The importance of establishing culturally-informed treatments is highlighted by the substantial number of young immigrants who need help and by the severity of symptoms that have been documented in this population. This article focuses on how the varied issues with regard to immigration stressors, integration processes, value clashes, sense of belonging to the community, and discrimination can be more effectively addressed by a culturally informed treatment.
Key words : family, adolescents, immigrants, culture, minority
Family members, especially children and adolescents, may experience stress when they relocate from one country to another. The number of youths immigrating with their families to Greece from other countries (the Balkans, Asia, Africa, etc.) has been steadily increasing.
'Community Mental Health Centers' should respond to the increasing demand to help young immigrants who appear to have behavioral problems, developmental, psychosocial, etc. Most of these issues are connected to preexisting or growing difficulties of family relationships during the migration process (Voulgaridou M., Tomaras V. 2001).
Immigration status and history also play a key role in the living experiences of many ethnic minority individuals. Some refugees from Asia, the Middle East, the Balkans and Africa realize that they may never be able to return to their homeland. They often experience emotional cutoff and wonder if and when there will be a reunion with their family. Such geographical disconnections and intergenerational family emotional cutoffs have adverse implications for family structure and functioning. "Voluntary migrants" have a better social culture and educational adjustment in any given country(McGoldrick M.et al, 2005).
The emigrating families’ dreams and fears become part of their heritage. Parents’ attitudes towards what came before and what lies ahead will have a profound impact on the expressed or tacit messages they transmit to the children (Wilson M. N., 1995).
Other issues are connected with factors that distinguish minorities from the mainstream Greek society and these are (Man Keung Ho, 2003):
**1. ** Ethnic minority reality
Racism and poverty dominate the lives of many ethnic minorities. Unemployment is a major factor that lowers the economic level of ethnic minorities.
2. Impact of the external system on minority culture
In addition to coping with racism, poverty and social constraints, ethnic minority families must also adjust tensions created by the conflicting value system of the mainstream society. Due to differences in value systems, discriminatory conditions, and social constraints, ethnic minority members can be expected to experience significant family and individual difficulties.
A member of a minority is inevitably part of two cultures. Biculturalism demands the bilateral bringing together of elements, values and behaviors. It requires two sets of behavior. This dual response involves two distinct ways of coping with tasks, expectations and behaviors.
**4. ** Ethnicity difference in minority status
Several factors affect the status and adjustment of particular ethnic groups (skin color, race, religion, culture, etc). The status each ethnic group experiences affects social adjustment and family living. Another major factor is whether the ethnic minority individual is a legal resident or illegal alien; the latter is known to suffer incredible exploitation.
5. Ethnicity and language
Language is a fundamental element of national identity. A common language provides a psychic bond. Many problems can be traced back to miscommunication. An ethnic minority client may need to use his native language to describe personal intimate, gut-level issues.
6. Ethnicity and social class
Social class refers to differences based on wealth, income, occupation, group identification, family background, etc.). Few ethnic minority members have the income to belong in the upper or middle class and enjoy higher social prestige. For those in the lower social class the ethnic reality is translated into persistent discrimination in terms of work, housing, education as well as in the treatment by healthcare and welfare institutions.
Migration is so disruptive that it seems to add an entire extra stage to the life circle for those who must negotiate it. Families migrating with adolescents may have less time together as a unit before the children move out. Many adolescents develop symptoms in reaction to their parents’ anxieties and often reject their parents’ "ethnic" values. Intergenerational conflicts often reflect the value struggle of families adapting to the new country (Suarez-Orozco, 2001).
During family therapy, individual or family problems with adolescents are not perceived as a disease but as a deficit in the environment (as in the case of immigration), as dysfunctional transactions among systems (social services, medical care and social benefit system), as adaptation strategies, or as a result of interrupted growth and development (Man Keung Ho, p 20, 2003). Intervention strategies make use of natural systems and life experience. The family itself is a natural helping system and an instrument of change. The therapist’s role in such situations may be that of a cultural mediator, helping family members to recognize their own ethnic values and resolve the conflicts that arise out of different perceptions and experience (Man Keung Ho, p 20, 2003).
All the above can be understood with the presentation of a clinical case.
CASE – REPORT
Dimitris is a sixteen-year-old student and the eldest son of a four-member family from Albania which came to Greece seventeen years ago. The younger son is fourteen years old and a student in high-school. Both children were born in Greece. The father of the family is 46 years old and runs a small company which makes aluminum structures. The mother of the family doesn’t work. The two maternal grandparents also live with them.
The reason for coming to our Community Mental Health Service is that Dimitris presents some emotional and behavioral problems such as: fear of death from cancer, depressive moods, low self-esteem, runaway tensions, arguments with parents and brother, and a general state of nervous irritation.
Individual medical history
Dimitris faced suffocation problems and dyskinesia in his nether limbs at birth, for which he has been on a program of physiotherapy for many years. He has also borderline intelligence and learning problems.
The family shows low socialization and deficient emotional communication. There were arguments between the parents during the early years of their marriage. The father of the family had serious depression symptoms four years ago and was treated with medication.
The maternal grandfather is also on antidepressant medication. The mother is characterized as stressful and over-protective.
Issues of the therapy process
The father was ambivalent about emigrating and strongly wishes to return to Albania, abandoning his family, in order to take care of his sick father. He also has financial difficulties in Greece due to an unsuccessful business partnership. All this has emerged over the last year.
Jealous behavior on the part of the husband and psychological violence towards the mother during her first pregnancy led to the premature birth of Dimitris, as both parents admit.
The father sometimes resorts to corporal punishment in order to discipline and control his children. He often rejects Dimitris but the mother has developed a strong emotional connection with her son. The father has frequent and sudden bursts of anger while the mother looks sad and frustrated.
Both parents report racist treatment on the part of both their local community and the children’s school.
Dimitris considers himself inept and useless. He also expresses a "death desire". He feels isolated from people of his age due to his physical and learning disabilities.
Family therapy focused on:
- Finding an appropriate educational context for Dimitris.
- Giving the children the opportunity to express their thoughts and feelings about the family problems and also about their adolescence, while the parents talked about their "two" countries and their integration problems in Greece.
- The system of values and beliefs of the family’s previous generations.
- An advisory process, in order to set boundaries to the children and ensure that their needs and desires are listened to and better understood.
- Setting acceptance as a goal for the father-Dimitris duo, and emotional separation as a goal for mother and Dimitris.
- Reinforcing the subsystems of the couple and the siblings and improving communication and the observance of boundaries.
- Devising a better strategy in order to find a solution for business, financial and social problems.
- Releasing the parents from their guilt about Dimitris’s health condition.
- Reinforcing Dimitris’s socialization and self-esteem and improving his mood regarding his feelings of rejection, as well as getting him not to be involved with his mother’s negative emotions.
- Dealing with the family’s abandonment from the father (due to his possible return to Albania).
Ethnicity is a social reality of our age that requires the therapist to be more culturally aware. Race, gender, religion, class, immigration status and age are critical identity issues that we must consider in order to understand our clients. Add to this the rapidly changing nature of family life, and it becomes clear that we need to re-examine our therapy approaches in a large multicultural context.
 The name of the patient has been changed.
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