two genders, with the oldest being male). This description accounts for only 3% of the actual population in the United States (McGoldrick & Hardy, 2019). It is also an ideal that has not served women well, rendering the “mother … perpetually on call for everyone emotionally and physically” (p. 6). It is a patriarchal arrangement that reinforces gender stereotypes while minimizing or eliminating much-needed alternatives for the other 97% of the population.
Race, class, ethnicity, culture, gender, health and ability, and sexual and affectional orientation are dynamic parts of individuals and family systems. To know ourselves as individuals and family practitioners requires that we investigate our families of origin for the cultural experiences that relate to these dynamics. Before we can know the richness and diversity of other families, we must come to know our own heritage. Whether we are part of the dominant culture or of one or more marginalized cultures, both our values and our families have been organized in ways that shape these meanings in our lives.
Of all the discriminations people face in the world, sexism and the oppression of women are the oldest and most pervasive. Indeed, one of the most difficult aspects of working with multicultural families is balancing the need to be sensitive and appreciative of cultural differences when those differences still involve discrimination against women. Still, no society or culture lacks feminist voices. In the first decades of the 21st century, we have truly become a global village: Television and mass communication are joining people across borders. Women all over the world are supporting one another in their acquisition of freedom and equality.
What meanings do you attach to being male or female or some other gender identity? What pronouns are appropriate for you? What is your cultural heritage? How did these perspectives shape your life when you were young, and how do they shape it now? Who benefits from the definitions you attach to gender and culture? Who is privileged by these definitions? Who is marginalized? If you were going to make a special effort to be sensitive to and appreciate diversity, how would that effort affect your family practice? How would it affect your role with others? How would your words reflect your sensitivity and appreciation?
Because gender and cultural perspectives are so important to the field today, I give special consideration to these lenses at the end of each theory chapter—in addition to considering the lenses in more detail in Chapter 18 on integration. The most effective models and practitioners tailor their approach to fit the unique needs of families with a wide range of structures, cultures, economics, and genders. Family practitioners today are required to possess knowledge for working with various cultures and are called to a personal and professional consideration of their own gender heritage and cultural experiences. In an effort to prevent harm, they must learn the culturally sensitive skills needed to assist families with the realities of their individual cultures.
The Scholar-Practitioner in Family Counseling and Therapy
With few exceptions, the models of family therapy presented in this book emerged from the efforts of clinicians who wanted to understand family practice through engagement and action. Bowen at the National Institute of Mental Health and Georgetown University; Bateson, Jackson, and associates at the Mental Research Institute in Palo Alto, California; and Minuchin and colleagues at the Philadelphia Child Guidance Clinic studied families in an effort to see what worked. These men were, for the most part, scholar-practitioners determined to discover or create the interventions that would make a difference with some of the most severe problems encountered in physical and mental health. In many ways, they were qualitative and action researchers embedded in and connected with the very systems they sought to know and study.
Even practitioners in private practice such as Dreikurs, Satir, and Whitaker brought an investigative orientation to their clinical work that focused on the development of personal and professional skills as well as family growth and development. In more recent years, Monica McGoldrick and her many associates have focused on developing theory and practice that seeks to articulate the relationship of race, ethnicity, culture, gender, and sexual orientation to families and family therapy (see McGoldrick & Hardy, 2019).
Starting in 1942 with the formation of the American Association for Marriage and Family Therapy there has been a concerted effort to demonstrate the efficacy and effectiveness of family practice through the Journal of Marital and Family Therapy. In 1995, meta-analyses of effectiveness studies concluded the following:
Marriage and family therapy worked better than no psychotherapy at all;
Marriage and family therapy did not appear to have negative or harmful effects;
Marriage and family therapy was more efficacious than individual therapy for adult schizophrenia, marital distress, depressed women in distressed marriages, adult alcoholism and substance abuse, adolescent conduct disorders, anorexia in teenage women, childhood autism, and a variety of physical illnesses in both adults and children;
No particular model of marital and family therapy was superior to (more effective than) any other approach;
There was some evidence that marital and family therapy was more cost effective than inpatient or residential treatment for schizophrenia and severe conduct disorders or delinquency in adolescents; and
Although marriage and family therapy was a critical and necessary component in the treatment of severe problems, the most effective programs also included psychoeducational therapies, individual or group counseling, and/ or medication (Pinsof & Wynne, 1995).
Reviews of outcome research over the past 20-plus years have not produced any noticeable changes or differences in these reported results. Indeed, additional studies have continued to confirm these findings (see Gladding, 2019; I. Goldenberg et al., 2017; Nichols & Davis, 2017). Those parenting and family models related to behaviorist family interventions have produced change in behavioral and conduct disorders (S. A. Baldwin et al., 2012; Henggeler & Sheidow, 2012; Kaslow et al., 2012).
The year 2012 was a huge year for reporting on the effectiveness of couples and family counseling, thanks in large part to a special issue of the Journal of Marital and Family Therapy. Couples and family interventions have reduced relational problems and led to enhanced couple functionality (Lebow et al., 2012; Markham & Rhoades, 2012). O’Farrell and Clements (2012) and Rowe (2012) validated the effectiveness of family interventions in addictions work. Shields et al. (2012) addressed the effectiveness of couples and family work in addressing health problems. Stith et al. (2012) reported on couples and family interventions related to intimate partner violence, and Beach and Whisman (2012) noted the effectiveness of family interventions with affective disorders.
Southern (2005) noted that four marriage and family therapy journals publishing 131 articles between 1980 and 1999 contained the results of mostly quantitative studies. Even though qualitative research was increasing, it accounted for a very small percentage of the articles. For a field that still feels it must validate and justify its methods, such a finding is perhaps not surprising. This same study also noted that articles addressing diversity issues in the Journal of Marital and Family Therapy nearly doubled in 10 years to 31% of the articles in the 5 years leading up to 2000.
Toward the end of the 1980s, the International Association of Marriage and Family Counselors established The Family Journal in an additional effort to provide a forum for “groundbreaking, innovative scholarship for counseling researchers, educators, and practitioners” (Carlson, 1993, p. 3). For almost 30 years, this journal has provided space for both qualitative and quantitative research; the development of theory and practice; the relationship of personal exploration and growth to professional development; considerations of race, culture, and gender in family counseling; and efficacy studies for the training of family practitioners.
In
