HE.S.T.A.F.T.A. - Scientific Society of Mental Health Professionals


Translation: Tonia Deliyiannis, SHO In Child and Adolescent Psychiatry _This transcript is based on the author’s article entitled “Coppie miste: le sfide della multiculturalita”, published in Connessioni, vol. 27, 2012, pp. 95-117. _

Introduction: A biographical note

This essay is a result of personal and professional experience. I have the privilege of being a member of an intercultural family and a multicultural extensive family system. My husband is Greek and our daughter perceives herself as “one hundred per cent Greek and one hundred per cent Italian” (Stone et. al., 2005). My father in law was born in Asia Minor; one of the daughters in law in the broad family is Jewish-American with Polish roots and another one is American with Chinese roots. In expanded family meetings, three or four languages are simultaneously “crossed”. Besides the linguistic, cultural and religious background, multiculturalism is “consolidated” in everyday life activities such as customs, diet, beliefs, aesthetics, habits, sense of humor, therapeutic “remedies”, and many more. Furthermore, in the network of our social relations, mixed couples are a majority. As a psychotherapist and supervisor working in Athens for 25 years, I met plenty of mixed couples, many with an Italian husband or wife, and several with partners of other ethnicities[1]. I thus faced the exceptional situation where I practiced my therapeutic work in a frame dominated by a different, and initially foreign to me, language (Burck, 2004), and where the therapist (i.e. myself) was the “foreigner”. Using this personal and professional dual perspective, I will attempt to analyze the most important aspects that characterize mixed couples, with references to couples I have worked with as a counselor, psychotherapist or supervisor. It is worth noting that bibliographic references on the subject have increased in the last two decades, reflecting the developments in Western societies, which tend to become more multicultural and globalised on one hand and more defensive and xenophobic on the other.

Beginning with the definition of the “mixed couple”, I will focus on describing the differences (in language, customs, habits, values, religion, gender roles, power, etc.) that affect the couple’s life and also on how its members can handle the challenges and difficulties that might occur in the beginning or during their common life. It must be pointed out that every couple is, in essence, an intercultural experience for its members (Pomini, 2008), even when these members have the same ethnicity, or belong to the same community. The gender differences in heterosexual couples, the cultural differences of their families of origin, and differences in values and beliefs, render the meeting with the other person an experience of adjustment, interaction, respect and utilization of differences, and as such, it has much in common with the process of intercultural adjustment. Finally, I will try to demonstrate the particularities of counseling and psychotherapy with mixed couples, the aspects that the therapist has to evaluate and the importance of developing a “multicultural sensitivity” (Falicov, 1995), perceiving the interaction with people from different cultures as an “epigenetic learning procedure” (Boscolo & Bertrando, 1996). This procedure is constantly enriched through clinical and personal experience.

Mixed couples: a definition

The definition “mixed couple” generally refers to couples with members from different cultures and/or nations. “Intercultural marriage exists when two people of different cultures meet. This meeting is part of a strategic adjustment through which genetic combinations are formed. These combinations, in turn, lead to a cultural transformation” (Hotvedt, 1999, pg. 364). The concept of “mixité” (Allievi, 1996) refers to phenotypic differences, ethnic, religious and cultural, individual or their overlays. In Anglo-Saxon literature, the general term “intermarriage” is used for couples with members from different countries (binational marriage), or belonging to different religions (interfaith marriage) or races (interracial marriage), or ethnicities (interethnic marriage) (Panari, doctoral thesis). Transnational couple or family is another currently prevalent definition (Stone et. al., 2005. Bacigalupe & Lambe, 2011), according to which one or rarely both members originate from different minorities or countries other than the country where they reside. The term bicultural couple (Falikov, 2007) indicates the effort and need for adaptation between two different cultures within the couple on one side, and the unique result of such a process on the other side. Mixed couples have always existed, formed by choice or by coercion (a common practice of attacking forces after an invasion, as well as marriages, consensual or not, in relation to state affairs). Sometimes mixed marriages have played an extremely important part in the evolution of mankind and civilization. Mixed couples are a particularly important observatory in relation to the integration between cultures on an interpersonal, family and social level (Scabini et. al. 2007, quoted by Ardone and Lombardini, 2010). Such couples have been described as a multicultural niche, multicultural laboratories and intercultural border zone, where differences and similarities coexist, often leading to conflicts but also promoting coexistence and creative interaction between groups of diverse cultures (Falicov, 1995). Examples of couples consisting of people viewed as “different” to each other from either’s social group are often presented in literature and the cinema, usually leading to a dramatic turn of events due to external pressure from each partner’s family and social group (Romeo and Juliette, Madame Butterfly, West Side Story, etc.). Mixed couples in movies such as Guess who’s coming to dinner, the comedy My big fat Greek wedding, or the more recent Ae fond kiss by K. Loach, are faced primarily with prejudice and other people’s denial towards the “different other”, rather than the difficulties regarding their mutual and personal adjustment to their interpersonal differences. This mutual adjustment is considered a process of “mutual acculturation” (Falicov, 1995) and evolves through recognizing, accepting, integrating and utilizing diversity. This is an ongoing procedure, not confined by time, and results from the processing of the couple’s identity, including offspring and family identity as a whole (Lombardi & Ardone, 2010). Members of the couple’s broader family and social network are not excluded from such a process, the latter being one of intercultural “initiation”, spreading directly or indirectly through the couple’s social framework. Mixed couples are important as factors of change, reshape and cultural development, acting, in reality, as a bridge between communities (Panari, ibidem). In an interview a few years ago, Umberto Eco stressed the importance of the European Universities’ Erasmus exchange programs. Such programs, among other benefits, enhance the possibility of the formation of multilingual, multicultural mixed families, whose offspring could become a future social group with a broader European vision. In light of the serious economic and social crisis Europe faces today, such thoughts offer some hope of change and strengthening of the European institution. The frequency of marriage to a foreign husband or wife in Italy reached 9.2% of total marriages in 2009, compared to 5.6% in 2000, proving that such marriages are in constant rise (ISTAT, 2011). Although a sizeable part of mixed marriages is among European Union citizens, in the majority of cases one of the spouses originates from a non-EU country (Panari, ibidem). There are substantial differences but also notable affinities between these two types of couples: when the foreign spouse originates from a Western European country, there is a stronger cultural and socioeconomic similarity between the partners and their families of origin. Also, a lingual equality is present because, as it will be analyzed further on in the text, learning a second European language, especially of Western origin, is usually considered desirable and socially beneficial. The imbalances between the two cultures and the drive for cultural assimilation of the host country is much greater in couples with a non-EU spouse, or one from Eastern Europe, especially when there is a strong socioeconomic gap among the couple members. It should be noted that such differences were until recently present even among couples established in an inner-European migration frame or even on Italian ground, between North and South.

The choice of partner

What are the factors that lead two people from different cultures and/or nations to choose one another and establish a stable relationship? Usually, as in every couple, sexual attraction and love are the basis of romantic choice of partners. The allure of diversity may lead people that already have a cosmopolitan mentality to fall in love with a foreign partner (scelta esogama – exogamous choice), disregarding the conservatism of the saying “better wed over the mixen than over the moor” (i.e. better marry a neighbor than a stranger) (scelta endogama – endogamous choice). Love is not the only motive for starting a relationship and eventually establishing a mixed marriage: in some cases it offers benefits such as the means to remain in the host country (matrimonio di convenienza – marriage of convenience), or it could be a social assimilation strategy (matrimonio facilitatore – access marriage), or it could even be the consequence of a childbirth, especially if the wife is the foreign member (matrimonio riparatore – reparative marriage) (Tognetti Bordogna, 1996). During the 70s and 80s the dominant motive for a choice of partner of different ethnicity was probably the urge to react and rebel against social standards. In some cases, this choice may be connected to a hidden pathology (the mixed couple as a functional framework for an individual type of psychological difficulties) (Fenaroli and Panari, 2006). The structural approach changed the outlook in studying mixed couples, focusing on both partners’ social groups. According to this approach, mixed marriages are more frequent in communities that are more receptive towards mixed couples. In such a social framework, the individual characteristics of each partner are considered more important than his/her social and cultural origin (Fenaroli and Panari, 2006). The motivational approach designates three basic factors that determine the choice of partner: the allure of a different culture, the similarities in things like education, values, beliefs as perceived by the other person, and the unconventional choice of partner as a sign of independence and opening to something new (Fenaroli and Panari, 2006). It can be deduced that the high level of mobility for work or studies, along with the migrating movements characterizing contemporary societies, result in a multiplication of chances for meeting in “mixed” environments. Opening to something new, social acceptance and the motive for intercultural assimilation are factors that determine the increase of the number of mixed couples in modern-day Western societies. Gozzoli and Regalia (2005) suggest a very interesting classification. They introduce the idea of motivational agreements (patti motivazionali), considering the motives and expectations of both partners, and identify three categories: a) convenience agreement, when the relationship is connected to the achievement of personal goals without any particular emotional investment in the relationship, b) comfort agreement, when the relationship aims to reduce the feeling of marginalization that people experience in a social and/or family framework, and c) integration agreement, when the relationship presupposes a definite personal and social identity of the partners, who ally to expand their personal sense of self (Panari, cit.) Mixed couples usually have a conscious perception of their similarities and differences and often report. a bigger commitment to their relationship and its stability and continuity. Also, they actively try to learn about their partner’s cultural background and create a unique family culture that includes elements from both sides. Diversity is perceived as a source of wealth and not as an obstacle for the relationship, and as a source of opportunity for their children. Interculturality augments satisfaction in the relationship, increasing curiosity and interest for the “other” (Inman et. al., 2011).

Linguistic differences

Language reflects the classification of the world and is the tool that allows us to make distinctions for our world (Keeny, 1987). According to Sepulveda (2001), language is everyone’s true homeland. It is not just the vehicle of a particular culture, but culture itself. This implies that one’s spoken language is an integral part of his or her cultural identity. In mixed couples and families, the linguistic code is of great importance on the levels of communication, relationships and society. Mixed families are a complex linguistic laboratory, where the everyday use of two or more languages constitutes an advantage and a source of greater mental flexibility and creativity. Bilingual people, indeed, demonstrate a greater relationship competence (Burck, 2004). Also, psycholinguistic studies converge to the following: the use of two or more languages, especially by children, leads not only to a better cognitive development in general, but also to enhanced psycholinguistic abilities, reinforcing psychoneurological development (Timpano Sportiello, 2002). Understanding bilingualism as a double way of describing reality, it could be said that double description, like binocular vision, probably helps achieve a deeper knowledge of the world, which contains rather than excludes different beliefs, strengthening tolerance (Telfener and Casadio, 2005). The mixed couple is thus in a process of negotiation regarding the language of communication among the partners and that of the family system. This process leads to a great variety of possible behaviors with diverse outcomes, especially for the children, depending on whether the parents are proficient in both languages or end up adopting one of the two or a third language (Pomini, 2006). The prevailing language in the social environment is most often used in the communication between the children and can gradually be adopted by the family system (e.g. between brothers), unless this is consciously obstructed by the parents who might decide to encourage the use of both languages. In mixed couples language can reflect, on a microsystem level, the influence of the prevailing language in the macrosystem. For example, in a family where one parent speaks English, the children are most likely to be encouraged to use English. In this case, bilingualism is considered an advantage at a personal and social level. If the foreign parent’s language is not socially “desirable”, especially when the mixed couple was formed in an immigration context, it is possible that its use will not be encouraged, perhaps as a strategy for the children’s better social integration. Sometimes the use of language may reflect an unequal distribution of power between the couple, especially if one does not speak the other’s language and is thus afraid of marginalization, even in relation to his/her children. In other cases, the use of two languages could be discouraged by an invasive family and a local community, as is evident in the following example.

Angela and Grigoris

Angela met Grigoris in the early ‘70s, when they were both students at the University of Florence. He was a brilliant student and was given the opportunity to follow an academic carrier in Italy. He seemed unlikely to return to Greece, and much less to his native village. They decided to get married even though Angela had not completed her studies. That caused an extreme reaction in Grigoris’ origin family: His mother threatened to commit suicide if her son did not return! Grigoris gave up the dream of an academic career and persuaded Angela to follow him to Greece. The first years were hard for her, until the time Gregoris succeeded in his profession and the family moved to Athens. Before that, Angela, who in the meantime had had a daughter, had to face unprecedented living conditions and was prevented from using her native language in the presence of Grigoris’ family. She gradually stopped speaking Italian with her daughter and the children that followed. She began to withdraw into herself, and an episode of major depression followed, with serious consequences for her and the rest of her family.

If one of the couple’s lingual codes is restricted or forgotten, it results in a loss of an important opportunity for the whole family, as will be seen later in Jose and Dimitra’s example. Undoubtedly, growing up in a bilingual environment not only increases a person’s “metalinguistic” learning ability but also enhances the diversity and variety of cultural stimulants to which children are exposed from birth. Bilingual families usually develop a family vocabulary which presents code switching as a metalinguistic ability, i.e. a quick transition from one lingual code to the other, with alternating terms in one or the other language. Some studies (Timpano, 2002; Burck, 2004) have analyzed the different use of bilingualism by fathers and mothers. The latter tend to use their own language more with their children. This demonstrates a mother’s important role not only as a means of learning the language (it is obviously not by chance that is called a “mother” tongue), but also as a means of learning about the culture associated with that language — its traditions, meanings, visions, etc.

The difference in religious beliefs

Religious differences in mixed couples can be of either minor or major importance, depending on the beliefs and the significance of religion for each partner, and also on the social framework in which they belong. In families where religious faith is of importance, difficulties may arise concerning rituals, holidays, diet customs, or the couple’s sex life, the children’s education, and also the relationship with their extended families and the community (Fenaroli and Panari, 2006). In countries where national and cultural identity are firmly linked to religious identity, the incorporation of any belief differences in the mixed couple seems to be more difficult, especially regarding the education of their children. This is partly true of Italy, and is of course, true in Greece, where religious marriage and christening are the norm among new family formation rituals. In cases of mixed couples where one partner, especially if that is the male partner, originates from an Islamic country, there is a great risk of religious conflict that may affect other important cultural and legal aspects of marital and family life (Zanatta, 2008). Islam, more than any other religion, closely regulates social life, family institutions and family law (Allievi, 1996). In case of a couple’s conflict or break up and divorce, religious beliefs play an important part in the handling or dissolution of the relationship and in terms of child custody, which could be denied to a different religion parent in order to ensure that the children will not be removed from their religious faith. Discriminations between men and women in Islam reflect the social acceptance of mixed marriages. For example, the union to a man of different religion is considered inappropriate for a Muslim woman, and could even put shame on her family of origin. By contrast, a Muslim man’s union with a woman of another religion is acceptable (there is a chance of rivalry towards the foreign wife from the women in the man’s extended family), provided that the children will be educated exclusively according to the father’s religious beliefs (Allievi, 1996). Conflict originating from the difference in religious faith was one of the issues concerning the clinical example that follows.

Maria and Assad

Maria is 45 years old. She has been married (by civil marriage) to Assad, who is 48 years old, for ten years, and together they have a 10 year old son. Assad originates from Alexandria, Egypt, the city where Maria was born to Greek parents. Her family moved to Athens, Greece when she was still an infant. Maria’s father knew Assad’s father and he helped the young Assad when the latter first moved to Athens in order to work. After their marriage, Assad continued visiting Egypt and was away for long periods of time. Lately, Maria started believing that her husband has formed another family, something that is allowed by his religious faith. Assad denies it, stating that his travels are business oriented, but fails to reassure his wife. Maria refuses to accompany her husband on his visits to Egypt, fearing the pressure by Assad’s family regarding their 10 year old son’s faith and his kinship to Islamic customs. The couple’s conflicting relationship has got worse, and their son shows signs of psychological discomfort, probably due to the crisis in his parents’ relationship.

The relationship with the families of origin

Most of the studies regarding mixed couples (Killian, 2002; Inman et. al., 2011; Lombardi and Ardone, 2010) report initially negative responses from the larger families during the formation of the couple’s relationship. Some families may implement strategies in order to discourage the couple and/or be hostile toward it. The couple’s intercultural choice may cause close relatives to experience fear of loss, fear towards something different and “foreign”, feelings of betrayal and cancelation of their expectations, while sometimes it is perceived by the family as a rejection of the origin culture. Some couples consciously ignore their families’ expectations, adopt different values and create a new framework of intercultural interaction (Killian, 2002). In some cases, couples mention feelings of embarrassment and/or discomfort regarding the handling of ethnic or national differences in the context of the extended family. It is possible that the history of the foreign partner’s family could be marginalized, especially if he or she belongs to a minority, and beliefs and traditions could be avoided or ignored by the couple (Killian, 2002). On the other hand, the family of origin might consider the mixed marriage to be a threat to the continuation of its culture, or be afraid that their son or daughter feels inferior in relation to his/her partner (Fenaroli and Panari, 2006). The negative stance of larger families is usually a source of tension between the couple. On a personal level, one of the partners may possibly experience feelings of guilt and a conflict of loyalty towards the family’s traditions on one side and his or her partner on the other. It has been observed that in the course of the years, negative reactions of the larger families become gradually milder, or even change towards positive (Inman et. al., 2011), although the linguistic, cultural and geographical barriers may still continue to hinder communication between them. For example, the presence of relatives from both families of origin in major events and ceremonies of the family may not be possible, or one of the partners may feel an excessive interference from the other’s family in everyday life, or relatives may still continue to exert pressure, even from a distance (as in Angela and Grigoris case). It should be noted that a few decades ago, someone leaving his/her country and family usually constituted a definite separation, whereas today contact and communication are significantly easier due to faster and cheaper transport and technological progress, enabling frequent and low-cost contact with friends and family, watching television programs and generally allowing the foreign partner and his/her children to keep in touch with the origin kinship and culture (Falicov, 2007; Stone et. al., 2009; Bacigalupe and Lambe, 2011). Thanks to the internet, families can keep strong ties through a “virtual” participation in the life of the couple and the family (Bacigalupe and Lambe, 2011), or be reunited after many years (as in the case of Jose and Dimitra, analyzed further in the text).

**Gender and power issues in mixed couples **

Role distribution between men and women and aspects of power and equality are particularly important in mixed couples, relating to cultural and individual differences[2] An intercultural perspective demands a more complex approach to these issues and should connect each couple’s experience with its value system and culture. Usually, the cultural framework in which the couple lives—that includes customs and beliefs related to roles and power distribution—strongly influences the relationship model that the couple adopts (Knudson-Martin and Mahoney, 2009; Maciel, Van Putten, Knudson-Martin, 2009). Regardless of their origin, the partners usually desire a relationship of mutual support, exchange and equality, even when they accept and maintain tradition customs of their culture (Knudson-Martin and Mahoney, 2009). Achieving a satisfactory balance for both partners is a result of negotiation and mutual adjustment, as in every couple, and can cause conflicts through time.

Emanuela and Yiannis

_Emanuela is Italian and Yiannis is Greek. They met and fell in love in London, a “foreign” environment for both. For a long period of time, their relationship was satisfactory, based on mutual support, on equality in role distribution, on emotional and sexual fulfillment. Emanuela agreed to follow Yiannis to Greece in order to facilitate his academic career, but also since she had found herself a profession of interest there and felt the need to return to a Mediterranean country. In Athens, Yiannis’ behavior changed radically: he began going out on his own, without informing his partner and he neglected housework, implying that they are a “woman’s duty”. Generally, his approach and attitude changed completely, becoming more traditional, and this was tacitly acceptable in their new environment. _

The issue of power and role distribution between the couple relates to each partner’s autonomy and individual prosperity in the framework of the relationship, and involves matters like organization and responsibility for the home and children, the finances, etc. The overlapping and confused roles that characterize couples in modern Western societies (Pomini, 2008) is an added test for the intercultural couple: the balance that can be achieved could be more conscious and satisfactory in comparison to same- culture couples, because members of a mixed couple usually invest more in the effort of mutual adjustment, acknowledgement and acceptance of diversity. A study by Maciel et. al. (2009) refers to immigrant couples either from the same or different country, focusing on the aspects of the processes of cultural adaptation and negotiation regarding gender equality and power issues also present in an intercultural couple. The authors mention three adjustment models: a) forced, when some aspects are imposed on one of the partners (for example, for a couple with a Muslim partner living in Europe, the social framework imposes a less authoritarian male role), b) picking and choosing, where both members choose to adopt certain elements of one or the other culture, and c) default, when a cultural model is suggested and becomes accepted without it being a conscious choice but a given fact (Maciel et. al., 2009). In reality, each couple usually goes through all three stages over their time together. If the couple is of middle class origin with a high level of education, it can be easier to arrive at a mutually satisfactory balance, overcoming the prejudices of the origin culture. When there are strong social differences between the partners (e.g. cultural), the “foreign” partner may face more difficulties in relation to role and power distribution. For example, a financially weak woman originating from an emigration country (Eastern Europe, Africa, SE Asia, etc) could be more vulnerable and give in to her partner, but could also find support and help in the host country to claim her rights, possibly more so than in her original country. It is thus vital to frame cultural differences in relationship dynamics, in a social level between predominant social groups and minorities. This point of view inevitably influences the relationship models of intercultural couples: lack of social and professional acknowledgement of the “foreign” partner, stereotypes, prejudice, and the need to adjust to the dominant culture can affect equality in the relationship (Panari, ibidem.) Another parameter is that of the couple’s original agreement and possible “silent” expectations (invisible contracts) (Jenkins, 2006): has the couple clarified the basis on which the relationship is built? For example, how was the decision taken regarding the country they would live in? Will they reside there permanently or temporarily? If not permanently, then for how long? Do they believe they have participated equally in this decision? Do they agree on the reasons on which their decision was based? The following example demonstrates the difficulties that could arise when there is no original agreement.

_Helen and Yiorgos. _

_The couple came with a referral from Helen’s psychiatrist, as Helen, who is 37 years old, shows signs of depression. Helen was born and raised in the United States and she met Yiorgos at an American University where they both studied for postgraduate degrees. They lived together for a while and then Helen moved to England for further specialization, and there she immediately found a temporary but excellent job. Yiorgos followed her to England, but could not find a suitable job. They both frequently visited Greece on vacation. In one of these journeys, Yiorgos was offered an exceptional business opportunity. He accepted and Helen did not try to renew her employment contract, thus consenting to follow Yiorgos to Greece for a time. They got married, so that Helen could get a residency permit, and in a short while they had three children. The family has been in Greece for seven years, but Helen has yet to find a job to suit her qualifications; she has a part-time job that allows her to take care of her children. She is in waiting, though, to return to the United States. Every time Helen and Yiorgos discuss the subject, they fail to reach any conclusion. Yiorgos believes that his wife has “silently” accepted the decision to live in Greece, whereas she gets very angry, because, according to her, he has no clear plan about their future and she resents being idle. Yiorgos is indecisive: in the United States his family will have a higher living standard, but he thinks Greek society is a safer environment for bringing up their children. _
_They both fear dealing with the subject. They worry it could lead to a rupture, something they do not want. But, avoiding conflict and reducing communication has emotionally separated them and leads to isolation. _

** Parental roles: children upbringing in an intercultural family**

Given that children are the continuation of a family and its culture as well, the parental role in the mixed couple is even more complex. of the birth of the children, the sharing of childcare duties, the expectations of each parent for the children’s education and transmission of cultural identity could lead to conflict (temporary or long-term), especially when the fusion and mix of the two cultures has not been dealt with adequately prior to the children’s birth. Moreover, serious issues arise regarding the children’s identity in relation to their ethnic and cultural characteristics. Particularly mothers from minorities often report their need to transmit their language and traditions to their children, but, at the same time, voice the fear of their children’s possible marginalization in the dominant culture (Inman et. al., 2011). Another factor that could cause additional difficulties is the influence of the origin families, especially after the birth of children. One parent may experience excessive pressure from the other parent’s culture (as in the case of Maria and Assad), or from the partner’s demands, or from the cultural traditions as voiced by grandparents and other relatives. This could lead to competition and conflict, obstructing the children from developing a harmonious intercultural identity. Apart from their conscious or unconscious expectations, parents from different cultures must accept that their children will develop their own, unique intercultural identity, which will not be completely that of one or the other parent. The more successful parents are in their intercultural adjustment, in creating a “cultural niche” as mentioned by Falicov (1995), the more children will develop an intercultural identity devoid of conflict. Otherwise, it is often observed that children tend to reject the culture of one of their parents, based on the process of identification or reactive confrontation towards one or the other parent. External factors should also be considered, such as social pressure and prejudice towards specific ethnic groups. Such factors obstruct a balanced intercultural adjustment of children in intercultural families. In case of a confrontational divorce, mixed couple parents may display a much more intense fear of separation and loss of the children than in the case of couples from the same cultural background. The procedure of getting custody of the children could lead to strategies of systematic devaluation of the other parent, with traumatic consequences for the children. Language, beliefs, family stories and traditions play a key role in the development of the children’s multicultural identity (Stone et. al, 2005). Negation of these cultural aspects could form the basis for the appearance of psychological problems in one or more members of the family, as in the case that follows.

José and Dimitra

The S. family was referred by a center for the diagnosis and treatment of learning difficulties that treated Anna (age 10), after a report from her school. What worried the teachers was Anna’s isolation from her classmates, her poor performance at school and the evident signs of malnourishment and neglect despite the fact that Anna comes from a family with no serious financial problems. After a psychological evaluation process, there was no evidence of learning difficulties, but there was evidence of difficulties due to emotional reasons. Her parents were advised to undergo family therapy.
_All four family members were present during the first session: Dimitra, the mother, aged 28, a young, comely woman with green eyes and a broad smile, very active and talkative. José, the father, age 30, small in stature, with a soft voice and a good command of the Greek language. He comes from Ecuador and moved to Greece 11 years ago. Since then, he has never been back to his homeland. Anna is the firstborn, a beautiful girl, with a thin figure, looking younger than her age. Spyros, 8 years old, is a cute, lively and talkative boy. _
The parents voiced their concern and surprise regarding the teachers’   _observations and recommendations about Anna’s behavior at school. They want to co-operate but at the same time show signs of concern and disbelief. _
_The “space” that Dimitra and Spyros occupy is impressive, while José and Anna, each by him/herself, sit somehow isolated. The vocabulary Anna uses is special: she gives one word answers with a “metallic” voice and a peculiar accent that, as observed later, is similar to that of her father’s. _
_Gradually, it is obvious that the parents and children have a great distance among them in their everyday life. Jose and Dimitra work and study at the University at the same time, thus they are away from home for many hours. After school, the children go to Dimitra’s parental home, where her grandmother, parents and three younger siblings live. It seems that there is no stable reference figure for the children. Their grandmother still works and is emotionally unavailable, the grandfather is occupied with the family business, the great grandmother is quite elderly and Dimitra’s siblings are students. The role distribution among the parents seems chaotic; it is not clear who is responsible for the house and children. Jose appears more present and attentive towards the children. _
_Jose teaches Spanish. He does not speak his native language with the children or Dimitra. Sometimes, when they do not want the children to know what they are saying, the parents speak English. José’s mother tongue, history and family are “unknown” to his children, whereas Dimitra’s family is present, sometimes in a chaotic and invasive manner. _
What led José and Dimitra to form a family? Jose arrived in Greece by chance. He was born in a small city and he and  his siblings initially grew up with his maternal grandmother and later lived on the street. His mother faced a serious health problem and his father distanced himself and neglected the children after the divorce. José wanted to study and a religious school was the only institution offering access to education, so he decided to follow it, and that led him to Greece. Here, he started working as a Spanish teacher and at the same time continued his studies. He met Dimitra and they fell in love at first site. After a few months, Dimitra was pregnant and they decided to get married. She had just finished High school and had gained admittance to the University, while working at the family business at the same time. She went through a difficult adolescence, showing self-destructive behavior, for which she had sought psychotherapy. Dimitra describes her relationship with her mother as conflicting. She is her family’s firstborn, and assumed a maternal role towards her younger siblings, helping her mother who focused on her work. Her relationship with José seemed to free her from the obligations towards her origin family and led to the formation of her own family at last. Jose was sensitive, calm and polite, whereas her parental home was filled with tension and everyone was on edge. The new couple soon faced difficulties: they were both simultaneously studying and working, and they became parents before “bonding” as a couple. Although they loved each other, Dimitra felt constricted in their relationship and sought friends and fun. José felt abandoned and isolated himself with his books, instead of joining Dimitra in her social activities. José had no contact with his past and was found “adopted” by Dimitra’s extended family, which was supportive in some areas but quite invasive and chaotic. He became a parent without having a paternal reference model, as his father had abandoned him when he was very young. Additionally, he had to face the difficulties of adjusting to a foreign country and of a complete separation from his own country.
In the course of a year, there was a developing co-operation with the family and its subsystems, especially the parents. In one of the meetings, in an emotionally charged environment, José’s story emerged, as well as his family’s, his complex experiences of abandonment, by his parents towards him and vice versa, his feelings of insecurity due to immigration, but also the possibilities and opportunities offered to him and his ability to utilize them. His family history, culture and language were used in the context of therapeutic dialogue, creating a bridge between past and present. The couple gradually understood the difficulties and emotional bonds that each had with their respective origin family, which they had “forgotten” and “locked” in the past, but which were also present in their relationship with their children. These difficulties were “reflected” in the emotional discomfort that the children, especially Anna, displayed in the present time (Pomini, 2011).
_The cultural conflict in the couple was resolved through a total assimilation of José to the Greek culture, costing him a geographical and emotional “distance” from his native country. Till that time, the children had no access to their father’s language and had never met his relatives. _
_In the end of the therapeutic collaboration, apart from Anna’s progress at school, José mentioned that after a request by his daughter, he started teaching her Spanish. Gradually, he started speaking Spanish with both his children and he also began communicating with his origin family, through Skype, after many years. For the first time, the relatives exchanged pictures of themselves, their homes and their environment and continue to do so on a weekly basis via the internet. Moreover, each parent made an effort to spend more time with the children, and the couple’s communication improved significantly. José assumed a more assertive role in the family and that seems to have helped Dimitra set boundaries to her origin family. _

Even in cases where intercultural balance has been achieved to a satisfactory level, difficulties may arise during a family’s new evolution stage:

Antonella and Markos

_Antonella and Markos are a couple over 50; she is Italian and he is Greek. Their two children, a boy and a girl, are studying in Italy. Both parents work and claim to be satisfied with their professional life. They have been living in Greece for the past 25 years, consciously deciding to reside in this country. Antonella adjusted successfully and with no particular difficulty, as they both report. _
_During the last year, the couple experiences intense conflicts, and in contrast to what happened in the past, they have frequent arguments. The children, especially the daughter (born second), are falling behind in their studies. Antonella blames Markos for supporting their daughter’s admission to the Italian University. Markos, on his behalf, believed it would be better for the children to live together abroad and could not imagine that this would distress Antonella. Their daughter is in a relationship with an Italian and Antonella is worried that both her children will choose to stay permanently in Italy. This prospect causes Markos to have conflicting emotions: he believes that the children have the right to choose where they wish to live, but he wishes his son to return to Greece and work in his business. Antonella, on her part, dreams of having her daughter by her side, of having grandchildren and giving her daughter the help she could not get from her mother due to distance. In the light of all these unspoken thoughts, the delay of both the children’s studies seems to facilitate the avoidance and deferral of difficult decisions in the future. _

Mixed couples in therapy: the intercultural sensitivity of the therapist

In Elkaim’s (1986) well-known article about the systemic therapy of couples, the clinical example is that of a mixed couple: an Italian man and a Dutch woman. The difficulties evident in that couple clearly fit in with what we identify as cultural conflict today, described by the author as a difference in the “maps of the world” (Bateson, 1972) that each partner has. During therapy, these “maps” necessarily contradict the  personal “map” of the therapist, who is also from an intercultural environment in this case. A systemic therapist’s awareness and clarity regarding his own national and cultural identity, as well as his/her clear personal attitude towards interculturality, are now considered fundamental requirements in order to efficiently deal with issues occurring in mixed couples and families (Falicov, 1995, 2007; Killian, 2002; Guanipa, 2003; Scheinkman, 2008). In these cases, the therapist should create a holding environment (Scheinkman, 2008), particularly necessary for working with mixed couples compared to same-culture couples. In this holding environment, the two partners should develop the comfort to express their point of view, position, values and emotions, in a framework of open dialogue, with respect to any difference and prejudice (Cecchin et. al., 1994) which should be voiced and discussed. The meaning of family varies according to the cultural framework (Singh, 2009): if the therapist has a precast idea of what family signifies, or considers it a given and universal entity, he or she is in danger of imposing his/her own model of cultural reference which may prove to be ineffective and/or detrimental. Also, the therapist could adopt, consciously or not, the dangerous attitude of normalization and collusion towards the couple’s dominant narration, for example, avoiding, undermining or ignoring any ethnic differences or regarding the “foreign” partner as overly “sensitive” towards the discrimination and/or racism he or she experiences in the social environment (Killian, 2002). The therapist must recognize and respect the complexity of a mixed couple and encourage the utilization of diversities as resources for themselves and their family, promote communication with relatives in the origin country and adopt an ecosystemic model that focuses on many levels: family relations, relations with the origin communities and the broader socio-cultural context (Falicov, 2007; Scheinkman, 2008). The training of a systemic therapist should include matters of multiculturalism in order to avoid undermining or overly emphasizing such matters during the therapeutic procedure. Working with an intercultural couple or family in therapy, is a valuable learning opportunity for the therapist, and could become a “mind broadening” experience for everyone involved in such a therapeutic process. Aside from the particular problems each couple presents, the challenge of an intercultural couple is that of a cultural change through the integration of two different cultures, conveying to their relatives and social framework a sense of tolerance, integration, creativity and peaceful conflict resolution. This process could be considered a “fusion of horizons” (Gadamer referring Taylor, 1998), in a microsystem dimension. The therapist’s duty is to encourage this process, taking an active part in it.


A writing on a high school wall in a provincial Italian city reads in Arabic: “Jessica, I love you”. It is expected that in the next adult generation (i.e. today’s adolescents) there will be a rise in marriages between people of different ethnic groups, with various degrees of difference (mixité) (Allievi, 1996), even in countries like Italy and Greece, where mass immigration is fairly recent. The studies and clinical cases cited in this article refer mainly to middle-class, middle or higher educational and professional level mixed couples, who have access to psychosocial services if the need arises. It is imperative to further research the discussed issues in social groups of a lower economic level or those more exposed to the consequences of the economic crisis, aiming at a  better understanding of the difficulties and resources of interculturality in different social groups and to offer professional and efficient psychological support, where required.


[1] The clinical cases described in the text refer to families and couples with which I collaborated as a therapist or supervisor mainly in the framework of the Family and couple practice of the Athens University First Psychiatric Clinic - Aeginitio Hospital. Names and other characteristics have been changed in order to safeguard personal data.

[2] Lack of space does not allow to approach relative subjects regarding homosexual intercultural couples in this article.


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Read the next article:

ARTICLE 6/ ISSUE 2, April 2013

Group Psychotherapy with parents of patients with psychosis

Dionysios Sakkas, Psychiatrist Psychotherapist, Director of the Psychiatric department, General Hospital of Athens, Eumorfia Paschalidou, Nurse General Hospital of Athens, Larisa Masco, Psychiatrist Psychotherapist, General Hospital of Athens,
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