Model has served to guide the discipline of Medical Family Therapy, reminding
us to assess, acknowledge and treat each of these systems and specifically not
to ignore the psychosocial when working in a medical setting. However, what
exactly is encompassed in the ‘social’ realm? For social workers it may include
basic living needs or connecting patients to other social service agencies. For
chaplains it may be connecting the patient to a religious/spiritual community.
For marriage and family therapists, it can include working to improve family
relationships. Each of these disciplines is addressing important needs of
patients that have been proven to aid in more effective treatment, faster
recovery, and increased patient satisfaction.
|While these ‘social’
interventions are improving the health and well-being of patients, I would like
to take a moment to dig a little deeper. I define the social aspects of life
and health as cultural and relational ways of being. With that said, it is
clear that ideas surrounding health, illness, cures, and healing will vary by
individual and community. Yet we utilize ‘evidence-based’ methods that only
allow for one way to see, cause and cure an illness which may be subjugating,
and possibly ineffective, for the patient.
||What would you do as a MedFT if this were
your patient? |
Let’s continue the conversation through the comments you make!
interventions, such as Motivational Interviewing (MI), allow for patient goals
and motivation to be accounted for. Further, Galanti (2004) suggests using the
‘4C’s (1. What do you call
problem/illness? 2. What do you think caused
the problem? 3. How do you cope
the problem? 4. What concerns
have about the problem?) can help to gain a better understanding of the
patient’s view of health and illness. Next, the information gained from this
assessment can be incorporated into treatment recommendations which will
respect the patient’s health belief system and worldview and, therefore, are
I argue that a
deeper and often more difficult intervention is necessary to accompany the
above-mentioned techniques. I believe that using cultural humility to
interact with patients will allow for some of the best health care outcomes
possible. Cultural humility is the constant examination of our own biases and perspective. The regular steps of cultural
competence still remain: learning/reading about a particular culture,
interacting with that culture, respecting cultures other than your own.
However, an additional set of criterion are necessary to become culturally
Acknowledge that you are on equal footing as their discussant/patient-There is
no better way to conceptualize health
(i.e., provider vs. patient beliefs surrounding health).
Be aware that the discussant lives their life by a set of rules related to their
family, history, and environment, which are individualized, discrete and
different from your own (Ethnorelativism).
Be aware of how your own personal life history over time effects your thoughts,
beliefs and behaviors (strengths and
limitations) in relation to the discussant.
Acknowledge that one can never truly know the perspective of another individual
or culture and that admitting your limitations opens the door to an honest
conversation and does not diminish your legitimacy, credentials, or strengths
Does not search to become culturally competent at some distinct point, instead
is continually learning about themselves and others through mutually beneficial
demonstrate this point I offer a case example based on a real scenario:
A medical provider and her colleagues have
been seeing a patient who has cancer (but has been in remission for 4 years) at
6 month intervals to ensure that the cancer (a rapid and progressive one) does
not return. At the end of every visit for 4 years, the provider tells the
patient and his family that he continues to be cancer-free and the family wails
with joy and tears at the end of every appointment. The provider and her team
have become frustrated with this response and do not understand the intense
emotional reaction to what seems like a routine check-up that has resulted in
the same positive outcome for many years. They hypothesize that there is some
psychological trauma that the family has incurred due to this health experience
that has resulted in some sort of psychological damage and are planning to
refer them to psychiatric services. The patient is being seen at an Indian
Health Service (IHS) facility in the Southwest United
States and belongs to a Southwest tribe of Native Americans.
What do you
think the provider and her team are missing from their assessment of the
patient and the family? Using MI, the 4C’s, cultural humility, or your
techniques to remain client-centered, what would you do as a MedFT if this were
your patient? Let’s continue the conversation through the comments you make!
Reference: Galanti, G.-A. (2004). Caring for patients from different cultures.
Third Edition. Anthropology of
Consciousness, 15, p.66–67. doi:10.1525/ac.2004.15.2.66
Melissa Lewis is a licensed Marriage and Family Therapist
in North Carolina. She received her Master's degree at Arizona State
University (MFT) in 2007 and her PhD from East Carolina University
(MedFT) in 2012.Her
research area broadly encompasses the relationship between stress
response and BPSS outcomes. Specifically, she studies the stress
transmission model with military couples and is also evaluating
integrated care interventions
aimed to reduce BPSS health symptoms in both Native American and
military populations. Melissa can be contacted at firstname.lastname@example.org