CULTURAL FAMILY THERAPY: INTEGRATING SYSTEMIC FAMILY THERAPY WITH CULTURAL PSYCHIATRY Co-Chairs: Vincenzo Di Nicola, M.Phil., M.D., Ph.D., Ellen Berman, M.D. SUMMARY: This interactive, case-based workshop is designed for clinicians who work with families presenting mental health challenges across cultures. Di Nicola will present Cultural Family Therapy (CFT), a synthesis of systemic family therapy and sociocultural psychiatry. In numerous publications and international workshops over the last 30 years, Di Nicola has elaborated a model of CFT, presented in his book, "A Stranger in the Family: Culture, Families, and Therapy" (1997). CFT weaves together family stories that express their mental and relational predicaments and conceptual tools for conducting clinical work. CFT is an ongoing update of our notions of “family” and “therapy,” on one hand, and of “culture” and “psychiatry,” on the other. Three basic principles and processes for CFT are: 1) the deep parallels between the notions of “family” and “culture,” mean that “culture” supersedes the notion of family “system”; 2) each family is the bearer of the larger culture(s) in which it is embedded and creates a culture of its own, so the family is the vehicle for intergenerational cultural transmission, for maintaining culture (cultural coherence), and for generating its own small-scale cultural adaptations, yielding three yoked family functions: cultural transmission, cultural maintenance/coherence, and cultural adaptation; 3) at the heart of systemic family theory and sociocultural psychiatry is a relational psychology that inverses theorizing from self to society by redefining the notions of identity and belonging through relations. With its relational and sociocultural approach, CFT is uniquely responsive to working with families undergoing culture change within and across cultures. In a world with huge global flows of migrants and refugees instigated by conflict, disasters, or economic and social reasons, CFT offers clinical tools to understand and treat families experiencing severe stress due to rapid and massive culture change. These processes will be explained, illustrated in case examples, and distributed to the workshop participants in handouts.

1. Cultural Family Therapy
Integrating
Systemic Family Therapy
with Cultural Psychiatry
Workshop Co-Chairs:
Vincenzo Di Nicola, MD, PhD
Ellen Berman, MD
American Psychiatric Association
Annual Meeting – Atlanta, GA
Monday, May 16th, 2016
3:30 – 5:00 pm

2. Workshop:
Cultural Family Therapy

3. Vincenzo Di Nicola, MD, PhD
vincenzodinicola@gmail.com
Professor of Psychiatry, University of Montreal
Chief, Child & Adolescent Psychiatry,
Montreal University Mental Health Institute
APA Quebec DB Representative & Past President
Chair, APA Global Mental Health Caucus
Founding President, Canadian Association of
Social Psychiatry

4. Ellen Berman, MD
emberman@yahoo.com
Clinical Professor of Psychiatry,
University of Pennsylvania
Director, Family Therapy Training, UPenn
President, Executive Board,
Association of Family Psychiatrists
Lifetime Achievement Award,
American Family Therapy Association

5. Conflicts of Interest
Neither of the presenters have any financial
conflicts of interest

6. Educational Objectives
At the conclusion of the session,
the participant should be able to:
1) Understand families in cultural context to
learn to listen to family stories in order to
identify their mental and relational
predicaments as expressions of their unique
cultures

7. Educational Objectives
At the conclusion of the session,
the participant should be able to:
2) Select with cultural sensitivity, using
translators and cultural mediators as needed,
at least three clinical tools that help families
tell their trauma stories

8. Educational Objectives
At the conclusion of the session,
the participant should be able to:
3) Define culture change and identify its
mental health impacts on families as a cascade
of consequences

9. Educational Objectives
At the conclusion of the session,
the participant should be able to:
4) Learn how to negotiate intervention
strategies that are both culturally congruent
and clinically effective for families undergoing
culture change

10. Purpose
• This interactive, case-based workshop is
designed for clinicians who work with families
presenting mental health challenges across
cultures

11. Workshop Structure
In Part I, the workshop leader will present
Cultural Family Therapy (CFT), a synthesis of
systemic family therapy and socio-cultural
psychiatry
(25 mins)

12. Workshop Structure
In Part II, participants will divide into two
groups for discussion of CFT theory and
practice, illustrated by two family cases in
treatment
(30 mins)

13. Workshop Structure
In Part III, the participants will reconvene for
an interactive discussion, with a focus on
applying CFT treatment strategies to their own
clinical work with family across cultures
(35 mins)

14. Part I:
Cultural Family Therapy

15. MARA
SELVINI
PALAZZOLI
(1916-1999)

16. Mara Selvini Palazzoli
La terapia familiare è il punto di partenza
per lo studio di unità sociali sempre più ampie.
Family therapy is the starting point
for the study of ever wider social units.

17. Cultural Family Therapy
CFT weaves together family stories that
express their mental and relational
predicaments and conceptual tools for
conducting clinical work

18. Cultural Family Therapy
• CFT is an ongoing update of our notions of
“family” and “therapy,” on one hand, and of
“culture” and “psychiatry,” on the other

19. With individual therapy, something’s missing …

20. Without cultural understanding,
we build walls instead
of bridges …

21. Cultural Family Therapy
CFT was constructed
to deal with threshold people
undergoing rapid cultural change

22. A STRANGER
IN THE
FAMILY
Culture, Families,
and Therapy
(New York & London:
W.W. Norton & Co., 1997)

23. Three CFT Principles and Processes
1) The deep parallels between the notions of
“family” and “culture,” mean that “culture”
supersedes the notion of family “system”

24. Three CFT Principles and Processes
1) Culture supersedes the notion of family
“system”

25. Three CFT Principles and Processes
2) Each family is the bearer of the larger
culture(s) in which it is embedded and creates
a culture of its own, so the family is the
vehicle for intergenerational cultural
transmission, for maintaining culture (cultural
coherence), and for generating its own small-
scale cultural adaptations, yielding three
yoked family functions: cultural transmission,
cultural maintenance/coherence, and cultural
adaptation

26. Three CFT Principles and Processes
2) CFT recognizes three yoked family functions:
cultural transmission
cultural maintenance/coherence
cultural adaptation

27. Three CFT Principles and Processes
3) At the heart of systemic family theory and
socio-cultural psychiatry is a relational
psychology that inverses theorizing from self
to society by redefining the notions of identity
and belonging through relations

28. Three CFT Principles and Processes
3) Relational psychology works
from society to self
by redefining identity and belonging
through relations

30. Key Features of CFT
Recognizing families as unique cultures
Immigrants as threshold people in transitional
states
Key theme: Liminality versus community

31. Clinical Tools for CFT
Tool
• Spirals
• Masks
• Roles
• Codes
• Cultural Strategies
• Bridges
• Suture
• Meeting strangers
• Cultural camouflage
• Insiders & outsiders
• Translation – Cultural &
therapeutic
• Adaptation &
acculturation
• Family life cycle in cultural
context
• CFT as story repair
Explanation

32. Applications
With its relational and socio-cultural
approach, CFT is uniquely responsive to
working with families undergoing culture
change within and across cultures

34. Applications
• In a world with huge global flows of migrants
and refugees instigated by conflict, disasters,
or economic and social reasons, CFT offers
clinical tools to understand and treat families
experiencing severe stress due to rapid and
massive culture change

35. Part II:
Family Cases
“Renata’s Lucid Folly”
“Black Skin, White Mask”

36. Family Case:
“Renata’s Lucid Folly”
An adolescent from Latin America whose
disturbing experiences only appear as
psychotic out of family and cultural context

37. Family Case:
“Renata’s Lucid Folly”
Renata 16-yr-old teen living in Montreal
Lives with mother, 15-yr-old sister, Angela, and
step-father of 3 yrs
Diagnosed schizophrenic at age 14 due to “voices”
The “voices” have relational meaning
She heard “voices,” but no was listening to her

39. Family Case:
“Black Skin, White Mask”
A young adult from a multicultural family with
parents living in two countries, Canada and
the Caribbean, whose uncertain, shifting sense
of belonging is as unanchored as her changing
tableau of anxious and depressive symptoms

40. Family Case:
“Black Skin, White Mask”
Cassandra, 18 yrs old, just returned from the
Caribbean where her francophone Black father lives
Anglophone White mother of Eastern European
background lives in Montreal with two daughters
Referred at 14 for depression, poor diabetic control
Fluctuating distress, poor social network, lack of
follow-through with school, therapy, & friends
Sibling rivalry, family pressure

41. Part III:
Interactive Discussion

42. The
relational
dialogue

43. Letters to a
Young Therapist
Relational Practices for
the Coming Community
(New York & Dresden:
Atropos Press 2011)

44. Culture Change
Both families have undergone culture change
Renata’s family moved from Latin America to
Canada
Underwent acculturation at different rates, with
different models of behavior
Cassandra’s parents constructed a family across
culture and class, language and race
Over the last few years, the marital contract has
been slowly dissolving as has Cassandra’s
sense of belonging

45. Culture
Culture is the crucible of human relations
The royal road for understanding
mind, self, and identity

46. Family
I see humanity as a family
that has hardly met.
– Theodore Zeldin
An Intimate History of Humanity

47. Bibliography
Di Nicola, V. A Stranger in the family : culture, families and
therapy. New York: W.W. Norton & Co., 1997.
Di Nicola, V. Letters to a Young Therapist: Relational
Practices for the Coming Community. New York: Atropos
Press, 2011.
Di Nicola, V. Family, psychosocial, and cultural
determinants of health. In: Sorel, Eliot, ed., 21st
Century
Global Mental Health. Burlington, MA: Jones & Bartlett
Learning, 2012, pp. 119-150.
Mollica, R.F. Healing Invisible Wounds: Paths to Hope and
Recovery in a Violent World. New York: Harcourt, 2006.

48. Acknowledgements
Family Therapy Colleagues
Dr. Ellen Berman & AFP
Dr. Steven Wolin & SSPC
Family Therapy Supervisors
Dr. Maurizio Andolfi
Dr. Mara Selvini Palazzoli
Cultural Psychiatry Mentors
Dr. Raymond H. Prince
Dr. Armando Favazza
Dr. Richard Mollica Turku, Finland