In our final chapter of this volume, we summarize the information from our contributors’ chapters and provide an overview of the future of the field of marriage and family therapy (MFT) and the continued need for attention to cross-cultural responsiveness and social justice . We bring together the overall themes of the book and how each of the authors has contributed to these themes as well as to the larger implications and conclusions we can draw regarding the future of systemic therapies and multiculturalism.

As we stated at the beginning of this volume, cross-cultural competence and sensitivity have been acknowledged as critical in the mental health professions for many decades as there has been continuing recognition of the rapidly changing demographics in the USA. In this volume, we the co-editors and the authors have attempted to address and challenge the notion that cultural competence and sensitivity are adequate in addressing the complex and unique needs of increasingly diverse client populations. We have tried to address these complex issues and concerns by bringing forth ideas and recommendations that are not “passive” but that require the active and persistent critique and analysis of ourselves as people, scholars, and clinicians, of the systemic models and theories that most of us “grew up with” professionally, and of the complex contexts and needs of our increasingly diverse client populations. Additionally, this volume goes beyond a focus on cross-cultural responsiveness and systems that work only in the USA; it includes attention to a diversity of systems: the microsystem of the individual and individual identity issues, to the much larger global and international macrosystemic context and the future of systemic therapies. In short, we have attempted to exemplify in our contributions exactly the kind of cultural responsiveness, attention to diversity, and social justice concerns that we believe is also needed in the field of couple and family therapy and to the work of systemic therapists everywhere.

As indicated earlier in this volume in our introduction, the contributors to this book themselves represent a wide range of diversity : in racial and ethnic identity, gender identity and sexual orientation, professional work settings and areas of expertise, years of experience as scholars and clinicians, and professional and clinical experiences past and present, in the USA as well as beyond in the global and international settings. This volume, we believe, gives voice to the diverse systemic clinicians and scholars in the field of systemic work and, through that expression, also gives voice in culturally responsive ways, to the diverse and cross-cultural client populations we all are committed to and whom we serve.

As we finalized the contributions and organized the volume, we became aware of several themes that had evolved almost organically over the course of this project; most important of these themes that emerged was a critical examination of therapist identity, privilege, power, social justice, and, in particular, white identity and privilege. Other important themes that emerged as we organized the volume included the cross-cultural responsiveness and implications of utilizing and training therapists in empirically based systemic models, the cross-cultural responsiveness and adaptation of more traditional and foundational systemic models, the cross-cultural responsiveness in systemic supervision and training, and the experiences, challenges, and implications for training therapists in systemic therapies and models in global and international contexts. As we conclude this project, we reflect on these overarching themes that emerged through the authors’ contributions and provide our (the co-editors as well as the authors) thoughts on the implications for the future of systemic therapies and the culturally responsive work of systemic therapist.

Therapist Identity, Privilege, Power, and Social Justice

A challenge right at the beginning of this volume was presented by co-authors Iman and Manijeh. In their chapter, the authors enjoin the reader to consider that the only way to move forward in our field to fully embrace social justice and advocacy work is for systemic therapists to start with their own understanding of their own societal positions and unearned privileges. The authors caution that if systemic therapists, in their efforts to be socially just and to advocate for their diverse clients, only focus on exploring clients’ marginalized experiences, therapists verge on perpetuating what the authors refer to as “systemic coercion and subjugation of clients.” According to the authors, “preparing the next generation of conscious therapist” who must be involved in social justice and advocacy work must include therapists’ own work on becoming more aware of their sociopolitical positions within their larger contexts and macrosystems and attend to issues of power and privilege within these structures. Therefore, as the authors so convincingly express, before we can understand another’s pain, we must face our own privilege and power and the impact, both good and bad, that this can have on the clients we are attempting to serve and advocate for. Thus, neutrality on our part as systemic therapists and in our understanding and application of our models, theories, and interventions is not an option if we are to be socially just and socially conscious in our work.

Carrying forward Iman and Manijeh’s focus on social location and unearned privilege, Cheryl closes her chapter on white identity and white privilege with a poignant statement, ostensibly from our clients’ desperate need to be heard, to be understood: Being that you’ve finally heard me, may I reschedule for another session? I think I can trust you now. As Cheryl highlights in her chapter, counselors and therapists (and developers of counseling and therapy theories and models) have historically been, and are currently still, predominantly white. However, the field of counseling and therapy has continued to operate more or less on the assumption that this is not of great concern to the delivery of mental health services to an increasingly diverse and often marginalized client population. Ignoring whiteness and the emotionalities of whiteness in our field is a “dangerous game” as Cheryl exhorts and one that buries “more deeply a chance for freedom in developing humanizing relationships.” Therapists and the field of counseling and therapy that ignore these realities risk undermining the very conditions needed to develop trust, understanding, and emotional investment in our diverse clients. Becoming a culturally responsive and culturally competent therapist involves first examining and courageously facing the emotionally difficult: the whiteness of the field and the white privilege that comes with it. As Cheryl points out, deep introspection, examination, and courage are required by counselors and therapists, to unmask our own emotional racial biases. Safety, trust, connection, and ultimately serving our clients and especially our clients of color, in socially just ways, will only come when therapists invest themselves fully in the painful process of investigating their own racial trauma and their unearned privilege and the impact to others around them.

Cross-Cultural Responsiveness: Implications for Utilizing and Training in EBPs

A second theme of our volume focuses on the implications for utilizing and training in evidence-based practices (EBPs). Robert’s chapter provides a comprehensive exploration of the field of couple and family research and its conceptualization of EBPs in how they take into consideration the issue of context and effectiveness. Robert’s chapter highlights the need for research on EBPs that focuses on first-person accounts of culturally adapted EBPs and that investigates which aspects are most meaningful and useful for clients who receive those treatments. Thus, while Robert makes a compelling case for the use of EBPs in our systemic work, he also highlights that those (our clients) on the receiving end of that work need to have a voice regarding the impact on them, their contexts, and their lives. The chapter points out that there is growing research evidence that culture and context influence almost every area of our clinical work. Thus, a critical element of our systemic work must be continuing to attend to cultural factors in our work, in our clients’ lives, and in the clinical practices we choose to employ. Employing EBPs effectively and in culturally responsive ways requires attention to contextual aspects of our clients’ experiences. Practitioners, researchers, and trainers/educators will need to give continual attention to their evidence-based work, its impact on culturally diverse clients, and how it needs to be culturally adapted.

Given Robert’s attention to the cultural adaptation of EBPs so that they can be applied in culturally responsive ways, Senem’s chapter, focusing on her experiences bringing an EBP, emotionally focused couple therapy (EFT) training, and practice to her home country, Turkey, is a useful follow-up to Robert’s chapter. Senem’s chapter outlines her experiences collaborating with US-based and Turkey-based EFT trainers and clinicians to bring EFT training and practice to systemic therapists in Turkey. In her chapter, she describes the trainings she and colleagues have provided to date, their experiences related to the pragmatics of such a venture, ways in which they had to adapt the model, and the training aspects of teaching the model. Poignant descriptions of events such as the recent terrorist attacks in Istanbul and Turkey and how these events have had very real-life impact on where trainings are held, how they are provided, and the safety of trainees and trainers are reminders that when we think of “adaptations,” we must at times “think outside of the box” depending on the particular cultural, political, geographical context in our field. Certainly, issues such as language, translation, cultural considerations in obtaining permission and participation in live sessions in training sessions, and other cultural considerations and experiences in a context outside of the USA are also important. Senem’s description of providing EFT trainings in the Turkish context highlights in a very relevant way the important considerations Robert’s chapter provided – that continual attention must be given to clinicians and trainers’ evidence-based work and how it needs to be culturally adapted to needs of clients and therapists’ contexts. Thus, Senem’s experiences in providing EFT training and practice in Turkey move her and others like her to develop their clinical work further, increasing the number of EFT-certified supervisors and therapists and conducting extensive clinical research in working with Turkish couples using EBPs such as EFT and developing culturally responsive guidelines for working through challenges of strict gender norms, refraining from expressing negative feelings and talking about conflict. Implications for those of us not directly working and training in these cultural contexts include supporting in whatever way we can our colleagues who are committed to the dissemination of not only systemic therapies but in particular EBPs such as EFT in culturally, socially, and politically diverse global contexts such as Turkey. We believe this type of support and collaboration can only lead to further improvement and application of systemic therapies in culturally responsive ways here in the USA as well as globally.

Cross-Cultural Responsiveness and the Use of Foundational Systemic Models

While EBPs and the cultural adaption of EBPs such as EFT here in the USA as well as abroad are cutting-edge endeavors, my (Shruti) interest in and love of foundational models and techniques and cross-cultural responsiveness and competence are often the foci of my work. However, given that I am also a systemic therapist that “grew up” professionally with postmodern sensibilities, much of my philosophical and intellectual lens has been on how to adapt and utilize foundational models and techniques such as the genogram, in ways that are congruent with my commitment to cultural responsiveness and working with diverse clients. The crux of my chapter is on using the genogram and cultural genogram from a common factor lens/perspective in my systemic practice. When I was in my doctoral program, Dr. Douglas Sprenkle, one of my professors, would often exhort us students to “not throw the baby out with the bath water” when it came to sorting through all the theories and models, foundational and postmodern, that we were learning and practicing. While the metaphor certainly brought to mind all sorts of vivid imagery, it has remained in my consciousness as a reminder that there are ways in which we can more effectively use many of the models and systemic therapies in ways that are integrative and much more culturally responsive than what the originators of the models may have intended or even bothered with given their own historical and cultural contexts. I have found it helpful to use the common factor lens particularly when using foundational systemic therapies as it allows me to adapt and use these models flexibly as I navigate as a clinician in an increasingly diverse and complex clinical world. While it can be challenging to use a lens such as common factors because there is no step-by-step template for applying it, I believe using such postmodern lenses is critical to our ability as systemic therapists to respond in culturally responsive and responsible ways to our diverse clients. Our field’s historical and foundational models have much to offer in our increasingly diverse world; but we also have to ensure that our use of these models that were not originally created with consideration to cultural and racial diversity does not contribute to the further marginalization and oppression of our most vulnerable clients.

Cross-Cultural Responsiveness in Systemic Supervision and Training

Nicole and Raji’s and Diane’s chapters focus on cultural responsiveness of our systemic supervision and training models. Committed as we all are to our own culturally responsive, socially just, and ethical systemic practice, we are also aware of our roles and responsibilities as educators, as supervisors, and as “gatekeepers” in our profession. Nicole and Raji, in their chapter, highlight the importance of understanding the impact we have on our students and supervisees given who we are and our positions of power and privilege. They also remind us of the possibility that in our roles as educators and supervisors, there is the potential for oppression or subjugation which also affects how our students experience us in relation to their own lived experiences and their identities. Implications for training and supervision include overtly acknowledging the power differentials of the relationships between therapist and supervisor and therapist and client and initiating and facilitating dialogue on all our intersectionalities and identities within these relationships.

Diane’s chapter reminds us of the critical role supervisors and educators have for providing students and trainees opportunities, guidance, and support in their growth and development toward cultural competence and cultural responsiveness. While supervisors and educators, often with their vast years and range of experience and expertise, bear the burden of providing appropriate opportunities to their supervisees, Diane also reminds us of the reciprocal nature of these relationships and that the responsibility to engage in their learning and growth also lies upon supervisees as well. This chapter is a useful reminder that as supervisors and supervisees, we have a shared belief and commitment that cultural competency and responsiveness are lifelong professional and personal processes that require a constant reflection of social identities, power dynamics, and internal and external contextual factors. Diane also shares in this chapter that her process as a supervisor and clinician is one of the constant reflections on what she knows and does not know; and she encourages us to engage in our own processes similarly in an effort to serve our supervisees, their clients, and our clients in culturally responsive ways. Confronting our biases, our assumptions, and our deficiencies in our knowledge and experience base is part of the “discomfort” in recognizing our limitations but also finding the courage to fully engage in our own and our supervisees’ learning processes.

Experiences, Challenges, and Implications: Systemic Training in International Contexts

The final two chapters of this volume focus on systemic therapy training in international contexts, specifically in India and in Turkey. Raji outlines in her chapter the need for globally and culturally responsive flow of knowledge and information across cultural and geographical borders in ways that have the potential to “increase personal freedom, promote cultural exchange, and revitalize both the native culture and the exporting culture.” She introduces the concept of “glocalization,” a framework for conceptualizing how global and local cultures interact reciprocally so that the experience is empowering for local cultures. Raji’s research in India provides insight on effective and culturally responsive application and training of systemic theory and practice, with attention to the active engagement needed between existing knowledge coming from the outside and the knowledge relevant to and originating from local entities and sociocultural structures of the indigenous societies. Recommendations for future engagement globally in systemic training include meeting the need for more indigenous trainers who can be a bridge between the outside source of knowledge and the native context. Educational materials focusing on systemic therapies and models need to include cultural adaptations and culturally relevant case examples that honor the nuances and needs of globally and culturally diverse client and systemic trainees’ contexts. Most importantly, the flow of knowledge should not be considered only unidirectionally; ideally, an exchange of students and scholars between family therapy/mental health programs globally would necessarily increase collaboration, understanding, and appreciation of different cultures and traditions and the mental health needs and practices in these different cultural contexts.

This volume ends with Nilufer and Yudum’s chapter on the developments and their professional experiences in the MFT field in Turkey. Their experiences are reminiscent of the early days of systemic therapies in the USA and Europe, when regulations, rules, ethics, and structure for the field, and its application and training, were rare or nonexistent. These were exciting and innovative times for the field of couple and family and systemic therapies in the West. In reading Nilufer and Yudum’s chapter, we are reminded of the promise and the potential our field brought to the mental health arena. We are also reminded that for the survival of our field, we must also look further and outside of our comfort zones, especially in the West where much of the field is regulated, structured, organized, and almost lost in the ever-increasing numbers of new treatment modalities popping up every day. Systemic therapies have a rare potential and gift to offer to the larger context of mental health services: the focus on context, ecology, environment, macrosystems, and culture. This lens is at the heart of systemic therapies, and we must have a continued commitment to promote the inherent cultural responsiveness systemic therapies have to offer. As with the experiences in Turkey, the field of course should continue to focus on critical core competencies; however, systemic therapies and those who utilize them, train and supervise in them, and promote them must do so with the guiding principles of cultural responsiveness and social justice. Just as systemic therapy trainers, clinicians, and educators in Turkey are at the forefront of ensuring the survival and future of MFT as a culturally responsive mental health practice, we in the USA must also commit to this in our own cultural context. Collaborations such as this volume, with the inclusion of multiple and diverse voices and insight, are just the beginning of an exciting and promising future for culturally responsive and socially just systemic therapies in the USA and globally.