6 questions can reveal families’ cultural conflicts

Ashley B. Benjamin, MD, MA;


Understanding how a patient’s cultural background intertwines with relationship concerns, communication issues, and family problems is key to diagnosis and to building a therapeutic alliance.

Asking patients from any culture these six questions can uncover subtleties of cultural interaction that may be contributing to an adjustment, anxiety, depressive, or other disorder.

  1. Are your parents content living in the United States? This is especially pertinent when treating children or second-generation adults for relationship problems or for an adjustment, anxiety, or depressive disorder. In clinical practice, we have seen that when parents are satisfied with their new home, children adapt more readily.
  2. What mainstream practices has your family adopted? Families tend to incorporate customs and values of the surrounding environment while maintaining much of their core culture. The family’s overriding desire to maintain cultural purity may turn some family members against their ethnicity. For example, children may marry outside their culture to escape a rigid or controlling family or ethnic environment. These divergences, however, are often fraught with guilt and consternation among family members.
  3. What value clashes persist in your family? Disagreements over dating or participation in athletics or cheerleading are common. Respect, which may be defined as acquiescing to elders’ opinions, can be an issue regarding personal relationships, occupational choices, or nursing home placement.
  4. Can everyone speak freely in your family? In many cultures, assertiveness is perceived as rude. Therefore, patients may need alternate methods of conflict resolution. For example, teaching the patient a more-direct communication pattern (such as politely asking the boss for a raise) may help him or her in the majority culture but can create problems within his or her native culture.
  5. Do you or a family member dread being alone? Individuals inured to a nuclear family may be uncomfortable with solitude. Also, some cultures define emotional closeness as the presence of multiple family members, rather than companionship between husband and wife.
  6. Is your family comfortable with people from the mainstream culture? Cultural integration requires multicultural contacts. Some families, however, try to maintain their culture at the expense of their stated values. For example, a dishonest, superficial friend from the native culture may be more highly valued than an honest person from the mainstream. These cultural distortions produce mixed messages for all involved.