How couples therapy needs to adapt in order to reach out to and connect with ethnic couples, and how one student is trying to teach it how, by Alwynne Gwilt
From the Toronto Star, January 23, 2007
In a comfortable, mood-lit office, a white married couple sit timidly, not quite willing to express their issues to the South Asian therapist sitting across from them.
They've never been to therapy. No one would understand them, their particular needs, their exact situation.
"What seems to be the problem?" the therapist asks.
"Well, ahem, I just, I need space," says the woman, quietly.
"Space? How many of there are you in the family?" replies the therapist.
"Just my husband, myself and our son," she responds.
"Where are your parents, or their siblings?" asks the therapist.
"Oh, well, I haven't seen my family or my husband's in a few years," she explains.
"What? No mother-in-law living with you? Well, of course you have problems. There's nofamily to fall back on. You're weak to want space!" the therapist chides. "You must surround yourself with family!"
Talking to a therapist can be uncomfortable at the best of times.
Now consider talking to a therapist who doesn't have the first clue about how your culture works. That's how many ethnic couples in the GTA feel at the thought of seeing a therapist trained with traditional Western values.
The image of Dr. Phil has been immortalized in Western culture, telling people to stand up for themselves, preaching independence. And although that's an extremely simplified approach to Western psychology, it's true that even Freud's beliefs generally put the individual first.
York University PhD student Saunia Ahmad has figured out this doesn't work for cultures where family is built into every nook and cranny of an individual's decisions.
Studying in the university's clinical psychology program, she's trying to craft a new form of therapy that will help those who don't want to be pigeonholed into Western solutions.
"Some people pay lip service to culture," the 26-year-old says. "Because if you're dealing with one person, culture's like an add-on.
"When really you've got to understand a person is really shaped by culture."
Ahmad says there's simply a lack of psychological services for ethnic couples.
"Some people in my community who seek out treatment feel they're stereotyped, or they just don't (go) because they don't feel people will understand their culture."
Ahmad is Muslim and her parents are from Hyderabad, India. But it's not only South Asian couples who could benefit from therapists with a bit of cultural awareness, according to Ahmad's supervisor and partner in the work.
"There's no doubt in my mind ... that what we may learn from working with South Asians may well benefit other cultures as well," explains David Reid, a psychology professor at York. "We overemphasize personality – which is a very individualistic perspective – and we need to look at other factors, like culture."
Other psychologists in the field agree. Typical advice is that couples should communicate a lot, gender roles should be egalitarian, and woman are encouraged to have independence, explains Andrew Ryder, who teaches an undergraduate course in cultural psychology at Concordia University.
"We lose sight of the fact that in some ways we're an unusual culture," he says. "Even our culture in the 19th century wasn't like that."
Yvonne Bohr, an associate professor in clinical psychology at York specializes in working with Chinese families. She says Ahmad's work is crucial in order to reach "communities that may not avail themselves of services that they should. It's very important work and we need to do more of it."
Ahmad and Reid are just beginning to figure out how to develop a therapy program for South Asians, meaning there's a significant learning curve for both.
For instance, Ahmad says, often Western-based therapy focuses on building a strong husband and wife foundation, before considering the role of children. Yet many people she's spoken with believe children are an intrinsic part of the marriage.
Couples "don't really always relate to each other as husband and wife," she says. "But they may be relating to each other a lot as mother and father."
Religion plays a greater role, even when she's compared religious Caucasian couples to religious South Asian ones. It's not so much that a therapist has to believe in someone's religion, she says. But a therapist has to appreciate and understand someone's religious beliefs.
Reid and Ahmad began working together at the start of her master's program. Her thesis compared happily married Caucasian couples to South Asian ones, in an attempt to understand how each views a satisfied marriage differently.
"Sometimes an extended family can make or break a marriage," says Ahmad.
One half of a happily married South Asian couple she interviewed included Shireen Ahmed, a 29-year-old mother of four.
"You don't marry a person, you marry the entire family. And that doesn't only apply to Pakistanis," she says, adding her mother-in-law is like her "right-hand man."
"There's a lot of joy in family and there's a lot of angst. My own family drives me crazy and obviously my husband's family is going to drive me crazy. But you've got to work at it."
For Reid, the challenge is altering how he's been operating as a psychologist for more than 20 years.
"We have to be very rigorous in not imposing our values or Western values," adds Reid, 64. "We want to be very open to entertaining the input from extended family."
That Freudian view of therapy is hard to overcome, say many of Ahmad's South Asian friends.
"Here you've got a therapist saying, `Well, why is your mother so involved?'" says Sheena Chaudry, an outspoken, single 31-year-old. But if you had someone who understood the culture, she says, the therapist would know that part of a common South Asian marriage is that the couple lives with their parents "and there's an expectation for the son to take care of them."
Before getting married, a bottom line frequently exists in South Asian culture: many feel they could never marry if the two families didn't jive. As well, if divorce was on the horizon, it's common that a religious leader or a trusted family member would be confided in before a therapist.
That could prove to be a difficult factor: even if you build a program for ethnic couples, there's no guaranteeing anyone will come.
"I speak with South Asians and some people say, you know, `Right on Saunia, we love what you're doing. You're going to help people.' But then there's also a lot of people thinking that marriage is not anyone else's business," says Ahmad.
She believes part of the solution will be helping people understand that the reason she's got so involved is because she's seeing so many marriages among second-generation South Asians end in divorce.
"I guess I just felt, I really want to help them," she says.
Ultimately, it's about creating a new type of therapy that anyone in a multicultural society could be comfortable with.
"If people relate us to Dr. Phil, then we're done," she says, laughing. "No one is going to come see us."
Toronto Psychology Clinic 123 Edward Street, Suite 1103 Toronto, Ontario M5G 1E2 Tel: 416-551-1759 Fax: 416-551-2183 Email: firstname.lastname@example.org