Abstract
Previous research on African Americans’ engagement in family therapy has focused on barriers to treatment. This qualitative study examines the experiences of African Americans who choose to attend family therapy. We utilized a pattern second cycle coding process to analyze survey data from 39 African American adults who attended family therapy. The findings generated five themes that describe the participants’ experiences that brought them to family therapy, (1) life experiences that led to family therapy, (2) perceptions of therapy, (3) positive experiences that encouraged participants’ use of family therapy, (4) factors that caused participants hesitancy in attending family therapy, (5) change in perception concerning family therapy. The final theme was generated by exploring participants’ perceptions of family therapy before and after engaging. Thirty-four participants reported positive beliefs about therapy after receiving family therapy. In addition, participants’ coping mechanisms before entering therapy are detailed to provide insights into how they managed issues before deciding to engage in family therapy. We offer recommendations for engaging African Americans in family therapy and implications for future research.
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Data Availability
The datasets generated and analyzed during the current study are not publicly available due the fact that participants were informed in their consent that their information would be kept confidential, only excerpts of their experiences are provided in the manuscript. Sharing the entirety of their data may pose risks to the participants’ confidentiality. Access to portions of the data is available from the corresponding author on reasonable request.
References
Alang, S. M. (2019). Mental health care among blacks in America: Confronting racism and constructing solutions. Health Services Research, 54(2), 346–355. https://doi.org/10.1111/1475-6773.13115.
American Psychological Association (2023). APA dictionary of psychology. https://dictionary.apa.org/family-therapy.
Awosan, C. I., Sandberg, J. G., & Hall, C. A. (2011). Understanding the experience of black clients in marriage and family therapy. Journal of Marital and Family Therapy, 37(2), 153–168. https://doi.org/10.1111/j.1752-0606.2009.00166.x.
Bell, C. C., Jackson, W. M., & Bell, B. H. (2015a). Misdiagnosis of African-Americans with Psychiatric issues - part I. Journal of the National Medical Association, 107(3), 25–34. https://doi.org/10.1016/S0027-9684(15)30048-1.
Bell, C. C., Jackson, W. M., & Bell, B. H. (2015b). Misdiagnosis of African-Americans with psychiatric issues - part II. Journal of the National Medical Association, 107(3), 35–41. https://doi.org/10.1016/S0027-9684(15)30049-3.
Billingsley, A. (1992). Climbing Jacob’s ladder: The enduring legacy of African-American families. Touchstone.
Blue Cross Blue Shield Association (2022). Racial disparities in diagnosis and treatment of major depression: Harnessing data, for the health of America. Retrieved January 12, 2024, from https://www.bcbs.com/the-health-of-america/reports/racial-disparities-diagnosis-and-treatment-of-major-depression.
Boyd-Franklin, N. (2006). Black families in therapy. The Guilford.
Braun, V., Clarke, V., Boulton, E., Davey, L., & McEvoy, C. (2021). The online survey as a qualitative research tool. International Journal of Social Research Methodology, 24(6), 641–654. https://doi.org/10.1080/13645579.2020.1805550.
Brody, D. J., Pratt, L. A., & Hughes, J. (2018). Prevalence of depression among adults aged 20 and over: United States, 2013–2016 (National Center for Health Statistics Data Brief, No. 303). National Center for Health Statistics. https://www.cdc.gov/nchs/data/databriefs/db303.pdf.
Campbell, R. D., & Long, L. A. (2014). Culture as a social determinant of mental and behavioral health: A look at culturally shaped beliefs and their impact on help-seeking behaviors and service use patterns of Black Americans with depression. Best. Practices in Mental Health, 10(2), 48–62. https://www.proquest.com/scholarly-journals/culture-as-social-determinant-mental-behavioral/docview/1661719528/se-2.
Campbell, R. D., & Mowbray, O. (2016). The stigma of depression: African American American experiences. Journal of Ethnic & Cultural Diversity in Social Work, 25(4), 253–269. https://doi.org/10.1080/15313204.2016.1187101.
Carr, A. (2020). Evidence for the efficacy and effectiveness of systemic family therapy. In K. S. Wampler, R. B. Miller, & R. B. Seedall (Eds.), The handbook of systemic family therapy: The profession of systemic family therapy (pp. 119–146). Wiley African Americanwell. https://doi.org/10.1002/9781119438519.ch6.
Conner, K. O., Copeland, V. C., Grote, N. K., Rosen, D., Albert, S., McMurray, M. L., Reynolds, C. F., Brown, C., & Loeske, G. (2010a). a. barriers to treatment and culturally endorsed coping strategies among depressed African-American older adults. Aging and Mental Health, 14(8), 971–983.
Conner, K. O., Lee, B., Mayers, V., Robinson, D., Reynolds, C. F., Albert, S., & Brown, C. (2010b). Attitudes and beliefs about mental health among African American older adults suffering from depression. Journal of Aging Studies, 24(4), 266–277. https://doi.org/10.1016/j.jaging.2010.05.007.
Copeland, V. C., & Snyder, K. (2011). Barriers to mental health treatment services for low-income African American women whose children receive behavioral health services: An ethnographic investigation. Social Work in Public Health, 26(1), 78–95. https://doi.org/10.1080/10911350903341036.
Creswell, J. W. (2014). Research design: Qualitative, quantitative, and mixed methods approaches (4th ed.). Sage.
Fripp, J. A., & Carlson, R. G. (2017). Exploring the influence of attitude and stigma on participation of African American and latino populations in mental health services. Journal of Multicultural Counseling and Development, 45(2), 80–94. https://doi.org/10.1002/jmcd.12066.
Gara, M. A., Minsky, S., Silverstein, S. M., Miskimen, T., & Strakowski, S. M. (2019). A naturalistic study of racial disparities in diagnoses at an outpatient behavioral health clinic. Psychiatric Services, 70(2), 130–134. https://doi.org/10.1176/appi.ps.201800223.
Hall, C. D., & Sandberg, J. G. (2012). We shall overcome: A qualitative exploratory study of the experiences of African Americans who overcame barriers to engage in family therapy. The American Journal of Family Therapy, 40, 445–458. https://doi.org/10.1080/01926187.2011.637486.
Hargrove, T. W., Halpern, C. T., Gaydosh, L., Hussey, J. M., Whitsel, E. A., Dole, N., Hummer, R. A., & Harris, K. M. (2020). Race/ethnicity, gender, and trajectories of depressive symptoms across early- and mid-life among the add health cohort. Journal of Racial and Ethnic Health Disparities, 7, 619–629. https://doi.org/10.1007/s40615-019-00692-8.
Hays, K., & Lincoln, K. D. (2017). Mental health help-seeking profiles among African Americans: Exploring the influence of religion. Race and Social Problems, 9(2), 127–138. https://doi.org/10.1007/s12552-017-9193-1.
Hill, R. B. (2003). The strengths of black families (2nd ed.). University Press of America.
Hudson, D. L., Eaton, J., Banks, A., Sewell, W., & Neighbors, H. (2018). Down in the sewers: Perceptions of depression and depression care among African American men. American Journal of Men’s Health, 12(1), 126–137. https://doi.org/10.1177/1557988316654864.
Killam, W. K., & Weber, B. (2013). The effectiveness of brief strategic family therapy with at-risk African American adolescents. In Ideas and research you can use: VISTAS 2013. https://www.counseling.org/docs/default-source/vistas/the-effectiveness-of-brief-strategic-family-therapy-with-at-risk.pdf?sfvrsn=459c154f_13.
Le Cook, B., Trinh, N., Li, Z., Hou, S. S., & Progovac, A. (2017). Trends in racial-ethnic disparities in access to mental health. 2004–2012. Psychiatric Services, 68(1), 9–16. https://doi.org/10.1176/appi.ps.201500453.
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Sage.
Lu, W., Silverstein, S. M., Mueser, K. T., Minsky, S., Bullock, D., Buchbinder, S., Chen, Q., Eubanks, R., & Guillaume-Salvant, A. (2023). Undocumented PTSD among African American clients with serious mental illness in a statewide mental health system. Psychological Trauma, 15(5), 781–790. https://doi.org/10.1037/tra0001243.
Marrast, L., Himmelstein, D. U., & Woolhandler, S. (2016). Racial and ethnic disparities in mental health care for children and young adults: A national study. International Journal of Health Services: Planning Administration Evaluation, 46(4), 810–824. https://doi.org/10.1177/0020731416662736.
McKenry, P. C., & Price, S. J. (Eds.). (2005). Families coping with problems and change: A conceptual overview. Sage.
National Center for Health Statistics (2019-2021a). Percentage of regularly having feelings of depression for adults aged 18 and over, United States, 2019–2021. National Health Interview Survey. Retrieved January 24, 2024, from https://wwwndev.cdc.gov/NHISDataQueryTool/SHS_2021_ADULT3YR/index.html.
National Center for Health Statistics (2019-2021b). Percentage of regularly having feelings of worry, nervousness, or anxiety for adults aged 18 and over, United States, 2019–2021. National Health Interview Survey. Retrieved January 24, 2024, from https://wwwndev.cdc.gov/NHISDataQueryTool/SHS_2021_ADULT3YR/index.html.
Nightingale, M., Awosan, C. I., & Stavrianopoulos, K. (2019). Emotionally focused therapy: A culturally sensitive approach for African American heterosexual couples. Journal of Family Psychotherapy, 30(3), 221–244. https://doi.org/10.1080/08975353.2019.1666497.
Price, S. J., Price, C. A., & McKenry, P. A. (Eds.). (2010). Families and change: Coping.
Saldana, J. (2009). The coding manual for qualitative researchers Sage.
Santisteban, D. A., Coatsworth, J. D., Perez-Vidal, A., Mitrani, V., Jean‐Gilles, M., & Szapocznik, J. (1997). Brief structural/strategic family therapy with African and hispanic high‐risk youth. Journal of Community Psychology, 25(5), 453–471. https://doi.org/10.1002/(SICI)1520-6629(199709)25:5%3C453::AID-JCOP6%3E3.0.CO;2-T.
Schwartz, R. C., & Blankenship, D. M. (2014). Racial disparities in psychotic disorder diagnosis: A review of empirical literature. World Journal of Psychiatry, 4(4), 133–140. https://doi.org/10.5498/wjp.v4.i4.133.
Substance Abuse and Mental Health Services Administration (2023). Key substance use and mental health indicators in the United States: Results from the 2022 National Survey on Drug Use and Health (HHS Publication No. PEP23-07-01-006, NSDUH Series H-58). Center for Behavioral Health Statistics and Quality. https://www.samhsa.gov/data/report/2022-nsduh-annual-national-report.
Taylor, R. E., & Kuo, B. C. H. (2019). Black American psychological help-seeking intention: An integrated literature review with recommendations for clinical practice. Journal of Psychotherapy Integration, 29(4), 325–337. https://doi.org/10.1037/int0000131.
Thurston, I. B., & Phares, V. (2008). Mental health service utilization among African American and Caucasian mothers and fathers. Journal of Consulting and Clinical . Psychology 76(6), 1058–1067. https://doi.org/10.1037/a0014007
Vaterlaus, J. M., Skogrand, L., & Chaney, C. (2015). Help-seeking for marital problems: Perceptions of individuals in strong African American marriages. Contemporary Family Therapy, 37(1), 22–32. https://doi.org/10.1007/s10591-014-9324-4.
Vyas, C. M., Donneyong, M., Mischoulon, D., Chang, G., & Gibson, H. Cook, N. R. Manson, J. E., Reynolds, C. F., & Okereke, O. (2020). Association of race and ethnicity with late-life depression severity, symptom burden, and care. JAMA Network Open, 3(3), e201606–e201606. https://doi.org/10.1001/jamanetworkopen.2020.1606
Williams, M. T., Domanico, J., Marques, L., Leblanc, N. J., & Turkheimer, E. (2012). Barriers to treatment among African Americans with obsessive-compulsive disorder. Journal of Anxiety Disorders, 26, 555–563. https://doi.org/10.1016/j.janxdis.2012.02.009.
With stressful events and transitions (4th ed.). Sage.
Woods-Giscombe, C., Robinson, M. N., Carthon, D., Devane-Johnson, S., & Corbie-Smith, G. (2016). Superwoman schema, stigma, spirituality, and culturally sensitive providers: Factors influencing African American women’s use of mental health services. Journal of Best Practices in Health Professions Diversity, 9(1), 1124–1144. https://www.proquest.com/scholarly-journals/superwoman-schema-stigma-spirituality-culturally/docview/1925183438/se-2.
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Holloway, F.J., Watts, K., Dean, G. et al. Why Choose Family Therapy? An Online Qualitative Study of African American Adult Self-Reports About Their Experiences that Brought Them to Family Therapy. Contemp Fam Ther (2024). https://doi.org/10.1007/s10591-024-09701-3
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DOI: https://doi.org/10.1007/s10591-024-09701-3