Chapter 11: Culture - A Challenge to Concepts of Normality PDF

C H A P T E R 11 CULTURE A Challenge to Concepts of Normality MONICA MCGOLDRICK DEIDRE ASHTON No one goes anywhere alone, least of all into exile—not even those who...

C H A P T E R 11 CULTURE A Challenge to Concepts of Normality MONICA MCGOLDRICK DEIDRE ASHTON No one goes anywhere alone, least of all into exile—not even those who arrive physically alone, unaccompanied by family, spouse, children, parents, or siblings. No one leaves his or her world without having been transfixed by its roots, or with a vacuum for a soul. We carry with us the memory of many fabrics, a self soaked in our history, our culture; a memory, sometimes scattered, sometimes sharp and clear, of the streets of our childhood. —F RIERE (1994, p. 32) I n psychotherapy and the provision of social service assistance to individu- als, couples, and families, culture matters. Culture is primary, essential, and integral to the healing process (McGoldrick & Hardy, 2008; Smith, 2010; Sue & Sue, 2008). It is significantly correlated with our worldview, how we see our- selves in relationship to our world and others, how we define and understand reality, and how we think (Sue & Sue, 2008). All of our theories of psychol- ogy, human development, family systems, wellness, pathology, and healing are informed by cultural values, beliefs, and norms (Carter, 2003; Ponterotto, Casas, Suzuki, & Alexander, 2010). For example, traditional Eastern cultures tend to define the person as a social being and categorize development by growth in the human capacity for empathy and connection. Many Western cultures, by contrast, begin by positing the individual as a psychological being and defining development as growth in the capacity for autonomous func- tioning. African Americans (Boyd-Franklin, 2006; Hines & Boyd-Franklin, 2005) have a very different foundation for their sense of identity, expressed as a communal sense of “We are, therefore I am” contrasting starkly with the individualistic European ideal: “I think, therefore I am.” In the United States, the dominant cultural assumptions have generally been derived from a few 249 250 CULTURAL DIMENSIONS IN FAMILY FUNCTIONING Northern European cultures and, above all, British assumptions, which are taken to be the universal standard. Those values have tended to be viewed as “normal,” and values derived from other cultures have tended to be viewed as “ethnic.” These other values have tended to be marginalized, even though they reflect the traditional values of the majority of the population. Historically, throughout the mental health field, therapeutic models have generally been presented as if they were free of cultural bias rather than reflec- tions of the social assumptions out of which they arise. For example, although human behavior results from an interplay of individual, interpersonal, famil- ial, socioeconomic, and cultural forces, the mental health field has paid great- est attention to the personality factors that shape life experiences and behav- ior. Family therapists have recognized that individual behavior is mediated through family rules and patterns, but we have not sufficiently appreciated how deeply these rules are rooted in cultural norms. The study of cultural influences on human emotional functioning has been left primarily to cultural anthropologists. And even they have more often explored these influences in distant non-European cultures rather than studying the tremendous ethnic diversity within our own society. Currently, many of our mental health, counseling, social work, and fam- ily therapy professional associations and credentialing bodies acknowledge the relevance of culture in their ethical codes and standards of practice (Amer- ican Association of Marriage and Family Therapy, 2004; American Counsel- ing Association, 2005; American Psychological Association, 2010; Council on Social Work Education, 2010; National Association of Social Workers, 2008) by mandating that practitioners become culturally competent. Griner and Smith (2006) have demonstrated that interventions congruent with the cultural values and beliefs of clients increase retention, client satisfaction, and improve intervention outcomes. Over recent decades, the field of family ther- apy has increasingly expanded from a universalist perspective to include an awareness of the structural impact of gender in families and the relevance of culture (McGoldrick & Hardy, 2008). Under the universal perspective, patri- archal, white, middle-class, heterosexual families were held as the standard for normal development and health family functioning (see Walsh, Chapter 1, this volume). Gender perspectives challenged the patriarchal values underly- ing family systems theories and the ways in which women held less power in the world and were held more responsible for family functioning. Cultural perspectives have recognized minority cultures, but culture still tends to be thought of as something that non-Americans and people of color possess. When discussion of ethnicity has occurred, it has often focused on groups’ “otherness” in ways that emphasize their deficits rather than their adaptive strengths or their place in the larger society. The emphasis has also been on how so- called “minorities” relate to the “dominant” societal values of “nor- mality.” Since the 1990s, family therapy has moved toward the understanding that for all people, including white people of European ancestry, culture orga- nizes family patterns, structure, values, beliefs, norms, and practices, and is  A Challenge to Concepts of Normality 251 central for our thinking with every family with whom we work (McGoldrick, Giordano, & Garcia-Preto, 2005). Thus, everyone’s assumptions must be examined, not just those kept at the periphery of society. Despite the growing awareness that culture is ubiquitous, and that each cultural group has its own particular worldview (Sue & Sue, 2008), we still find ourselves in the position of having to convince many of our colleagues, trainees, and students of the dominant culture that culture matters for everyone. In many mental health and social service agencies data about cultural identity are routinely collected as part of the assessment process, but little, if anything, is ever done with this information. Dominant cultural assumptions are too often used to define normality, to conceptualize the presenting problem and to formulate interven- tions. In reviewing many introductory family therapy texts we find culture discussed as if it is relevant only for those who are not white or of European ancestry, and relegated to one page, or one chapter in the text, under the cat- egory of special issues or the treatment of special populations. We still find that many trainees and practicing clinicians resist focusing on culture. Eyes glaze over and they tell us they want to focus on the “real” clinical issues or that they “did” culture already in their undergraduate or graduate programs. Some note clients’ ethnicity, social class, religion, or race on assessment forms or genograms but do not attend to culture in a substantive way. ADDRESSING CULTURE: DIVERSITY AND COMPLEXITY To address culture in a meaningful way, it is important to define what it is, how cultural identity is determined and by whom, and how meaningfully to integrate culture into therapy and counseling. Culture refers to the ongoing social context within which our lives have evolved. It patterns our thinking, feeling, and behavior in both obvious and subtle ways, although generally we are not aware of it. Culture plays a major role in determining how we live our lives—how we eat, work, love, raise our families, celebrate, grieve, and die. Cultural identity has a profound impact on our sense of well-being, our mental, physical, and spiritual health. We are defining “culture” as including ethnicity, race, class, gender, sexual identity or orientation, generational status, religion, and migration experience. “Ethnic- ity” is a complex construct that refers to a group’s common ancestry through which they have evolved shared values, beliefs, and customs that are transmit- ted over generations through the family, providing a sense of belonging and historical continuity, and shaping identity. For example, “Jewish ethnicity” is a meaningful term to millions of people (Rosen & Weltman, 2005), yet immi- grants come from all parts of the world, with different migration patterns, and speak many languages. They may have Ashkenazi cultural roots from North- ern and Eastern Europe, or Sephardic traditions from North Africa or Spain, They also vary in religious beliefs and practices from orthodox, conserva- tive, and reform movements to secular humanists. Similar complexity applies 252 CULTURAL DIMENSIONS IN FAMILY FUNCTIONING to definitions of Arabs (Abudabbeh, 2005), who may be Eastern Orthodox Syrians, Roman Catholic Lebanese, or Jordanian or Egyptian Muslims. Yet there is some sense of cultural connection among these groups. To name one’s ethnicity as a single ethnic group (e.g., Irish, Anglo, African American) is to oversimplify, since we all have multiple cultural roots and are in the process of transforming our ethnic identities throughout our lives, influenced by the changing contexts in which we live. Our Evolving Ethnicities We are all always in the process of ongoing cultural evolution. Our ethnic identity is ever- changing—incorporating ancestral influences, while forging new and emerging group identities. Group identities emerge in a complex interplay of members’ relationships with each other, and with outsiders. We may feel negative or proud and appreciative of our cultural heritage, or we may not know thre cultural groups to which we belong. But our relationship to our cultural heritage will in any case influence our well being, as will our sense of relationship to the dominant culture. Do we feel we belong to it? Are we “passing” as members? Do we feel like marginalized outsiders? Or are we outsiders who have so absorbed the dominant culture’s norms and values we do not even recognize that our internalized values reflect their prejudices and attempts to suppress cultural difference? Our society’s dominant definitions of cultural groups have shifted over time. In the 1700s only those of British and Dutch ancestry were thought to be “white.” As Ben Franklin put it: All Africa is black or tawny. Asia chiefly tawny. America (exclusive of the new Comers) wholly so. And in Europe the Spaniards, Italians, French, Rus- sians and Swedes are generally of what we call a swarthy Complexion; as are the Germans also, the Saxons only excepted, who with the English make up the principal body of White People on the face of the Earth. I could only wish their numbers were increased. (quoted in Hitchcock, 2001, p. 18) Over the centuries we have greatly expanded the category of “white” cultures to include Europeans previously considered “ethnic,” such as Poles, Italians, Irish, and Jews. People of mixed heritage are often pressed to identify with a single cultural group rather than being able to claim the true complexity of their cultural heritage (Root, 1992, 1996). The 2000 Census was the first to allow people to acknowledge any mixed heritage. However, many believe that white majorities are seeking to increase their count through distinctions for Latinos between those who are white and those who are of color, out of concern that whites are expected to become less than half of the population by 2050. Ethnic intermarriage also plays an enormous role in the evolution of cul- tural patterns (Crohn, 1995; McGoldrick & Garcia-Preto, 1984; Root, 2001).  A Challenge to Concepts of Normality 253 Although, as a nation, we have a long history of intercultural relationships, until 1967 our society explicitly forbade racial intermarriage, and discour- aged cultural intermarriage as well, because it challenged white supremacy. But traditional ethnic and racial categories are now increasingly being chal- lenged by the cultural and racial mixing that has been a long submerged part of our history. Maria Root (1996, 2001), one of the prime researchers on this area, has defined a special bill of rights for people of mixed race, asserting their right to define themselves for themselves, and not be limited by society’s racial and ethnic stereotypes and caricatures. The consciousness of ethnic identity varies greatly both between and within groups. Indigenous people of this land, and many immigrants, have been forced to assimilate and to give up their names, their language, and their cultural connections. Because of the pressure within our society to conform to dominant cultural norms that deny the existence of bias, others may ignore or deny their ethnicity by changing their names, and rejecting their families and social backgrounds. Whether by choice or force, the surrender of cultural connections creates a loss of historical and cultural continuity and identity. Intrafamily conflicts over the level of accommodation should be viewed not just as family conflicts, but also as reflecting explicit or implicit pressure from the dominant culture regarding which characteristics are more highly valued. Individuals should not have to suppress parts of themselves in order to “pass” for what the dominant group defines as “normal.” People function best when they are at peace with the multiple aspects of who they are and are not forced into rigidly defined group identities that cause strains in loyalties. Those who try to assimilate at the price of forgetting their connections to their heritage are likely to have more problems than those who maintain a positive sense of connection with their heritage. As family therapists we believe in help- ing clients understand their ethnicity as a fluid, ever- changing aspect of who they are, not something to be defined for them by others. The character Vivian Twostar in The Crown of Columbus (Erdrich & Dorris, 1991) describes the complexity this cultural self-definition always entails: I belong to the lost tribe of mixed bloods, that hodgepodge amalgam of hue and cry that defies easy placement. When the DNA of my various ancestors Irish and Coeur d’Alene and Spanish and Navajo and God knows what else combined to form me, the result was not some genteel indecipherable puree that comes from a Cuisinart. You know what they say on the side of the Bis- quick box, under instructions for pancakes? Mix with fork. Leave lumps. That was me. There are advantages to not being this or that. You have a million stories, one for every occasion, and in a way they’re all lies and in another way they’re all true. When Indians say to me, “What are you?” I know exactly what they’re asking and answer Coeur D’Alene. I don’t add, “Between a quarter and a half,” because that’s information they don’t require, first off though it may come later if I screw up and they’re look- ing for reasons why. If one of my Dartmouth colleagues wonders, “Where did you study?” I pick the best place, the hardest one to get into, in order 254 CULTURAL DIMENSIONS IN FAMILY FUNCTIONING to establish that I belong. If a stranger on the street questions where (my daughter) gets her light brown hair and dark skin, I say the Olde Sodde and let them figure it out. There are times when I control who I’ll be, and times when I let other people decide. I’m not all anything, but I’m a little bit of a lot. My roots spread in every direction, and if I water one set of them more often than others, it’s because they need it more.... I’ve read anthropo- logical papers written about people like me. We’re called marginal, as if we exist anywhere but on the center of the page. We’re parked on the bleachers looking into the arena, never the main players, but there are bonuses to peripheral vision. Out beyond the normal bounds, you at least know where you’re not. You escape the claustrophobia of belonging, and what you lack in security you gain by realizing—as those insiders never do—that security is an illusion.... “Caught between two worlds,” is the way we’re often characterized, but I’d put it differently. We are the catch. (pp. 166–167) Twostar’s brilliant expression of a multifaceted cultural identity com- prised of complex heritages reflects the experiences of many. It illustrates the ways in which context and the projection of others determine which aspect of identity we highlight, and emphasizes what those who belong have to learn from those who are marginalized. If we look carefully enough, everyone is a “hodgepodge.” Those who were born white, who conform to the dominant societal norms, probably grew up believing that “ethnicity” referred to others who were different from them- selves and that they were “regular.” As Tataki (1993) has pointed out, we have always tended to view Americans as European in ancestry. Many students, trainees, and professionals of European ancestry have made such assertions. Those of African, Latin, Asian, Arab, Aboriginal, or Indigenous ancestry are more likely to affirm that they have a culture and know what it is and what it is not. Cultural awareness is often born out of experiences of oppression and marginalization as cultural identity becomes a source of strength, resil- ience, and survival. Those who assert that they do not have a culture are often members of the dominant group whose way of being in the world is taken for granted, rarely challenged, and seen as universal truth. And those of us in mental health have been specifically trained by the official diagnostic manual (DSM) to define problems as if they exist in some universal vacuum, without reference to culture. The current edition of the manual specifically disallows discussion that asserted diagnoses are influenced by cultural factors. If we study our individual, family, and collective subjugated histories, we will learn or be reminded that many of us who claim one cultural identity or no cultural identity are “mixed blood,” and our context has determined how we name and claim ourselves as well as the way in which others view us. When asked about my cultural identity, today my (Deidre Ashton) quick response is Black (United States of) American or African American. As a child in the 1960s and 1970s I simply saw myself as Black, a member of a group who began in slavery. This limiting conceptualization was based on an edu- cation that did not discuss the history of Black people in the world prior to  A Challenge to Concepts of Normality 255 slavery. World history included primarily North America and Europe, and to a much lesser degree Asia, South America, and Central America. I did not see myself as American as I was aware that even following the civil rights move- ment, Black people held second-class status in the United States. I thought that only white people were American, because everything outside of my family reflected whiteness—my toys, television programs, music played on most radio stations, textbooks, and most of the literature presented in edu- cational settings, including my children’s Bible. When I entered college I was introduced to an Afrocentric worldview, and learned that I was of African descent and that, like many Black people born and raised in the United States, I could not specify a country of origin because my ancestors were forcibly taken from their homes. When African American became the seemingly self- selected name for ourselves, I was pleased to claim the African roots already integrated into my identity, but I had white colleagues who were born in South Africa and naturalized in the United States, so were they too African Ameri- can? Because being Black in the United States means being connected to a particular history, sociopolitical experience, values, and beliefs that have been shaped by African cosmology, racism, the maafa, enslavement, and liberation movements, I came to see Black/African as my racial/cultural identity. Finally, when I traveled outside the United States, I came to see myself as an (United States of) American, based on my language, beliefs and practices, and the unearned privilege I was granted by people of other nations. I am a Black/ African (United States of) American. However, there are other aspects of my ancestry that I do not name when I am asked to name my racial/ethnic identity. I am also of Shinnecock, Irish, and Scottish descent. These are the roots that I believe Twostar would describe as less watered. The color of my skin, and that of my parents, and their par- ents in migration between northern Virginia and Long Island, New York, and the system of racial stratification organizing the United States, determined that my Black, now African roots would be watered regularly and come to dominate my sense of ethnic identity. I do not claim that the Shinnecock, Scot- tish, and Irish do not have influence over my identity. For now, that influence is out of my awareness, gone on a conscious level but perhaps not forgotten on a metaphysical level. I (Monica McGoldrick), born in 1943 in Brooklyn, New York, one of the most diverse cities on the planet, and raised there and in Bucks County Pennsylvania, grew up thinking I was “regular” and that the concept of eth- nicity did not apply to me. Nowhere in all my education was this concept challenged. I learned basically only white history, educated in the 1950s east- ern United States in relatively affluent communities and schools (virtually all white all the way from kindergarten through graduate school). I am of Irish heritage, the fourth generation born in the United States, so by the time I came along we knew we were Irish in name only. No reference was ever made in my family to any influence of Irish heritage, and such a concept had no meaning to me. Having studied Russian culture in college and graduate 256 CULTURAL DIMENSIONS IN FAMILY FUNCTIONING school before moving to social work and family therapy in the mid-1960s, I still had no idea that culture pertained to me. Even when I married my Greek immigrant husband in 1970 I thought I was still “regular” but had just mar- ried into ethnicity! It was not until I was 32 and went to Ireland for the first time that I was transformed by the realization that I had been Irish all the time and never knew it. I think now my family felt so much shame and pain in their migration to this country that they saw their salvation in giving up their culture and trying to pass for the dominant group. So I grew up with a real emptiness about who I was, but without any awareness of the cultural mystification in which I was raised. I think often now of the questions I never thought to ask about my own history and about the history of others around me. I grew up in a multiracial household, where the person closest to me was African American, but the servant in the household. Yet I never asked why this racial arrangement existed, why my schools and neighborhoods were so segregated, why the history I learned was only about white people. It amazes me now how few cultural questions I ever asked. What happened to suppress my curiosity about the cultural context in which I grew up, and what has it cost me in obliviousness to the pernicious cultural structures in which all our lives are still embedded? Developing cultural respectful practice requires us to question the domi- nant culture values, to explore the complexities of cultural identity, and to develop culturally informed healing practices that are liberating (Sue & Sue, 2008). Our healing work may often entail helping clients locate themselves culturally so they can overcome their sense of mystification, invalidation, or alienation that comes from not being able to feel culturally at home in one’s society. It becomes imperative for every clinician, researcher, and educator in the field to examine his or her cultural identity. How do you define yourself culturally? Do you see yourself as of mixed blood? Of one cultural group? Of no cultural group? What experiences shape how you see and define yourself or how others see you? When asked to define yourself, what feelings emerge: pride, shame, confusion, anger? As a member of your cultural group(s) do you feel seen and understood, or are you, as the character Twostar says, at the margins? Is your response to these questions “It depends,” meaning that cul- ture is fluid, unfolding, evolving, complex, and embedded in history and con- text? We view “cultural genograms” as axiomatic for all work with trainees and clients (Hardy & Laszloffy, 1995; McGoldrick, Gerson, & Petry, 2008). Genograms should help us contextualize our kinship network in terms of cul- ture, class, race, gender, religion, and migration history. When we ask people to identify themselves ethnically, we are asking them to make explicit themes of cultural continuity and identity. We need to develop an open social system with flexible boundaries so that people can define themselves by the groupings that relate to their heritages and practices, and go beyond labels such as “minorities,” “Blacks,” “Lati- nos,” “Asians,” or “Americans.” Our limiting language reflects the biases embedded in our society’s dominant beliefs. The term “Latino,” for example,  A Challenge to Concepts of Normality 257 refers simultaneously to Native Americans of hundreds of different groups through Latin and South America, as well as to immigrants from numerous other cultures, including Cubans of Spanish origin; Chinese who settled in Puerto Rico; families from Africa, whose enslaved ancestors were brought to Latin and South America; and Argentinian Jews, whose ancestors fled Euro- pean ghettoes, pogroms, and the Nazi Holocaust (Bernal & Shapiro, 2005; Falicov, 2005; Garcia-Preto, 2005a, 2005b). The term “minority” peripheral- izes groups whose heritage is different from the dominant groups. The term “Black” obliterates the ancestral heritage of Americans of African heritage altogether and defines people only by their color. The term “Asian” lumps together separate cultural groups from India, Japan, Vietnam, Korea, China, Laos, and other countries that had thousands of years of separate history and even enmity toward each other. The fact that there is no term to describe people of the United States, such as “United Statesan,” but only the inaccu- rate term “American,” which makes invisible Canadians, Mexicans, and other Americans, is extremely limiting in our discussion of these issues. Factors Interacting with Ethnicity Understanding the intersection of ethnicity, race, class, gender, sexual orien- tation, class, religion, migration, and politics, as well as age and generation, and urban or rural background (Falicov, 1995) is essential to understanding culture. These factors influence every person’s social location in our society, access to resources, inclusion in dominant culture’s definitions of “belong- ing,” and how family members relate to their cultural heritage, to others of their cultural group, and to preserving cultural traditions. Systems of oppres- sion based on these socially constructed categories are interdependent and powerful forces as people who are marginalized may develop distinct world- views, values, beliefs, and survival practices in order to live under the weight of impoverished circumstances and contemptible treatment by individuals and institutions of the dominant, privileged cultural group (Liu, Soleck, Hopps, Dunston, & Pickett, 2004). Although two individuals may belong to the same ethnic group, their experiences may vary dramatically based on variation in membership in the socially constructed categories upon which society is strati- fied. In recognizing and working through a cultural lens, the challenge is to recognize the intersectionality of these multiple aspects of identity in an inte- grative and holistic manner rather than as additive statuses. However, for discussion purposes, we present each factor individually and ask the reader to think about the meaning of race, class, gender, sexual orientation, religion, migration status, and ethnicity as they interact with one another, and not as individual, competing components of culture. For exam- ple, when we discuss gender, let us not presume that we are focused on white, heterosexual, middle-class, natal women of European ancestry. We intend to focus on all women of varying ethnicities, classes, sexualities, gender expres- sions, races, and religions. We also attend to the interactive effects of the 258 CULTURAL DIMENSIONS IN FAMILY FUNCTIONING multiple forms of oppression that shape cultural evolution, family processes, and lived experience for both the privileged and the marginalized. Race and Racism Race is a sociopolitical issue, not a biological or genetic one. Despite our vari- ation in the ethnic identities, we all share a common ancestry tracing back to Africa (Cann, Stoneking, & Wilson, 1987). Race has been shown to be only skin deep and not correlated with any other meaningful attributes or abilities, such as intelligence. Racial groups differ in only about 6% of their genetic makeup, meaning that 94% of genetic variation is found to be within group variation (American Anthropological Association, 1998; Brown & Armela- gos, 2001; Goodman, 2006; Lewinton, 1972). As Ignatiev (1995) puts it: “No biologist has ever been able to provide a satisfactory definition of ‘race’—that is, a definition that includes all members of a given race and excludes all oth- ers.” Race is a biological expression of physical appearance that is socially and politically constructed to privilege certain people at the expense of oth- ers. It is a construct that imposes judgment on us from the outside, based on nothing more than our physical features. Racism operates like sexism, a similar system of privilege and oppression, justified within the dominant soci- ety as a biological or cultural phenomenon, which functions systematically to advantage certain members of society at the expense of others (Burton, Bonilla-Silva, Ray, Buckelew, & Freeman, 2010; Hardy & Laszloffy, 1992; Hitchcock, 2001; Katz, 1978; Mahmoud, 1998). Racism and poverty have always dominated the lives of ethnic minorities in the United States. Race has always been a major cultural definer and divider in our society, since those whose skin color marked them as different always suffered more discrimina- tion than others. They could not “pass,” as other immigrants might, leaving them with an “obligatory” ethnic and racial identification. Although racism may be more subtle and covert today, the politics of race continue to be complex and divisive, and, unfortunately, whites remain generally unaware of the problems our society creates for people of color. In a similar way that patriarchy, class hierarchies, and heterosexist ideologies have been invisible structural definers of all European groups’ ethnicity, race and racism have also been invisible definers of European groups’ cultural values. The invisible knapsack of privilege (McIntosh, 2008) that benefits all white Americans because of the color of their skin is something that most white eth- nics do not acknowledge. Although conditions have improved from a genera- tion ago, when Blacks were not permitted to drink from the same water foun- tains as whites or to attend integrated schools, we still live in an essentially segregated society. The racial divide continues to be a painful chasm creating profoundly different consciousness for people of color than for whites. Most people find it more difficult to talk to each other about race and racism than about ethnicity. Each new racial incident ignites feelings and expressions of anger and rage, helplessness and frustration. Exploring our  A Challenge to Concepts of Normality 259 own ethnicity and racial identity is vital to overcoming our prejudices and expanding understanding of ourselves in context. But we must also take care in our pursuit of multicultural understanding not to diminish our efforts to overcome racism (Katz, 1978). All therapists must be concerned about undo- ing racism to eradicate this pernicious force in our society. The judgments about self or family that reflect these false categorizations are almost impos- sible to avoid making in therapy (see Boyd-Franklin & Karger, Chapter 12, this volume). Social Class and Classism “Social class” is a complex construct that intertwines income, education, occupation, wealth, and access to resources, and reflects our social location and status (Laszloffy, 2008; Liu et al., 2004). Individuals of the same ethnic or racial group may have vastly different lives based on their social class. Those living in poverty have to deal with the stresses of survival; blighted and unsafe neighborhoods; and lack of access to quality education, jobs, and health care, as well as public scrutiny. All profoundly impact their way of being in the world, as well as the values and beliefs that they come to hold. In contrast, the worldview of the wealthy is informed by their experience of privacy and autonomy; getting their needs met is likely to be taken for granted, affording them time and energy to focus on fulfillment of their desires, without fear for their family’s support. The privileges of wealth may transform a worldview rooted in shared ethnic background and community interdependence and lead to an insensitivity to cultural context. The United States, always stratified along class lines, has become increas- ingly stratified in recent years, with the top 1% controlling 34% of our nation’s wealth, while the bottom 70% of our population controls just 29% (Kristof, 2010). This has led to a serious disconnect between those at the top, who control resources, and those below, who have less and less access or control over their lives and the values and direction of our nation. The dominant cul- ture tends to blame people for being poor, for failing to pull themselves up by their bootstraps, while ignoring the systems of oppression and inequality that deny access to the resources that support and enable the affluent to maintain and enhance their status (Laszloffy, 2008). When individuals and families of lower classes present for mental health or social service treatment, they are often objectified and treated as pathological because they are poor (Liu et al., 2004). Gender, Sexism, and Gender Oppression The dominant cultures of the United States, and many other societies hold the belief that biological sex determines gender, gender determines gender role, and gender role determines sexual orientation (Lev, 2004). While bio- logical sex may be a genetic fact, gender is a social construct that reflects the 260 CULTURAL DIMENSIONS IN FAMILY FUNCTIONING individual’s sense of self as man, woman, gender-variant or fluid, or tran- scendent of binary gender (Catalano, McCarthy, & Shlasko, 2007). Gender roles are socially constructed to reflect the ways in which society defines and determines the customs, behaviors, and practices deemed appropriate for peo- ple based on their biological sex and assumed gender identity (see Knudson- Martin, Chapter 14, this volume). Historically, when discussing the construct of gender we have thought of two categories: men and women. A binary gender system is a cornerstone in the construction of sexism, a system of oppression that privileges men over women (Botkin, Jones, & Kachwaha, 2007). The early feminist movement and gender perspectives in family therapy examined and challenged power differ- entials experienced by women in families and in society at large, and sought equality and justice in both private and public spheres. While they challenged patriarchal assumptions embedded in theories of normal family functioning, most did not name or challenge binary gender assumptions, As lesbian, gay, bisexual, and transgender (LGBT) professionals in our field advanced clini- cal awareness and attention to LGBT issues in clinical training and practice, there has more recently been greater consideration of gender-variant individu- als and wider recognition of gender fluidity and gender oppression (Lev, 2004; McGoldrick & Hardy, 2008). The relationship among culture, gender, and gender roles is multidirec- tional, as gender is embedded in cultural values and beliefs, and gender and gender roles shape the evolution of culture over time as the less empowered and marginalized groups develop counter worldviews to transcend the limita- tions of traditional cultural imperatives. Additionally, there is variation in the construction of gender identity and gender role performance cross culturally. For example, some of the indigenous peoples of the Americas do not subscribe to binary gender but to a continuum of multiple gender possibilities (Griffin, 2007). African American and Jewish cultures reflect more gender role flexibil- ity. Thus, as clinicians working through a cultural lens, we must investigate our gender assumptions, and those of the theories we use, those embedded in the specific culture of those presenting for service, and the ways in which con- formance to gender definitions and gender norms feels oppressive and restric- tive or empowering and adaptive. Sexual Orientation and Identity, Heterosexism, and Heteronormativity Sexual identity and orientation are social constructs of the 20th century that are embedded in culture, and like race, class, and gender, deeply impact our experiences and the evolution of cultural practices (Griffin, D’Errico, Harro, & Schiff, 2007). “Sexual identity” consists of the integration of one’s sexual ori- entation, gender identity, and gender role (Stonefish & Harvey, 2005). “Sexual orientation” reflects the direction of sexual, affectional, and emotional attrac- tion, may evolve and shift over time, and is not determined by biological sex, gender identity, or gender role (Griffin, 2007; Lev, 2004; Stonefish & Harvey,  A Challenge to Concepts of Normality 261 2005). Heterosexism has evolved along with sexism and gender oppression to privilege straight, natal men, with racism to privilege white straight, natal men, and classism to privilege white, middle-class, straight natal men. Much like the feminist movement at the outset, the gay and lesbian civil rights move- ments were begun by white, middle-class men and women, with early activ- ism sparked by the 1969 Stonewall uprising (that included white gay men and lesbians, working class and LGBT people of color; Griffin et al., 2007) and the AIDS epidemic in the 1980s. Gradually, focus has expanded to address con- cerns of LGBT persons of color, across cultures, and across class. However, it is still mostly white voices that are being heard (Catalano et al., 2007). A recent study focused on urban African American and Latino LGBT communities highlights the ways in which cultural groups that occupy mul- tiple marginalized statuses develop alternative kinship structures. One struc- ture that provides a protective, safe, accepting, and nurturing home for queer, urban African American and sometimes Latino/a LGBT people is known as the “ballroom” or “house culture” (Arnold & Bailey, 2009). The houses consist of fictive kin networks that join together to produce performance art shows. On the surface, show production may appear to be raison d’être for the ballroom community. However the houses feature a national kinship network in which queer African American and Latino youth and adults can feel cultur- ally at home, and create norms and customs that promote authentic gender and sexual identity expression and protect against the insidious effects of rac- ism, sexism, classism, gender oppression, and heterosexism. Ballroom culture illustrates the way race, ethnicity, gender, and sexual orientation interact to generate adaptive cultural practices that build on the African American and Latino/a traditions of creating family that is inclusive of fictive kin. Spirituality, Religion, Religious Oppression “Religion” is a socially constructed institution, organized by a set of values, beliefs, norms, practices, and ritual behaviors that joins people together and creates a spiritual community (Fukuyama & Sevig, 1999; Schlosser, Foley, Potrock Stein, & Holmwood, 2010; see Walsh, Chapter 15, this volume). Because religious institutions and dogma strongly influence individual and family beliefs and practices, religion has been a powerful force that shapes cul- ture and reinforces certain cultural norms, such as patriarchy. Ethnicity and religion are inextricably intertwined. People who practice Islam may be seen as an ethnic group despite variation in race, ethnicity, and nationality. Among many African Americans and other ethnic groups, religious tradition is an essential element of culture as it has been a powerful influence in organizing the community, and in resisting and overcoming oppression (Boyd-Franklin, 2006; Falicov, 2005; Kamya, 2008; Sue & Sue, 2008). Accordingly, attention to the potential of religion and spirituality for harm, as well as for healing and resilience, becomes critical in assessing strengths, resources, and organizing beliefs of families that present for therapy (Walsh, 2009, 2010). 262 CULTURAL DIMENSIONS IN FAMILY FUNCTIONING Migration Experience Because of the historical practices of eminent domain and the fact that this country consists mostly of immigrants who migrated in the both the distant and recent past, migration experience is a critical aspect of culture. Fami- lies’ migration experience may have a major influence on their cultural val- ues (see Falicov, Chapter 13, this volume). To understand them, it is essential to know the reasons for migration, the length of time since migration, the group’s historical experience, and the degree of discrimination experienced. A family’s dreams and fears when immigrating become part of its heritage. Parents’ attitudes toward what came before and what lies ahead will have a profound impact on the expressed or tacit messages they transmit to their chil- dren. Families that have experienced trauma and devastation within their own society, before even beginning the process of immigration, will have a monu- mentally more difficult time adjusting to a new life than those who migrated for economic betterment. The hidden effects of this history, especially where it goes unacknowledged, may linger for many generations, as illustrated by the history of the Irish (Hayden, 2001; McGoldrick et al., 2005), Armenians (Dagirmanjian, 1996), African Americans (Hines & Boyd-Franklin 2005), Latinos (Garcia-Preto, 2005b), and Jews (Cowan, 1982; Rosen & Weltman, 2005), among others. Adaptation to the new situation is also affected by whether one family member migrated alone or whether a large portion of the family or community came together. Those who migrate alone usually have a greater need to adapt, and their losses are often more hidden. Families who migrate together, such as the Scandinavians who settled in the Midwest, are often able to preserve much of their traditional heritage. When a large part of the population or nation comes together, as happened in the waves of Irish, Polish, Italian, and Jewish migration, discrimination against the group may be especially intense, as the newest immigrants are often regarded as a threat to those who came just before, who fear losing their tenuous social status and economic secu- rity. Collective migration may also create opportunity for an ethnic enclave to emerge. These neighborhoods can provide a cushion against the stresses of migration and help to sustain cultural links through the preservation of language and availability of familiar foods and local religious congregations. Families who remain within an ethnic neighborhood, who work and social- ize with members of their group, and those whose religion reinforces ethnic values, will probably maintain their ethnicity longer than those who live in heterogeneous settings. Therapists need to be as attuned to migration stresses and ethnic identity conflicts as they are to other stresses of a family’s history (Falicov, 2011). They should learn about the family’s ethnic network and encourage the rebuilding of social and informal connections through family visits or letters, or creat- ing new networks. Assessing such factors is crucial for determining whether a family’s dysfunction is a “normal” reaction to a high degree of cultural  A Challenge to Concepts of Normality 263 stress, or whether it goes beyond the bounds of transitional stress and requires greater intervention. Not Romanticizing Culture It is essential to remember that because values or beliefs are cultural does not mean they are sacrosanct. Some cultural practices are unethical. Mistreatment of women or children through disrespect, physical abuse, or sexual abuse is a human rights issue, no matter the cultural context in which it occurs. Every intervention is value laden. We must not use notions of neutrality or “decon- struction” to shy away from committing ourselves to the values we believe in. We must have the courage of our convictions, even while realizing that we can never be too certain that our perspective is the “correct” one. It means we must learn to tolerate ambiguities and continue to question our stance in rela- tion to the position and values of our clients. And we must be especially care- ful about the power differential if we are part of the dominant group, since the voices of those who are marginalized are harder to hear. The disenfranchised need more support to have their position heard than do those who feel they are entitled because theirs are the dominant values. We must address all forms of oppression and discrimination. We must work for the right of every person to have a voice and a sense of safety and belonging. When cultural groups are encouraged to “speak for themselves,” we must consider the process by which the spokesperson has been selected. Helping families define what is “normal” in the sense of healthy may require supporting marginalized voices within the cultural group that express liberat- ing possibilities for family adaptation. Stereotypes While generalizing about groups has often been used to reinforce prejudices, one cannot discuss ethnic cultures without generalizing. In fact, we perpetu- ate covert negative stereotyping by failure to address culture explicitly in our everyday work. Many avoid discussion of group characteristics altogether, in favor of individual family patterns, maintaining, “I prefer to think of each family as unique,” or “I prefer to think of family members as human beings rather than pigeonholing them in categories.” But the values, beliefs, status, and privileges of families in our society are profoundly influenced by their sociocultural location, which is deeply embedded in their cultural background; thus, these issues are essential to our clinical assessment and intervention, and the failure to acknowledge and discuss group characteristics is a failure to acknowledge culture. Our openness to making a space for cultural diversity is the key to expanding our cultural understanding. We learn about culture primarily not by learning the “facts” of another’s culture but by changing our own 264 CULTURAL DIMENSIONS IN FAMILY FUNCTIONING attitudes about cultural difference (Fadiman, 1998). Cultural paradigms are useful to the extent that they help us challenge our long-held beliefs about “the way things are or are supposed to be.” But we cannot learn about culture cookbook fashion through memorizing recipes for relating to other ethnic groups. Information we learn about cultural variation will, we hope, expand our understanding and cultivate humility and respectful curiosity about those who are different from us. The best cultural training for family therapists might be to experience what it is like not to be part of the dominant culture by traveling to a foreign country or participating in community experiences other than their own, such as attending a church in a Black or Latino community. It could help us gain the humility for respectful cultural interactions, based on more than a one-way hierarchy of normality, truth, and wisdom. CLINICAL PRACTICE GUIDELINES Appreciation of cultural variability and transparency about the cultural foun- dation of our working theories leads to a radically new conceptual model of clinical intervention. It is important to remember that variability exists not only between groups but within groups based on race, class, gender, sexual orientation, religious affiliation, and migration experience. Helping a person achieve a stronger sense of self may require resolving internalized negative cul- tural attitudes, and cultural conflicts within the family or between the family and the community, or in the wider context in which the family is embedded. It may also include helping individuals and families identify and consciously select which cultural values they wish to retain and which they wish to discon- tinue. Families may benefit from coaching to distinguish deeply held cultural beliefs and practices asserted for emotional reasons. It is almost impossible to understand the meaning of behavior unless one is first aware one’s own cultural assumptions, and knows something of the cultural values of a family. Even the definition of “family” differs greatly from group to group. For example, the dominant American (Anglo) defini- tion focuses on the intact nuclear family, whereas family for Italians means a strong, tightly knit three- or four-generational family, African American fam- ilies often include an even wider network of kin and community, and Chinese definitions of family generally reflect a very much longer time frame, including all male ancestors and descendents. Other obvious and essential variables are the family’s attitude toward help seeking and therapy, how they define prob- lems, and how they understand their resolution. The dominant assumption is that formal institutions can be trusted and are resources, and that talk is good and can heal a person. Therapy has even been referred to as “the talking cure.” Talking to the therapist or to other family members is seen as the path to heal- ing. Clients may not talk openly or seek therapy for many different reasons related to their cultural background or values. Consider the different value  A Challenge to Concepts of Normality 265 various cultures place on help seeking, the source of help, and talk therapy. For instance, in Sioux Indian culture, talking is actually proscribed in certain family relationships. A wife does not to talk directly to her father-in-law, for example, yet she may experience closeness to him. The reduced emphasis on verbal expression seems to free Native American families for other kinds of experiences of each other, of nature, and of the spiritual realm. There may be variation in what ethnic groups define as problematic behavior. First, culturally based strengths may become problematic as the context changes. Second, based on their worldview, groups may value some practices over others. Third, cultural groups vary in how they understand problem formation and conceptualize useful responses to problems. How- ever, we cannot make assumptions about how families define problem forma- tion or possible solutions simply because we know how they identify cultur- ally. We must bring respectful curiosity to our work and awareness of our own worldview. As we seek to join families in facilitating healing, in addition to listening for the various ways in which problems may emerge, be defined, or responded to, we must also listen for the ways families define and organize themselves, socialize their members, define and demarcate life-cycle transitions, and draw boundaries between themselves and the rest of the world (McGoldrick et al., 2005). What is adaptive in a given situation? Answering this requires apprecia- tion of the total context in which behavior occurs. The following case may help to illustrate this. Syreeta, a 36-year-old African American, middle-class, female therapist, working in a school-based counseling program in an urban, low-income community of color, presented a family in clinical supervision. Syreeta began working with the family when Mona, a 17-year-old Mexican American high school senior who was a stellar student, began to decline in her grades. Syreeta learned that Mona was pregnant and experienc- ing conflict with her parents because of the pregnancy. Mona wanted to graduate and then get a job in order to provide for her child, while Mona’s parents wanted her to drop out and join her mother on the fac- tory assembly line in order to prepare for the birth of her child. Syreeta met with Mona, her parents, and paternal grandmother in their home. She listened for the family’s description of the problem, their strengths, attempted solutions, and preferred outcome. Syreeta also informed the family that Mona needed a high school education and joined with Mona in attempting to shift the position of the parents. When presenting the family in supervision, Syreeta described the family as multigenera- tional, working class, and Mexican American. She expressed her lim- ited knowledge of Mexican American culture, and described the way in which she interviewed the family to elicit their cultural values, beliefs, and practices. Syreeta stated that she was deeply troubled by the fam- ily’s insistence that Mona drop out of school. In her hypothesis, Syreeta 266 CULTURAL DIMENSIONS IN FAMILY FUNCTIONING indicated that the parents seemed to conform to traditional Mexican gender roles, characterizing the father as a distant, uninvolved protector and provider, and the mother as a caretaker who was enmeshed with her daughter. Syreeta thought that the work of the therapy was to help the family acculturate, so that the parents would allow Mona to complete high school. Syreeta seemed to use her previous training about culture to explore cul- tural influence, to acknowledge her own knowledge gap, and to defer to the family’s expertise about their culture. However, she then erroneously inter- acted with the family in a way that was culturally incongruent and assessed the family according to culturally bound theories of normative development and healthy family functioning, the programmatic goal of increasing student retention, and her own middle-class African American values in which educa- tion is valued as the key to liberation. Her conceptualization of the presenting problem pathologized the family and resulted in formulation of a solution that required the family to devalue its culture and conform to the dominant norms. Through the lens of dominant culture theories, the supervisee did not acknowledge the ways in which a caring, cohesive family was attempting to keep the family together and prepare for the next generation. She potentially undermined the therapeutic relationship and the possibility of co- constructing a culturally respectful solution to address the needs of the student as an indi- vidual, and as a family member. Rather than seeing the family’s solution to a challenging situation as dysfunctional or wrong, the family was better served once the clinician was able to use supervision to recognize the cultural values and assumptions that informed her assessment and intervention. Syreeta was then able to recognize and respect the values of the family members, and their culture, and build on adaptive cultural strengths. She was able to ask questions about the fam- ily’s belief system, relationship history, migration story, level of acculturation, community relatedness, hopes, dreams, fears, and concerns without measur- ing them against dominant culture standards. Collaboratively, they were able to develop a plan for Mona to remain in school while working and preparing for the birth of her child, and using her family as a resource. The therapist’s role in such situations may become one of a cultural broker, helping family members to recognize their own ethnic values and to resolve the conflicts that evolve out of different perceptions and experiences. CONCLUSION Clinicians must conduct culturally grounded assessments that enhance the likelihood of engagement in culturally respectful, congruent, and competent healing practices. We need to inquire about the family’s cultural identity and  A Challenge to Concepts of Normality 267 listen for the way family members conceptualize their identity, and how that identity informs their lived experiences. We must listen for the worldview of the family members and the primary beliefs and rules that organize them as a system. Our inquiry must elicit culturally embedded strengths, resources, and limitations, and experiences of oppression as they relate to reasons that a family is presenting for treatment. Clinicians must also be aware of the difficulties related to cultural differ- ence that we may experience in engaging families. We must be aware of the ways in which our cultural beliefs may be an asset or a liability in engagement, assessment, and intervention processes. The following questions may be helpful in helping both clinician and client understand the client’s cultural background (McGoldrick et al., 2005). They can be useful in guiding the clinician and family in locating the family’s sources of resilience, the values of its heritage, and family members’ ability to transform their lives and work toward long-range goals that fit with their cultural values. Basically, we recommend use of questions that help to locate families in their cultural context and help them access their strengths in the midst of the stress of their current situation. What ethnic groups, religious traditions, nations, racial groups, trades, professions, communities, and other groups do you consider yourself a part of? When and why did you or your family come to the United States? To this community? How old were family members at the time? Did they and do you feel secure about your status in the United States? Did they (Do you) have a green card? What language did they (do you) speak at home? In the community? In your family of origin? What burdening wounds has your cultural/racial/ethnic group experi- enced? What burden does your group carry for injuries to other groups? How have you been affected by the wounds your group has committed, or that have been committed against your group? How have you been wounded by the wrongs done to your ancestors? How have you been complicit in the wrongs done by your ancestors? How can you give voice to your group’s guilt, your own sorrow, or your own complicity in the harm done by your ancestors? What would reparations entail? What experiences have been most stressful for family members in the United States? To whom do family members in your culture turn when in need of help? What are your culture’s values regarding male and female roles? Gen- der identity? Sexual orientation? Education? Work and success? Family 268 CULTURAL DIMENSIONS IN FAMILY FUNCTIONING connectedness? Family caretaking? Religious practices? Have these values changed in your family over time? Do you still have contact with family members in your country of ori- gin? Has immigration changed family members’ education or social status? What do you feel about your culture(s) of origin? Do you feel you belong to the dominant U.S. culture? Culturally respectful clinical work involves helping people clarify their cultural and self-identity in relation to family, community, and their history, while also adapting to changing circumstances as they move through life. The following guiding assumptions are meant to suggest the kind of inclusive thinking that is necessary for judging family problems and normal adaptation in cultural context. Assume that all theories of psychology, family therapy, human develop- ment, pathology, wellness, intervention models, and definitions of nor- mality reflect specific worldviews, and values (including this chapter). Assume that all clinicians bring their particular worldviews and cul- tural values to the therapy process. Assume that awareness of and transparency about the values and worldview of the clinician enhance the therapeutic interaction. Assume that family members’ cultural background influences how they view their problems and possible solutions, until you have evidence to the contrary. Assume that language matters, and that working in the preferred lan- guage of the client is best. Understand that language conveys culture, and that the language of origin may be far more expressive. Assume that no one can ever fully understand another’s culture, but that curiosity, humility, awareness of one’s own cultural values and of history will contribute to sensitive interviewing. Assume that having a positive awareness of one’s cultural heritage, just like a positive connection to one’s family of origin, contributes to one’s sense of mental health and well-being. Assume that a negative feeling or lack of awareness of one’s cultural heritage might be reflective of cutoffs, oppression, or traumatic experi- ences that have led to suppression of history. Assume that clients from marginalized cultures have probably inter- nalized society’s prejudices about them, and that those from dominant cultural groups have probably internalized assumptions about their own superiority and right to be privileged within our society. Last, as a field, we must broaden our theories of development and models of intervention to take into account multiple cultural worldviews.  A Challenge to Concepts of Normality 269 REFERENCES Abudabbeh, N. (2005). Arab families. In M. McGoldrick, J. Giordano, & N. Garcia- Preto (Eds.), Ethnicity and family therapy (3rd ed.). New York: Guilford Press. American Anthropological Association. (1998). Statement on race. Retrieved Septem- ber 3, 2010, from www.aaanet.org/stmts/racepp.htm. American Association of Marriage and Family Therapy. (2004). Marriage and fam- ily therapy core competencies. Retrieved August 28, 2010, from www.aamft. org/about/coamfte/version%2011%20standards/mft%20core%20competen- cies%20(december%202004).doc. American Counseling Association. (2005). ACA Code of Ethics. Retrieved August 28, 2010, from www.counseling.org/resources/codeofethics/tp/home/ct2.aspx. American Psychological Association. (2010). Ethical principles of psychologists and code of conduct. Retrieved on August 28, 2010, from www.apa.org/ethics/code/ index.aspx. Arnold, E. A., & Bailey, M. M. (2009). Constructing home and family: How the ball- room community supports African American GLBTQ youth in the face of HIV/ AIDS. Journal of Gay and Lesbian Social Services, 21(2), 171–188. Bernal, G., & Shapiro, E. (2005). Cuban families. In M. McGoldrick, J. Giordano, & N. Garcia-Preto (Eds.), Ethnicity and family therapy (3rd ed.). New York: Guilford Press. Botkin, S., Jones, J., & Kachwaha, T. (2007). Sexism curriculum design. In M. Adams, L. A. Bell, & P. Griffin (Eds.), Teaching for diversity and social justice (2nd ed.). New York: Routledge. Boyd-Franklin, N. (2006). Black families in therapy: Understanding the African American experience. New York: Guilford Press. Brown, R. A., & Armelagos, G. J. (2001). Apportionment of racial diversity: A review. Evolutionary Anthtropolgy, 10, 34–40. Burton, L. M., Bonilla-Silva, E., Ray, V., Buckelew, R., Freeman, E. H. (2010). Criti- cal race theories, colorism, and the decade’s research on families of color. Journal of Marriage and Family, 72(3), 440–459. Cann, R. L., Stoneking, M., & Wilson, A. C. (1987). Mitochondrial DNA and human evolution. Nature, 325, 31–36. Carter, R. (2003). Becoming racially and culturally competent: The racial– cultural counseling laboratory. Journal of Multicultural Counseling and Development, 31(1), 20–30. Catalano, C., McCarthy, L., & Shlasko, D. (2007). Transgender oppression curricu- lum. In M. Adams, L. A. Bell, & P. Griffin (Eds.), Teaching for diversity and social justice (2nd ed.). New York: Routledge. Council on Social Work Education. (2010). Educational policy and accreditation stan- dards. Retrieved July 15, 2010, from www.cswe.org/accreditation/41865.aspx. Cowan, P. (1982). An orphan in history: Retrieving a Jewish legacy. New York: Dou- bleday. Crohn, J. (1995). Mixed matches. New York: Fawcett Columbine. Dagirmanjian, S. (2005). Armenian families. In M. McGoldrick, J. Giordano, & J. K. Pearce (Eds.), Ethnicity and family therapy (2nd ed.). New York: Guilford Press. Erdrich, L., & Dorris, M. (1991). The crown of Columbus. New York: Harper. 270 CULTURAL DIMENSIONS IN FAMILY FUNCTIONING Fadiman, A. (1998). The spirit catches you and you fall down: A Hmong child, her American doctors and the collision of two cultures. New York: Farrar, Straus & Giroux. Falicov, C. J. (1995). Training to think culturally: A multidimensional framework. Family Process, 34, 373–388. Falicov, C. J. (2005). Mexican families. In M. McGoldrick, J. Giordano, & N. Garcia- Preto (Eds.), Ethnicity and family therapy (3rd ed.). New York: Guilford Press. Falicov, C. J. (2011). Migration and the family life cycle. In M. McGoldrick, B. Carter, & N. Garcia-Preto (Eds.), The expanded family life cycle: Individual, family, and social perspectives (4th ed.). Boston: Allyn & Bacon. Friere, P. (1994). The pedagogy of hope. New York: Continuum. Fukuyama, M. A., & Sevig, T. D. (1999). Integrating spirituality into multicultural counseling. Thousand Oaks, CA: Sage. Garcia-Preto, N. (2005a). Latino families: An overview. In M. McGoldrick, J. Gior- dano, & N. Garcia-Preto (Eds.), Ethnicity and family therapy (3rd ed.). New York: Guilford Press. Garcia-Preto, N. (2005b). Puerto Rican families. In M. McGoldrick, J. Giordano, & N. Garcia Preto (Eds.), Ethnicity and family therapy (3rd ed.). New York: Guilford Press. Goodman, A. (2006). Two questions about race. Retrieved on September 3, 2010, from raceandgenomics.ssrc.org/goodman. Griffin, P. (2007). Overview: Sexism, heterosexism, and transgender oppression. In M. Adams, L. A. Bell, & P. Griffin (Eds.), Teaching for diversity and social jus- tice (2nd ed.). New York: Routledge. Griffin, P., D’Errico, H. H., Harro, B., & Schiff, T. (2007). Heterosexism curriculum design. In M. Adams, L. A. Bell, & P. Griffin (Eds.), Teaching for diversity and social justice (2nd ed.). New York: Routledge. Griner, D., & Smith, T. (2006). Culturally adapted mental health interventions: A meta-analytic review. Psychotherapy: Theory, Research, Practice, and Training, 43, 531–548. Hardy, K. V., & Laszloffy, T. A. (1992). Training racially sensitive family therapists: Context, content and contact. Families in Society, 73(6), 363–370. Hardy, K. V., & Laszloffy, T. A. (1995). The cultural genogram: Key to training cul- turally competent family therapists. Journal of Marital and Family Therapy, 21(3), 227–237. Hayden, T. (2001). Irish on the inside: In search of the soul of Irish America. New York: Verso. Hines, P. M., & Boyd-Franklin, N. (2005). African American families. In M. McGol- drick, J. Giordano, & N. Garcia Preto (Eds.), Ethnicity and family therapy (3rd ed.). New York: Guilford Press. Hitchcock, J. (2001). Unraveling the white cocoon. Dubuque, IA: Kendall/Hunt. Ignatiev, N. (1995). How the Irish became white. New York: Routledge. Kamya, H. (2008). Healing from refugee trauma: The significance of spiritual beliefs, faith community, and faith-based services. In F. Walsh (Ed.), Spiritual resources in family therapy (2nd ed., pp. 286–300). New York: Guilford Press. Katz, J. H. (1978). White awareness: Handbook for anti- racism training. Norman: University of Oklahoma Press. Kristof, N. D. (2010, November 18). A hedge fund republic? New York Times, p. A37.  A Challenge to Concepts of Normality 271 Laszloffy, T. (2008). Social class: Implications for family therapy. In M. McGoldrick & K. V. Hardy (Eds.), Revisoning family therapy: Race, culture, and gender in clinical practice (2nd ed.). New York: Guilford Press. Lev, A. I. (2004). Transgender emergence: Therapeutic guidelines for working with gender- variant people and their families. Binghamton, NY: Haworth. Lewinton, R. C. (1972). The apportionment of human diversity. Evolutionary Biol- ogy, 6, 381–398. Liu, W. M., Soleck, G., Hopps, J., Dunston, K., & Pickett T., Jr. (2004). A new frame- work to understand social class in counseling: The social class worldview model and modern classism theory. Journal of Multicultural Counseling and Develop- ment, 32(2), 95–122. Mahmoud, V. (1998). The double bind dynamics of racism. In M. McGoldrick (Ed.), Re- visioning family therapy: Race, culture, and gender in clinical practice. New York: Guilford Press. McGoldrick, M., & Garcia-Preto, N. (1984). Ethnic intermarriage. Family Process, 23(3), 347–362. McGoldrick, M., Gerson, R., & Petry, S. (2008). Genograms: Assessment and inter- vention (3rd ed.). New York: Norton. McGoldrick, M., Giordano, J., & Garcia-Preto, N. (2005). Overview. In M. McGol- drick, J. Giordano, & N. Garcia-Preto (Eds.), Ethnicity and family therapy (3rd ed.). New York: Guilford Press. McGoldrick, M., & Hardy, K. (2008). Introduction: Re-visioning family therapy from a multicultural perspective. In M. McGoldrick & K. V. Hardy (Eds.), Re- visioning family therapy: Race, culture, and gender in clinical practice (2nd ed.). New York: Guilford Press. McIntosh, P. (2008). White privilege and male privilege: A personal account. In M. McGoldrick & K. V. Hardy (Eds.), Re- visioning family therapy: Race, culture, and gender in clinical practice (2nd ed.). New York: Guilford Press. National Association of Social Workers. (2008). Code of Ethics. Retrieved August 28, 2010, from www.naswdc.org/pubs/code/code.asp. Ponterotto, J., Casas, J., Suzuki, L., & Alexander, C. (2010). Handbook of multicul- tural counseling (3rd ed.). Thousand Oaks, CA: Sage. Root, M. P. P. (Ed.). (1992). Racially mixed people in America. Thousand Oaks, CA: Sage. Root, M. P. P. (Ed.). (1996). The multiracial experience: Racial borders as the new frontier. Thousand Oaks, CA: Sage. Root, M. P. P. (2001). Love’s revolution: Interracial marriage. Philadelphia: Temple University Press. Rosen, E., & Weltman, S. (2005). Jewish families: An overview. In M. McGoldrick, J. Giordano, & N. Garcia-Preto (Eds.), Ethnicity and family therapy (3rd ed.). New York: Guilford Press. Schlosser, L. Z., Foley, P. F., Potrock Stein, E., & Holmwood, J. R. (2010). Why does counseling psychology exclude religion?: A content analysis and methodological critique. In J. Ponterotto, J. Casas, L. Suzuki, & C. Alexander (Eds.), Handbook of multicultural counseling (3rd ed.). Thousand Oaks, CA: Sage. Smith, T. (2010). Culturally congruent practices in counseling and psychotherapy: A review of research. In J. Ponterotto, J. Casas, L. Suzuki, & C. Alexander (Eds.), Handbook of multicultural counseling (3rd ed.). Thousand Oaks, CA: Sage. 272 CULTURAL DIMENSIONS IN FAMILY FUNCTIONING Stonefish, L., & Harvey, R. (2005). Nurturing queer youth: Family therapy trans- formed. New York: Norton. Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse: Theory and practice (5th ed.). Hoboken, NJ: Wiley. Tataki, R. (1993). A different mirror: A history of multicultural America. Boston: Little, Brown. Walsh, F. (Ed.). (2008). Spiritual resources in family therapy (2nd ed.). New York: Guilford Press. Walsh, F. (2011). Spiritual diversity: Multifaith perspectives in family therapy. Family Process, 49, 330–348.