- Email: [email protected]
Working with Culture: Psychotherapeutic Interventions with Ethnic Minority Children and Adolescents
BOOK REVIEWS
period (p. 11). Teresa Marciano, who coined rhis term, is clear that these are relationships which by choice avoid the encumbrances of shared living. Thus there are networks of singles, a series of extended non-kin relationships in the neighborhoods ofAfrican-Americans, the close-knit membership of a yacht club, etc. Of special interest is the description of the wider families of lesbian parents and their significance to the partners and their children. As a whole, this book reminds us that the significant relationship system may not reside with an individual and there are often substantial resources to be found by inquiring about these wider family relationships. Alcoholism and the Family contains 18 papers presented at an International Symposium sponsored by the Research Institute of Tokyo in 1989 . These papers all deal with research on untangling nature and nurture in alcoholism. While there is unquestionable familial genetic role in alcoholism, the mystery still remains about which genes and how genetic vulnerability interacts with environment to produce patterns of alcoholism. Of interest are the following: (1) Some researchers have differentiated two types of alcoholism. Type I is associated with anxiety, withdrawal, and panic, while type II is associated with antisocial behavior in males and "hysteria" or Briquet's syndrome in females (are you surprised that these researchers are at Washington University?). (2) Vaillant's observations from large cohorts studied longitudinally are that genetics predisposes to alcoholism, but environment determines its onset and course. Of interest are the data showing that more than 50% of inner-city delinquent alcoholics established their alcoholism by age 30, but by age 47 almost 50% were "recovered." In contrast, the cohort of Harvard graduate alcoholics established much later and persisted in much higher proportion. (3) There is no doubt at all from research around the world that children growing up in homes with alcoholic parents are placed at substantial risk in rheir emotional development. (4) With improvements in the methods for studying family interaction, some research with adopted children in Finland suggests that while there is clearly a genetic principle in transmission of illnesses such as schizophrenia, there are some protective factors in family interaction so that some individuals with strong genetic loading do not become ill. This work helps to focus further on adaptation and competence in families. (5) Family rherapy practice has inevitably broadened the view of alcoholic behavior to include rhe effects of the behaviors of those around the alcoholic. Terms such as " enabler" and "co-dependent" are familiar examples . (6) There are some characteristic responses of children growing up with alcoholics in the family that lead to some of the syndromes common to the "adult children of alcoholic""responsible child," "adjuster," "placater," and "acting-out child." As with other family members, these children's
1064
J.
attitudes are characterized by denial of feelings and perceptions about what is happening in the home. Contributors include such American luminaries as Schuckit, Steinglass, and Vaillant, as well as Claudia Black, the anthropologists James and Sandra Whittaker (who present a fascinating discussion of alcoholism among Native Americans), and rhe anthropologist Genevieve Ames. This is an excellent overview of recent developments in thinking, research, and treatment of alcoholism and families. Overall, this selection of books reaffirms that it is not possible to understand, formulate, diagnose, or treat a troubled individual (particularly a child or adolescent) without a profound assessment of family context and its "widest" manifestation. While the increasing evidence of this fact may appear to add complexity to our work as child psychiatrists, the opportunities for remedy discovered in families makes the endeavor well worth the effort. Lee Combrinck-Graham, M.D. Associate Professor of Clinical Psychiatry University of Illinois at Chicago
Working wirh Culture: Psychorherapeutic Interventions wirh Erhnie Minority Children and Adolescents. Edited by
Luis A. Vargas andJoan D. Koss-Chioino. San Francisco, CA: [ossey-Bass, Inc, Publishers, 1992, $29.95 (hardcover). This book is offered as one in a hoped-for series of writings in the field of psychotherapy. The editors look to colleagues who, to date, have shared a relatively small amount of their total collective expertise on the subject. One method of encouraging increased contributions to rhe literature has been the one that gave rise to this book. The 12 middle chapters of this 14-chapter work have evolved from presentations in several different settings including papers and discussions from a series of conferences on cultural diversity hosted by the University of New Mexico School of Medicine. The first and last chapters are written by rhe editors. Working with Culture approaches the subject in an interesting manner. In rhe introductory chapter, rhe editors present the organizing principle for the work. Their goal was to . select presentations that would address discrete problems that affect specific erhnic minority groups and have a higher valence ofimportance for members ofthose particular groups. Next, the organizing concept behind the book is presented, specifically, "a multidimensional model" that could accommodate rhe clinical practices of "any" school of thought. The reader is asked to think of the presentation as proposing "a multidimensional lens through which to view the relationship between the culture of the client and process and method of psychotherapy." Some concise definitions give
AM . ACAD . CHILD ADOLESC. PSYCHIATRY. 33:7. SEPTEMBER 1994
BOOK REVIEWS
the reader more exact pieces to weigh. For example, cultural content is defined as "the specific meanings ..." that we picture when speaking ofculture, e.g., child-rearing practices, values, language, foods, role definitions. Cultural context is defined in relationship to the psychotherapeutic situation as relating to "the client's culturally patterned expectations in interaction with those defined and experienced by the therapist." Examples are given for play therapy that include having a therapist use the awareness that different children picture different foods, clothing, and play material as familiar. Practitioners are challenged to think about some basic questions, including the following: What really happens when a child or adolescent, family, and therapist come together? What is our understanding of why one approach or another is pursued? Why does one approach prove effective but another one does not? How do we teach what we know? How do we know when our colleagues are successful? The middle 12 chapters give 12 different lessons for us to consider. As noted in the introduction, the overall tone for the chapters was set by the editors, but the final style of the chapter rests with the authors. The authors are from various backgrounds and settings, mainly psychology, social work, and anthropology. There is a chapter by a child psychiatrist on "Treating First-Generation Asian Americans." The 12 chapters are grouped into four sections. Each section is devoted to three issues related to one specific ethnic group: African American, Hispanic, Asian American and American Indian. Each chapter has different authorship. The editors add a vety interesting concluding chapter in which each middle chapter is succinctly analyzed in terms of the original multidimensional conceptual frame of reference. This concluding critique notes which components of the theory appear to be of what relative importance to each author or group of authors. Not only is there variation in the authors' clinical approaches, but there is clear variation in style and some variation in the quality of the writing. For example, one reads precisely circumscribed and clear material such as Jones' "Self-Esteem and Identity in Psychotherapy with Adolescents from Upwardly Mobile MiddleClassAfrican American Families" or Cervantes and Ramirez's broader and equally clear "Spirituality and Family Dynamics in Psychotherapy with Latino Children," through Willis, Dobrec, and Sipes' presentation of more demographic data in "Treating American Indian Victims of Abuse and Neglect," to Nguyen's initially promising but ultimately disappointing "Living between Two Cultures: Treating FirstGeneration Asian Americans." Authors such as Greene, Martinez, Valdez, and Ho present helpful material in defining such concepts as racial socialization, culturally relevant play material, and the matching of treatment modalities with the
J.
cultural values of the child/adolescent and family, respectively. For readers who do not feel familiar with anyone set of cultural issues, the necessarily edited bibliographies are generally a mixture of classical and contemporaty references that should be helpful to most readers. One finds one other theme in this book, namely, the diversity within any cultural group. One example is in Chao's "The Inner Heart." She refers to a colleague's comment that "we do not even eat rice the same." Working with Culture is a helpful addition to our stillgrowing literature on cultural diversity. This book can be used in teaching undergraduate, graduate, or postgraduate students. Ruth L. Fuller, M.D. Associate Professor of Psychiatry University of Colorado Health Sciences Center, Denver
Playing For Real: A Child Therapist Explores the World of Play Therapy and the Inner Worlds of Children. By Richard Bromfield, Ph.D. New York: Plume Press, 1992,240 pp., $10.00 (softcover). It is a difficult task to describe therapy in an interesting manner and even harder to try to write about play therapy. Yet in a very succinct book, Richard Bromfield is able to do both. He appears to be writing from the heart and explores play therapy not only in his child patients but in himself as well. Step by step he depicts various cases he has dealt with from "Beginning" to "Ending." He openly narrates his successes and failires in a humorous and touching way. As a recent child fellow graduate I have been introduced to many therapy textbooks for adult, child, and family therapies. It was a welcome relief to read a book that is not only helpful but fun. Never dry or wordy, it takes a refreshing look into a therapy room, almost like watching through a one-way mirror. The descriptions flow gracefully through the many stages and issuesinvolved in working with children and their families. And even more importantly, the author undertakes to answer the most critical question all trainees and practicing therapists face repeatedly: "why children's playing in therapy ... is for real." As Bromfield opens his text, he immediately immerses the reader in the painful reality of termination and how becoming close to someone makes it so hard to say goodbye. He continuously explores each case for psychodynamic issues such as transference and countertransference. To his credit, he is able to help the reader better understand psychoanalytic
AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 33:7, SEPTEMBER 1994
1065
period (p. 11). Teresa Marciano, who coined rhis term, is clear that these are relationships which by choice avoid the encumbrances of shared living. Thus there are networks of singles, a series of extended non-kin relationships in the neighborhoods ofAfrican-Americans, the close-knit membership of a yacht club, etc. Of special interest is the description of the wider families of lesbian parents and their significance to the partners and their children. As a whole, this book reminds us that the significant relationship system may not reside with an individual and there are often substantial resources to be found by inquiring about these wider family relationships. Alcoholism and the Family contains 18 papers presented at an International Symposium sponsored by the Research Institute of Tokyo in 1989 . These papers all deal with research on untangling nature and nurture in alcoholism. While there is unquestionable familial genetic role in alcoholism, the mystery still remains about which genes and how genetic vulnerability interacts with environment to produce patterns of alcoholism. Of interest are the following: (1) Some researchers have differentiated two types of alcoholism. Type I is associated with anxiety, withdrawal, and panic, while type II is associated with antisocial behavior in males and "hysteria" or Briquet's syndrome in females (are you surprised that these researchers are at Washington University?). (2) Vaillant's observations from large cohorts studied longitudinally are that genetics predisposes to alcoholism, but environment determines its onset and course. Of interest are the data showing that more than 50% of inner-city delinquent alcoholics established their alcoholism by age 30, but by age 47 almost 50% were "recovered." In contrast, the cohort of Harvard graduate alcoholics established much later and persisted in much higher proportion. (3) There is no doubt at all from research around the world that children growing up in homes with alcoholic parents are placed at substantial risk in rheir emotional development. (4) With improvements in the methods for studying family interaction, some research with adopted children in Finland suggests that while there is clearly a genetic principle in transmission of illnesses such as schizophrenia, there are some protective factors in family interaction so that some individuals with strong genetic loading do not become ill. This work helps to focus further on adaptation and competence in families. (5) Family rherapy practice has inevitably broadened the view of alcoholic behavior to include rhe effects of the behaviors of those around the alcoholic. Terms such as " enabler" and "co-dependent" are familiar examples . (6) There are some characteristic responses of children growing up with alcoholics in the family that lead to some of the syndromes common to the "adult children of alcoholic""responsible child," "adjuster," "placater," and "acting-out child." As with other family members, these children's
1064
J.
attitudes are characterized by denial of feelings and perceptions about what is happening in the home. Contributors include such American luminaries as Schuckit, Steinglass, and Vaillant, as well as Claudia Black, the anthropologists James and Sandra Whittaker (who present a fascinating discussion of alcoholism among Native Americans), and rhe anthropologist Genevieve Ames. This is an excellent overview of recent developments in thinking, research, and treatment of alcoholism and families. Overall, this selection of books reaffirms that it is not possible to understand, formulate, diagnose, or treat a troubled individual (particularly a child or adolescent) without a profound assessment of family context and its "widest" manifestation. While the increasing evidence of this fact may appear to add complexity to our work as child psychiatrists, the opportunities for remedy discovered in families makes the endeavor well worth the effort. Lee Combrinck-Graham, M.D. Associate Professor of Clinical Psychiatry University of Illinois at Chicago
Working wirh Culture: Psychorherapeutic Interventions wirh Erhnie Minority Children and Adolescents. Edited by
Luis A. Vargas andJoan D. Koss-Chioino. San Francisco, CA: [ossey-Bass, Inc, Publishers, 1992, $29.95 (hardcover). This book is offered as one in a hoped-for series of writings in the field of psychotherapy. The editors look to colleagues who, to date, have shared a relatively small amount of their total collective expertise on the subject. One method of encouraging increased contributions to rhe literature has been the one that gave rise to this book. The 12 middle chapters of this 14-chapter work have evolved from presentations in several different settings including papers and discussions from a series of conferences on cultural diversity hosted by the University of New Mexico School of Medicine. The first and last chapters are written by rhe editors. Working with Culture approaches the subject in an interesting manner. In rhe introductory chapter, rhe editors present the organizing principle for the work. Their goal was to . select presentations that would address discrete problems that affect specific erhnic minority groups and have a higher valence ofimportance for members ofthose particular groups. Next, the organizing concept behind the book is presented, specifically, "a multidimensional model" that could accommodate rhe clinical practices of "any" school of thought. The reader is asked to think of the presentation as proposing "a multidimensional lens through which to view the relationship between the culture of the client and process and method of psychotherapy." Some concise definitions give
AM . ACAD . CHILD ADOLESC. PSYCHIATRY. 33:7. SEPTEMBER 1994
BOOK REVIEWS
the reader more exact pieces to weigh. For example, cultural content is defined as "the specific meanings ..." that we picture when speaking ofculture, e.g., child-rearing practices, values, language, foods, role definitions. Cultural context is defined in relationship to the psychotherapeutic situation as relating to "the client's culturally patterned expectations in interaction with those defined and experienced by the therapist." Examples are given for play therapy that include having a therapist use the awareness that different children picture different foods, clothing, and play material as familiar. Practitioners are challenged to think about some basic questions, including the following: What really happens when a child or adolescent, family, and therapist come together? What is our understanding of why one approach or another is pursued? Why does one approach prove effective but another one does not? How do we teach what we know? How do we know when our colleagues are successful? The middle 12 chapters give 12 different lessons for us to consider. As noted in the introduction, the overall tone for the chapters was set by the editors, but the final style of the chapter rests with the authors. The authors are from various backgrounds and settings, mainly psychology, social work, and anthropology. There is a chapter by a child psychiatrist on "Treating First-Generation Asian Americans." The 12 chapters are grouped into four sections. Each section is devoted to three issues related to one specific ethnic group: African American, Hispanic, Asian American and American Indian. Each chapter has different authorship. The editors add a vety interesting concluding chapter in which each middle chapter is succinctly analyzed in terms of the original multidimensional conceptual frame of reference. This concluding critique notes which components of the theory appear to be of what relative importance to each author or group of authors. Not only is there variation in the authors' clinical approaches, but there is clear variation in style and some variation in the quality of the writing. For example, one reads precisely circumscribed and clear material such as Jones' "Self-Esteem and Identity in Psychotherapy with Adolescents from Upwardly Mobile MiddleClassAfrican American Families" or Cervantes and Ramirez's broader and equally clear "Spirituality and Family Dynamics in Psychotherapy with Latino Children," through Willis, Dobrec, and Sipes' presentation of more demographic data in "Treating American Indian Victims of Abuse and Neglect," to Nguyen's initially promising but ultimately disappointing "Living between Two Cultures: Treating FirstGeneration Asian Americans." Authors such as Greene, Martinez, Valdez, and Ho present helpful material in defining such concepts as racial socialization, culturally relevant play material, and the matching of treatment modalities with the
J.
cultural values of the child/adolescent and family, respectively. For readers who do not feel familiar with anyone set of cultural issues, the necessarily edited bibliographies are generally a mixture of classical and contemporaty references that should be helpful to most readers. One finds one other theme in this book, namely, the diversity within any cultural group. One example is in Chao's "The Inner Heart." She refers to a colleague's comment that "we do not even eat rice the same." Working with Culture is a helpful addition to our stillgrowing literature on cultural diversity. This book can be used in teaching undergraduate, graduate, or postgraduate students. Ruth L. Fuller, M.D. Associate Professor of Psychiatry University of Colorado Health Sciences Center, Denver
Playing For Real: A Child Therapist Explores the World of Play Therapy and the Inner Worlds of Children. By Richard Bromfield, Ph.D. New York: Plume Press, 1992,240 pp., $10.00 (softcover). It is a difficult task to describe therapy in an interesting manner and even harder to try to write about play therapy. Yet in a very succinct book, Richard Bromfield is able to do both. He appears to be writing from the heart and explores play therapy not only in his child patients but in himself as well. Step by step he depicts various cases he has dealt with from "Beginning" to "Ending." He openly narrates his successes and failires in a humorous and touching way. As a recent child fellow graduate I have been introduced to many therapy textbooks for adult, child, and family therapies. It was a welcome relief to read a book that is not only helpful but fun. Never dry or wordy, it takes a refreshing look into a therapy room, almost like watching through a one-way mirror. The descriptions flow gracefully through the many stages and issuesinvolved in working with children and their families. And even more importantly, the author undertakes to answer the most critical question all trainees and practicing therapists face repeatedly: "why children's playing in therapy ... is for real." As Bromfield opens his text, he immediately immerses the reader in the painful reality of termination and how becoming close to someone makes it so hard to say goodbye. He continuously explores each case for psychodynamic issues such as transference and countertransference. To his credit, he is able to help the reader better understand psychoanalytic
AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 33:7, SEPTEMBER 1994
1065