CLINICAL INTERVIEWING - PART 9 potx

differentiation and multigenerational transmission, writers and therapists with a fam- ily orientation attend to a much broader domain than those focusing on individuals or even nuclear families (see Goldenberg & Goldenberg, 2000). A family therapist working in the structural family theory model approaches the family as a living organism, which leads to an open definition of both family and nor- mality (J. Patterson et al., 1998). During an initial interview, the therapist absorbs all aspects of family functioning to begin to draw a family map. This map, or schema, al- lows for an analysis of structural strengths and weaknesses in the family. Orienting to a family and to the family’s distress systemically will substantially change interviewer-client interactions and interviewer inquiry. For instance, in the body of a family interview, coming from an ecosystemic approach, Amatea and Brown (1993) recommend seeking answers to the following: 1. What is the nature of the problem and what solutions have been tried to solve this problem? 2. Who else has been involved in helping with this problem? 3. If you were to bring in anyone to help with this problem, whom would you invite? 4. Who would be the last person(s) to bring in to help with this problem? 5. If this problem were solved, how would things be different? The authors also advocate assessing the entire ecosystem that surrounds the problem and intervening at whatever junctions in the system seem most likely to positively effect change. Amatea and Brown draw heavily from the MRI (Mental Research Institute) approach, which stems from the early work of Gregory Bateson, Paul Watzlawick, Don Jackson, Jay Haley, Virginia Satir, and others (see Goldenberg & Goldenberg, 2000, for review; Bertolino & O’Hanlon, 2002; Fisch, Weakland, & Segal, 1982). Using a systems or ecological perspective to some extent, behavioral family therapy shares similarities with behavioral couples therapy. Behavioral family therapists believe that families develop behavioral patterns that may be counterproductive or maladap- tive, but these behaviors represent the family’s best efforts to respond to their situation (I. Falloon, 1988). Behavioral therapists’ intentions are to conduct a functional anal- ysis of the problem(s) and begin altering behaviors through traditional behavioral change strategies. Education and communication training are also important features of behavioral family therapy. To summarize, the body of an initial family interview most likely involves seeing the family from a systems or ecological perspective. Problems, tensions, and distress are discussed in relation to the context in which they occur, rather than to the pathology of one or more family members. Many, if not most, family counselors send the family home with homework or experiments, or at least new ways to think about their situa- tion. The bulk of the interview body provides the foundation for designing and imple- menting these interventions. Common Areas to Address Regardless of theoretical orientation in working with couples or families, there are cer- tain assessment domains that should be considered and, in most cases, explored during the body of an initial interview. These domains are described in the following section. The first three assessment domains—sex, money, and level of commitment—are spe- cific to couples. 354 Interviewing Special Populations Sex When working with romantic partners, satisfaction with sexual intimacy is a central area to assess. However, it can be difficult for interviewers to ask questions about sex- ual functioning. Therefore, you should practice asking unusual or difficult questions. One of our favorite homework assignments for interviewers consists of the following: “During the next week, spend several hours loudly discussing the details of your sex life with your class partner while out at a crowded local restaurant.” Of course, after giving this assignment, we follow it with: “Okay, if you’d rather not complete the original assignment, then simply discuss sex with each other quietly, in a very private and confidential setting.” The point is that interviewers, as well as couples, need to become comfortable talking about sex. For the most part, you may find relief in the fact that couples probably have a more difficult time answering your questions about their sex life than you have asking, which makes your comfort with this aspect of couple functioning all the more important. In the first interview, you may or may not get a chance to ask about sex, and in addition, when you do ask, you may get a quick “Oh, fine. We’re fine in that area.” Later, after more trust has been established, very different answers to questions about sexual func- tioning may surface. What matters is that you ask about sexual functioning, compati- bility, and satisfaction in a natural, caring way. Money Although easier to ask about than sex, money is often a difficult issue for couples. Ques- tions about money practices include who pays the bills, whether checking accounts are joint or separate, if there is agreement with regard to saving and spending, and so on. By evaluating how couples manage money in their relationship, interviewers may also glimpse how power is managed (or abused) in the relationship. Level of Relationship Commitment Only a minority of couples enter counseling because they simply want to improve their relationship. They arrive excited and interested to explore ways to increase their rela- tionship satisfaction, and are fully committed to continuing the relationship. Other couples come to counseling to repair or work on certain troublesome areas in their re- lationship but have not seriously considered ending the relationship. They are commit- ted, but are experiencing significant distress. Still other couples come to counseling with a marked imbalance in their commitment, with one deeply questioning whether to stay in the relationship and the other desperately committed to keeping things together. Finally, there are couples who come to counseling as a last resort; they are not very committed to each other anymore and hold little hope for continuing their relationship. Either directly or indirectly, you need to obtain a clear idea of where the couple you are interviewing fits along this continuum. The Stuart Couples’ Precounseling Inven- tory provides each client with questions that interviewers can use to assess commitment without asking about it directly in front of the other partner during an interview (Stu- art & Stuart, 1975). Additional couple relationship measures range from the 280-item Marital Satisfaction Scale (D. K. Snyder, 1979) to the 32-item Dyadic Adjustment Scale (Spanier, 1976; see Sporakowski, Prouty, & Habben, 2001, for a brief review). Family of Origin It is certainly not feasible to devote a great deal of time to each person’s upbringing and family of origin relationship patterns, but it helps to at least get an overview of this im- Interviewing Couples and Families 355 portant area, both in couple and family work. You can gain a great deal of information by designing your intake paperwork to include the family history of each member of the couple with regard to relationships, deaths, divorces, and so on. It is also helpful to know about siblings’ marriages. However, beginning interviewers may have the follow- ing question when working with couples: Should I interpret the couple’s unresolved family of origin issues early on? Despite our belief that unresolved family of origin issues can strongly influence couple or marital interaction, we strongly advise against family of origin–based couple conflict interpretations during initial interviews. Premature interpretation in the couple context is generally inappropriate and certainly can turn couples off to counseling. In- stead, make a mental note or written progress note indicating that family of origin is- sues may be fueling couple conflict. Additionally, it may be appropriate to acknowledge this likelihood, but not describe the dynamics in an initial session. For example: “As you both probably know, your childhood experiences, your relationships with your mother and father or brothers and sisters can shape the way you relate to each other. I’m not sure if this is the case with the two of you, but as we work together, it may be useful for us to occasionally discuss how your family of origin experiences may be contributing to your current conflicts and the ways you go about trying to resolve these conflicts. But, because this is our first session, I won’t even venture any guesses about how your childhood experiences might be influ- encing your relationship.” As some theoretical perspectives suggest, family of origin issues may be deeply in- fluential, but they may also be outside client awareness (Gurman & Jacobson, 2002; Odell & Campbell, 1998). Consequently, as in the case of psychoanalytic interpreta- tions (discussed in Chapter 5), family of origin interpretations must wait for sufficient rapport and supporting information (or data) before they can be used effectively. As a family therapy technique, interpreting intergenerational family themes is probably less threatening, but should still be approached carefully. Genograms Most modes of family therapy and some modes of couple therapy use a schematic drawing of the family tree of both parents, including stepparents and half siblings. There are slight variations in the construction guidelines, but knowing how to do a ba- sic genogram is essential in working with families (Hartman, 1995; McGoldrick & Ger- son, 1985). The counselor may not actually do a genogram with the family present but may accumulate the data necessary to complete one. However, it is a common activity to do with families early in treatment. Numerous books are available for teaching in- terviewers how to complete genograms (Hood & Johnson, 1997; McGoldrick & Ger- son, 1985). Gathering Family Therapy Goals Many family therapists, when gathering information during the body of an interview, maintain balance by systematically orienting toward each family member. For ex- ample, Lankton, Lankton, and Matthews (1991) state: “We always ask each member what he or she would like to have changed in the family and how, and even if members contradict each other, each input becomes the basis of a goal” (p. 241). A key to gathering goals in family therapy is to emphasize inclusion and minimize 356 Interviewing Special Populations scapegoating or constant references to the identified patient. It is crucial to explore the range and quality of strengths and deficits of all family members and to begin deter- mining how they are influencing the identified patient (I. Falloon, 1988). Willingness to Make Changes A close corollary to the level of commitment in couple interviewing is each person’s will- ingness to do homework, try new things, experiment with change, and try out new per- spectives. Besides asking directly, a good way to assess this area is to have each member try a new behavior or listening skill during the interview. This can be as simple as saying: “Barney, I wonder if you could take Betty’s hand for a minute and just let her cry.” “Mom, it seems like you and Karen are sitting closer together than anyone else. I wonder if you could have Karen sit by her brother for a few minutes while Dad moves over here and we talk a bit further.” If the couple or family agrees to homework or to setting aside talking time, interview- ers should inquire as to exactly when such a new behavior might fit into their schedules. Kids, Parents, Neighbors, Friends Often, couples and/or families are the core of a circle of wider relationships, all of which contribute to one another’s well-being or struggles. Getting an idea of these interper- sonal and role demands operating on the couple or family system is important. Grand- parents, children and their friends, stepchildren, in-laws, close friends, and other asso- ciates can play influential roles in the happiness or unhappiness of a couple or family and can contribute to, or use up, many relationship resources. Considering the rich and interactive ways in which many outside factors influence couples and families is a core concept of the ecological approach to therapy (Brofenbrenner, 1979, 1986). Drugs, Alcohol, and Physical Violence Intake forms may help with gathering information about concerns in these areas. Sometimes, this opens the door to further sharing regarding fears of alcohol abuse or instances of past violence. This, like sex, may be an area wherein you get a simple “Everything’s fine” answer until much later, when trust has been established. However, simply asking, either in writing or verbally, begins the process of letting everyone know that you are open to hearing about trouble in these areas. When questionnaires or in- take forms are used to inquire about sensitive issues, interviewers should review the forms thoroughly and discuss significant issues with the couple or family. Depending on your perspective, it should be made clear to couples and families that any issues mentioned on questionnaires or intake forms are not confidential in the family or couple system and, therefore, may be discussed during the interview. The Closing Watching the clock closely is essential, but very difficult, in an initial interview with families and couples. There are more clients to manage and profound issues may be raised with just moments left in a session. We believe that when new issues are raised at the session’s end, it is appropriate, unless the issue represents a true crisis, to close the session by stating something such as: Interviewing Couples and Families 357 “Rosa, I’m glad you brought up the fact that you want to change your curfew. Un- fortunately, we’re out of time for today. So, next time, I want you to remind us about the curfew issue and we can discuss it earlier in the session, when we have enough time to deal with how everyone feels about it.” When working with families, it is often best to meet for an hour and a half or even two hours, but interviewers should be careful to stay within whatever time boundaries are originally agreed on. Make sure you allow plenty of time to “put things back to- gether” because the session may involve some intensely emotional material. You can- not be responsible for making each person feel better about the situation, nor is it eth- ical to minimize the problems so everyone leaves feeling artificially hopeful. On the other hand, it is in your power to support and compliment everyone’s efforts in coming for help. It is in your power to provide structure that enables each person to regain com- posure. In addition, it is usually in your power to offer a sense of direction for the fam- ily counseling work. As with all closings, summarization is an important tool. Couples or families who come and share their problems and fears need to be reassured that they have been heard. They also need help finding closure and preparing to leave. A thorough, sensi- tive summary helps facilitate these goals: “Well, today we certainly covered a lot of important material. Your family has been through a lot and you have ideas about things that you would like to work on. Grandma’s death seemed like it would be much easier than it has been, given she had been ill for so long. Her death, along with Peter’s recent legal trouble and Ginny’s decision to move in with her boyfriend next month, has just seemed like too much, and your old comfortable ways of talking with each other seem to have disappeared. Dad, you’re often angry. Mom, you feel torn 50 different ways. Ginny, you feel nobody pays much attention to you, and Peter, everyone pays too much attention to you. Now, I may not have repeated everything, but I think that catches some of the main areas. Did I miss any big ones?” Another common closing tool for many theoretical orientations is the homework as- signment. This might involve communication time, journaling, charting behaviors, go- ing on dates, reading, listening to instructional tapes, or any number of activities. The important thing to remember is that your opening explanation of how you work should alert the couple or family to the notion that you would be asking them to do something between sessions. Finally, in closing with multiple people, try to acknowledge that their lives will con- tinue to intersect after the session. You may want to devise a short statement, the es- sence of which communicates “This will be different at home.” An example is: “Being in counseling together, with me here to guide, ask questions, and even boss people around, is obviously different from when you are together at home. We’ve talked about some areas that are really troubling and hard. I’m sure you’ll con- tinue talking about them at home, but I hope you will remember to try some of the guidelines we’ve used today. If it gets too damaging, or too hard, we’ll have more time to work on things next week. It’s okay if everything doesn’t get solved at once.” 358 Interviewing Special Populations Termination As noted earlier, working with couples and families is complex simply because of the number of people involved. In some situations, it can be complicated to schedule the next meeting, so a few minutes for this need should be allocated at the session’s end. It is awkward and unprofessional to run out of time and leave people unsure of when the next meeting time is. Concluding comments should be brief, reassuring, and upbeat. Again expressing your respect for their choice to come in, your appreciation for their work, or noting events up- coming in the week (birthdays, travel plans) can be good transitional termination talk. FORMAL COUPLE AND FAMILY ASSESSMENT PROCEDURES Numerous couple and family assessment devices exist. It is beyond the purpose of this book to provide detailed descriptions of these devices. Therefore, instead of providing an exhaustive review of couple and family assessment procedures, we have listed some of the most popular instruments and procedures, along with their original references, in Table 12.1. Interviewing Couples and Families 359 Table 12.1. Couples and Family Assessment Instruments Instrument and Citation General Description Family Environment Scale The assumption underlying this measure is that environments, (FES), Moos and Moos, 1986 such as families, have unique personalities that can be mea- sured in much the same way as individual personality. Thus, the 90-item family environment scale seeks to measure the unique social climate within the family. The Family Genogram, The family genogram is a procedure that enables therapists to McGoldrick and Gerson, graphically represent family structure. It is very popular among 1985 family therapists. The genogram is essentially a visual map of family relationships. It contains factual information such as names, ages, deaths, divorces, etc., as well as relationships. Marital Satisfaction Inventory This instrument is a self-report designed to assess marital in- (MSI), D. Snyder, 1981 teraction and marital distress. It includes 11 subscales (e.g., problem-solving communication, disagreement about finances, sexual dissatisfaction). The inventory should be completed by both partners and results are graphed on a single profile so that partner differences can be identified, discussed, and ad- dressed in counseling. Myers-Briggs Type Indicator Widely known as the MBTI, this instrument is often used to (MBTI), I. Myers and help couples understand their differences and similarities. The McCaulley, 1985 MBTI emphasizes normality rather than pathology, and there- fore couples are given feedback about their normal differences and how to live together more efficiently. Stuart Couples’ Precounseling This questionnaire assesses couple relationship areas such as Inventory (SCPI), Stuart and communication, conflict management, relationship change Stuart, 1975 goals, and others. It emphasizes a social learning approach to relationship change. Consequently, the instrument focuses on descriptions of current interaction patterns, rather than per- sonality characteristics. SPECIAL CONSIDERATIONS The following discussion focuses on situations and issues that interviewers who plan to work with couples and families should consider. These situations and issues are unique to working with couples and families. Identifying, Managing, and Modifying Conflict Couples or families who come for help are frequently there because they have encoun- tered serious conflicts in their relationship and lack the skills to resolve them. There- fore, interviewers must identify, manage, and sometimes modify the ways couples and families express their conflict. Some couples and families seem to fight more readily and naturally than they do anything else. There are a number of issues related to conflict that manifest when interviewing couples or families. Conflict Process versus Conflict Content Couples come to counseling with numerous conflicts. For example, three of the top ar- eas of ongoing conflict reported by couples are money, sex, and in-laws. Of course, there are many other potential couple conflict areas, including division of labor, child rear- ing, and recreational and religious pursuits/preferences (D. K. Snyder, 1979). Similarly, families arrive in counseling with a variety of common conflict areas. Shared duties, chores, children’s individuation needs, and fairness in family resource allocation are some of the most common family issues presented in counseling. Conflict content refers to what is argued about. In contrast, conflict process refers to how everyone argues. This is an important distinction, and clinical interviewers must, during the first session, help couples and families identify both what they are arguing about as well as how they are arguing with one another. Most couples and families who come to therapy are engaging in destructive or inef- ficient conflict process. This is an assumption, albeit a relatively safe one. Specifically, we are assuming that couples and families who come to counseling have, at least to some extent, conflict resolution skill deficits. They are having problems with the how of conflict. Most human beings are not completely equipped with healthy and effective conflict management skills (Wilmot & Hocker, 1997). Of course, there are occasions when couples and families have significant conflict in numerous content areas and have tried various adaptive strategies to resolve their differences. Both conflict content and conflict process are manifest during an initial family or couple counseling interview. Both are important. Further, it is likely that the inter- viewer may have personal reactions to both what families and couples argue about and how they argue. How Do You Feel about Conflict? Not everyone enjoys open conflict. Some people are conflict avoiders and others are conflict seekers (Wilmot & Hocker, 1997). This is true about counselors as well as clients. If, as an interviewer, you find yourself having strong conflict avoidance quali- ties, you may not be well-suited to becoming a couple or family counselor. Generally, before entering the marriage and family counseling field, it is advisable to explore how you respond to interpersonal conflict and what conflict issues push your buttons (see Putting It in Practice 12.2). 360 Interviewing Special Populations How Much Should You Let People Argue and Fight during the Session? As you might guess from material covered thus far in this chapter, our answer to this question is: Not much. As noted, usually families and couples come to counseling partly because their joint conflict resolution skills are poor or dysfunctional. Therefore, if you allow them to engage in open conflict without intervening and changing the pro- cess, they simply recapitulate their dysfunctional conflict patterns. It is the interviewer’s responsibility, among other things, to disrupt these patterns and help people establish new, different, and more adaptive conflict and conflict resolution patterns. The only reasonable rationale for allowing couples or families to engage in their usual dysfunctional conflict patterns is to gather assessment information. It can be useful for an interviewer to have a glimpse of how people usually argue and fight with one another. However, this observation period should be relatively brief, followed by a more analytic discussion of what happens when the couple or family system experi- ences conflict. To help couples or families transition from deeply emotional conflict to a more intellectual analysis of their conflict patterns, make a statement similar to the following: “Okay, I’d like you two (or in the case of families, everyone) to stop your argu- ment now.” Depending on the intensity of the conflict, this statement may need to be repeated or stated in a strong, authoritative manner. Continue your statement: Interviewing Couples and Families 361 Exploring Your Conflict Buttons To explore, in advance, how you might respond to various couple and family conflict scenarios, reflect on some of the following questions: 1. Do you have any conflict topics that push your personal or emotional but- tons? For example, some interviewers with extensive problems with their in- laws bring so much personal baggage into the session that they cannot help but reveal their biases when couples begin discussing in-law issues. 2. Do you have any strong biases about the ways that couples have to behave to continue in a marriage or partnership, or ways parents, children, and other family members must behave to be a “healthy” family? For example, some counselors may have idealistic visions of couple or family relationships. Having an overly idealistic attitude toward relationships may cause you to become rigid regarding how families or couples should relate to one another to maintain their relationship. 3. Do you carry conflict home with you? Working with families and couples is usually quite emotionally charged work. The conflicts you witness, help manage, and sometimes become a part of can be very draining. 4. When you were growing up, what conflict content issues and process styles were characteristic of your family? Did your mother and father avoid con- flict with each other, or did they engage in scary and threatening conflicts? Or, did they handle conflict gracefully? Putting It in Practice 12.2 “You’ve given me a glimpse into how you sometimes handle your conflicts. Let me tell you what I saw. First, Judy, I saw you express criticism toward Bill about his lack of involvement in housecleaning. Then, Bill, I saw you defend yourself by complaining that Judy’s housecleaning standards are too high. Then, Judy countered Bill’s statement by suggesting that his housecleaning standards are abysmally low. And then, Bill, you started talking about how usually, men and women have different cleanliness standards and that Judy needs to loosen up. And finally, the reason I interrupted your argument is that you both seemed to be getting more and more frustrated because little progress was happening. Is that right?” As you can see from this relatively tame example, conflict interactions accumulate a great deal of material very rapidly. Many things happen simultaneously. It can be daunting for an interviewer to perform the “simple” task of tracking and then accu- rately summarizing conflict process. This simple task is not so simple. It requires ex- ceptional listening skills and concise communication. It requires sensitivity. Couples are especially wary about whether the interviewer is siding more with one partner than the other. Aligning with a certain family member in family work is a potent interven- tion and should never be done inadvertently (Odell & Campbell, 1998; J. Patterson et al., 1998). Managing conflict also requires tact because interviewers must determine when and how to interrupt couple conflict. Interestingly, some theoretical orientations emphasize that the couple conflict pro- cess is guided and sometimes determined by unresolved family of origin issues (Luquet, 1996; Strean, 1985). While managing interpersonal conflict, it is also wise to note both content and process with this intergenerational view in mind. Putting It in Practice 12.3 provides a sample couple conflict scenario. Conflict interactions can escalate quickly. This is especially true in cases of physi- cally or emotionally abusive couples or families. Abusive or highly conflicted couples 362 Interviewing Special Populations Couple Conflict Intervention Imagine you are the interviewer for the following scenario. As you read the ex- ample, evaluate how comfortable you believe you would feel during the session. Write, word-for-word, an intervention you might try after the couple had re- turned to your office. Compare and contrast your answers with those of others. Darren is a 58-year-old American Indian. He is married to Anita, a 45-year- old Caucasian. It is Darren’s third marriage and Anita’s second marriage. Dur- ing the first few minutes of their initial session, Anita erupts in anger toward Darren. She accuses him of physical abuse, tells him she now understands why he’s been divorced twice before, and marches out of your office. Darren jumps up and runs after her. They both return about one minute later. Anita contin- ues to look angry and Darren is pleading with her to stay in the session and try to work things out. Anita turns to you and says that she refuses to speak to Dar- ren for the remainder of the session, but she will stay if you will try to “talk some sense into his head.” Reflect, either on your own or with a partner, how you might handle this couple’s counseling situation. Putting It in Practice 12.3 and families often have so much emotional energy and baggage that their conflicts erupt in powerful outbursts. We have had clients refuse to speak for the remainder of a session, try to hit or kick each other in the counseling office, and abruptly leave sessions amidst a flurry of profanity. The potential emotional explosiveness of couple and fam- ily interviews requires that interviewers maintain control throughout the session (Born- stein & Bornstein, 1986). Generally, with more disturbed couple or family systems, you must use greater structure and control to moderate the session. In extreme cases, you may act as an intermediary, paraphrasing almost everything that is said and sometimes not allowing the conflicting parties to speak directly to each other. In summary, allowing families or couples to act out their emotionally based, de- structive conflict processes during counseling is almost always ill-advised. Clients should not be allowed to yell at one another, raise accusations in an abusive manner, or repeatedly use ineffective communication skills. Instead, interviewers must structure the session and become more active, especially when working with high-conflict fami- lies and couples (Gurman & Jacobson, 2002; J. Patterson et al., 1998). Limit-Setting in the Service of Therapy Besides the bad modeling and potential damage done by allowing too much conflict in the couple or family work, the conflict itself can become a distraction. It is the inter- viewer’s job to control and minimize distractions so that the necessary work can get done. However, minimizing distractions often involves limit-setting that is uncomfort- able for the beginning interviewer to enact. Putting It in Practice 12.4 helps you explore your ability to set limits when interviewing couples and families. Diversity Issues Working with gay and lesbian couples or couples and families from different cultural backgrounds can present interviewers with unique problems (Green, 1996; Igartua, 1998). As discussed in Chapter 13, when an interviewer and client have clear and un- mistakable differences, the client may initially scrutinize the interviewer more closely than if the client and interviewer are culturally similar or of the same sexual orienta- tion. These circumstances call for sensitivity, tact, and a discussion of the obvious. The following case example illustrates one scenario requiring multicultural counseling skills. CASE EXAMPLE Jim and Ollie had been together for three years when they began encountering diffi- culties in their relationship. Both were students and had limited budgets, so they de- cided to seek couple counseling at a counseling clinic on campus, staffed by counsel- ing interns. When Jim called for the appointment, he simply indicated he wanted to see someone for couple counseling. The receptionist asked a few basic questions and set up a time for Jim and his partner to come in and see Mary, a fourth-year coun- seling graduate student. The receptionist had mistakenly assumed Ollie was female, so naturally, Mary was somewhat surprised to meet Jim and Ollie. Mary decided to use the receptionist’s error to start a discussion regarding the fact that Jim and Ollie were a gay couple and she was a heterosexual female therapist with very little background in working with gay or lesbian couples. With a warm Interviewing Couples and Families 363 [...]... relationship in doing effective multicultural counseling (Ho, 199 2; Paniagua, 199 8, 2001; D W Sue & Sue, 199 9) But what are essential components of such a relationship? What are helpful but optional components? Toward what should we be striving, as we become more multiculturally sensitive interviewers? How can we avoid cultural arrogance, the self-referencing syndrome, and counseling as oppression when working... which adds more relational and role strain (E Lee, 199 6) Orientation toward Authority Many Asian cultures are rigid and hierarchical in structure (E Lee, 199 6; Reischauer, 198 8) This is directly related to a concept called filial piety, which refers to the honor, reverence, obedience, and loyalty owed to those who are hierarchically above you (Kitano, 196 9) The deference toward authority manifests in a... oppression or do not fit the mold of young, White, and male (Atkinson & Hackett, 199 8; Wilkinson & Kitzinger, 199 6) There are many ways people find themselves grouped together and many ways these groupings affect identity formation, functioning in the world, and quality of life in the dominant culture As D W Sue et al ( 199 6) state: Each client (individual, family, group, organization) has multiple cultural... dominant parenting role Couples counseling often occurs because of child-focused concerns (Hines & BoydFranklin, 199 6) Also, African American women have been noted to stay in a dysfunctional relationship because of a reluctance to add further distress to the burdened lives of African American men (McGoldrick, Garcia-Preto, Hines, & Lee, 198 9) This reluctance to take care of themselves out of deference to... ill-advised to strongly confront Hispanics regard- Multicultural and Diversity Issues 383 ing their fatalistic or external locus of control orientation In some cases, encouragement to become or stay involved with the church may help Personalism Hispanic cultures are known for placing great emphasis on interpersonal relationships and valuing warmth, closeness, and honest self-disclosure (Axelson, 199 9)... emotionality, and gentleness According to Comas-Díaz ( 198 9), the concept of marianismo includes a belief in the spiritual superiority of women, who endure all the suffering produced by men Needless to say, machismo and marianismo are not generally socially acceptable gender-role guidelines in the dominant culture in the United States Families who im- 384 Interviewing Special Populations migrated experience... information about family functioning from a systems-psychodynamic perspective Skerrett, K ( 199 6) From isolation to mutuality: A feminist collaborative model of couples therapy In M Hill & E D Rothblum (Eds.), Feminist perspectives (pp 93 –105) New York: Harrington Park Press This chapter briefly describes a feminist approach to couples counseling Tannen, D ( 199 0) You just don’t understand: Women and men in... best to consider homosexuality, like left- or right-handedness, simply a fact of nature Some people are attracted to opposite-sex partners for sexual intimacy, and some people are attracted to members of the same sex Many homosexual people report knowing they were homosexual even before kindergarten, and others report becoming aware much later in life (White, 199 4) Because of stigma and lack of cultural... gay-friendly therapists suggest leaving homosexual-friendly pamphlets or literature in the waiting room to communicate an open attitude toward these issues (C Van den Burg, personal communication, November 199 7) It is also important that care is taken to avoid using gender-specific words indicating the assumption of heterosexuality For example, when inquiring about intimate relationships, the word partner... • Different culture-bound syndromes and matters of etiquette to consider when interviewing minority clients 371 372 Interviewing Special Populations RELATIONSHIP IN THE CONTEXT OF DIVERSITY Throughout this text, we emphasize the importance of the therapeutic relationship We believe that relationship is foundational to everything mental health professionals do— including clinical interviewing Many mental . other partner during an interview (Stu- art & Stuart, 197 5). Additional couple relationship measures range from the 280-item Marital Satisfaction Scale (D. K. Snyder, 197 9) to the 32-item. do— including clinical interviewing. Many mental health professionals emphasize the cen- trality of a therapeutic relationship in doing effective multicultural counseling (Ho, 199 2; Paniagua, 199 8, 2001;. treatment. Numerous books are available for teaching in- terviewers how to complete genograms (Hood & Johnson, 199 7; McGoldrick & Ger- son, 198 5). Gathering Family Therapy Goals Many family