Marriage & Family Therapy Around the World

The podcast discusses family therapy challenges in different parts of the world. In Japan, family therapy is integrated with other professionals. In Istanbul, involving more people in treatment helps improve outcomes. India is implementing a new healthcare bill to include marriage and family therapists. China has a younger family therapy field and is influenced by Western cultures. India faces a shortage of therapists and a stigma around seeking therapy. Mental health treatment is a struggle in India, but efforts are being made to address it. The Systems of Care approach focuses on community involvement and empowerment. Families are involved in decision-making and goal-setting. New Zealand has a successful family therapy model. Overall, there is a need for more therapists and collaboration to improve family therapy worldwide. Welcome to my podcast, this is Rebecca Brennan, and the podcast today is on family challenges throughout the world. And today I'm interviewing two people, the first person is Janine Roberts, who wrote the article with her colleagues, Up Close Family Therapy Challenges and Innovations Throughout the World. Hello, Janine Roberts. Thanks for having me. Today I want to talk about the challenges with families in other parts of the world and what you see for marriage and family therapists. Oh, yes, thank you. One thing we know, out of the 10 countries that we observed, the world is very diverse in family therapy. Japan, for example, likes to integrate its family therapy with social workers, doctors, lawyers, teachers, and nurses to collaborate. And in Istanbul, undergraduates were able to connect better with boys who lived in shelters, became better listeners when they had more people involved in their treatment. India is implementing a new health care bill to now include marriage and family therapists. The world is really changing in this area. How about training in this area? We definitely need more training in supervision. Supervision obviously is key. Now since it is available online, it is important to get training out of the individuals in other countries to help. So what is happening in China in the world of marriage and family therapy? China is still very young in this field. It really did not even start until the 1990s. Then in 2012, the Shanghai Association of Social Workers introduced their first course of family therapy. This is really good news because the Chinese culture has been very reluctant towards any kind of therapy. It could be that Western cultures have been an influence on the Chinese and that therapy can be effective. China's divorce rate is on the rise. However, culturally, they seem to appreciate seeking out advice from their elders rather than professionals. Well, tell us why it is so hard for Chinese families to seek out therapy and what can a therapist do to help? As I said before, the Chinese culture is very pro-child, pro-child-parent relationship even over their marriage. How to combat this might be to work in a shorter time frame and understand the Chinese culture and what works well and what does not. What about India? How is it different there? India has an extreme shortage of marriage and family therapists. In addition to Indians, tend to cover up their problems and not discuss them openly. Therefore, the family is burdened with fixing the problem. There is also a social stigma with going to a therapist. One of the biggest problems with India is the hierarchy system. India tends to be a patriarchal society, so women and children may truly suffer by not getting the help they need. Suicide is a huge problem in this country with being the leading cause of death in ages in the late teens to early adults. Well, tell us what you have learned from studying the importance of marriage and family therapy in other cultures. I learned this when I was working in Mumbai with AIDS victims. I learned that getting their family involved in the therapeutic process helped with the therapeutic process. This dynamic with spouses and the infected brought on a ton of animosity. Often families would fight over their diagnosis and men would be encouraged to leave the woman, whereas women were encouraged to stay with their infected spouse. Training is imperative so that the therapist could know how to deal with angry, hostile, or grieving spouses, as well as to understand the family dynamics on how to navigate that. Well, what country is struggling the most with mental health treatment and how do we overcome this? It feels like India is struggling a great deal. The National Mental Health Care Bill will hopefully help. The bill comes from a social aspect rather than a medical model. Access is a human right and that everyone should get care. They will get advanced directives and decide who will care for them in the event of an illness. In addition, suicide is not considered criminal. We also need to address the shortage of therapists. Also, we therapists need to focus on gender equality as well as regressive traditions. Rapes and violent crimes are a huge problem in India. Mental health has been neglected for years. Mental health disorders have contributed 11.8% to disease, yet only 10% receive treatment. What is India doing to help with such a crisis? Sengaf, a non-profit, is currently training laypersons like teachers, community health care workers in areas of depression, schizophrenia, and other mental health disorders to help with this incredible problem. The Banyan is a non-profit serving mentally ill, homeless women, children with medication, therapy, and makes them stronger to reintegrate women in their communities. The Schizophrenia Research Foundation has mobile clinics to go to 800 villages plus telehealth to help others in remote areas. Now we will switch over to William C. Madison, who wrote the article, Taking It to the Streets, Family Therapy and Family-Centered Services. Welcome William Madison. Thanks so much for having me. Tell me a little bit about the systems of care approach and how you have gone about it. That's a great question. Systems of care is really about building community. It is a wraparound care for families and youth to be able to function better in school with their families, community, and overall better life. We implemented this program because the basis of care should not be about one person but one community. It takes a village to raise a child, as the saying goes. There are eight parts of this equation, health, substance abuse, social, vocational, recreational, and vocational services. The whole point is to help the child with wraparound services with the family and community integrating culture, experiences, and a better life. When communities come forward to help a child, it helps the child and family flourish. Tell us about how the family benefits from this. The family benefits because they are in charge. They create the goals and implement the services. Our motto is voice and choice. Goals and needs of the family drive their efforts. No plans are made without the parents' involvement. We really try to avoid blame but instead empower the family to help create a healthy atmosphere to open healthy discussions. What has made this process work so well? By making the family have decision-making, which puts them with equal footing to the professionals. When families are educated on the process, it allows them to make good choices for their family. It also gives the family great resources like having a professional's help, peer support, and training. This then focuses the shift, like some other countries have, on family therapy being a negative, shameful experience to build strengths and skills and hope within the family unit. This collaborative system also allows families to be accountable towards their goals. So how do we make the family accountable? We form goals through family group conferencing. This includes the family and networks to promote safety and what is in the child's best interest. We have this model in 25 states and 30 countries. But no one does it better than New Zealand. The plan is to prep for the meeting, have the meeting, then continue to do follow-up throughout. The family and the network therapists, social workers, and other professionals are all told the goals and their roles. The meeting is in four steps. The introduction is to introduce the family members to the professionals and discuss goals and roles. The information stage is where the facts are given to the social worker and the family's strengths are talked about. Support is given to the family so they can come up with their own plan. Private time is the next stage in which the family is asked to discuss this privately. This is so they can come up with a plan themselves. Finally, the decision. The family comes up with the best way to be able to protect the child and help the child. If there is a disagreement, this can be brought to family court. According to the professionals, this type of family therapy is 78% effective after just 18 to 24 months. Families communicate better, there is less conflict, and they are overall happier. So what made this successful? What has made it successful? I believe the reason it is successful is because the family is the expert. They believe in themselves on their terms. They are empowered and they are held accountable. These are all steps for success in the family collaborative model. Well thank you so much, you two, for both of your time. It has been very enlightening. I think that using these techniques can really change views on family therapy and overall help the family work together and heal together. So in conclusion, what I am hearing from both of you is that the world is in some parts is really lacking in family therapy based on shame and patriarchy society as well as culture and preferring to ask parents for advice rather than a professional. It sounds like many of the countries, including the U.S., New Zealand, and Japan are making strides in changing that to better collaborate with other professionals and families to improve their dialogue and overall structure. It seems like there is a huge shortage of marriage or family therapists so we need to bridge this gap. We need to get other professionals involved to help as well as work on plans like systems of care and the National Mental Health Care Bill. Thank you so much for joining me today. Thank you.