Can Relationship Conflict Affect Family Relationships?

Relational conflict manifests itself in a plethora of situations and circumstances both in clinical and non-clinical settings. According to Barth (2009), "child-parent psychotherapy, which focuses on relationship enhancement, appears effective in reducing the behavioral problems and traumatic symptoms of children living with domestic violence" (p. 101).

According to Swick (2008), relational conflict has the capacity to not only disrupt and affect normal familial bonding relationships, but also may result in family isolation and degradation. Sande (2004) posits that biblical models to resolve conflict "can turn conflict into an opportunity to strengthen relationships, preserve valuable resources, and make lives a testimony to the love and power of Christ" (p. 12).

The Importance of Cultural Competency in the Therapist-Client Relationship: Clinical Vignette

The clinical vignette used in this discussion was contextually adapted from the 2015 Pennsylvania Psychological Association’s Annual Convention held in Harrisburg. The vignette was used to highlight how positive ethical, multicultural; consultation and intervention therapeutic practices may be implemented in clinical settings. Diversity in the Supervisory Relationship was adapted from the Ethics casebook of the American Psychoanalytic Association.

Dr. Ruth Abrams, a Jewish post-doctoral therapist, presented an exploratory psychotherapy case of an African American female patient to her Jewish supervisor, Dr. David Stein. Six months into therapy evolving attachments to early childhood traumas began to surface with the patient, who then became apprehensive that her therapist was not African American. As therapy continued, the patient began to gain a better understanding of her transference experiences with race.

However, in a series of sessions following the therapist had an unexpected week-long absence due to illness in his own family. Suddenly, the patient began to express rage over the fact that “millions of slaves had been killed in transit from Africa to America.” The patient expressed grave disappointment and rage that America had never come to terms with this atrocity. The patient openly expressed her concerns to her therapist, Dr. Stein, as well as to Dr. Adams, the intern. Dr. Adams reported this development to, Dr. Stein, her supervisor.

His response, in both situations, was that there was no reasonable comparison to be made between the fate of the Jews in the Holocaust and the fate of African slaves in the transatlantic crossing. The African America female patient immediately terminated her therapeutic sessions due to, what she termed, relational conflict caused by cultural insensitivity.

Heightening Cultural Awareness Using the Three-Factor Model

I posit that much clinical relational conflict can be avoided if therapists adopt an intentional and purposeful approach to acquiring cultural competency. The vignette presented in this blog article clearly highlights the need for clinicians to heighten their cultural awareness and sensitivity. Lewis (2016) contends that the Three-factor Model is a “conceptual framework” (p. 151) or customized-tool that arguably presents a viable option for clinicians.

Essentially, the model “invokes an intentional and systematic interview process” (p. 152) aimed at identifying four key components referred to as: (a) starting resources, (b) key activities, (c) goals, and (d) supporting mechanisms (Lewis, 2006). Using these criteria for investigation, the therapist assesses his/her “cognitive schemas” (p. 152) and “toolbox of interventions” (p. 152). As such, he/she can determine the key activities required to achieve a positive relationship with the client, to set specific client-goals, and to articulate the supporting processes required to achieve effective and positive client outcomes.

The Integrated Therapeutic Approach

In conclusion, several factors have been identified as important in understanding recovery and adjustment among traumatized patients (Green, Korol, & Grace, 1991; Chamberlain, 2008; Pine & Cohen, 2002). These include event parameters, individual child risk and protective factors as well as environmental variables. For all types of traumas, the level of exposure to the event has consistently predicated the level of psychopathology (Pine & Cohen, 2002). In summary, according to Lewis (2006) and Pine and Cohen (2002), the central tenet employed to reduce relational conflict must be intentional relationship enhancement. This may be achieved through integrative therapies such as: cognitive behavior therapy, parent-child and spousal interaction therapy, mutual development of child behavioral management programs, and/or counselor home visitation programs (Lewis, 2006).

References

Barth, R. (2009). Preventing child abuse and neglect with parent training: Evidence and opportunities. Future of Children, 19(2), 95-118.

Chamberlain, L. (2008). Ten lessons learned in Alaska: Home visitation and intimate partner violence. Journal of Emotional Abuse, 8(1), 205-216.

Green, B., Korol, M., & Grace, M. (1991). Children and disaster: Age, gender, and parental effects on PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 945-951.

Lewis, A. N. (2006). Three-factor model of multicultural counseling for consumers with disabilities. Journal of Vocational Rehabilitation, 24(3), 151-159.

Pennsylvania Psychological Association. (2015). Hot topics in ethics – applying positive ethics and multiculturalism to therapeutic practice, consultation and interventions [PDF File].Retrieved from http://c.ymcdn.com/sites/www.papsy.org/resource/collection/963F4F5F-A142-47DE-B287-78F6B4E04F03/W22_Ethics_Diversity_Hot_Topics_Vignettes_PPA_15.pdf

Pine, D. S., & Cohen, J. A. (2002). Trauma in children and adolescents: risk and treatment of psychiatric sequelae. Biological Psychiatry, 51(7), 519-531.