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Socioculturally Attuned Family Therapy

Socioculturally Attuned Family Therapy addresses the need for socially responsible couple,
marriage, and family therapy that infuses diversity, equity, and inclusion throughout the-
ory and clinical practice. The text begins with a discussion of societal systems, diversity, and
socially just practice. The authors then integrate principles of societal context, power, and
equity into the core concepts of ten major family therapy models, paying close attention to
the “how to’s” of change processes through a highly diverse range of case examples. The text
concludes with descriptions of integrative, equity based family therapy guidelines that clini-
cians can apply to their practice.

Teresa McDowell, EdD, is a professor of marriage, couple, and family therapy and chair of
the Department of Counseling Psychology at Lewis & Clark Graduate School of Education
and Counseling in Portland, Oregon. She is a licensed marriage and family therapist,
AAMFT clinical fellow, and approved supervisor. Her work includes a focus on applying
critical social theory to family therapy practice.

Carmen Knudson-Martin, PhD, LMFT, is a professor and director of the marriage, couple,
and family therapy program at Lewis & Clark Graduate School of Education and Counseling.
She is a past president of the American Association for Marital and Family Therapy—
California Division, and recipient of the 2017 Distinguished Contribution to Family Therapy
and Practice award from the American Family Therapy Academy. She is a founder of socio-
emotional relationship therapy.

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, and supervision.
Socioculturally Attuned Family
Therapy
Guidelines for Equitable Theory and Practice

Teresa McDowell, Carmen Knudson-Martin,

and J. Maria Bermudez
First edition published 2018
by Routledge
711 Third Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
 2018 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 the authors of this material has been
asserted by them 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.
Library of Congress Cataloging-in-Publication Data
Names: McDowell, Teresa, author. | Knudson-Martin, Carmen, author. |
Bermudez, J. Maria, author.
Title: Socioculturally attuned family therapy : guidelines for equitable
theory and practice / Teresa McDowell, Carmen Knudson-Martin, and
J. Maria Bermudez.
Description: New York, NY : Routledge, 2017. | Includes bibliographical
references and index.
Identifiers: LCCN 2017032515| ISBN 9781138678200 (hardcover :
alk. paper) | ISBN 9781138678217 (pbk. : alk. paper) | ISBN
9781315559094 (e-book)
Subjects: | MESH: Family Therapy | Culturally Competent Care |
Sociological Factors
Classification: LCC RC488.53 | NLM WM 430.5.F2 | DDC
616.89/156—dc23
LC record available at https://lccn.loc.gov/2017032515

ISBN: 978-1-138-67820-0 (hbk)

ISBN: 978-1-138-67821-7 (pbk)
ISBN: 978-1-315-55909-4 (ebk)

Typeset in Bembo
by Swales & Willis Ltd, Exeter, Devon, UK
Toward a more equitable future,
we lovingly dedicate this book to the next generation:
to our students, our children, and our grandchildren
Contents

Foreword (Fred P. Piercy) viii

Preface: Introducing Ourselves x
Acknowledgments xiii

1 Why Sociocultural Attunement and Equity Matter 1

2 Guiding Principles for Socioculturally Attuned Family Therapy 12
3 Self-of-the-Therapist and Ethical Considerations in Socioculturally
Attuned Family Therapy 26
4 Socioculturally Attuned Structural Family Therapy 38
5 Socioculturally Attuned Brief and Strategic Family Therapies 56
6 Socioculturally Attuned Experiential Family Therapy 75
7 Socioculturally Attuned Attachment Based Family Therapies 94
8 Socioculturally Attuned Bowenian Family Therapy 114
9 Socioculturally Attuned Contextual Family Therapy 138
10 Socioculturally Attuned Cognitive Behavioral Family Therapy 159
11 Socioculturally Attuned Solution Focused Family Therapy 179
12 Socioculturally Attuned Collaborative Family Therapy 196
13 Socioculturally Attuned Narrative Family Therapy 217
14 Integrated Equity Based Approaches to Family Therapy 236

Index 250
Foreword
Fred P. Piercy

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 sociocul-
tural 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 sociocultural 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 ineq-
uities, 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 under-
standing 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 con-
scientiousness. 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
 Foreword ix
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 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.
Preface
Introducing Ourselves

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 rela-
tionships with each other. We are hard workers who have shared our energy and creativity
over the course of writing 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 dif-
ferences between us, which allows each of us to see with more than our own eyes. Next, 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 walking around amazed, gaping at pat-
terns 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, structural and strategic fam-
ily therapy, and the work of Milton Erickson. 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 think-
ing, unexamined whiteness, heterosexual and cisgender privilege, and middle-class legacy.
During the first half of my career I looked to family therapy to help me understand the
world. During the second half I searched in and out of family therapy to find ways to under-
stand 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 dif-
ference. 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.
 Preface xi
Carmen
Before I came to this field, I taught family life education in high schools. I found myself fas-
cinated 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 relation-
ships 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 experi-
enced the privileges accorded English speakers and U.S. citizenship.
In 1983 I began to study family therapy as part of a PhD in sociology. This was pure luck!
Since then I have focused on how the larger societal context operates in the 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, tem-
porarily 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 practicing couple and family therapist for over 24 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 studies. What initially drew me to the field of
family therapy was the 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 peo-
ple’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 and collaborative values, such as with postmodern and social constructionist
approaches to family therapy.
Nonetheless, I didn’t 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
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 ther-
apy 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.
xii Preface
I remember first being aware of disparities at a young age. During my childhood and
adolescence, my mother and I traveled to Honduras to see my father and my family there.
We went four times; at age 4, 11, 15, and 19. It was impactful for me. Not only was it
strange for me that everyone 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 to me and no one explained to me
what was happening. I wasn’t exposed to this in the U.S. Although my family in Honduras
and the U.S. was mostly “working” middle-class, as I got older, I developed a sincere and
deep gratitude and appreciation for our privilege. We had a house, consistent electricity,
food, clean water, washing machines, a reliable postal system, good public education, new
clothes and shoes, and a peaceful way of life. We did not come here fleeing persecution or
escaping violence or financial distress. Instead, my mother, who learned to speak English
in school and worked in an office as an accountant, brought us to the U.S. for a “better
way of life.” My father, who was well-regarded for his work as an auto mechanic, did not
want to immigrate, but conceded because of the opportunities that were not possible for us
there. 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, 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; not in the U.S. or anywhere. The structural barriers and the
trajectories 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 U.S. Although I was 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 had not been able to change the course
of our lives. As a consequence, I am greatly humbled and honored to co-author this book
with such outstanding scholars in the field of family therapy. It is my hope that our theorizing
and critical lens will help the readers of this text critically evaluate and attune, with a sense
of urgency, to the factors that shape our lives and our ways of working. It is time for another
paradigm shift!

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 text, we have been
immersed in that mix. We pass our work on to you now with the hope that you will have
the courage to both use and challenge our ideas, that you will bear the humility of not always
doing social justice based family therapy “right,” and that you will join in our excitement
about the future of family therapy.
Acknowledgments

Maria
It is such an honor to co-author my first book with two scholars that I greatly admire. I want
to first thank Drs. Teresa McDowell and Carmen Knudson-Martin for giving me the amazing
opportunity to embark on this journey with them. It has truly been a privilege. Our process
was richly generative, collaborative, and inspiring. I am hopeful that our body of work will
be generative to others as well and that it will serve to move our field forward in important
and necessary ways.
The richness of my journey could not have been possible without walking alongside the
remarkable people that have paved the way for me. I would first like to thank my family,
who laid such an important foundation for my life; especially my mother, Judith Silva Perez,
who was my first feminist mentor. She taught me what it meant to be a strong, independent,
courageous woman, mother, and professional. She would say, “If you are going to do some-
thing, do it right.” I can still hear her say, “Hágalo bien y con amor!” And to my father, Rene
Enrique Perez, who passed away during my adolescence; he was a gentle and kind man and
I have such sweet memories of him. I would also like to thank my siblings and their spouses
for their constant love and support of me; Zoila and Mario, Eddy and Toni, Ruy and Sandra,
Manuel and Amalia, Gerardo and Rosana, and Renee and Marcelo, as well as my nieces and
nephews, and their spouses and children. Let’s keep dancing and celebrating life together. And
to my family of choice, my lifelong best friends in Texas, I am so grateful for each one of you!
I would also like to thank and acknowledge other important giants in my life—my feminist
mentors/professors/colleagues/friends who strengthened me with their critical conscious-
ness, highest standards of excellence, and undying passion for marriage and family therapy
and family science; Drs. Lorna Hecker, Joe Wetchler, Anne Prouty, Katherine Allen, Saliha
Bava, Karen Wampler, Gwen Sorell, Elizabeth Sharp, Nancy Robinson, Tom Stone Carlson,
Christi McGeorge, and Yajaira Curiel. I find myself repeating your words and phrases with
my students and our conversations consistently echo in my mind. I hope that I will be
able to influence my students the way you have influenced me. And to my community of
scholars from the University of Georgia, especially Drs. Jay Mancini, Jerry Gale, Desiree
Seponski, Morgan Stinson, Bertranna Muruthi, and soon to be doctors, Andrea Farnham,
Ashley Walsdorf, Valerie Maxey, and Josh Boe—I appreciate how you help me acknowledge
what I know, while simultaneously keeping me in an unsettled “not-knowing” stance. You
continuously move my thinking forward. I would also like to thank and acknowledge my
clients and research participants, who are a constant source of challenge and inspiration for
me. Without them, I would not be able to theorize, learn, and grow in the ways I do.
I would also like to thank my partner and best friend, Romulo (Ronnie) Rama for giving
me “for better and better” and sharing his life with me. And I am also grateful to Meg and
Nicolas, Eric and Leah, and Mandy, for welcoming me into their lives. I am looking forward
to our future together!
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