirituality.
I work clinically with resident and attending physicians along with medical
students to support their well-being while taking into consideration the hierarch­
ical, high stakes environment within which they do their training. As an outsider to
the medical community and culture, I have tried to understand the power
structures and dominant discourses. Whenever I work with individuals–wherever
they may be on the medical hierarchy–I consider how they are impacted by the
larger discourses, what agency they have within the system, and what are
realistic, appropriate, and safe ways for them to engage. I look for ways I can
effect change at various systemic levels through psychoeducation in grand rounds
or consultation with directors and deans.
I often work with physicians and medical students with marginalized identities. I
ask about the various parts of their identity to learn about their experiences within
the system. I also speak to the discourses within, and impact of, the medical
culture that interacts with these parts of their identity. This often resonates with
them as they make these connections for the first time.
I find that the most powerful way for me to amplify those who are silenced or
marginalized (students of color, queer members of community) is to address their
concerns in faculty meetings when I can speak to deans and program directors
who are able to effect change at a larger level. I often need to fight past my own
internalized racism and break model minority stereotypes so that I can speak
loudly, clearly, and have these concerns heard.
As is true in many systems, it seems that who says something and how it is said goes a
long way in terms of how something is heard, received, and responded to. This
awareness leads me to interrupt and challenge in ways that are congruent with my
personality and racial/ethnic intersections. I am thinking of Harlene Anderson and Tom
Andersen’s concept of “appropriately unusual,” where I might offer a new perspective
that is more easily “digestible” to those in positions of power.
I think of my work as planting seeds. Often the individuals and departments
within which I work are extensions of a larger medical system with a long history of
hierarchy and oppression. Because I interface with most clients and colleagues in
multiple capacities, they hear me pose similar questions and offer feedback that
speaks to issues of sociocultural context and societal structures. I also use
personal examples or past clinical experiences to highlight the significance of
having a contextual lens. In the medical world, I find that problems are most often
understood at the individual/personal level. When possible, I try to ask questions
about relationships, about support systems, about the impact of these on one
another. When I am in more of a consultant role, I encourage the person trying to
“fix a problem” to consider their personal connection to the change desired.
As I write these reflections, I find that much of how I do my work has to do with my own
social location. I am in this interesting position of being respected as an Asian American
colleague (not my experience in the MFT field, but in medicine, where there are a lot of Asian
American physicians), but this is a double-edged sword. There is a major racialized issue in
the assumption of Asian American proximity to Whiteness and the expectations associated
with the stereotype of the model minority. This affects how I can or cannot show up in a
predominantly White institution.
344 Socioculturally Attuned Praxis
Public Participation, Politics, and Policies
The majority of this text focuses on what Holyoak et al. (2021) refer to as micro-level
advocacy, that is the “client-centered advocacy conducted by CFTs daily in their work
with clients” (p. 2). This includes not only socioculturally attuned in-session interventions,
but extensions of therapy that involve advocating with and for specific clients in schools,
courts, medical systems, and so on. In this section, we explore what Holyoak et al. (2021)
refer to as macro-level advocacy, that is political and policy involvement beyond the
therapy room.
We agree with Jordan and Seponski (2018) who stated: “given the consequences policies
and politics have for therapists, their clients, and their profession … therapists can [should]
push beyond the boundaries of therapy into the public arena to transform the social politics
that constrain well-being” (p.19). In many ways, family therapists are well equipped to
contribute to the common good through political and policy work because of their expertise
in micro-level advocacy (Holyoak et al., 2021) and their systemic training (Hodgson &
Lamson, 2020). Family therapists are on the frontlines, witnessing the needs of clients and the
everyday abuse of human rights (Jordan et al., 2021; McDowell et al., 2012). We are well
positioned to shed light on seemingly “private” injustices to support public change that
protects the most vulnerable members of society. We can also use what we witness to inform
our research, which in turn can influence public policy (Waldegrave 2009). While details of
advocacy and policy work are beyond the scope of this text, we direct readers to Hodgson
and Lamson (2020), who offers a primer for how family therapists can engage in advocacy
and public policy. According to Hodgson and Lamson (2020) policy and advocacy are critical
to the work of systemic family therapists. The importance of this work is inherent in the
following description:

Policies are a series of plans used as a basis for decision making that can either cohere
or divide communities; they have the capacity to set a society onto a beneficial or
sometimes alarming trajectory. Regardless of individual opinions on policies, they are
essential to stimulating change, enforcing boundaries to protect and define, and
allocating rights and privileges (p. 730).

In Text Box 15.6, William Turner describes his role in developing public policy, empha­
sizing the unique fit between policy work and systemic thinking.

Text Box 15.6 William Turner, PhD, LMFT

William Turner, Distinguished Professor of Leadership and Public Policy and

Special Counsel to the President for Equity, Diversity and Inclusion at Lipscomb
University, Nashville, TN. He was a Robert Wood Johnson Fellow for Senator
Obama and continued to advise President Obama.
I distinguish between politics and policy. My experiences have been primarily in the
policy realm. Policies are the rules that govern and guide us. Often, we don’t know the
origins of our policies, even the ones that most impact us; many have been perpetuated
for generations. But if we go back to look at the origins, sadly, many of them were racist
at their core. I try to encourage students to think about the genesis of policies that
impact families and how these policies either stunt growth or encourage people to
develop their fullest potential. Because of their training and expertise as family
 Socioculturally Attuned Praxis 345

academicians or therapists, particularly as systems thinkers, they have skills and

abilities that very few people have to appreciate the full impact of policies on the lived
experiences of families.
Earlier in my career, when I was a professor at the University of Minnesota, I was
engaged in a program of research focusing on African American family strengths when I
met a director of the Hubert Humphrey Center for Public Policy. He pointed out that by
writing academic papers, although important, I was reaching a very small audience in
comparison to writing and influencing legislation. He said to me, “I don’t know anybody
else who is studying the strengths of Black people and families. I know a lot of people
who look at pathology and dysfunction. I can guarantee you that there are very few
people in the US Congress who are aware that there is that kind of work being done.” I
realized he was probably right. If I wanted to have a greater impact, I needed to impact
the policies that were being written. He suggested that I should explore and consider
applying for the Robert Wood Johnson Health Policy Fellowship. If I wanted to make a
meaningful difference, I had to affect the policies that are being developed. So, I
applied.
An important feature of the Robert Wood Johnson Health Policy Fellowship is
that it provides exclusive, hands-on policy experience in the nation’s capital,
allowing its participants to work hand-in-hand with key players in federal health
policy. The goal is to use that leadership experience to improve health, health
care, and health policy. After being introduced to the majority of the key health-
related players, offices, and organizations in Washington, the fellows are then
selected to work hand-and-hand with a member of the US Senate or the US House
of Representatives on health policy related matters.
As I applied to work with various senators and representatives, I talked about
things I was doing in a modified systems language, in ways I thought they could
understand, and they appreciated that. After I was hired by Barack Obama, he
said “one of the reasons I chose you was that you spoke the language of humanity.
You looked at things from a broader perspective.” I realized that carried a lot of
clout. Even when I got to Washington and was working for Obama, other offices
would seek me out because of that kind of understanding.
I believe that our training as systems thinkers gives us the ability to look at things
more broadly than the average person. If you’re like me, in your earlier career you
probably thought about how to be a great clinician or researcher-clinician. I
encourage you to think more broadly than that. We can have a much greater
impact than we sometimes realize we can.

Opportunities to engage in public advocacy and policy work may not be as “far away”
as they seem. We position ourselves as potential change agents every time we agree
to serve on a state advisory board, write a policy and procedures manual, participate
in program accreditation efforts, attend a town meeting focusing on a public concern such
as gentrification, volunteer for a public health committee such as a maternal mortality
review board, bear witness at a county mental health board meeting, provide professional
testimony as part of lobbying efforts, or participate in one of our own professional asso­
ciation meetings.
346 Socioculturally Attuned Praxis
We may also be positioned to influence organizational policies and practices when we are
invited into private and public institutions as consultants or to engage in specific initiatives.
This includes among other things, offering expert testimony, advising municipalities and state
departments of health, and serving on local and state mental health advisory boards. In Text
Box 15.7, Andraé Brown shares his transformative approach, offering examples of working
with municipalities and court systems.

Text Box 15.7 Andraé Brown, PhD, LMFT

Andraé Brown identifies as a Black male transformative, feminist family therapist

and psychologist. His work centers on a critical Black perspective that includes
spirituality as well as analysis of race, gender, sexual orientation, social class, and
other identities and points of reference.
I strive to use third order thinking in all aspects of my work. This means tying or
fitting together what can seem incongruent by connecting the dots from the lowest
to highest levels of systems. For example, as a child, it didn’t make sense that a
just God would create unjust disparities. I kept searching to understand what was
at play at broader institutional and societal levels that would account for such
inequity.
I work from a holistic, collaborative framework across disciplines to integrate
and contextualize individual, family, community, and national systems (e.g.,
economics, public policy, legal systems). My goal is to think and work in
comprehensive and synergetic ways that allow me to go beyond typical practices
and effectively move across contexts. For example, in my work as a community
consultant working with inner city youth and my work as a court consultant, it is
important for me to bring multiple perspectives and involve others to the table
when planning and implementing community interventions or making sentencing
recommendations.
I pay close attention to both the psychological and physical spaces we inhabit to
discover sites of resilience. Recommending sentences that are tailored to the
rehabilitation of different individuals who commit the same crime or transferring
what might work in one community to another requires careful consideration of
context, including history, geography, and community setting.
For example, the City of Los Angeles engaged in a successful youth summer
program in communities with high levels of violence and gang activity by engaging
youth across neighborhoods to plan park activities. The parks remained open late
into the night with lights, police presence, sports and other community building
activities to keep youth safe and active. Such youth programs could not be directly
replicated in North Carolina, however, in part due to physical space. There were
simply fewer parks, no lights, high summer heat, and the unbearable presence of
mosquitos. Summer youth programs could borrow ideas from each other but
needed to be developed by community members and youth to meet specific needs
within unique contexts.
The physical setting also allows for differences in the types and consequences
of crimes. For example, a drive-by shooting near a highway in California allows for
a quick escape, as does a shooting on a busy street in New York where one can
 Socioculturally Attuned Praxis 347

blend into a crowd. Contrast this with a similar crime in the rural South where
everyone knows all members of the community and there is nowhere to hide.
As a court consultant, I am often asked to make recommendations for rehabi­
litative sentencing. My goal is to use my influence to create more just outcomes. To
do so, I reach out to judges, attorneys, families, community members, and other
professionals to ask the question “What could happen if we all did this right? How
can we do this in ways that benefit everyone? What can every person involved do
to encourage a particular youth’s rehabilitation?” This provides a joint opportunity
to think about the potential for rehabilitation while holding youth accountable for
their actions. A comprehensive analysis of social and physical context doesn’t
explain or excuse criminal behavior, but does encourage penalties that are just,
appropriate, and offer opportunities for change.
Another example of encouraging third-order change occurred in my past work
with youth transitioning out of incarceration. At first, we were given notice 30-60
days prior to a youth being released, during which time we scrambled to get
supports in place. Oftentimes, youth were released without any notice. Eventually,
the juvenile justice system agreed to notify us when youth were adjudicated/
sentenced, allowing us to work with families, schools, and the community to
increase youth accountability, develop positive relationships, negotiate living
situations, plan for school attendance and sports involvement, etc. This moved
the broader system toward a greater focus on rehabilitation that engaged multiple
members of the community in the process of transformative change.
In my work, I have found transformation can occur in communities and juvenile
justice systems when I am able to engage myself and others in ways that attune to
and name the impact of family, community, physical, and societal contexts, value
the lives of all youth within these contexts, interrupt legal and community systems
that maintain unjust treatment of youth, and bring communities as well as
professionals together to envision and act on what is possible and just.

Transformative Praxis Across National Contexts

Liberation based work is itself situated in contested and uneven territory of societal/global
contexts and power dynamics. Even though third order thinking invites critical analysis of
dominant ideologies and power processes, most of us will fall short of being able to fully
recognize how our praxis is impacted by our epistemological lenses and social positions. We
echo the work of marcela polanco, who urged family therapists to acknowledge and to hold
themselves accountable for the effects of the internationalization of knowledge produced in
prosperous countries that traverse complex cultural borders and circumstances. Her aim is to
disrupt the global expansion of family therapy training within a neoliberal context as she
urges family therapists to embrace a decolonizing “multi-lateral fair trade agreement of
knowledge,” in clinical training and practice. This approach would enable transformative
cultural alternatives. She added that by doing this work, therapists can honor the legitimacy
of all cultures as valid contributors of equity-based knowledge. In the words of marcela
polanco (2016),

I hope to raise a critical perspective to be considered by family therapists when training

and practicing in global contexts. This is by cautioning the reader on the importance of
situating family therapy theories in the euroamerican geographical and political context
348 Socioculturally Attuned Praxis
in which they belong, along with their values, traditions, and intentions, making visible
their foreignness and potential intentions to domesticate or suffocate if not received
critically. Rendering foreignness visible may open space for the reader/audience to
imagine their own transformative local production of knowledge outside the euro­
american paradigms. (p. 15)

In Text Box 15.8 Mario Fausto Gómez Lamont describes the dangers of wide-spread
adoption of therapy models in a non-critical manner as well as their use of third order
thinking and praxis in Mexico.

Text Box 15.8 Lic. Mario Fausto Gómez Lamont

Fausto Lamont is a licensed psychologist, practicing family therapist, and faculty

member in Superior Studies Iztacala of the National Autonomous University of
México. He is a doctoral student in Research Psychology at the University
Iberoamericana and belongs to the network of specialists in Gender Studies and
Feminism for the Center for Research and Gender Studies of the UNAM. He
identifies as a gender-fluid, cisgender gay man, able bodied, with White and
educational privilege.
Third order thinking has become a breath of fresh air for our practice as systemic
family therapy educators at the National Autonomous University of Mexico. In our
search for a critical paradigm for our practice, we observed with discouragement
the continuous “buying and selling” of family therapy models. The consequences
have led to a lack of critical consciousness, as students and faculty conform to
what is being “sold” to them from the Global North. We surveyed 100 graduates of
family therapy postgraduate programs in Mexico and found most of them worked
from foundational family therapy models from the United States and/or Europe,
applying them to Mexican families without incorporating critical consciousness
(Gómez-Lamont, 2021).
In Mexico, the national health plan 2015/2019 specifies that it is fundamental
that all health service providers, public and private, must have multicultural and
sociocultural training. This includes the mandate that a multicultural approach
must recognize the epistemologies of the South as an axis of social justice (i.e.,
Indigenous and other ways of knowing). Socioculturally attuned family therapy
and third order thinking/intervention helped us strengthen critical thinking about
privilege and social inequality that is reproduced in our training, practice, and into
society; that is, from systems of systems. Guidelines for transformational
practice–attuning, naming, valuing, interrupting, envisioning, and transforming—
are aligned with the aims of making forms of power visible that allow inequalities to
reproduce.
Consider a traditional family attending consultation because their daughter has
disclosed that she is transgender. The family consists of a cis-heterosexual
working-class mother and her 11-year-old transgender daughter. The mother
shares with the therapist that she thought it might be appropriate for her child to go
to therapy to “stop being confused.” Shortly thereafter, they shared with the
therapist that they are Christian and their community will not accept her being
transgender. It is common in systemic therapy for decisions to be made based on
utilitarianism; “what is best for the greatest number of people” (Gómez-Lamont,
 Socioculturally Attuned Praxis 349

2016, 2021) or in postmodern therapies that look at all realities as “valid.” In either
case, it is necessary to tune into the family and community oppression being
experienced by the transgender daughter. To do this, the therapist must have
knowledge and value what is socially and relationally just.
Cultural relativism becomes problematic when we can no longer say that the
customs of other societies or our own are unjust. If we simply adopt a stance of
cultural relativism, discriminatory practices, such as erasing someone’s identity
because they are considered incapable of recognizing their own subjectivity, are
immune to criticism, especially if all realities are valid and must be respected. This
is unfortunate. The ways in which social constructionism has been applied to
systemic family therapy in Mexico has stagnated change, social inclusion, and
access to justice for minorities. In doing this work, I ask the following reflexive
questions: What are the limits of the post-modern interpretation in systemic
therapy that makes third order thinking visible? How can Mexican family therapists
attune to the critique of third order thinking, intersectionality, and feminism in
therapy? How would systemic therapists name, integrate, and value third order
thinking in epistemologies from the Global South to combat the neoliberal model
that has turned therapy and the training of therapists into a business, denying so
many families who cannot afford therapy?
No doubt, I will not be able to answer these questions if I keep embracing the
use of hegemonic theoretical paths used in systemic therapy. Third order thinking
in family therapy is a humble, socially just approach that coincides with the
concerns we have in Latin America and specifically, what we are living in Mexico.
Feminism and third order thinking are critical studies that question the evolution of
knowledge that has privileged a small global population of men, heterosexuals,
and Catholics/Christians (Gómez-Lamont, 2015; 2021). Lastly, I think it is vital for
systemic therapists to identify, name, and value third-order thinking in epistemol­
ogies from the Global South in their therapeutic work. In many ways, third order
thinking integrates a central part of theoretical discourses that connect social
action and socioculturalism across diverse academic fields. A critical, multi­
cultural approach must recognize the epistemologies of the Global South as an
axis of social justice.

In the text box above, Fausto described a critical perspective that he and his colleagues
were longing to have, however, it is also important to acknowledge that these ideas are
recursive and developed and shared across many people and contexts. While many have co-
constructed these ideas, not everyone is credited or rewarded in the same manner. Who gets
acknowledged for particular ideas is significant to note. Questions to consider are; Who is
credited? Which ideas are privileged and seen as valuable? Whose ideas are subjugated and
whose are brought forth and elevated as being “cutting edge,” “brilliant,” “scientific,” and
“novel?” Although we have applied critical/contextual frameworks to family therapy, many
of the ideas foundational to socioculturally attuned family therapy stem from the work of
scholars who came before us, from South America and other parts of the world. For example,
we have applied Martin-Baró’s work in liberation psychology and Paulo Freire’s concept of
conscientization, and many others to socially just family therapy practices. In doing so, we are
acutely aware of balancing the tension of honoring and applying those perspectives and not
culturally appropriating them. We are also aware that the reader will interpret these ideas as
either liberatory, colonizing, or a combination of both. Our approach, which is significantly
350 Socioculturally Attuned Praxis
based on the work of those from the Global South, is now seen as new or a breath of fresh air.
This indeed is a colonizing paradox.

Engaging in Equity-based Knowledge Production

All research and professional knowledge is produced, evaluated, and assumed to be true or
untrue based on our epistemological lenses (see Chapter 3). We separate what we believe
from what we don’t believe by determining whether or not legitimate proof has been offered
that fits within our worldviews. Consider a Western medical doctor who views traditional
Chinese medicine as unproven even though its healing qualities have been recognized and its
use has been perfected over thousands of years. In this case, the dominance of Western
scientific epistemology (Harding, 1998, 2008) prevails over how and what is considered to be
proven as effective.
The evidence-based practice movement in behavioral health has followed the Western
medical model in an attempt to prove treatment of one type or another is effective, or more
effective than an alternative treatment. While this is certainly useful in determining best
practices and what is most helpful for solving specific types of problems, this stance often
discounts that which has not undergone an evidence-based research process. Furthermore,
there is a tendency to view evidence of effectiveness as an overall stamp of approval, rather
than carefully reviewing the usefulness of outcome criteria, study limits, and other socio­
political, economic, and contextual factors inherent in the industry of knowledge production
and research processes.
The modern scientific agenda prioritizes research that leads to knowledge that describes
and explains and allows us to predict and control. The preoccupation with generalizability
and validity makes sense when a phenomenon is viewed from an essentialist perspective––
that is the belief that what is being studied is real and can be known and understood from
a single objective vantage point (Harding, 2006). The assumption that modern scientific
methods ensure the objectivity of truth claims delimits what questions get asked, which
research projects get funded, and what types of analyses are considered legitimate. The as­
sociation between numbers and truth further creates a false dichotomy when applied to
research. Both positivist and non-positivist approaches to knowledge production can have
numbers associated with results.
Critical theorists, Indigenous scholars, and those writing about decolonizing methods have
long advocated for the need to dismantle positivist, elitist approaches to research (Denzin
et al., 2008). These approaches include methods that are not conducive to evidence-based
trials. The wisdom that extends beyond manualized treatment and diverse forms of
knowledge that originate from nondominant epistemologies are at risk of losing credibility as
a result of the rush toward scientific knowledge, at the expense of all else. In recent years,
there has been increasing interest in creating knowledge from critical and social construc­
tionist frameworks. Critical research aims to question truth claims created through dominant
scientific methods that obscure the politics of knowledge production behind a veil of (non-
existent) objectivity. Critical researchers consider who benefits from knowledge claims,
whose voices are being marginalized, what experiences are being rendered silent, and whose
perspectives dominate the process (Bermúdez et al., 2016; Brown & Strega, 2015). Critical
scholars and social constructionists consider questions such as who is telling the story, how
are truth claims influenced by the questions being asked, and how does the research open
and/or close possibilities for multiple truths and previously silenced narratives?
The answer to some of these questions will often determine whose research gets funded or
is considered legitimate. At the same time, empirically supported treatments are necessary and
important in terms of advancing scientific knowledge, clinical practice, and the field of family
 Socioculturally Attuned Praxis 351
therapy. The tension we are holding is the one in which empirical research and treatment are
often viewed as the only form of research that is deemed rigorous, valuable, and legitimate. In
Text Box 15.9, Iva Košutić describes her work as a social researcher who pays close attention
to how knowledge is constructed and the potential impact of research to both obscure and
expose social inequities.

Text Box 15.9 Iva Košutić, PhD

Iva Košutić (she/her) is a scholar and social researcher. She is the author of
numerous publications that support social equity in, and beyond, family therapy.
Much of her current work involves the evaluation of social and health programs.
Having inhabited different national and local contexts, I have learned that the
valuation of a wide range of attributes is a function of social agreement. What is
deemed beautiful, important, successful within one local or national context may
not be deemed so within another. And similarly, what is silenced and marginalized
in one setting may not be so elsewhere. As I operate within any one reality, I bear
in mind memories of other realities and I maintain awareness of the fact that
attributions of value are, in most instances, relative. I have experienced being
more intelligent, more interesting, more attractive in some contexts than in others,
and I imagine that the same would be true of others. There is often (if not always?)
another way to look at things, and the collective perception of reality may be just
as flawed as individual perceptions often are.
Interruption of injustice within professional contexts is challenging for me
because I tend to operate in fits and bursts, and experience disappointment
when change doesn’t happen quickly. Support from like-minded colleagues and a
focus on the process—a steady progression of tiny contributions—helps me
continue to work in the face of injustice.
I try to avoid thinking that my perception is correct, and I maintain openness to
the possibility that there are errors in my thinking. These days, the chief way in
which I influence others is through my way of being, with the hope that I am making
a positive contribution to lives.
Applied to social research, this approach involves considering how programs,
interventions, and people fit within local and national contexts and how they
contribute to or detract from health equity. Such considerations inform all aspects
of research, from planning and data collection to interpretation of findings and
reporting. For example, the finding of an absence of difference in health outcomes
between two groups may be prematurely celebrated as a sign of health equity.
Considering such findings within the sociocultural context, and triangulating it with
other data sources, often points to the shifting form of inequity as an alternate
explanation.
Over the past two decades, there has been much emphasis in social science on
evidence-based programs and interventions. The evidence-based designation
rests on evidence from randomized controlled trials (RCTs), which are considered
the gold standard for effectiveness research, and quasi-experimental comparison
group designs. Such evidence most often pertains to isolated, narrowly defined
outcomes that in real life typically manifest as but a few symptoms of a bigger
problem.
352 Socioculturally Attuned Praxis

The reduction of complex phenomena to their constituent elements is consistent

with the scientific approach, as often understood and implemented, but is
inconsistent with people’s lived realities. Interventions that are validated through
the evidence-based designation may indeed have a positive effect on the
outcomes of interest, and they may, at the same time, do little for the underlying
problem. For example, sexual health programs are deemed evidence-based if
they are backed by “rigorous evaluations” (RCTs) that show an improvement in
outcomes such as abstinence, consistent condom use, absence of disease, or
absence of mistimed pregnancy. That a program may be successful in addressing
one or a handful of these outcomes does not say anything about its ability to
promote sexual health, the broader concept of relational health, or an even
broader concept of community health.
To be clear, I am not discounting the value of RCTs and quasi-experimental
designs. Rather, I am advocating for an expansion in our collective view of what
counts as knowledge to include research approaches that draw from a contextual
perspective and bring the voices and the lived experiences of research partici­
pants to the fore.

As mentioned, science is not neutral nor objective. Scholars such as Allen (2022) and Allen
et al. (2009) contend that socially just family scholars must engage in critically reflexive
methods and consciousness that leads to praxis. Given the urgency of social change, feminism
offers a framework for epistemology (knowledge), methodology (production of knowledge),
ontology (the subjective way in which we live in the world), and praxis (how we translate
knowledge into action that creates social change) (Allen, 2022). Allen asserts that feminist
family science, in particular, is vital for advancing critical, intersectional, and queer ap­
proaches to examine inequity, injustice, and abuses of power among individuals and families
in diverse contexts. We must attend to the politics and ideologies embedded within every
facet of the research process, as well as within the self-of-the-researcher (Brown & Strega,
2015). Socioculturally attuned researchers hold the tensions of multiple epistemologies and
research methodologies in ways that provide access to the opportunity to do research and to
disseminate knowledge that supports social equity. McDowell and Fang (2007) pointed to six
fundamental assumptions for engaging in feminist-informed, critical multicultural, equity-
based research. These include 1) holding ourselves accountable as researchers to be aware and
accountable for our own positionality and social awareness, 2) interrogating the politics of
knowledge production itself, 3) carefully attending to culture and context prior to and
throughout the research process, 4) making certain the efforts of the researcher amplify
marginalized voices, 5) ensuring the research serves to benefit those in the center of the
analysis, and 6) using diverse methodologies and methods to support social equity.
Socioculturally attuned researchers might ask themselves a number of questions, including:
Am I the right person to do this research? What do I need to understand about the socio­
cultural context I am asking to enter? Am I an insider or outsider to the group I am hoping to
research? Who will own the results of the research and have the right to disseminate the
knowledge produced by this study? Who will benefit from this research and how? What
epistemological lens am I proposing for this research and what effect will that have on the
production of knowledge? How will research methods affect participants and study out­
comes? And so on. Researchers might also apply ANVIET to their work, as suggested by the
questions in Table 15.1.
 Socioculturally Attuned Praxis 353
Table 15.1 Applying ANVIET to equity-based research

Attune How do I make certain I am attuned as a researcher to the sociocultural experience of

participants? How will the research increase attunement?
Name In what ways will this research help name what is unjust?
Value How do I design and report research in ways that optimize that likelihood of
marginalized experiences being valued and participants feeling valued?
Intervene How does the research aim to intervene in what is unjust? How do I ensure that
dominant power dynamics of knowledge production don’t misshape or silence results?
Envision How does the research and the way I present results encourage participants and others to
see greater possibilities for liberation? How might the research process itself help
participants envision pathways for equity and transformation?
Transform What is the aim of this research? How is it designed, implemented, and shared in ways
that are transformative? What potential does the research process have to transform the
lives of participants?

In Text Box 15.10 Sally St. George and Dan Wulff (St. George et al., 2015; Wulff & St.
George, 2014, 2020) share their approach to Research As Daily Practice and how this ap­
proach broadens possibilities by challenging what we think we know, including what we
believe qualifies as research.

Text Box 15.10 Sally St. George, PhD and Dan Wulff, PhD

Sally St. George (she/her) describes herself as a “pracademic.” Sally is developing

a new phase of professional life primarily focused on supporting others as they
develop their work.
Dan Wulff (he/him) is a retired professor who is now investing in reading all those
books he intended to for many years and writing about the things he most wants to
write about.
What we value most about a systemic/relational/social constructionist stance is
working in the areas of connection. Therefore, we as “pracademics” (practitioners
and academics), developed ways to attend to the mutual influence across our
research, therapy practices, service, and teaching. In an era of increasing
specialization, we prefer focusing on the intersections between practices and
issues. We propose a way of re-imagining and conducting research that is already
contained within family therapy practice itself, with “research” part of everything
else and no longer a stand-alone practice. Using established methodological
practices, or parts of them, or developing new ways, we systematically examine
what we are doing in ways that make common or intuitive sense to us while trying
to improve our work as we are engaged in it. We call this Research As Daily
Practice.
Research As Daily Practice is predicated on partnering with others and
capitalizing on a variety of viewpoints. For example, when we are feeling
unsuccessful in working with certain situations in therapy (e.g., high-conflict
families living in multiple households), we gather with our colleagues to compare
our various understandings of what is happening and what could happen. We
examine how to understand our situations by systematically looking across cases
and therapists with the aim of envisioning alternative approaches.
354 Socioculturally Attuned Praxis

In our Research As Daily Practice, we ask ourselves “What are we missing?” or

“What else could we know?” and seek a wide range of perspectives. Our aim is to
stretch our thinking about the issues we are attending to rather than to affirm or
confirm current understandings. We deliberately and persistently inquire about
ideas or viewpoints that are not currently present in our thinking or practice. One
question could be, “What are various ways in which this situation could make
‘perfect sense’?”
Research As Daily Practice is our attempt to loosen the grip of standardized
regimes of locating and determining truth, thereby opening opportunities to talk
about and imagine people’s lives differently. Other questions could include, “Who
benefits and who does not as we work in the current situation?” What does this
family feel entitled to?” “Who is not present in our conversation and who could
be?” “What ideas have been dismissed as irrelevant?” “How might practitioners in
other fields or disciplines understand this situation?” We would consider inviting
representatives of opinions that are most distant from our current understandings
about the issue in therapy. We reach for understandings from other cultural
locations, languages, or times that might shake our confidence in our traditional
ways of knowing and practicing.
This way of working varies markedly from utilizing “evidence-based practice”
or “best practices.” We believe there is an endless supply of ways to respond
to families in therapy. We embrace variety and special cases. We search to see
what problems look like as they present in differing families and contexts.
Examining how unfairnesses presents and is articulated, performed, and re­
sponded to in different families extends our understanding and enabales
responses that are more attuned to the specific context within and outside of the
family in therapy.
Research As Daily Practice allows us to entertain the question of transformative
change with fewer limitations or boundaries. Values, relationships, and inclusive­
ness have room to flourish. Equity, for example, can become the primary frame­
work for our therapeutic work/response. We can build our practices around
positions of value and bring interpersonal commitments into the center.

Conclusion
Many voices have joined in this text to encourage third order change in our work with
individuals, families, communities, agencies, institutions, governments, and beyond. We
have been encouraged to do our best to influence public policy and support environmental
justice in ways that support social and relational equity, as well as the environment itself.
We have been called to work together across national borders while using a global
framework in our local contexts. As systems thinkers and relationship experts, we are in the
unique position of being able to take transformative action that is connecting rather than
polarizing. Thinking from a third order perspective helps us avoid attempting first order
solutions; thinking strategically and collaboratively to create systemic change rather than
expecting change to occur when we simply point out when we believe something is not
right or others are not socially aware.
 Socioculturally Attuned Praxis 355
It is difficult to end a book such as this. Even as we write, we experience endless urges to
further investigate, analyze, cite more authors, reorganize our ideas, and rethink what we
“know.” The ideas and ways of applying third order thinking are fluid and continuously
evolving. Our work will need to be critiqued, expanded, and revised by others in response to
societal changes and collective movement in the field toward just praxis. The work itself is
rewarding, yet arduous, messy, contradictory, painful, and often carried out in stressful,
perilous, and liminal spaces. The pace of change can be excruciatingly slow, and the costs are
often high, particularly for those at the margins.
We have come to believe that socioculturally attuned family therapists must balance
courage with discernment, knowledge, and awareness with humility, and realism with hope.
Looking back over the years and our careers in the field of family therapy, we have witnessed
uneven, hard-won, yet persistent movement toward socially just practice. Experiencing small
“wins” and witnessing transformation gives us hope for the future; hope that collectively,
family therapists will continue to win battles for inclusion and equity as they create new and
creative ways to do this work.

Reflexive Questions
• What alliances have you developed to collectively engage in change efforts within
organizations, agencies, communities, and/or societal systems?
• How can you actively rally support for collective values instead of focusing on political
differences and divides?
• How can calling people in with care and compassion (instead of calling out) help create a
context in which everyone can grow, learn, and be held accountable, while prioritizing
mutual respect, health, and wellbeing?
• When building a collective vision, what strategies can you use to involve all
stakeholders? How can you engage in socioculturally attuned praxis within the various
contexts you inhabit (e.g., clinical, research, personal, political, community, etc.)?
• What is your vision for your own praxis (consciousness in action)?

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Index

Note: Italicized, bold and bold italics refer to figures, tables and boxes.

AAMFT see American Association for Marriage and relationship therapy 309, 312, 316–317; structural
Family Therapy (AAMFT) family therapy 87; third order ethics 60, 68
abandonment 45, 159, 199 accreditation standards 4, 334
ABFTs see attachment based family therapies acting out 45, 110, 154, 167, 169, 214, 235
(ABFTs) AFAB (assigned female at birth) 147
ability 2, 11, 14; attachment based family therapies affairs 75–76, 76, 83, 86, 166, 195, 279
141, 144, 146, 149, 159; Bowenian family affirm symptom-free resistance 108–109, 112–113
therapy 163–166, 171, 172, 176, 180–182, 184; African Americans: collective trauma 169; culture of
brief and strategic family therapies 112; cognitive 41; differentiation of self 164; economy 7; family
behavioral family therapy 217, 218, 228, 230; strengths 345; households 112; living conditions
collaborative family therapy 257, 261–264, 267, 8; poverty 82; renaming rituals 133; social
273; contextual family therapy 188, 196, 197; schemas 215; sons 148; trauma 82; violence 9
experiential family therapy 116, 121, 123, 127, Afuape, T. 105
129, 136; family cartography 124; family therapy age 12, 28, 76, 98, 335; AAMFT Code of Ethics 54;
9, 21, 34, 37, 41; narrative family therapy 294, Bowenian family therapy 168; brief and strategic
295; socioculturally attuned praxis 332, 345, 352; family therapies 108; cognitive behavioral family
socio-emotional relationship theory 300, 304, therapy 217; collaborative family therapy 268;
309, 310, 326; solution focused family therapy experiential family therapy 129; health issues 5;
235, 244, 248; structural family therapy 80, 82; myth of neutrality 60; opportunities 10; self-
third order ethics 58, 61, 62, 64, 65 disclosure and relational engagement 61;
ableism: Cultural Context Model 46; experimental socioculturally attuned praxis 335; socio-
family therapy 121; narrative family therapy 290; emotional relationship therapy 324
societal power imbalances and 108 ageism 29, 30, 108, 277
ABTs see attachment based therapists (ABTs) agency: attachment based family therapies 150;
abuse 21, 47, 352; attachment based family therapies collaborative family therapy 262, 271, 273;
154, 156, 159; brief and strategic family therapies leadership 47; narrative family therapy 280, 283,
103, 104, 106; contextual family therapy 188, 285, 291, 293, 296; personal agency, recognizing
190; emotional 320; experiential family therapy societal constraints on 63–64; policies 330;
127, 134; of human rights 344; narrative family structural family therapy 82, 87; structure and
therapy 292–296; of police power 7; religious client process 47
147; sexual 143, 147, 191, 293, 294; socio- aggression 111, 112, 234, 315
emotional relationship therapy 326; substance 6, alcohol 45, 101, 130, 163, 193, 280, 322, 323
193, 322; third order ethics 67 Allen, K. R. 352
Acceptance and Commitment Therapy 209 Almeida, R. V. 3, 44–45, 46–47
accountability 45; ANVIET 42; attachment based altar-making 134
family therapies 153, 155; brief and strategic American Association for Marriage and Family
family therapies 102; contextual family therapy Therapy (AAMFT): Code of Ethics 53–54
194, 199, 204, 205; Cultural Context Model 46, American Psychological Association (APA):
47; experiential family therapy 117, 123; family Commission on Accreditation 4
therapy 3; goal therapy 1; Just Therapy 48, 49; American Public Health Association 7
narrative family therapy 286; socioculturally Anderson, H. 251, 256, 264
attuned praxis 339, 342, 347; socio-emotional Anderson, S. R. 13
 Index 359
Anderson, T. 251 sharing through engaged enactments 155,
anger 34, 37, 42; attachment based family therapies 157–158; practice guidelines 152–155; relational
144, 150, 151; Bowenian family therapy 166, needs 154–155, 157; relational process 140–141;
171, 172, 176–180; brief and strategic family relational security 143; responsiveness 142; social
therapies 103, 109, 111; cognitive behavioral construction of emotion 146; societal context
family therapy 210, 228; contextual family 144–150; sociocultural attunement, integrating
therapy 189, 193; experiential family therapy 120, principles of 143–159; third order change
127; socio-emotional relationship therapy 301, 151–152, 159; trust 143
308, 309, 312, 320, 324 Attachment Based Family Therapy 139
antiretroviral (ARV) 27 attachment based therapists (ABTs) 141
ANVIET 15, 39, 49–50, 50, 313, 330; attuned Attachment Focused Family Therapy 139
relationships, building and maintaining 332; attachment theory 143, 149
attune to context and power 38–40; collective attuned relationships, building and maintaining 332
values, identifying and building 334; engage in attunement: ANVIET 38–40; attachment based
and support transformation 335–336; envision family therapies 141; Bowenian family therapy
just alternatives 41–42; equity-based practice 353; 175; cognitive behavioral family therapy 214;
as guide for third order systemic change 332–336; contextual family therapy 197; Cultural Context
informed supervision 68, 69–70; intervene in Model 45–46; culturally attuned, equity-based
power dynamics 41; intervene with intention community interventions 340; Just Therapy 47;
334–335; name injustice 40; transform to make mutual 306; narrative family therapy 290, 294;
the imagined a reality 42; values 40–41 power effect on 151; to sociocultural emotion
anxiety 6, 32, 57; attachment based family therapies 153, 156–157, 315; socio-emotional relationship
142, 149, 159; Bowenian family therapy 163, therapy 314–316, 316–317, 321, 322
165–169, 171–172, 174–178; brief and strategic Auerswald, E. H. 2
family therapies 100, 102; cognitive behavioral authority: distinguished from power 312–313;
family therapy 228; contextual family therapy distinguished from responsibility 312–313
198; experiential family therapy 116, 117, 123, autocratic leadership 172
132; flow of 165; narrative family therapy 280, automatic thought 212, 217, 221, 225, 226,
282; socio-emotional relationship therapy 306; 228, 230
structural family therapy 91 autonomy 1, 29, 41, 54; attachment based family
APA see American Psychological Association (APA) therapies 140, 143, 145, 151; Bowenian family
arousal: attachment based family therapies 142, 148 therapy 165, 168, 170, 175; cognitive behavioral
ARV see antiretroviral (ARV) family therapy 213; contextual family therapy
aseuxlity 260, 267 198; narrative family therapy 291; socio-
assumptions 24, 30, 42, 55, 57, 59, 60, 64, 339, 350, emotional relationship therapy 302, 308;
352; attachment based family therapies 139, structural family therapy 87
144–146; Bowenian family therapy 180, 181; awareness of power 59
brief and strategic family therapies 94, 95, 101,
104; cognitive behavioral family therapy 211, Baima, T. 57, 122–123, 153–154
221, 228; collaborative family therapy 252; Bandura, A. 210
contextual family therapy 190, 204; cultural 28, Barbetta, P. 104
41, 53, 54, 66, 68, 144–146; epistemological 56; Bartunek, J. M. 340
experiential family therapy 121; narrative family Bateson, G. 22, 24, 94
therapy 283; ontological 56; socio-emotional Bava, S. 254–255
relationship therapy 299, 304, 313; solution behavior: change based on new schemas 223, 229;
focused family therapy 232, 244; structural family relational patterns of 211–212; socio-emotional
therapy 78–80, 87 relationship therapy 312
attachment based family therapies 148, 152, 154 behavioral health 256
attachment based family therapies (ABFTs) behavioral medicine 256
139–160; attune to sociocultural nature of belonging 27, 48, 86, 132, 170, 176, 279, 303, 304
emotion 153, 156–157; case example 155–159; BFTC see Brief Family Therapy Center (BFTC)
change through emotional connection 143; class bi-directional power 35
148–149; dominant cultural assumptions and Bidwell, D. R. 241
contexts 144–146; equitable relational patterns bilingual education 83
155, 158–159; gender and relational needs Black Lives Matter Movement 4, 9, 28, 34
146–147; hermeneutical justice 149–150; bodily sensations 174
interdependence 142; intersubjective emotional Boje, D. 283
regulation 142; power 150–151; power’s effects Boszormenyi-Nagy, I. 42, 59, 189, 332
on relational safety, recognizing 152, 156; power- boundaries 35, 42, 47, 344; attachment based family
360 Index
therapies 159; brief and strategic family therapies Circle of Care 305, 305–307, 309, 310, 312, 313,
108, 120; collaborative family therapy 252, 272; 320, 326
contextual family therapy 189; solution focused circular causality 210
family therapy 233, 234; structural family therapy circularity 95–97, 101–102
75, 76, 76, 80, 81 circular questioning 107
Bourdieu, P.: cultural capital and 29; doxa and 83; cisgenderism 88, 289
habitus and 31, 82–83 cisgender masculinity 302
Bowenian family therapy Civil Rights Act of 1964 28
Bowlby, J. 139, 144 class/classism: attachment based family therapies
brief and strategic family therapies 94–114; affirm 148–149; Bowenian family therapy 171;
symptom-free resistance 108–109, 112–113; case collaborative family therapy 257; discrimination
illustration 109–113; circle, broadening 107, 110; 2; family cartography 124; narrative family
circularity 95–97, 101–102; counter-intuitive therapy 277; socio-emotional relationship
thinking 97–98, 107–108, 110–111; everyday therapy 304
resistance, symptoms as forms of 105–106; client goals 237–239; equity in co-constructing
incongruent hierarchies 98–99; just relationships, 245, 248
supporting 109, 113; power 103–106; practice client resonance 39
guidelines 106–109; problem formation, at climate change 34–35; in social determinants of
societal level 102–103; problems as attempted health, role of 6–7
solutions 97; societal context 101; societal power COAMFTE see Commission for Accreditation of
imbalances 108, 112; sociocultural attunement, Marriage and Family Therapy Education
integrating principles of 100–106; therapist as (COAMFTE)
agent of change 99–100; third order change cognition 119, 210, 212, 302
106, 113 cognitive behavioral family therapy (CBFT)
Brief Family Therapy Center (BFTC) 232 209–230; behavior, relational patterns of
Brooks, S. 58, 196–197 211–212; behavioral change based on new
Brown, A. 133, 346–347 schemas 223, 229; case example 223–229;
Brown, J. 107–108 cognitive distortion/incongruent thinking 211;
Buber, M. 188 commit to alternative relationship models
Butler, M. 80 222–223, 228–229; contextual nature of schema
213–215; emotions, relational patterns of
CACREP see Commission for Accreditation of 211–212; mutual behavioral reinforcement 210;
Counseling and Related Educational Programs practice guidelines 220–223; problematic
(CACREP) schemas, identification of 220, 224–225; schemas
California Gold Rush 9 see schemas; sociocultural attunement, integrating
calling out 333 principles of 213–220; therapist as coach
Campbell, W. 47 212–213; third order change 218, 229–230;
cancel culture 333 thought, relational patterns of 211–212; track
capital: cultural 29–30, 43, 56, 84, 86, 215, 263, 286, patterns at multiple levels 220, 222, 225–226, 226
310, 340; economic 84; emotional 302; Cognitive Behavioral Therapy (CBT) 209, 211
investment 84; social 6, 30, 31, 48, 50, 58, 84, cognitive distortion/incongruent thinking 211
324, 340; structural family therapy 82, 84–85; collaborative family therapy 251–273; attend to
symbolic 84, 92 culture and power differences in dialogical
capitalism 28, 45, 285; cognitive behavioral family processes 271–272; conversational partners 252;
therapy 214, 217; global 26, 29; narrative family critically informed stance 265–266, 268–270;
therapy 285; racial 8; socio-emotional relationship humility 252–253; participate with transparency
therapy 307 266, 270; possibilities, expanding 253; power
Carter, B. 60 261–263; practice guidelines 265–267; social
CBFT see cognitive behavioral family therapy construction of meaning 252; societal context
(CBFT) 253–260; sociocultural attunement, integrating
CBT see Cognitive Behavioral Therapy (CBT) principles of 253–265; sociocultural experience
CCM see Cultural Context Model (CCM) near 266–267, 271; third order change 253,
Centers for Disease Control and Prevention 7 263–264, 273; uncertainty 252–253; use inquiry
Chappelle, N. 82 to promote equity 267, 272–273
ChenFeng, J. 62, 125, 343 collaborative therapeutic relationships 236–237
childhood 2, 5, 45, 83, 84, 88, 102, 119, 127, 133, collective trauma 169–170
156, 189, 198, 210, 312 collective values, identifying and building 334
Cianconi, P. 7 collective vision. creation of 335
circle, broadening 107, 110 collectivism 125
 Index 361
Collins, P. H. 150, 330 critical conversation 3
colonization 8, 13, 26, 27, 30, 42, 46, 54, 349, 350; critical dialogue 38
collaborative family therapy 263; contextual critical discourse analysis 243
family therapy 192, 193; experiential family critical genogram 5
therapy 122; narrative family therapy 286–287; critical geography 22
solution focused family therapy 246 critically informed stance 265–266, 268–270
Commission for Accreditation of Counseling and critical pedagogy 283
Related Educational Programs (CACREP) 4 critical postmodernism 283
Commission for Accreditation of Marriage and critical race theory 28, 340
Family Therapy Education (COAMFTE) 4 critical self-reflection 338, 339
communication: attachment based family therapies critical social awareness 58
141; emotional 141, 195; experiential family critical social theory 35, 283
therapy 117–118; socio-emotional relationship CSWE COA see Council on Social Work Education
therapy 306 Commission on Accreditation (CSWE COA)
community: attachment based family therapies cultural attunement 125–126
151–152; Bowenian family therapy 178, 183 cultural awareness 12
competition: Bowenian family therapy 175 cultural capital 29–30, 43, 56, 84, 86, 215, 263, 286,
competitiveness: contextual family therapy 198 310, 340
complementary relationships 35 cultural competence 105
compositionism 258 cultural context: solution focused family therapy
Connell, G. 120 241–242
consciousness-raising 108, 184, 221 Cultural Context Model (CCM) 43, 45–47, 339;
constructive entitlement 189 attune 45–46; envision 46–47; intervene 46;
contextual family therapy 187–206, 188–189; name 46; transform 47; value 46
accountability 199, 205; case illustration 200–205; cultural democracy 26, 105, 125–126, 339
due crediting 198–199, 205; entitlement 189; cultural equity 47
focus forward 199–200, 205–206; cultural genocide 193
intergenerational loyalty 189–190; interpersonal cultural genogram 5
consequences 188; levels of 187; multidirected cultural identity 12, 56
partiality 190–191; multidirected sociocultural culturally attuned, equity-based community
attunement 197, 200–201; people’s desire to give interventions 339–340
to and support others 198, 204–205; power culturally sensitivity 65–67
194–195; practice guidelines 197–200; cultural overdose 169
sociohistorical context/background 197–198, cultural reflexivity 259
201–203; third order change 195–196; unfairness, cultural relativism 349
identification and acknowledge of 198, 203–204 cultural scripts 135, 136
contextual self-in-relationship 55, 57 cultural sensitivity 12
conversational partners, in collaborative family cultural values: Bowenian family therapy 175;
therapy 252 collaborative family therapy 259, 261
coping questions 235, 236 culture 29–31; Bowenian family therapy 168–169;
core beliefs 210–212, 214 cancel 333; circles 46; cognitive behavioral family
corporeal turn 104 therapy 210; collaborative family therapy 259;
Council on Social Work Education Commission on contextual family therapy 194; narrative family
Accreditation (CSWE COA) 4 therapy 286–287; and power 105
counter-hegemony 100, 107–108 curricula, equity-based 4
counterintuitive approach to change 94
counter-intuitive thinking 97–98, 107–108, Daneshpour, M. 336–338
110–111 D’Aniello, C. 12
couple therapy 149 D’Arrigo, J. 14, 258–259
COVID-19 9; social determinants of health and 7–8 D’Arrigo-Patrick, J. 257
Cozolino, L. 142 Deatrick, J. 6
critical awareness 174 decolonizaion 13, 43, 55, 286–287, 339, 347, 350
critical consciousness 3, 10, 44, 45, 46, 330, 336, decolonizing theory 22
339, 348; Bowenian family therapy 174, 176–177, definitional ceremonies 283
181–182; brief and strategic family therapies 108; democracy: brief and strategic family therapies
collaborative family therapy 265, 268; socio- 105; cognitive behavioral family therapy 214,
emotional relationship therapy 324; solution 218; cultural 26, 105, 125–126, 339;
focused family therapy 241; structured family experiential family therapy 122; narrative family
therapy 88, 89; third order ethics 65 therapy 285
362 Index
Department of Health and Human Services: on emotional engagement, maintaining: Bowenian
social determinants of health 5 family therapy 165–166
depression 5, 6, 14, 32, 37, 41; attachment based emotional expression 312
family therapies 157–159; Bowenian family emotional fusion 164, 166, 167, 171, 173, 184
therapy 163, 169; brief and strategic family Emotionally Focused Family Therapy 139
therapies 102, 106; cognitive behavioral family Emotionally Focused Therapy (EFT) 139, 146
therapy 228; contextual family therapy 193, 194, emotional salience 303
200; economic 101; experiential family therapy Emotion-Focused Couples Therapy 139
132; narrative family therapy 280, 292; socio- emotions 139; attune to sociocultural nature of 153,
emotional relationship therapy 300, 306; solution 156–157; Bowenian family therapy 172–173;
focused family therapy 234 cognitive behavioral family therapy 215; power
de Shazer, S. 97, 235, 242 and 126–127; power effect on 150–151; relational
desire: attachment based family therapies 143 patterns of 211–212; and resistance 127–128;
destructive entitlement 189, 191, 192, 199, 203, 206 sharing 118–119; social construction of 146; social
detouring 81 context of 307–308; social valuation of 309–310
Dialectical Behavior Therapy 209 empathy 10, 41; attachment based family therapies
dialogue 3, 25, 38, 39, 44, 141, 143, 193, 199, 241, 142, 143, 157; Bowenian family therapy 173,
252, 253, 255, 257, 260, 262, 263, 270, 272, 273, 176, 181; cognitive behavioral family therapy
315; collaborative 267; therapeutic 88; 216; contextual family therapy 190, 192, 197,
transformative 264 198; experiential family therapy 116, 129;
differentiation 41, 163, 166, 170–174, 184; and narrative family therapy 293; socio-emotional
culture, intersection of 168–169; from dominant relationship therapy 308; structural family
cultural values 175; emotional 65, 168; of self 164, therapy 77
165; of social context 167–171; through relational empowerment 3, 46, 63; attachment based family
lens, assessment of 176, 180–181 therapies 151–152, 159; Bowenian family therapy
disability 54, 59, 60, 157, 159, 288; AAMFT Code 167, 173–175, 184; collaborative family therapy
of Ethics 54; physical 41 262, 265, 272; socio-emotional relationship
disciplinary knowledge 13 therapy 319
discrimination 5–7, 9; class 2; as cognitive distortion entitlement: constructive 189; contextual family
215–217; contextual family therapy 192; racial 7; therapy 189, 191–192; destructive 189
socio-emotional relationship therapy 312; environmental justice 2, 31–32, 193–194
solution focused family therapy 243 envisioning 15, 22, 38; attachment based family
disorganized families 2 therapies 155; Bowenian family therapy 178; brief
disposition 82, 83, 91, 148 and strategic family therapies 108, 111; cognitive
diversity 4, 15, 68, 125, 218, 334 behavioral family therapy 217; contextual family
Dolan, Y. 235, 242 therapy 200; Cultural Context Model 46–47;
domestic violence 102–103 culturally attuned, equity-based community
dominance 243 interventions 340; experiential family therapy
doxa 83 121, 133; just alternatives 41–42; Just Therapy 49;
due crediting 188, 190 narrative family therapy 289, 295; socio-
emotional relationship therapy 318, 324; solution
economic capital 84 focused family therapy 245; structural family
economic depression 101 therapy 91
economic justice 2 epistemic injustice 10
eco-structural approach 2–3 epistemological flexibility 55
ecosystemic approach 2, 232 epistemology 55
ecosystemic epistemology 3 Epston, D. 283, 295; Narrative Means to Therapeutic
education 31, 102, 103, 121, 123, 183, 223; access 5; Ends 276
bilingual 83; emancipatory 241; equal access to equality 34; Bowenian family therapy 163–184, 170,
63; family therapy 15; liberation-based 22; 173, 183, 184; brief and strategic family therapies
psychoeducation 343; quality 5; socioeducation 101, 105, 113; case example 178–183; client
25, 133; structural family therapy 83 observation 177–178, 182; cognitive behavioral
EFT see Emotionally Focused Therapy (EFT) family therapy (CBFT) 218, 228; collaborative
emancipatory education 241 family therapy 267; collective trauma, societal
emotional capital 302 transmission of 169–170; critical consciousness,
emotional connection, change through 143 develop and support 176–177, 181–182;
emotional contact: attachment based family differentiation and culture, intersection of
therapies 141 168–169; differentiation in societal context
 Index 363
167–171; differentiation through relational lens, integrating principles of 121–129; interventions
assessment of 176, 180–181; emotional 119–120; power 126–129;
engagement, maintaining 165–166; power–emotion–expression relationship
empowerment 173–175; equity 178, 182–183; 131–132, 135; practice guidelines 129–133;
flexibility 178, 182–183; flow of anxiety 165; societal context 121–126; therapist’s use of self
gender 122, 282; immediate situation, stabilizing 120–121; third order change 129, 136
176, 180; meetings with family and community, experts, clients as 240
planning 178, 183; power 171–173; practice exploitation 151, 272
guidelines 175–178; presenting problem to larger
contexts, expansion of 175, 179–180; relational fairness 1, 195; balance of 188–189, 193;
37; relationship 319; self, differentiation of 164; collaborative family therapy 257; contextual
sociocultural attunement, integrating principles of family therapy 190; see also equity; justice
167–175; solution focused family therapy 244; families as systems 94
therapist’s family of origin work 167; third order family cartography 124
change 173–175, 184; transgenerational patterns family development 75–76
164–165; transmission 164–165; value of family hierarchy 76, 76–77, 77
belonging 170; see also inequality family maps 76, 77, 86, 90, 90, 93
Equal Pay Act of 1963 28 family of origin work 167
equitable interaction patterns 305–306 family power dynamics: societal influences on,
equitable relational patterns 155, 158–159 identifying 87, 89–90
equitable therapy 1–2 family projection process 165
equity 1; Bowenian family therapy 178, 182–183; in family roles 2, 79, 80
co-constructing client goals 245, 248; cognitive family schemas 221–222, 222
behavioral family therapy 217; connection and family structure 76, 76–77, 77; and societal
128–129; cultural 47; racial 4, 28; relational 5, structures, connecting 87–89
87–88, 91–92, 103, 292, 294–295, 340, 342; family therapy 2–4; attachment based 139–160;
social 3, 5, 42–49; structural 88; systemic 340; Bowenian 163–184; brief and strategic 94–114;
see also fairness; inequity; justice contextual see contextual family therapy;
equity-based attunement and connection, experiential 116–136; feminist 3; first and second
promotion of 132–133, 136 order changes in 25; narrative see narrative family
equity-based knowledge production 350–354 therapy (NFT); power in practice of 35–36;
equity-based practice 2, 3, 60, 340; ANVIET 353 solution focused see solution focused family
equity-based relationships 87, 91 therapy (SFFT); structural 74–93
Erickson, M. 94, 97 Fang, S. R. S. 352
ethics: codes of 53–54; relational 54, 187, 190, 191, fear: attachment based family therapies 143;
195, 197; third order see third order ethics Bowenian family therapy 171–172, 177
ethnicity: AAMFT Code of Ethics 54; cognitive feeling: Bowenian family therapy 170–171
behavioral family therapy 210; socioculturally felt identities 302–303
attuned praxis 335; solution focused family felt resistance 128, 177
therapy 243 femininity 105, 259
everyday resistance, symptoms as forms of 105–106 feminism 349, 352; racial-ethnic 330; third
evidence-based therapy movement 55 wave 337
exceptions: Bowenian family therapy 181; cognitive feminist family therapy 3
behavioral family therapy 216; discovering and feminist-informed, critical multicultural, equity-
amplifying 239–240; narrative family therapy 279, based research 352
282; solution focused family therapy 233, first order change 24–25, 336; attachment based
235–240, 243, 245, 246, 248, 249 family therapies 159; brief and strategic family
exoneration 190 therapies 113; cognitive behavioral family therapy
expectancy for change 13–14 229; experiential family therapy 129; narrative
experiential family therapy 116–136; awareness of family therapy 290, 295; socio-emotional
self and other in context, encouraging 130–131, relationship therapy 326; structural family
134; broader societal context 121–123; case therapy 92
illustration 133–136; communication 117–118; first order thinking 22
community context 123–125; cultural flexibility 30, 175; Bowenian family therapy 178,
attunement 125–126; cultural democracy 182–183; cognitive behavioral family therapy
125–126; emotions, sharing 118–119; equity- 211; epistemological 55; socio-emotional
based attunement and connection, promotion of relationship therapy 300
132–133, 136; honoring culturally relevant flow of anxiety: Bowenian family therapy 165
experience and expression 129–130, 134; forgiveness 190
364 Index
Foucault, M. 35, 287, 289 hermeneutical injustice 149, 287
14th Amendment 28 hermeneutical justice 149–150
Fraenkel, P. 264–265 Hernández, P. 47
Freire, P. 3, 22, 46, 174, 184, 241 heteronormativity 63, 182, 214, 259, 284, 289
Fricker, M. 10, 55, 149 heterosexism 46, 92, 212, 290
heterosexuality 214
gambling 96, 97, 308; behavior 107; rituals 107 hierarchy 35, 59; attachment based family therapies
Garcia, M. 127 146, 150; Bowenian family therapy 168, 173;
Garcia-Westberg, M. 66 cognitive behavioral family therapy 214;
Gardner, B. 80 collaborative family therapy 262, 263, 268, 270;
gender: AAMFT Code of Ethics 54; attachment socio-emotional relationship therapy 313;
based family therapies 146–147; binary 146; structural family therapy 74, 76–77
Bowenian family therapy 171; cognitive Hodgson, J. 344
behavioral family therapy 210; dysphoria 257; Hoffman, L. 251
equality 122, 282; expression 243; family Holyoak, D. 344
cartography 124; identity 54, 122, 179, 183; homelessness 5, 264, 265
imbalance, in relational responsibility 312; homophobia 2, 16, 30, 36, 46, 62–64, 333; brief and
inequality 210; inequity 102; myth of neutrality strategic family therapies 102; cognitive
60; oppression 12, 46; schema 213–214; self- behavioral family therapy 214, 228; collaborative
disclosure and relational engagement 61; family therapy 253, 257; experiential family
socioculturally attuned praxis 335; socio- therapy 121; narrative family therapy 277, 290;
emotional relationship therapy 308–309; solution solution focused family therapy 244; structural
focused family therapy 243 family therapy 84, 88, 89, 91
generativity 16 honoring culturally relevant experience and
genograms 166, 176, 179, 182, 196, 288; critical 5, expression 129–130, 134
177; cultural 5, 177 honoring perspectives 65–67
Gergen 55 Huenergardt, D. 192
Giammattei, S. V. 288–289 human potential 116, 117
Global Mental Health (GMH) 33 humility 60, 252–253, 263, 268, 355; collaborative
GMH see Global Mental Health (GMH) family therapy 252–253
goal-directedness: Bowenian family therapy 175 hurt 34
Gómez Lamont, M. F. 348–349
Goodrich, T. 3, 101 identity: cultural 12, 56; felt 302–303; gender 54,
Goolishian, H. 251 122, 179, 183; landscape of 282; marginalized
grand narratives 256, 257, 260, 273, 287 123, 154, 244, 267, 288, 343; queer 179, 258;
Greenberg, L. 146 sexual 28, 43, 61; social construction of 139;
group membership 216, 291 transgender 133
group relational systems 83 Imber-Black, E. 3
Guilfoyle, M. 263 imprisonment 7, 8
guilt 34, 39, 127, 189, 269 incongruent hierarchies 98–99
independence 30, 105, 140, 146, 148, 169, 182,
habitus 31, 82–83, 86 291, 302, 315
Haley, J. 99–101 Indian Health Services 7
Hardy, K. V.: Validation, Challenge, Request Indigenous people 8, 9, 193
(VCR) intervention 154 individualism 125, 140, 176, 309
Hare-Mustin, R. 253 inequality 7, 38, 243, 292, 326; gender 210; high-
harm 1, 26, 31, 35, 36, 45, 80, 99, 108, 189, 198, income 5; social 257, 264, 348; structural 6, 151,
210, 243, 244, 258, 295, 333, 342 264; see also equality
Harry Benjamin International Gender Dysphoria inequity 1, 2; gender 102; hermeneutical injustice
Association (now World Professional Association 149, 287; racial 8; relational 13, 291; social 40, 58;
for Transgender Health) 66 socioculturally attuned praxis 330, 338; structural
healing 11, 40, 43, 44, 55, 56, 57, 77, 120, 130, 170, 8–9, 38, 191, 217; see also equity
181, 197, 198, 205, 350 inhibition 142
health status: AAMFT Code of Ethics 54 injustice: contextual family therapy 191, 192;
Healthy People 2030 6 epistemic 10; hermeneutical 149, 287; historical
Hecker, L. 55 192–193; name 40, 291; social 127;
hegemony 10, 108; counter-hegemony 100, socioculturally attuned praxis 330; see also justice
106–108, 110–111; cultural 336 inquiry 39, 67, 196, 267, 272–273, 354
helplessness: Bowenian family therapy 176 institutionalized racism 1, 9
 Index 365
institutions, third order change in 340–342 123; solution focused family therapy 243, 244;
intangible loss 125 structural family therapy 91, 106, 109, 113
interdependence 140, 142 Just Therapy 3; attune 47; envision 49; intervene 48,
interdisciplinary knowledge 13 48; name 48; transform 49; value 48
intergenerational loyalty 187, 189–190; contextual
family therapy 189–190 Kabura, P. 103
internalized oppression 58, 64, 216 Keeney, B. P. 3
International Family Therapy Association 169 Kelly, S. 8–9
interpersonal consequences, in contextual family Kim, L. 10, 11–12, 313
therapy 188 knowledge: disciplinary 13; interdisciplinary 13;
interpersonal neurobiology 139 non-disciplinary 13; production, equity-based
interrupting 10, 21, 22, 35, 41, 55, 59, 68; 350–354; professional 66; scientific 350
attachment based family therapies 143, 145, 148, Knudson-Martin, C. 34, 174, 192, 311, 313
155, 158; brief and strategic family therapies 99, Korin, E. 3
109; contextual family therapy 199; experiential Košutić, I. 351–352
family therapy 117, 133; narrative family therapy Krasner, B. R. 189
286, 289; socio-emotional relationship therapy
322–324; structural family therapy 80, 81 Lamson, A. L. 344
intersectionality 3 landscape of action 282
intersubjective emotional regulation: attachment landscape of identity 282
based family therapies 142 language 3, 9, 10, 28, 29, 44, 48, 56, 342, 345, 354;
intervening 2, 3, 6, 12, 22, 28, 37, 38, 67, 68; barriers 30; Bowenian family therapy 175;
attachment based family therapies 155; Bowenian collaborative family therapy 251–253, 252, 254,
family therapy 178; brief and strategic family 255, 259, 260, 268, 271, 272; contextual family
therapies 94, 101, 103, 106, 108, 109; cognitive therapy 193; experiential family therapy 126, 132,
behavioral family therapy 217; contextual family 136; family cartography 124; narrative family
therapy 198; Cultural Context Model 46; therapy 277, 281, 283, 285, 293–295; solution
culturally attuned, equity-based community focused family therapy 233–236, 238, 240–243,
interventions 340; experiential family therapy 247, 248; structural family therapy 77, 83, 84
127; Just Therapy 48; narrative family therapy Larner, G. 53, 262
294; in power dynamics 41; solution focused latent power 194
family therapy 246; structural family therapy 91 Latinas/Latinos 14; attachment based family
intervention: collaborative family therapy 267; therapies 147, 148, 152; cognitive behavioral
socio-emotional relationship therapy 322, 324 family therapy 223; collaborative family therapy
intimate partner violence (IPV) 21, 26, 37 251, 259, 260, 269, 270; experiential family
intuition 116, 170–171, 176, 215 therapy 134; narrative family therapy 293
investment capital 84 Latino Health Access (LHA) 152
invisible loyalty 189 Latour, B. 258
IPV see intimate partner violence (IPV) learning theory 210
isolation: attachment based family therapies 141, ledgers of merits 190
142, 150, 158 LGBTQ+ youth 5
isomorphism 38 LHA see Latino Health Access (LHA)
I–thou process 188 liberation 22, 43, 44, 48, 64, 92, 105, 174, 184, 196,
255, 347, 349
Johansson, A. 64 liberation-based education 22
Johnson, L. N. 13 Loscocco, K. 312
Johnson, S. 146–147 loss 67, 96, 125, 126, 136, 141, 143, 165, 179, 187,
joining 77–78 193, 206, 228, 236, 241, 268, 272, 304, 308, 321
Jordan, L. S. 344 Luttrell, T. 311
justice 1, 28; contextual family therapy 188,
191–192, 194; economic 2; environmental 2, Madanes, C. 35, 112, 113
31–32, 193–194; hermeneutical 149–150; male privilege 12, 36, 341; experiential family
relational 58, 173, 191, 194, 195; social 10, 39, therapy 122, 127–129, 136; narrative family
257, 283, 341; see also equity; fairness; injustice therapy 278, 282, 286, 291; structural family
just relationships 22, 26, 32, 38, 42, 53, 58–60, 68; therapy 87
brief and strategic family therapies 109, 113; marginalization 7, 8, 10, 11, 14, 30, 41, 42, 43, 48,
cognitive behavioral family therapy 229; Cultural 55, 57, 59, 62, 63–65, 66, 68, 332, 335, 337, 338,
Context Model 46; experiential family therapy 340, 341, 343, 350, 351; attachment based family
366 Index
therapies 148, 154; Bowenian family therapy 177, name/naming: attachment based family therapies
178, 182; brief and strategic family therapies 102, 155; Bowenian family therapy 175; brief and
104, 112; cognitive behavioral family therapy 215, strategic family therapies 107; cognitive
216; collaborative family therapy 253, 255, 258, behavioral family therapy 214, 215;
263, 264, 267–269; contextual family therapy collaborative family therapy 266; contextual
196, 203; experiential family therapy 121, 123, family therapy 197, 198; Cultural Context
125, 131, 133; of LGBTQ+ clients 341; narrative Model 46; culturally attuned, equity-based
family therapy 278, 284, 288; socioculturally community interventions 340; experiential
attuned praxis 332; socio-emotional relationship family therapy 131, 132; injustice 40, 291,
therapy 309, 317, 326; solution focused family 293–294; Just Therapy 48; narrative family
therapy 244, 248; structural family therapy 85, 88 therapy 290, 292, 294; socio-emotional
marginalized groups 10; cognitive behavioral family relationship therapy 314, 315, 317, 322; solution
therapy 215, 216; collaborative family therapy focused family therapy 245; structural family
263; Just Therapy 48 therapy 89
marginalized identities 123, 154, 244, 267, 288, 343 Napier, A. Y. 119
Martin-Baró, I. 3, 349 Nardone, G. 98, 99
masculinity 104, 136, 212, 228, 229, 259, 260, 323; narrative family therapy (NFT) 3, 276–296; case
cisgender 302; patriarchal 309 illustration 292–295; culture 286–287; (de)
materialization: Bowenian family therapy 175 colonization 286–287; life of the problem,
maternal deprivation 139 deconstruct of 281–282, 281; map of the
Maton, K. 83 problem, expansion of 290–291, 293; meaning
McDowell, Q. R. 341–342 277–278; name injustices 291; oppressive power
McDowell, T. 36, 60, 124, 352 dynamics, disrupting 292, 294–295; people not
McGoldrick, M. 166, 175–177, 176 defined by problems 280–281; power-embedded
meaning: narrative family therapy 277–278; social relational inequity, deconstruction of 291;
construction of 252; solution focused family practice guidelines 290–292; preferred narratives,
therapy 242–243 co-creation of 282–283; reality 277–278;
medical model 2, 350 relational equity, support 292; resilience 292, 295;
mental health 1, 4–7, 15, 22, 31, 38, 54, 55, 59, 64, resistance, discourses of 285–286, 292, 295;
256, 337, 345, 346; collaborative family therapy societal context 285–286; sociocultural
256, 264; contextual family therapy 193; narrative attunement, integrating principles of 283–290;
family therapy 284, 286; socio-emotional subjugation 287, 289–290; third order change
relationship therapy 300, 304; solution focused 290, 295–296; time oriented and generative 279;
family therapy 243, 244 values 291
Mental Research Institute 94 Narrative Means to Therapeutic Ends (White and
meritocracy, myth of 63, 216, 285 Epston) 276
meta-perspective 24, 55, 80, 85, 222, 229 National Organization of Men Against Sexism 286
Mexican-American War 9 nationism 30, 121
microaggression 34, 64, 133, 244 nation of origin 10, 28; AAMFT Code of Ethics 54;
middle-class 10, 38, 40, 64, 67, 88, 109, 216, 228, experiential family therapy 124; family
233, 259, 277, 308 cartography 124; narrative family therapy 291
Milan group 94 neurobiology 4, 139, 146, 173, 299, 303, 313
mindfulness 223 neutrality, myth of 59–60
Minuchin, S. 2, 35, 74, 76–78, 92 NFT see narrative family therapy (NFT)
miracle questions 235 Nguyen, H. 43
mirror neurons 142, 149 non-disciplinary knowledge 13
misogyny: solution focused family therapy 244 non-discrimination 54
mobility 29, 84, 291 norms 10, 28, 42, 43; androcentric 58; attachment
Moch, M. K. 340 based family therapies 144; Bowenian family
mononormativity 149 therapy 171, 181; brief and strategic family
mother-blaming 2 therapies 101; cognitive behavioral family therapy
motherhood 242, 316 214, 216, 218, 230; collaborative family therapy
multidirected partiality: contextual family therapy 259, 269; contextual family therapy 191, 194;
190–191 cultural 25, 54, 83, 101, 129, 191, 218, 248, 259,
multidirected sociocultural attunement: contextual 269, 313; experiential family therapy 121, 129;
family therapy 197, 200–201 institutional 342; social 38, 216, 218; socio-
Murphy, M. 55 emotional relationship therapy 313; solution
mutual behavioral reinforcement 210 focused family therapy 241, 248; structural family
mutuality 1 therapy 82, 83
 Index 367
not-knowing stance 251, 252, 262, 263, 267, 203, 256, 269; experiential family therapy 121;
268, 273 structural family therapy 82
power 32, 34–37, 84–85; attachment based family
objectivity: Bowenian family therapy 175 therapies 150–151; awareness of 59; balance of
ontological turn 104 310–312, 311; balancing 67–68; and behavior
oppression 1, 2, 5–9, 11, 14, 16, 22, 26, 30, 31, 34, 312; bi-directional 35; Bowenian family therapy
35, 41, 43–45, 49, 53, 57, 58, 59, 68, 330, 333, 171–173; brief and strategic family therapies
336–339, 341, 343, 349; Bowenian family therapy 103–106; collaborative family therapy 261–263;
170, 181; brief and strategic family therapies 104, contextual family therapy 194–195; culture and
105, 106, 108, 109, 112; challenging 65–67; 105; decisions about using 36–37; differences,
cognitive behavioral family therapy (CBFT) 216, relational consequences of 315; distinguished
217, 230; as cognitive distortion 216; from authority 312–313; distinguished from
collaborative family therapy 254, 261, 261, 262, responsibility 312–313; dynamics, in ANVIET
264, 265, 267–269, 271–273; contextual family 41; effect on attunes 151; effect on emotion
therapy 191–193, 196, 198; experiential family 150–151; effects on relational safety, recognizing
therapy 121, 122, 124, 125, 127, 136; exploitative 152, 156; and emotion 126–127; and emotional
191; gender 12, 46; internalized 58, 64, 216; expression 312; experiential family therapy
narrative family therapy 276, 277, 283, 284, 286, 126–129; imbalances 35, 104–105, 194–195;
289, 290, 292, 294–295; racial 112; resistance to latent 194; narrative family therapy 283, 287,
37, 63, 127; socioculturally attuned praxis 330, 289–290; in practice of family therapy 35–36;
338, 343; socio-emotional relationship therapy relational 35, 261; relational flow of 303–304; and
302; solution focused family therapy 242, 243, resistance 37; shift from personal to contextual
243–244, 244, 246; structural family therapy meaning of 317; and social schemas 215–217;
84–85, 87, 88, 91, 92; systemic 58 socioculturally attuned praxis 338; socio-
oppressive power dynamics, disrupting 292, emotional relationship therapy 310–313; solution
294–295 focused family therapy 242–243; structure
ordeal therapy 99 171–172; therapist 195; use of, in practice 60–61
organizational leadership 341 power–emotion–expression relationship
organizations, third order change in 340–342 131–132, 135
power-sharing through engaged enactments 155,
paradoxical interventions 99 157–158
parentified child 189 practice standards, changes in 4
Parker, E. 218–219 preferred narratives, co-creation of 282–283
Parker, K. 7 prejudice 61, 89, 151, 262; as cognitive distortion
patriarchal business model 91 215–217
patriarchal masculinity 309 privacy 29, 31, 32, 123, 124, 124, 294
patriarchy 2, 22, 25, 28, 29, 38, 48; brief and privilege 1, 2, 4, 5, 8, 10, 22, 28, 30, 31, 35, 44,
strategic family therapies 104, 111; cognitive 45–47, 55, 59, 60, 62, 63, 65, 76, 349; attachment
behavioral family therapy 214, 218; experiential based family therapies 140, 153–154; Bowenian
family therapy 122; narrative family therapy 286, family therapy 168, 171, 176; brief and strategic
287, 291, 292; socio-emotional relationship family therapies 105, 106, 112; class 89, 106, 127;
therapy 307, 309, 312, 323; structural family cognitive behavioral family therapy 214–216;
therapy 89, 91, 92; see also male privilege; sexism collaborative family therapy 261, 263, 264, 265,
Penn, P. 251 268; contextual family therapy 191–192, 196,
personal agency, recognizing societal constraints on 198; economic 32; experiential family therapy
63–64 122, 123, 127–130, 132, 135, 136; male 12, 36,
Piercy, F. 1, 140 87, 89, 122, 127–129, 136, 278, 282, 286, 291,
place 31–32 341; narrative family therapy 277, 278, 281–283,
polanco, M. 286–287, 347–348 286, 288, 291, 292, 294; professional 40; racial 34,
policies 344–346 58, 83, 87, 135, 277, 291; role 335; sexual
politics 344–346 orientation 54; socioculturally attuned praxis 338;
Polyvagel theory 143 socio-emotional relationship therapy 309, 324;
Porges, S. W. 143 solution focused family therapy 243, 248, 258;
postmodernism 276, 283 structural family therapy 83, 84, 86–90, 92; white
poststructural, social constructionist language: 58, 83, 87, 89, 281, 282, 291
solution focused family therapy 233–236 problem formation, at societal level 102–103
poverty 2, 7, 9, 32, 47, 64; brief and strategic family problems as attempted solutions 97
therapies 102, 104, 109; cognitive behavioral professional knowledge 66
family therapy 228; collaborative family therapy Project RACE 286
368 Index
psychopathology 2 Bowenian family therapy 170, 176, 178, 180, 181;
psychotherapy 256 contextual family therapy 197; experiential family
public participation 344–346 therapy 122, 129; narrative family therapy 291;
solution focused family therapy 243, 246
queer identity 179, 258 religious affiliation: socioculturally attuned
queer theory 281 praxis 335
remembering conversations 283
race/racism 5, 8, 278; AAMFT Code of Ethics 54; renaming rituals 133
Bowenian family therapy 171; cognitive resilience 14, 33, 37, 48, 49, 63, 65, 346; attachment
behavioral family therapy 210; collaborative based family therapies 141, 148, 167; Bowenian
family therapy 257; family cartography 124; family therapy 167, 177; brief and strategic family
institutionalized 2, 9; narrative family therapy therapies 102, 106, 108; collaborative family
277, 290; self-disclosure and relational therapy 264, 273; experiential family therapy 124,
engagement 61; socioculturally attuned praxis 129; narrative family therapy 288, 289, 292, 294,
335, 341; socio-emotional relationship therapy 295; solution focused family therapy 236, 239,
304, 312; solution focused family therapy 243 241, 245, 246; transgenerational 8
racial capitalism 8 resistance 8, 14, 48, 56, 63, 65, 66, 330, 335;
racial discrimination 7 attachment based family therapies 151; Bowenian
racial equity 4, 28 family therapy 167, 177, 184; brief and strategic
racial ethnic feminism 330 family therapies 99, 101, 105, 106, 108–109,
racial inequity 8 112–113; collaborative family therapy 263; costs
randomized controlled trials (RCTs) 351, 352 of 64–65; covert 64, 65; discourses of 285–286;
Rastogi, M. 32, 33–34 emotion and 127–128; experiential family therapy
RCTs see randomized controlled trials (RCTs) 124, 127–128; narrative family therapy 278,
reality: narrative family therapy 277–278 285–286, 289, 292, 295; to oppression 37; overt
reciprocally responsive relational engagement 64; power and 37; socio-emotional relationship
300–301 therapy 325; solution focused family therapy 237,
reciprocity 1, 188, 189, 261, 300, 304, 307, 313 241, 245; structural family therapy 84; symptom-
reflective functioning 142 free 108–109, 112–113
reinforcement 318; mutual behavioral 210 resonance 39, 174, 300
relational bonds 139, 144 responsibility: distinguished from authority
relational change 64, 144 312–313; distinguished from power 312–313
relational discursive loop 254 responsiveness 122, 139, 140, 142, 254, 300,
relational engagement 61–62 304, 306
relational equity 5, 103, 292, 294–295, 340, 342; Robbins, R. 56–57
restructure to support developmentally Roberts, J. 120
appropriate 87–88, 91–92 role privilege 335
relational ethics 54, 187, 190, 191, 195, 197 Ross, L. J. 333
relational flow of power 303–304
relational inequity 13; power-embedded 291 sacredness 48
relational justice 58, 173, 191, 194, 195 sadness: attachment based family therapies 143;
relational needs 146–147, 154–155, 157 Bowenian family therapy 176; socio-emotional
relational power 3, 21, 34, 35, 62, 86, 121, 173, 245 relationship therapy 301
relational practices checklist 224 safety 1, 31, 32, 37, 63; attachment based family
relational process 140–141, 264, 289, 304, 307, therapies 140, 143, 147, 150–153, 155, 156, 158;
311, 312 brief and strategic family therapies 102, 103, 110;
relational responsibility 191, 300, 305, 320, 326; cognitive behavioral family therapy (CBFT) 228;
gender imbalance in 312; shared 306, 313, collaborative family therapy 269; contextual
317, 325 family therapy 201; emotional 147; experiential
relational safety 152–156, 316 family therapy 121, 123, 124; physical 121;
relational satisfaction 5 psychological 121; relational 152, 155, 156;
relational security 143 socio-emotional relationship therapy 304, 307,
relational systems 11, 21, 38, 211; group 83 313, 316, 321; solution focused family
relational well-being 1, 3, 4, 15, 22, 31, 34, 214, therapy 241
304, 330 Şahin, F. A. 131, 319
Relationship Balance Assessment 311 Salmon, L. 284
relationship status: AAMFT Code of Ethics 54 Satir, V. 117, 119
religion 27, 29, 336, 342; AAMFT Code of Ethics SCAFT therapists 49
54; attachment based family therapies 147; scaling questions 235–236
 Index 369
schemas 210–212; behavioral change based on new 127; name without 333–334; socio-emotional
223, 229; commit to alternative 222–223, relationship therapy 303, 310
228–229; contextual nature of 213–215; family shared relational responsibility 306
221–222, 222, 226–228; individual 221–222, SIF see Systemic Integrative Framework (SIF)
222, 226–228; problematic, identification of 220, social capital 6, 30, 31, 48, 50, 58, 84, 324, 340
224–225; relational 215; social 215, 217, 218, social change 1, 3, 26, 128, 193, 352
226–228; societal 221, 221–222, 227 social cohesion 6
scientific knowledge 350 social constructionism 11, 94, 104, 254, 349
SDOH see socio-relational determinants of health social constructionist theory 241
(SDOH) social construction of emotion 146
second order change 3, 22, 24–25, 336; attachment social construction of meaning 252
based family therapies 159; brief and strategic social constructivism 3
family therapies 113; cognitive behavioral family social context: brief and strategic family therapies
therapy 229, 230; contextual family therapy 195; 101; experiential family therapy 121–126;
experiential family therapy 129; narrative family socioculturally attuned family therapy 26–27
therapy 290, 295; socio-emotional relationship social equity 3, 5, 42–49
therapy 326; structural family therapy 92 social inequality 257, 264, 348
second order morality 55 social inequity 40, 58
second order thinking 21, 22 social injustice 43, 127, 148
self 141, 170; differentiation of 164; sense of 164, social justice 10, 39, 257, 283, 341
167, 178, 184, 191, 256, 260, 284, 336; solid 164, social location 5, 8, 11, 12, 44, 46, 49, 53, 60, 332,
165; therapists use of 120–121 335, 337, 338, 342, 343; attachment based family
self-as-problem 289 therapies 151, 159; Bowenian family therapy 176;
self-awareness 61, 120, 165, 268, 272 cognitive behavioral family therapy 210;
self-blame 222, 269 collaborative family therapy 254, 259, 263, 264;
self-disclosure 61–62, 120, 123, 153 contextual family therapy 191, 202; experiential
self-esteem 32 family therapy 122; marginalized 59; narrative
self-in-relation 141 family therapy 278, 288, 291, 292; socio-
self-of-the-researcher 352 emotional relationship therapy 301, 308, 326;
self-reflectivity 58 solution focused family therapy 243, 244;
self-reflexivity 58, 60, 68, 258 structural family therapy 82, 83, 89; therapist 58
self-report 311 socially aware listening 149
Sen, S. 287 social networks 6, 30, 42, 84, 144
Seponski, D. M. 344 social schema 215, 217, 218
SERT see socioemotional relationship therapy social structures 8, 11, 27–28, 36, 40, 42, 53, 86,
(SERT) 148, 151, 171, 184, 206, 216, 267, 291, 302
sexism 88; collaborative family therapy 257; social support 6, 42, 216, 242, 285
heterosexism 46, 92, 212, 290; narrative family social synapse 142
therapy 277, 290 societal context 26–27; attachment based family
sexual harassment 202 therapies 144–150; Bowenian family therapy
sexual identity 28, 43, 61; self-disclosure and 167–171; clients to explore, inviting 245,
relational engagement 61 247–248; collaborative family therapy 253–260;
sexuality: Bowenian family therapy 171; narrative family therapy 285–286; socio-
heterosexuality 214 emotional relationship therapy 307–310; solution
sexual orientation 3–5, 10, 12, 54, 335, 342, 346; focused family therapy 241–242; structural family
AAMFT Code of Ethics 54; Bowenian family therapy 82–83
therapy 176; cognitive behavioral family therapy societal discourses 302–303
210, 214, 217, 225, 228; experiential family societal power imbalances 108, 112
therapy 123, 124; family cartography 124; societal schemas 221–222, 222
narrative family therapy 291; socioculturally societal structures 11, 12, 25, 44, 49, 74, 343;
attuned praxis 335; socio-emotional relationship collaborative family therapy 257; experiential
therapy 304; solution focused family therapy 243; family therapy 129, 136; narrative family therapy
structural family therapy 82, 83, 85 283, 290; solution focused family therapy 244;
SFFT see solution focused family therapy (SFFT) structural family therapy 82, 86–89
SFT see structural family therapy (SFT) societal systems 2, 3, 6, 10, 12, 14, 15, 22, 26, 27,
shame 34, 40, 43, 342; attachment based family 30, 36, 53, 58, 63, 65, 330, 331, 332, 336;
therapies 142, 143, 146, 155; Bowenian family attachment based family therapies 144; brief and
therapy 169, 176, 177, 179; contextual family strategic family therapies 94, 102, 108, 109;
therapy 193; experiential family therapy 118, 119, contextual family therapy 191–194, 191–196;
370 Index
Cultural Context Model 46; experiential family 236–237; equity in co-constructing client goals
therapy 117, 121, 122, 129, 130; narrative family 245, 248; exceptions, discovering and amplifying
therapy 285, 290; solution focused family therapy 239–240; just solutions, identifying and
233, 241, 242; structural family therapy 81, 88 amplifying 246, 249; language 242–243; meaning
sociocultural attunement 39, 54, 309, 319, 336; 242–243; poststructural, social constructionist
application of models 14; attachment based family language 233–236; power 242–243; practice
therapies 143–159; Bowenian family therapy guidelines 245–246; sociocultural attunement,
167–175; brief and strategic family therapies integrating principles of 240–243; solutions in
100–106; client and extratherapeutic factors and societal and cultural context 241–242; solutions to
12; cognitive behavioral family therapy 213–220; wider context, broaden search for 245–246,
collaborative family therapy 253–265; common 248–249; third order change 243, 249
factors and 10, 12–14; enduring patterns across space 31–32
contexts 82–83; expectancy for change and Spark, G. M. 59
13–14; group relational systems 83; narrative split loyalty 190
family therapy 283–290; solution focused family stereotypes: cultural gender 147; masculine 146
therapy 240–243; structured family therapy Stevenson, B. 172
81–85; therapeutic relationship and 12–13; St. George, S. 40, 353–354
therapist characteristics and 12–13 Stone, D. 62, 338–339
sociocultural brain 173–174 storyboarding 295
sociocultural discourses 315–316 strategic family therapies see brief and strategic family
socioculturally attuned family therapy 9–10, 348; therapies
complexities in 64–65; conceptual framework for Strategic Family Therapists 94
23; culture 29–31; guiding principles for 21–50; stress 5–7, 34, 36, 142, 165, 168, 174, 192, 201, 217,
limitations of 16; place 31–32; power 32, 34–37; 226, 228, 229, 242, 272, 280, 300, 306, 310
social structures 27–28; societal context 26–27; structural equity 88
socio-emotional relationship therapy 307–313; structural family therapy (SFT) 74–93; assumptions,
space 31–32; tensions in 63–68 challenging 78–80; case illustration 88–92, 90;
socioculturally attuned praxis 330–355, 331 equity-based relationships 87, 91; family and
socioeconomic status: AAMFT Code of Ethics 54; societal structures, connecting 86–87; family
cognitive behavioral family therapy 210; solution development 75–76; joining 77–78; patterns of
focused family therapy 243 interaction 74–75; practice guidelines 86–88;
socioemotional experience 301–302 restructure to support developmentally
socio-emotional expression 308 appropriate relational equity 87–88, 91–92;
socio-emotional relationship therapy (SERT) 11, restructuring 80–81; societal influences on family
155, 228, 299–326; case illustration 320–325; power dynamics, identifying 87, 89–90
Circle of Care 305, 305–306; equitable interaction structural inequality 6, 151, 264
patterns 305–306; felt identities 302–303; structural inequity 38, 191, 217; history of 8–9
interrupting 316–317; positioning 314–316, subjugation: narrative family therapy 287, 289–290
321–322; power 310–313; practice guidelines substance abuse 6, 134, 193, 322
313–320, 314; practicing 317–320, 324–325; Sundman, P. 237
reciprocally responsive relational engagement supervision 15, 41, 68, 69–70, 170, 244, 324, 330,
300–301; relational flow of power 303–304; 337, 338
relational work, acknowledging 317; societal symbolic capital 84, 92
context 307–310; societal discourses 302–303; symbolic violence 84–85
socioculturally attuned family therapy, principles of symmetrical relationships 35
307–313; socioemotional experience 301–302; systemic equity 340
theory of change 307, 326; third order change 313 Systemic Integrative Framework (SIF) 32, 33, 34
sociohistorical context: contextual family therapy systems theory 22
197–198, 201–203
socio-relational determinants of health (SDOH) Tadros, E. 82
4–6; climate change, role of 6–7; and lessons from Tamasese, K. 47
COVID-19 7–8 Tamura, T. 169
Soja, E. 31–32 tantrums 100
solidarity 6 Tatum, B. 263
solid self 164, 165 Telfener, U. 104
solution focused family therapy (SFFT) 232–250; TGE (transgender, non-binary, gender expansive)
case illustration 246–249; client goals 237–239; clients 288
clients to explore societal context, inviting 245, therapeutic conversations 11, 118, 233, 234,
247–248; collaborative therapeutic relationships 242, 287
 Index 371
therapeutic endeavor 22 contextual family therapy 192–193; history of
therapeutic relationship 12–13 8–9; socio-emotional relationship therapy
therapeutic self-disclosure 153–154 308–309; structural family therapy 82
therapists: as agent of change 99–100; attachment triangulation 165
based 141; behavioral change based on new 223; Tronick, E. 141
characteristics of 12–13; as coach 212–213; family trust 59; attachment based family therapies 140–143,
of origin work 167; power 195; social location 145, 149, 150, 153, 156; Bowenian family
58; use of self 120–121 therapy 175, 179, 181; cognitive behavioral
thinking errors 212 family therapy 225; collaborative family therapy
third order change: ANVIET as guide for 332–336; 268; contextual family therapy 189, 190, 192,
attachment based family therapies 151–152, 159; 194, 197; experiential family therapy 116, 122,
Bowenian family therapy 173–175, 184; brief and 135; socio-emotional relationship therapy 303,
strategic family therapies 106, 113; cognitive 307, 321, 324; solution focused family therapy
behavioral family therapy 218, 229–230; 239; structural family therapy 91
collaborative family therapy 253, 263–264, 273; Tuhakla, F. 47
contextual family therapy 195–196, 206; Turner, W. 85–86, 332–333
culturally attuned, equity-based community Typology of Parent-Child Relational
interventions 339–340; equity-based knowledge Orientations 313
production 350–354; experiential family therapy
129, 136; narrative family therapy 290, 295–296; unbalancing 81
in organizations and institutions 340–342; policies uncertainty 7, 140, 189, 190, 252–253, 255, 268,
344–346; politics 344–346; praxis 336–354; 280, 282
public participation 344–346; socioculturally undocumented immigrants 293
attuned family therapy 22, 24–27, 42; socio- unfairness 76, 168, 179, 181, 188, 192, 198,
emotional relationship therapy 313, 326; solution 203–204, 206, 228, 312, 337, 354
focused family therapy 243, 249; structural family United States (US): Border Patrol 9; Homestead Act
therapy 85, 92; transformative praxis 347–350 of 1862 9; Indian Appropriations Act of 1851 9;
third order ethics 54–62; awareness of power 59; trauma and structural inequity, history of 8–9
contextual self-in-relationship 55, 57; myth of US see United States (US)
neutrality 59–60; self-disclosure and relational
engagement 61–62; therapist social location 58; values/valuing 40–41; attachment based family
use of power in practice 60–61 therapies 154; of belonging 170; Bowenian family
third order thinking 21–22, 26 therapy 176; brief and strategic family therapies
third space 38 108; cognitive behavioral family therapy 214;
third wave feminism 337 collaborative family therapy 266; contextual
Tilsen, J. 281 family therapy 192, 198; Cultural Context Model
Tipirneni, R. 7 46; culturally attuned, equity-based community
totalitarian leadership 172 interventions 340; experiential family therapy
Tourse, R. W. 9 131, 132; of intuition and feeling 170–171; Just
transformative praxis 347–350 Therapy 48; narrative family therapy 291, 294;
transforming: attachment based family therapies 155; socio-emotional relationship therapy 314, 315,
Bowenian family therapy 178; cognitive 322, 323; solution focused family therapy 245;
behavioral family therapy 217; contextual family structural family therapy 91
therapy 200; culturally attuned, equity-based van Dijk, T,. A. 243
community interventions 340; Cutural Context VCR (Validation, Challenge, Request) intervention
Model 47; engage in and support 335–336; 154, 197
experiential family therapy 133; Just Therapy 49; Vinthagen, S. 64
to make the imagined a reality 42; narrative family violence: domestic 102–103; symbolic 84–85
therapy 292, 295; socio-emotional relationship voicing 341
therapy 316, 318, 324; solution focused family vulnerability 6, 59; attachment based family
therapy 246; structural family therapy 91 therapies 152, 153, 154, 155, 158; Bowenian
transgender identity 133 family therapy 172; brief and strategic family
transgender people 66, 288, 289 therapies 125; collaborative family therapy 273;
transgenerational patterns: Bowenian family therapy experiential family therapy 131, 135; mutual 305;
164–165 narrative family therapy 277, 296; socio-
transmission 164–165 emotional relationship therapy 301, 303, 305,
transphobia: narrative family therapy 288, 289; 308–309, 312, 315–317, 316–317, 319
solution focused family therapy 244
trauma: Bowenian family therapy 169–170; Waldegrave, C. 3, 47, 49
372 Index
Walzer, S. 312 Williams, K. 195, 312
Watson, M. F. 2, 4, 169 Williams, N. D. 81
Watzlawick, P. 98, 99 Wilson, E. E. 147–148
well being: cognitive behavioral family therapy 217 World Health Organization 139
Wells, M. A. 312 worthlessness: attachment based family therapies 142
Western culture 140, 154, 192, 300 Wulff, D. 40, 353–354
Whitaker, C. 119 Wynne, L. 3
White, M. 278, 279, 283, 295; Narrative Means to
Therapeutic Ends 276 xenophobia 16, 253
whiteness 84, 259, 343
white privilege 58; experiential family therapy 135; Zimmerman, T. S. 243–245
narrative family therapy 277, 281, 282, 291;
structured family therapy 83, 87