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Effects of Family Therapy During COVID-19

Studying the characteristics of individual communities’ life is the topic of many research projects. In her book, Boyd-Franklin (2003) describes her experience of interacting with the African American population from the perspective of both therapeutic interventions and outside observation. According to the author, the topics that are essential to study relate to family patterns and family relationships (Boyd-Franklin, 2003). These aspects concern the intrinsic values ​​and socialization norms promoted in the community in question, and the assessment of specific conditions of interaction among family members allows obtaining a comprehensive picture of the existing problems and, therefore, determining the optimal interventions to address the target audience’s needs. In terms of strengths to explore in working with African American families, Boyd-Franklin (2003) suggests reviewing “strong kinship bonds, strong work orientation, adaptability of family roles, high achievement orientation, and strong religious orientation” (p. 19). In a long journey towards independence and equality, this community has experienced severe trials that, in turn, have made the people of this group stronger. Therefore, the proposed aspects to consider are significant criteria reflecting some unique characteristics of African American families and their social and cultural peculiarities.

When interacting with a specific community, a social worker can fall into some of the traps that are typical in certain situations. In particular, as Boyd-Franklin (2003) notes, while working with members of another cultural class, one of the misconceptions and mistakes is to perceive their problems through one’s own life experience. The long history of the formation of ethnic, social, and other norms of African Americans’ life differ from those of the white population. Although the author herself is from the African American group, she is aware that many other social workers may not be aware of some of the behavioral and other characteristics of social interaction in this population. Another trap a social worker can fall into is expressing open sympathy. Shelby (2019) proposes a concept of white privilege that is based on race. When applied to Boyd-Franklin’s (2003) analysis, this concept is unacceptable as a negative driver for causing African American families to feel humiliated and submissive to members of the other race. An opportunity to be treated equally is a show of respect, and empathy can be seen as a deliberate demeaning of honor and dignity.

Due to the differences in the formation of ethnic and social identities between the African American and the white population, the concept of “vibes” has developed as one of the factors interpreting the nuances of perception in American culture. According to Boyd-Franklin (2003), the concept is to establish a link between an African American patients and a clinicians based on various factors assessed by the former. In particular, as the author argues, when interacting with a white interlocutor, an African American tends to analyze him or her “in terms of appearance, race, skin color, clothing, perceived social class, language, and a range of more subtle clues” (Boyd-Franklin, 2003, p. 178). Perception is based on a number of criteria rather than one specific factor, which distinguishes the two cultures. As Boyd-Franklin (2003) states, this behavior is due to the fact that “in African American culture the vibes of the human connections are most often of greatest significance in establishing bonds with another person or group of people” (p. 178). Therefore, this concept should be taken into account when working with African American families.

Close interaction with families in the provision of appropriate therapeutic care can be a prerequisite for the development of various ethical issues. As part of communication with minorities, risks are heightened due to distinctive social, cultural, and other values. For instance, George et al. (2020) provide an example of African American communication with white physicians and note that racist contexts can emerge by chance. The dominant population providing healthcare services may display inappropriate behavior towards minorities unknowingly, which, nevertheless, is a cause for an ethical conflict. Differences in social and cultural background explain the difference in understanding of usual life aspects, and what may seem natural to one group, for instance, a patriarchal family structure, may be considered unacceptable in another one.

Ethical conflicts that arise during provider-patient interactions are significant barriers to maintaining supportive care and treatment. Boyd-Franklin (2003) cites an example of such a situation when an ethical dilemma manifests itself, and her example concerns working with minorities. According to the author, therapists may face the challenge of continuing to work with a particular family based on their ability to pay for care and treatment or stop providing services (Boyd-Franklin, 2003). In this ethical conflict, the situation is complicated by the fact that, in addition to interpersonal principles of interaction, the legal aspects of therapeutic work are to be taken into account. Policy manuals, work instructions, and other formal regulations assume physicians’ strict responsibility, including financial matters. In other words, the therapist is financially accountable, and any unpaid work may be the cause of questions to the employee based on why he or she did not receive money for the services provided. In this format, the resolution of the ethical conflict in question seems obvious and requires an end to interaction with families unable to pay.

At the same time, when faced with such a case, a therapist may be guided by personal motives, in particular, the ethical principles of working and providing assistance to those who need it. Boyd-Franklin (2003) states that based on the national regulation standards, clinicians should follow the existing legislative practices when interacting with patients, “irrespective of their socioeconomic or income level and employment status” (p. 264). Nevertheless, in a situation when clients cannot pay for healthcare services, therapists can do their best to provide all possible help for free. The principles of medical work prescribe responsibility to the population, regardless of the social conditions of a particular community, and failure to help is contrary to the ethical principles prescribed in the Code of Ethics. Therefore, the resolution of the considered conflict depends on therapists’ personal beliefs.

As a result, the ethical controversy in ambiguous legislation regarding the provision of medical services to non-paying clients should involve revising the existing healthcare policies governing paid care. Any case is individual, and low social status is not always an objective reason to deny adequate assistance due to the established moral norms. Thus, Boyd-Franklin (2003) suggests following compassionate policies, particularly when dealing with minorities, such as African Americans. In addition, as the author remarks, this approach is consistent with the traditional cultural values ​​promoted in this community (Boyd-Franklin, 2003). Therefore, an individual approach based on the assessment of each specific case is the correct and ethically sound decision in the context of the conflict in question.

Despite the ethical and professional values promoted in the medical community, there are some challenges associated with providing comprehensive care to some groups of the population. In particular, as a population at risk, one can mention Afro-American children since, based on the statistics presented by Boyd-Franklin (2003), their lives are accompanied with greater problems compared to those of white children. According to the author, “although African American children comprise 15% of the population, they continue to be overrepresented in out-of-home placements at 45%” (Boyd-Franklin, 2003, p. 255). Based on the available data, the group in question is at risk of long stays not only in healthcare facilities but also in other public places where they need care and attention. As Boyd-Franklin (2003) argues, these “children are half as likely as white children to return home and less likely to achieve permanency through adoption” (p. 255). As a result, such a gap requires taking appropriate measures at the family level to reduce risks and address the needs of the target population; otherwise, therapists’ and social workers’ activities may be meaningless.

One of the therapy approaches to apply to solve the presented problem is interaction with adoptive families. Boyd-Franklin (2003) notes that healthcare employees can provide psychological support to help adults understand that a child experiences a wide range of feelings and emotions in foster care. To avoid aggravating morale, therapists should create an effective communication environment and prepare both the child and the foster family for potential challenges and issues, for instance, a long period of adaptation to new living conditions or potential disagreements with individual family members. In addition, as a meaningful initiative to address the needs of African American children who are abandoned, responsible employees need to ensure that all formal adoption and fostering rules are followed. According to Boyd-Franklin (2003), in the African American community, adopting a child is often an informal practice not accompanied by the preparation of the relevant documents to obtain a permit. However, to protect the target population from potential threats and abuse, following a formal adoption procedure is critical. Therapists can help foster families with paperwork and legal guardianship, thus ensuring that both foster parents and the child are guaranteed social protection.

While taking into account the presented problem, its coverage should be a mandatory aspect of targeted work to help African American children in difficult life situations. However, as Turney and Wildeman (2017) argue, “despite good reason to believe that children in foster care are disproportionately exposed to adverse childhood experiences (ACEs), relatively little research considers exposure to ACEs among this group of vulnerable children” (p. 117). This gap is a critical reason to draw the responsible authorities’ attention to the issue and adopt the necessary legislative practices to expand the range of responsibility for reporting. Turney and Wildeman (2017) highlight that, among the child population, about “12% of African American children” are adopted, while among white children, this figure is about 5% (p. 117). Therapists are often unaware of which treatment and interaction practices should be applied due to the lack of an appropriate regulation base. Therefore, to protect the target population and prevent African American children’s problems with socialization, more research work needs to be done to discuss the issue comprehensively, thereby providing background to advance relevant initiatives to promote care practices.

The COVID-19 pandemic has had a significant impact on various fields, including not only social but also cultural, ethical, and other aspects. With regard to family therapy, the threat of the spread of the coronavirus has made its adjustments. According to Watson et al. (2020), the role of counseling has been transformed under the influence of the existing social constraints that determine the specifics of human interaction. In particular, individual problems have faded into the background, and the emphasis on the broader concept of health has become key. In addition, as Watson et al. (2020) remark, family therapists have begun to face clients’ psychological problems more often than before the pandemic. Social isolation that implies spending a long time in limited space affects people’s psyche negatively by awakening irritability and weakening stress resistance. At the same time, due to the inability to interact with customers directly, family therapists cannot establish productive communication, even taking into account technologies that provide remote interaction. Therefore, increased empathy and openness have become essential requirements for these employees to reduce stress in families and help the public to cope with increased anxiety and concerns.

Stress and anxiety are common conditions during the pandemic, which many families experience. Associated threats to physical health exacerbate morale and cause concerns. Watson et al. (2020) note that families may experience unstable emotional responses to the existing challenges, which, in turn, can lead to mental health problems. In addition, the authors urge to pay attention to the fact “that family therapists may exhibit consequential inattentiveness by ignoring, downplaying, or inadequately informing themselves about the likely harms of lack of knowledge about many of these issues” (Watson et al., 2020, p. 839). In this regard, effective supportive care is of great value.

As a family theory to apply when working with a family during the COVID-19 pandemic, therapists can refer to the Bowenian concept. According to Boyd-Franklin (2003), this concept implies anxiety reduction by educating the population to cope with the drivers of negative emotions. The Bowenian model offers a structured approach to address the current needs and problems of the target audience, thereby codifying specific and allowing adequate support. As a result, this theory makes it possible to find an approach to each family and track the dynamics of people’s problems.

As a population group that might be more at risk with the pandemic, one can mention older adults. The coronavirus affects those in poor health, and age is one of the incentives to take additional safety measures. By taking a deep look at the problem, one can also suggest that older people belonging to minority groups are at even greater risk. Boyd-Franklin (2003), who examines family therapy among African American families, raises the issues of access to health care services and the evidence of inequities in receiving adequate support. Consequently, older African Americans are a group at risk in conditions of the existing social constraints. Moreover, as Boyd-Franklin (2003), “many older African Americans couples are very child-focused” (p. 110). This means that these people experience social isolation more severely and may be more likely to be infected from younger loved ones. Thus, focusing on this category of the population is one of the priorities of family therapy for the effective fight against mortality from COVID-19 and accompanying psychological problems.

References

Boyd-Franklin, N. (2003). Black families in therapy: Understanding the African American experience (2nd ed.). Guilford Press.

George, J. R., Michaels, T. I., Sevelius, J., & Williams, M. T. (2020). The psychedelic renaissance and the limitations of a White-dominant medical framework: A call for indigenous and ethnic minority inclusion. Journal of Psychedelic Studies, 4(1), 4-15. Web.

Shelby, R. (2019). White privilege, pathological shame and guilt, and the perversion of morality. In M. McGoldrick & K. V. Hardy (Eds.), Re-visioning family therapy: Addressing diversity in clinical practice (3rd ed.) (pp. 283-297). Guilford Publications

Turney, K., & Wildeman, C. (2017). Adverse childhood experiences among children placed in and adopted from foster care: Evidence from a nationally representative survey. Child Abuse & Neglect, 64, 117-129. Web.

Watson, M. F., Bacigalupe, G., Daneshpour, M., Han, W. J., & Parra‐Cardona, R. (2020). COVID‐19 interconnectedness: Health inequity, the climate crisis, and collective trauma. Family Process, 59(3), 832-846. Web.

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