The Intercultural Exeter Couples Model. Reenee Singh

differences bring. These reside within a cultural context in which there may be differing values and beliefs that bring about different expectations around behaviors within life together. They may also reflect variations within the couple's background and actual cultural conditions—for instance, around sociopolitical differences and economic inequality. It is imperative, given these potentially powerful differences, that therapists be able to help a couple unearth how they affect interactional processes.

      However, it is also imperative that therapists know how to guard against the opposite problem of not attending, unearthing, and understanding: pathologizing—that is, to guard against assuming that whatever the problem is, it is always related to intercultural/interfaith differences.

THE INTERVENTIONS OF THE INTERCULTURAL EXETER MODEL

      Many of the interventions that are made within the adapted EM to fit intercultural work utilize the original methods, but direct the therapists to asking specific questions, using them around culture. However, just as we ask “what is the presenting problem” so that we can clearly delineate the maintenance cycle of that problem (e.g., “depression” with “depressive symptoms” at the top of the maintenance cycle), the IEM explicitly starts with “what is an intercultural couple?” Is this couple one which is facing issues that arise or are colored by being from different cultures? Sometimes the couple self‐define as “intercultural,” and sometimes the answer to this question is obvious, at face validity: the couple clearly come from different cultures or faith. But sometimes the answer is not obvious: sometimes intercultural couples might appear to be from the same culture, but because an earlier, different, generation's very strong influence, for instance, has dominated in one member's upbringing but not the other's, a different culture is having a real but not necessarily clearly observable impact. Or sometimes having been raised even partially within a different country or education system, or coming from a stronger versus a weaker faith system within the families‐of‐origin, can mean there are not obvious but still very strong and active cultural differences playing out within a couple.

The central theme in interculturally influenced therapy is to create a shared meaning to the extent that it is possible, while tolerating the differences. To achieve this we use two particular interventions designed to address culture, but also we build questions from interventions within the EM to access cultural ideas and potential tensions or dilemmas.

      These are such questions as what is the meaning of home, for instance, or the loss of home for displaced cultures; or the important but different and differently valued practices of religion and culture; or the beliefs of religion and culture associated with distress or mental health difficulties; or experiences of racism, disadvantage, and expectations of protection; or of differences in parenting styles and ways of relating to extended families. These are now, through the development of the intercultural part, specifically built into the extant EM interventions. For example, the IEM will be asking therapists to help couples explore what is the “script” around mental health or their present distress, within each of the cultures, or, while designing a family genogram the therapist will be asking about such things.

      But in addition to building specificity within the existing interventions, there are two specifically culturally focused methods that we also use. These are discussed in the following sections.

THE CULTURAL GENOGRAM: A KEY INTERVENTION

      The cultural genogram (Hardy & Laszloffy, 1995) enquires about the cultural, ethnic, and religious heritages of the people explicitly within the genogram. Within intercultural work, this is “best practice” intervention and as such it has become a key intervention within the IEM.

      The cultural genogram is a method to expand the couple's stories and ability to question their often unspoken differing and potentially conflictual cultural practices and beliefs. Via cultural genograms partners can discuss their cultural backgrounds, recount beliefs carried by family members in generations past, and convey their feelings regarding family rituals and legacies. Genograms are also an opportunity to bring into view contradictions among historical narratives originating both in each partner's family of origin and in the larger society (i.e., what is discussed and what has been omitted, and by whom and for what purposes). Specific family themes, such as heterogamous relationships, cultural ancestry, and the circumstances under which partners' ancestors entered the country can be coded with colors and/or symbols that carry meaning for each partner. Family photographs, cultural artifacts, and recreating a cultural ritual in the therapy room can add to the experience (Hardy & Laszloffy, 1995; Singh, Killian, Bhugun, & Tseng, 2020).

The cultural genogram can be used in conjunction with the EM method of tracking the maintenance cycle of the interacting circularities: the thoughts and feelings part of which may well be informed by these differing yet unspoken beliefs and assumed practices. Vicious cycles have the possibilities to become virtuous cycles: adding in explicitly the intercultural dimension can unearth deeply held ideas and expectations that can block this process if not made clear.

      The method for doing this is the cultural genogram, an illustration of which will appear in the second part of this book.

THE CULTUREGRAM: A SECOND INTERCULTURAL METHOD OF INTERVENTION

      The culturegram is an assessment tool that originates in Berlin and Cannon's (2013) work. Together the therapist and clients construct a diagram that provides a chance for intercultural couples to do some thinking about the differences in their family beliefs, values, traditions, and legacies. It charts beliefs and values that affect the couple's lives that may or may not be unconsciously directing them around particularly meaningful and often divisive areas of their lives. The themes can vary, for instance, from religious values to ideas about sex, to disciplining children to education, to gender roles, to ideas about work and home life.

      Through exploring specific themes, chosen by the couple, within the diagram, families' similarities and differences are laid bare and clarified. The diagram comprises a series of circles that depict beliefs and practices of their respective families, with linking lines to how they play out within their present relationship.

      A fuller description and illustration of the culturegram and an example of its use is in the second part of the book.

WHO CAN USE THE INTERCULTURAL EXETER MODEL?

      Therapists who have worked within either the systemic or behavioral models who work with couples would be able to work within the systemic‐behavioral model. Indeed, trainees in the original model were drawn from both of these groups. For systemically trained therapists it trains in the use and rationale for validated practices of CBT within the conceptual framework of systemic practice. For CBT trained practitioners it gives a way to think and practice within the context of interactions and the larger framework of their clients' lives. For those trained in both ways of working it gives an integrated rationale for combining techniques.

THE FORMAT OF THE BOOK

      The model is manualized, as set forth in the second part of this book, and so, for therapists, working to specific interventions that are clearly defined, this means it affords clarity about the use of these largely validated and endorsed interventions and a framework for why they are deployed. This is usual practice within CBT, as is specifying what the presenting problem the work is targeting, and agreeing to this—which the IEM maintenance cycle work does. However these are not necessarily an expected part of normal practice for systemic therapists. We think that this idea of the maintenance cycle helps to guide the therapist toward clearer, more accountable and collaborative work, and, for the client, it promotes clarity in communication both with the therapist and the other member of the couple. (For example, from the beginning what they are working on has been stated and agreed upon.) Finally, the EM in both of its versions—the EM and the IEM—specifies largely validated interventions that will guide the therapy.

      The