On the Threshold: Liminality versus Community in Immigrant Families in Therapy Using a model of cultural family therapy for working with immigrant children and families, the author reviews 25 years of practice in Canada’s two largest provinces, Ontario and Quebec, conducted in English and French. The author integrates cultural psychiatry and family therapy (McGill transcultural psychiatry and Milan systemic family therapy with elements of French ethnopsychiatry), to practice Cultural Family Therapy (CFT). Key features of CFT include recognizing families as unique cultures and immigrants as threshold people in transitional states. An overview of adaptation and its vicissitudes revealed in CFT is highlighted with brief clinical vignettes of selective mutism, eating disorders, and PTSD. The key theme that emerges from this review is liminality versus community. Many immigrant families in treatment are marked by a precarious balance between liminality and community with social isolation leading to marginalization. Although family members are differentially affected, the family’s level of adaptation often creates barriers to the healthy functioning of dependent members. The Canadian model of “multiculturalism” is contrasted to the Quebec model of “reasonable accomodations” and alternatives offered: “pluriculturalism” and “mutual accomodations.” Moving away from categories of pathology or identity fosters the study of adaptational problems among threshold people in transitional states. Abstract word count: 197 Learning objectives At the conclusion of this presentation the participant should be able to: 1. Understand a model of cultural family therapy and families as unique cultures 2. Recognize the dilemmas of liminality versus community in treating immigrant families 3. Demonstrate the limits of multiculturalism with increasing globalisation Key words: Cultural family therapy (CFT) Families as unique cultures Liminality versus community Threshold people and transitional states

1. Society for the Study of Psychiatry & Culture
New York, New York
May 11, 2012
On the Threshold:
Liminality versus
Community in
Immigrant Families
in Therapy
Vincenzo Di Nicola, MD

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3. Liminality vs community in immigrant families in therapy 3
Vincenzo Di Nicola, MPhil, MD, FRCPC, FAPA
• Chief, Child and Adolescent Psychiatry, HMR
• Professeur titulaire de psychiatrie, Université de Montréal

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Learning objectives
1. Understand a model of cultural family therapy and families as unique
cultures
1. Recognize the dilemmas of liminality versus community in treating
immigrant families
1. Demonstrate the limits of multiculturalism with increasing
globalisation

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Key words
1. Cultural family therapy (CFT)
1. Families as unique cultures
2. Liminality versus community
1. Threshold people and transitional states

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Cultural Family Therapy (CFT)
An integration of cultural psychiatry
(McGill social and transcultural psychiatry with elements of French
ethnopsychiatry)
and family therapy
(Milan systemic family therapy with Andersen’s reflecting team)

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Elements of CFT
Milan family therapy: Positive connotation
Andersen: Reflecting team
Nathan: Bombardement sémantique
Bakhtin: Dialogism
Lévinas: Face-to-face encounter

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Family therapy is the starting point
for the study of ever wider social units.
—Mara Selvini Palazzoli (1974)

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Key Features of CFT
• Recognizing families as unique cultures
• Immigrants as threshold people in transitional states

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Key Features of CFT
• Family therapy is the space that we open to explore
the possibilities of the family

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Key Features of CFT
• Family therapy is the space that we open to explore
the possibilities of the family

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Family Therapy Interventions
Family therapists do three simple things:
• enhance uncertainty
• introduce novelty, and
• encourage diversity
(Di Nicola, 1997)

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Negative and Positive Conceptions of Cultural Encounters
Negative conceptions
Shock
Trauma
Anxiety
Mourning
Overall theme –
Dislocation and loss
Positive conceptions
Surprise
Learning
Delight
Celebration
Overall theme –
Discovery and growth

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Adaptation and Its Vicissitudes
• Alexis – from Burkina Faso – query psychosis
« Why choose me? »
• Afrah – from Iraq – trauma sequelae probable
« I want to forget / The memory clinic »
• Senga – from Congo – behavior problem
« An African restavek »

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Key Theme: Liminality vs Community
• Victor Turner: The Ritual Process
Liminality – « betwixt and between »
• Jean-Luc Nancy – La Communauté désoeuvrée (1983) –
The Inoperative Community (1986)
"The community that becomes a single thing (body, mind, fatherland,
Leader) ... necessarily loses the in of being-in-common.
Or, it loses the with or the together that defines it. It yields its being-together
to a being of togetherness. The truth of community, on the
contrary, resides in the retreat of such a being."

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Key Theme: Liminality vs Community
• Giorgio Agamben – La comunità che viene (1990) –
The Coming Community (1993)
A philosopher of the threshold – he has written on indeterminate being,
infancy, potenza, potentiality

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Conclusion: Après-coup
• Nachträglich - deferred action – Freud
• Après-coup – Jacques Lacan
A chronologically anterior event as supplement to a posterior one

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Conclusion: Après-coup
• Après-coup – Jacques Lacan
A chronologically anterior event as supplement to a posterior one
What has always troubled me about “King Lear” is that Shakespeare
gives his characters no past. In “Ran,” I have tried to give Lear a
history.
—Akira Kurosawa

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Conclusion
To sum up, suturing a number of concepts and practices together –
• The family as a storying culture where narrative (Bakhtin’s dialogism)
and culture (anthropology) are privileged
• liminality is acknowledged and threshold people in transitional states
(Victor Turner) become more visible and more present to us
• in the face-to-face encounter (Levinas)
• where witnessing (Primo Levi, Agamben, Richard Mollica) is possible
for the resignification of past experiences (Freud/Lacan, Michael
White)

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Après la Coupe mondiale - 2006 Photo : V Di Nicola

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