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J Marital Family Therapy - July 1995 - Hardy - THE CULTURAL GENOGRAM KEY TO TRAINING CULTURALLY COMPETENT FAMILY (1)

Key Distinctions: Cultural “Awareness” vs. Cultural “Sensitivity”

  • Awareness
    • Primarily cognitive: conscious recognition & intellectual processing of cultural info.
    • Typical training focus: exposure to multicultural content (facts, history, customs, statistics).
    • Limitation: knowledge alone rarely transforms into changed feelings or behavior.
  • Sensitivity
    • Primarily affective: emotional responsiveness marked by delicacy, respect, empathy.
    • Requires experiential learning that challenges personal comfort zones.
    • Nuanced overlap: “conscious sensitivity” within awareness & “delicate awareness” within sensitivity.
  • Essential training mission: facilitate continuous interplay of awareness and sensitivity so therapists examine how their own cultural identities shape perceptions of culturally similar/dissimilar clients.

The Genogram as a Training Tool (General Background)

  • Originally used across disciplines to:
    • Join with clients (Carter & Orfandis, 1976).
    • Reveal psychological patterns (Watchel, 1982).
    • Gather family data (Doherty & Baird, 1983).
    • Assess systemic patterns (McGoldrick & Gerson, 1985).
  • As a TRAINING device (Bahr, 1990):
    • Goal ≠ changing the family; goal = helping students visualize & understand their own system and emotional issues.
    • Provides powerful self-of-the-therapist work.

The Cultural Genogram: Purpose & Core Objectives

  • Primary goal: promote both cultural awareness and cultural sensitivity by illuminating trainees’ cultural identities.
  • Achieved through five micro-objectives:
    1. Illustrate & clarify cultural influence on family systems.
    2. Identify all contributing groups to one’s cultural identity.
    3. Trigger candid dialogue that challenges assumptions & stereotypes.
    4. Surface unresolved “emotional triggers” around culture.
    5. Explore how unique cultural identities will affect therapeutic style/effectiveness.

Culture vs. Ethnicity (Conceptual Clarification)

  • Culture
    • Multidimensional umbrella: includes ethnicity, gender, social class, region, religion, etc.
  • Ethnicity
    • Lineage-based sense of “peoplehood;” one (key) dimension of culture.
  • Relationship in the cultural genogram
    • Ethnicity = vehicle to explore the larger construct of culture; not an end in itself.
    • Multiple dimensions eventually converge into the holistic “cultural identity.”

Preparing a Cultural Genogram

  • Overall sequence: Getting Organized → Putting It Together → Questions → Presentation → Synthesis.

Getting Organized

  • Define “culture of origin”
    • First US-arriving generation of each ancestral group (exception: Native Americans already present).
    • Example: U.S.-born trainee w/ Irish & Greek grandparents → Irish + Greek = culture of origin.
  • Identify organizing principles
    • Fundamental constructs shaping perceptions/behaviors (e.g., Jewish “fear of persecution”).
  • Identify pride/shame issues
    • Cultural aspects labeled distinctly positive or negative (e.g., Jewish emphasis on educational achievement).
    • Similar to organizing principles but punctuate behavior with value judgments.
    • Data sources: personal memories, interviews, books, films, artifacts.
  • Create symbols
    • Unique icon per pride/shame issue; placed directly on genogram for analogic, emotional communication.
  • Select colors
    • One color per contributing group; each individual’s symbol segmented proportionally (e.g., half yellow Swedish, ¼ red Ugandan, ¼ blue Venezuelan).
    • Immediate visual hypothesis-generation (homogeneity vs. multicultural collage).
  • Mark intercultural marriages
    • Symbolized by “(-)”; prompts exploration of negotiation of cultural differences & intergenerational impact.

Putting It Together

  • Develop Cultural Framework Charts (CFCs)
    • Serve as map legends: list organizing principles + pride/shame issues + matching symbols for EACH group.
  • Assemble at least a 3-generation genogram
    • Overlay: (-) symbols, color coding, pride/shame icons.
  • Answer “Questions to Consider” (Table 1) BEFORE presenting.
    • Provide depth on migration, oppression, religion, gender, stereotypes, naming, class, etc.

Table 1 – Core Reflection Questions (abbreviated)

  1. Migration patterns & conditions of U.S. entry (immigrant, slave, refugee?).
  2. Historical & present oppression experiences/markers.
  3. Intragroup conflicts & dividing issues.
  4. Race/skin-color/hair significance.
  5. Dominant religions & role of spirituality.
  6. Geographic/regional influences.
  7. Gender roles & views on sexual orientation.
  8. Prejudices/stereotypes held by, about, and within the group.
  9. Naming rituals, social-class definitions, valued occupations.
  10. Age, family definition, attitudes toward outsiders & mental-health professionals.
  11. Transmission & impact of organizing principles and pride/shame issues.
  12. Negotiation of multiple-group differences & intergenerational consequences.

Interpretation & Presentation Phase

  • Step 1: Trainee introduces CFCs (didactic).
  • Step 2: Uses genogram to trace pride/shame issues across generations (experiential).
  • Facilitator encourages group dialogue, hypothesis testing, and emotional processing.

Synthesis Stage (Culmination)

  • Two interconnected tasks:
    1. Retrospective self-reflection: “What did I learn?”
    2. Integration: Align thoughts/feelings, content/process, personal/professional identities.
  • Ritual of closure: marks official “end” yet signals lifelong cultural self-exploration.
  • Required written synthesis paper answers (Table 2 highlights):
    • Family beliefs about origin groups, comfort vs. difficulty “owning” aspects, easiest/hardest client groups, impact on therapist tendencies, overall exercise value.

Role of the Facilitator

  • Balances emotional support with intellectual challenge; manages own involvement.
  • Key responsibilities:
    • Clarify & evaluate goals.
    • Detect factors aiding/impeding progress.
    • Respect different learning styles.
    • Build emotionally safe, risk-taking milieu.
    • Encourage respectful challenge of stereotypes.
    • Tolerate/manage anxiety, anger, fear.
  • Dual role: interaction catalyst & permission broker for difficult dialogue.
  • Sample guiding questions (Table 3): content/process insights, color/symbol relevance, pride vs. shame skew, negotiation of multiple groups, presenter's comfort level, peer impact, data-gathering process, etc.

Implications for Treatment

  • “Know thy own culture” (Lappin, 1983): Cultural competence starts with self.
  • Cultural genogram helps therapists:
    • Identify unresolved cultural issues likely to impede cross-cultural or same-culture work.
    • Replace “myth of sameness” with respect for true differences (e.g., scheduling on religious days, naming preferences).
  • Clinically, can generate culturally informed hypotheses rather than stereotypes.

Research Implications

  • Empirical gaps: reliability/validity of cultural genogram as training & clinical tool.
  • Potential research lines:
    • Outcome data on trainee competence.
    • Program-wide aggregation to guide curriculum design.
    • Modification for clinical assessment of cross-cultural families or therapist competence.

Reflections & Recognized Cultural Biases in the Instrument

  • Authors acknowledge Western lens:
    • Two-dimensional diagram may omit expansive kinship networks (e.g., S. Indian Hindu trainee with 900 relatives at a wedding).
    • Trainees from historically enslaved groups (e.g., African Americans) may lack ancestral knowledge.
    • “Marriage” defined narrowly by Western legal standards; may differ elsewhere.
  • Warning: Avoid “square-peg-in-round-hole” impositions; use genogram to expose what we do not yet know.

Selected References Cited (for further reading/example context)

  • Bahr, 1990 – Student reactions to genogram use.
  • Carter & Orfandis, 1976 – Joining via genogram.
  • Falicov, 1988 – Teaching trainees to “think culturally.”
  • Hardy, 1990 – Importance of minority therapist self-knowledge.
  • Lappin, 1983 – First step: create three-generation cultural genogram.
  • McGoldrick & Gerson, 1985 – Genograms in family assessment.
  • Additional methodological or clinical texts: Doherty & Baird (1983), Kramer (1985), Lewis (1989), etc.

Practical Take-Away Checklist for Trainees

  • [ ] Identify ancestral groups (culture of origin).
  • [ ] Gather data on organizing principles & pride/shame issues.
  • [ ] Design unique symbols; select distinct colors.
  • [ ] Build \geq 3-generation color-coded genogram.
  • [ ] Complete Cultural Framework Charts.
  • [ ] Reflect using all Table 1 questions.
  • [ ] Present CFC + genogram; facilitate discussion.
  • [ ] Write synthesis paper addressing