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Section 25
Psychotherapy with Intercultural Couples

Question 25 | Test | Table of Contents

Therapy with Intercultural Couples
When patients present in a therapist's office, they have acknowledged that they are unable to either meet each other's needs, or to get their own needs met. Intercultural couples come to therapy with two very distinct and divergent ways of organizing experience based on their respective cultural backgrounds and familial developmental history. Sometimes these distinct modes of organizing experience collide and create disjunctions and failures in their mutual provision of selfobject functions. All couples arrive at the therapist's office without the understanding that each of the partner's ways of organizing his/her subjective experience is based on unconscious and taken for granted familial and cultural organizing principles.

When a therapist is able to understand empathically and to respond to each of the individuals, he/she will provide simultaneously a selfobject experience for one partner and allow the other partner to see the therapist make "empathic" sense of the partner's behavior and organization of experience. Each partner's "self object needs" to be empathically understood can be met as each discovers how his or her organizing principles may be self-limiting in significant ways.
One of the difficulties in working with intercultural couples, particularly those who are not psychologically aware, is that each partner views the other (and any difficulties that may exist between them) through his or her own cultural organizing principles, without being aware that the perceptions, and the feelings that arise from them, are individual, subjective and culturally influenced. Rather, individuals presume that his or her perception of the other is objective, true and factual. Each partner makes sense of the other's affect, behavior and expression in terms of his or her own unconscious cultural organizing principles.

In cases where the therapist can identify and interpret the differences in perceptions as culturally grounded, the therapist may help the partners to better understand and accept those differences. Therapy with these couples requires the therapist to develop an empathic understanding of each individual's experience. The therapist must be able to articulate his or her understanding in a way that enables each partner to more fully comprehend the experience of the other, as well as those factors that will influence each partner's individual constructions of meaning and interpretation.

The therapist must create an atmosphere of nonjudgmental curiosity and willingness to understand the other to illuminate, describe, and interpret organizing principles that are the cultural and idiosyncratic ways of interpreting and creating meaning of the other's behavior. Sustained empathic inquiry is both the stance and method in this approach to therapy with intercultural couples. The therapist must endeavor to "understand" and interpret how each of the partners might come to think, feel, believe or behave in the ways that they do.

In a paper we published in 2004, we noted that:
In the process of interpreting the central organizing principles of intercultural couples, via sustained empathic inquiry, the therapist must reflect on his or her own subjective creation of meaning and interpretation. Therapists cannot step outside of their own organizing principles 'because they are the only means of understanding we have' (Stern, B., 1994, p. 446). Such subjective reflection invariably results in coming to terms with the cultural and linguistic construction of the therapist's subjectivity. Working with intercultural couples requires therapists to expand their own cultural horizons (Rubalcava & Waldman, 2004, p. 137).

We are not suggesting that the cultural organizing principles are the singular or most important differences confronting the intercultural couple, but rather that the cultural organizing principles will be imbedded within the individual subjectivities of the partners. However, cultural organizing principles may be used to both illuminate differences between individuals and to help individuals understand those differences. When a therapist is able to introduce the concept of the cultural organizing principle, it may have the effect of de-pathologizing behaviors and increasing communication and understanding.

Hector and Sandra
An example of how a culturally grounded individualistic mode of cognition and perception can clash with a collectivist or interdependent organization of experience is exemplified by the case of Hector and Sandra. The therapist in this case was able to use cultural differences to "lower the heat of the conflict," and help the individuals better understand and support each other.

Hector is a first-generation Chicano( n3) born into a family of ten siblings. He was the second youngest in the family constellation. Sandra is a third-generation Mexican-American with one younger sister. Although both Sandra and Hector are of Mexican descent, they had very different cultural organizing principles as a result of having been raised in different cultural surrounds. The different cultural organizing principles supported differences in values, behavior and understanding. Hector had a predominantly collectivist orientation that is consistent with the Mexican culture, whereas Sandra, being highly acculturated into the dominant American culture, had a more individualistic Eurocentric perspective. Their differently organized experiential worlds collided and precipitated multiple crises in their new marriage.

This is one example of how cultural differences exacerbated their marital difficulties. During one of our sessions Sandra bitterly lamented that Hector had loaned a new suit she had bought him for a job interview to one of his brothers. She was particularly disturbed by what she perceived as his lack of appreciation for what she had done for him. He, in turn, retorted that growing up in a poor family of ten siblings forced them to share everything. He proceeded to bitterly accuse Sandra of being a selfish capitalist who was insensitive to the needs of his family. She in turn accused him of being a communist. How could he not appreciate and value hard-earned material possessions? Their mutual frustration was exacerbated by meanings they each applied to the other's behavior. As is often the case, frustration led to further polarization and attempts to denigrate the other's perspective.

Sandra often referred to Hector as a "mama's boy." I asked her what she meant by that. She explained that "it was obvious that he had not managed to cut the proverbial umbilical cord because he insisted on seeing his mother every day!" Hector, the second-youngest child in his family, experienced himself as his mother's good little boy, her "angelito." Sandra insisted that it was time for Hector to grow up, finish college, earn his bachelor's degree, and get a full-time job. She proudly proclaimed that she had managed to separate from her own domineering mother and only visited her every three months. Although there were many factors contributing to the repetitive polarizing patterns that Hector and Sandra were experiencing, cultural value differences were omnipresent.

With a glimmer of insight into her behavior, Sandra lamented that in her relationship with Hector she was acting in many ways like her dominant mother. Sandra thus provided me with an exquisite opportunity to explore how their own relational and familial histories were influencing their marital relationship. I was able to point out to Sandra that by insisting on imposing her own, culturally grounded values of autonomy, separation and individuation, she was asserting paradoxically her power and helping Hector to stay a compliant little boy.

As noted above, because of their differences in acculturation, Sandra and Hector had two distinct ways of organizing experience. Each insisted on the correctness of his or her own perceptions. Since their respective cultural organizing principles were largely unconscious, the first therapeutic task was to shift the locus of the problem from the couple to their cultural differences (Falicov, 1995). This facilitated bringing their organizing activities to consciousness. Once their respective cultural organizing principles were brought into consciousness, they were able to reflect, negotiate and more consciously co-construct their own unique marital subculture.

The therapist's task is not to identify with or pathologize either partner's perspective. Seen from the individualistic orientation of the American culture, Hector's behavior was seen as dependent and infantile. Seen from the collectivist perspective, Hector behaves like a good and loyal son. From the collectivist perspective, Sandra's behavior is perceived as self centered and insensitive. Therapists must be aware of how their own cultural organizing principles might lead them to take sides rather than to recognize the cultural origins of each perspective.

Making empathic interpretations of cultural organizing principles is an effective method for stimulating change in an intercultural couple's relational dynamics. An intervention that simultaneously conveys therapist understanding of each partner and a more neutral or positive cultural interpretation of the event(s), enables each partner to develop a more empathic understanding of the other. We view the therapeutic encounter between couple and therapist as a complex intercultural system. When the therapist is able to enter into the intersubjective field of the couple and provide selfobject experiences for each partner, the therapist demonstrates how one can provide selfobject experiences for another by making a sincere attempt to understand each of the partners from his or her own point of view and flame of reference.

- Waldman, K., & Rubalcava, L. (2005) Psychotherapy with Intercultural Couples: A Contemporary Psychodynamic Approach. American Journal of Psychotherapy, 59(3).

Observation of Couple Conflicts: Clinical Assessment Applications,
Stubborn Truths, and Shaky Foundations


- Heyman, R. E. (2001). Observation of Couple Conflicts: Clinical Assessment Applications, Stubborn Truths, and Shaky Foundations. Psychol Assess., 13(1). 5-35.
Reviewed 2023

Update
Intercultural sensitivity as a mediator in the relationship between implicit intercultural identification and emotional disturbance-An exploratory study of international high school students

He, J., Song, X., Wang, C., & Zhang, R. (2023). Intercultural sensitivity as a mediator in the relationship between implicit intercultural identification and emotional disturbance-An exploratory study of international high school students. Frontiers in psychiatry, 14, 1098671. https://doi.org/10.3389/fpsyt.2023.1098671


Peer-Reviewed Journal Article References:
Auelua-Toomey, S. L., & Roberts, S. O. (2023). Romantic racism: How racial preferences (and beliefs about racial preferences) reinforce hierarchy in U.S. interracial relationships. Cultural Diversity and Ethnic Minority Psychology. Advance online publication. https://doi.org/10.1037/cdp0000592

Chang, C. J., Halvorson, M. A., Lehavot, K., Simpson, T. L., & Harned, M. S. (2023). Sexual identity and race/ethnicity as predictors of treatment outcome and retention in dialectical behavior therapy. Journal of Consulting and Clinical Psychology, 91(10), 614–621. https://doi.org/10.1037/ccp0000826

Feuerman, M. L. (2018). Therapeutic presence in emotionally focused couples therapy. Journal of Experiential Psychotherapy, 21(3), 22-32.

Li, P., & Johnson, L. N. (2018). Couples' depression and relationship satisfaction: Examining the moderating effects of demand/withdraw Communication Patterns. Journal of Family Therapy, Supplement, 40, 63-85.

Riekkola, J., Rutberg, S., Lilja, M., & Isaksson, G. (2019). Strategies of older couples to sustain togetherness. Journal of Aging Studies, 48, 60–66.

Veldhuis, C. B., Kamp Dush, C., Cerezo, A., & LeBlanc, A. (2023). An intersectional approach to understanding minority stressors and relationship satisfaction in sexual and gender minority women’s same-gender interracial/interethnic intimate relationships. Psychology of Sexual Orientation and Gender Diversity. Advance online publication. https://doi.org/10.1037/sgd0000666

QUESTION 25
Sustained empathic inquiry is both the stance and method in approaching therapy with intercultural couples.  What is sustained empathic inquiry? To select and enter your answer go to Test.

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