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CHAPTER 20
THERAPY WITH AFRICAN
FAMILIES
AMERICAN INNER-CITY
Nancy Boyd-Franklin
The treatment of African American inner-city families
is a critical component in family psychology. Clinical
training programs, however, frequently do not train
students to work with these families. This chapter
presents key areas that family psychologists must ad- dress in order to provide effective treatment.
Although families of African descent come from
many different countries and backgrounds, such as
Afro-Caribbean, Haitian, African, and Afro-Latino,
the emphasis here will be on African American fami- lies whose ancestors were brought to this country as
slaves. This chapter will highlight the treatment is- sues for African American families living in poverty,
even though many similarities exist with middle-class
African American families.
therapists working with poor, inner-city, African
American families is provided. The class-not-race
myth, the opinions many of these families have of
therapy, and the importance of the therapist’s use of
self are emphasized. Some of the multiple family
structures often found within these families are de- scribed, and the importance of spirituality to this
population is stressed. Next the effects of racism on
gender roles are examined, and treatment-relevant is- sues related to poverty are highlighted. In each of
these areas, implications for practice are described.
In the second part of the chapter a multisystem
intervention model for working with these families is
introduced. Multisystemic issues, tools to assess mul- tisystems, and use of the model to organize treat- ment are explained. To see the model in action, an
In the first half of this chapter, a background for
extended case example of work with an African
American extended family, living in poverty in the
inner city, is provided. The chapter concludes by ex- amining some of the implications of this model for
training and supervising professionals.
INITIAL CULTURAL AND
THERAPEUTIC CONSIDERATIONS
To understand the complex therapeutic relationships
that family psychologists may encounter in the treat- ment of African Americans, professionals first need to
be cautioned against stereotyping, to realize the
shortcomings of the class-not-race theory, to compre- hend the expected responses of African American
families to therapy, and to understand the impor- tance of the therapist’s use of self with these families.
There is tremendous variability among African
American families in terms of geographic region,
spiritual or religious orientation, class and socioeco- nomic level, education, skin color, and family struc- ture. The material in this chapter should be used as
a cultural lens through which African American in- ner-city families can be viewed, or as a set of guide- lines that must be readjusted and sometimes dis- carded, depending on the particular family with
which the therapist is working.
sues affecting African American families, one must
consider both social class and racial issues (Boyd- Franklin, 1989). Poor African American families are
affected daily by unemployment, violence, crime,
drugs, and homelessness. Furthermore, the intrusive- ness of outside systems, such as the welfare depart- To understand fully the complex interplay of is- 357
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Nancy Boyd-Franklin
ment, child protective services, and various agencies,
clinics, and hospitals engenders a profound suspi- cion. In addition, unlike other ethnic groups, they
must cope with the burdens of racism, discrimina- tion, and oppression as a consequence of the legacy
of slavery in the United States.
to dismiss racial differences. Many Caucasian clini- cians tend to minimize these differences as “class- not-race’’ issues (Boyd, 1977). This dismissal is un- fortunate because the issues of race and racism
persist even as the individual and family rises to
middle class and a higher income and educational
level. Therapists must be aware of the complex inter- play of racial, cultural, and class themes in order to
work effectively with these clients.
The clinician needs to understand the suspicion
toward therapy that exists in many African American
communities, which derives from the class and race
issues just discussed. Grier and Cobbs (1968) have
called this “healthy cultural paranoia.” I prefer
“healthy cultural suspicion,” because of the pejorative
nature of the word paranoia.
Therapy is also viewed by many African Ameri- cans as being appropriate only for others-sick,
crazy, or weak people, or for Caucasians. African
Americans may also distrust therapy because they see
it as being anti-spiritual. Because of these unfavorable
predispositions, family psychologists must first take
the time to join with all family members and to build
trust. This is particularly important with clients who
feel coerced into therapy, as is common with inner- city African American families. Too often, African
American clients are mislabeled as “resistant” and
may be dismissed by therapists because many train- ing programs prepare clinicians to work only with
clients who want therapy However, the majority of
these families can and do benefit from therapy once
their fears and concerns are addressed. This process
will be discussed in more detail later in the chapter.
The most important component in the treatment
of inner-city African American families is the therap- ist‘s use of self. Indeed, this is the most important
part of the therapeutic process with any family It is
particularly crucial in work with African American
families because of the healthy cultural suspicion
There is a tendency on the part of some clinicians
with which they may approach therapy. Therapists
must especially take the time to connect with these
families and help them understand the process of
therapy
Because of the legacy of racism and discrimina- tion in this country, African Americans are particu- larly sensitive to the way in which they are ap- proached by therapists. This is not only an issue m
cross-racial therapy. A therapist who is of the same
race as the family may still be perceived by family
members as different-either as a result of social
class or because the therapist is identified as being
part of the system.
African Americans are very conscious of “vibes”-
verbal and nonverbal clues that indicate whether the
therapist respects them, is judgmental of their lives
or family circumstances, and is “for real” (Boyd- Franklin, 1989). It is very important during supervi- sory sessions that therapists be helped to be them- selves and to take the time to connect as people with
each family member. It is often very helpful, for ex- ample, for the therapist in a cross-racial therapeutic
situation to ask the family how they feel about work- ing with a Caucasian therapist. This gives a message
that even the difficult subject of race can be raised in
therapy This should not be done in the first session
but should be raised only at points where the thera- pist is encountering resistance from the family.
MULTIPLE FAMILY STRUCTURES
Although the stereotype in the literature is of single- parent families (Deutsch & Brown, 1964; Moynihan,
1963, many family structures are represented within
African American inner-city communities. Families
may be traditional two-parent nuclear families, they
may consist of a single parent and a boyfriend or
girlfriend, or they may form a complex extended
family that includes members from both inside and
outside the household, as well as blood and non- blood relatives (Billingsley, 1968; Boyd-Franklin,
1989; Hill, 1972, 1977). Clinicians must be aware of
this diversity because African American families who
are suspicious about therapy may send in an “expe- ditionary force” to “check out” the therapist.
may include complex extended family kinship sys- As was just mentioned, African American families
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Therapy With African American Inner-City Families
tems. Stack (1974) discussed the reciprocity inherent
in these systems in which very poor family members
assist each other with child care, finances, emotional
support, housing, counseling, and so forth, particu- larly in times of trouble or stress. Blood family mem- bers might include mothers, fathers, grandmothers,
grandfathers, aunts, uncles, cousins, or siblings. In
addition, African American families, particularly
when moving to new communities, may create
bonds with nonblood relatives, such as neighbors,
babysitters, friends, ministers, ministers’ wives, and
church family, that are as strong as those with family
members (Boyd-Franklin, 1989; Billingsley, 1968;
Hill, 1972, 1977; Hines & Boyd-Franklin, 1982; Mc- Adoo, 1981; McAdoo & McAdoo, 1985).
In addition, because of the legacy of slavery in
which family systems were pulled apart, and the seg- regated nature of child welfare and adoption systems
prior to 1950, African Americans have developed
their own informal systems to take in children (and
sometimes the elderly) in times of loss, separation, or
crisis-a process called informal adoption by Hill
(1977). This concept, often confusing for family psy- chologists when first encountered, is also compli- cated by the reluctance of African Americans to air
family business in public (Boyd-Franklin, 1989;
Hines & Boyd-Franklin, 1982). Also, because of a
cultural admonition not to discuss these issues with
children (irrespective of age), family secrets may re- sult. The exploration of such secrets requires a great
deal of sensitivity and timing on the part of the ther- apist (Boyd-Franklin, 1989).
When family systems are very complex, therapists
may spend hours treating the “wrong” family or a
small subsystem of the family (eg, mothers and
children). Far too often powerful family members- blood as well as nonblood-are overlooked because
they are not the initial patients. However, these
members can undermine or sabotage treatment if
they are not engaged.
Families may not reveal the true, complex nature
of the family support system to the therapist until
trust is established. As trust develops, constructing a
genogram may be of great help. Because of the fami- ly’s potential suspicion, therapists are cautioned
against using a genogram in a first session (Boyd- Franklin, 1989). The process of gathering this infor- mation should evolve over time: As trust in the ther- apist grows, more family members will be revealed.
Although many family psychologists have been
trained to expect a family to come in for treatment,
effective therapy with African Americans often in- volves outreach in the form of home visits, letters, or
phone calls. Fathers or boyfriends are often particu- larly difficult to engage. The following is an example
of a letter that might be sent to a father in order to
reach out to him initially. This direct communication
in a letter or a phone call is often more effective
than working through mothers:
Dear
working with your son Johnny in family
counseling to try to resolve his school prob- lems. As you know, things are very serious
right now, and the school has threatened to
leave him back if his behavior does not im- prove. Your wife and 1 have been working
with him on doing his homework after
school, but we need your help. Can you
give me a call at (telephone number) so
that I can get your ideas on how best to
help him? You are a very important person
is his life, and I would not treat your son
without asking for your input and advice.
We have been meeting on Wednesday
nights at 7:OO p.m. If you can join us next
week, it would be very helpful. Let me
know if the time is a problem and we can
reschedule.
My name is , and I am
Sincerely yours,
The extended family kinship system is a cultural
legacy and testament to the survival skills of those of
African heritage. However, therapists must distin- guish between functional kinship networks and con- flictual support systems. In functional systems, there
is a great deal of reciprocity between extended family
members; in conflictual systems there often tends to
be one central (Aponte, 1976a, 1976b), overbur- dened family member-typically a grandmother,
mother, or aunt-who constantly provides support
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