Marital problems among Arab families: between cultural and family therapy interventions.

INTRODUCTION

UNTIL TODAY NO EPIDEMIOLOGICAL STUDY to investigate the mental health of the Arab population in most Arab countries (Ibrahim & Ibrahim, 1993) has been carried out. The reasons for this are attributable to the government's priorities on the one hand and to the structure of the Arab culture and its norms, on the other.

This essay aims to show the relationship between psychological well being and social customs and cultural traditions in Arab societies. In particular it deals with the traditional treatment of marital problems and the social support that aim to achieve the continuity of traditions. Subsequently, it focuses on the cultural meaning of the "upset" wife, Z'alana, on the politics involved, and on its effect on the well being of the children in the family. With respect to the latter, the paper focuses on the effect of an unstable marital relationship on the mental health of all members of the family.

In the last part of the essay, a comparison between the cultural methods of solving marital problems and a family therapist's methods is discussed. Throughout the paper a case study is used as an illustration. The voice of the client, her narration, is interwoven with the theoretical discussion. Parts of the case are referred to, in accordance with their relevance to the stage being discussed in the paper.

THE PSYCHOLOGICAL WELL-BEING AND THE SOCIAL CUSTOMS: A SAMPLE OF A MARITAL PROBLEM IN THE ARAB FAMILY

Shireen is a Palestinian woman aged 32, who has been married for fourteen years to her cousin who is four years her senior. The relationship between them has worsened over the last seven years, during which time he began to gamble. He would return home late and would not pay the family expenses. When she complained about his behavior he beat her. In the beginning she tried to face the problem alone, but then she turned for help to her close friend. However when the situation worsened and she saw that she could have no effect on her husband's behavior, she turned to her parents and asked them to take the necessary steps in dealing with him. Some women in such cases also turn to their parents-in-law and older brothers-in-law, requesting their intervention. The parents of Samir, Shircen's husband, were divorced and did not live in the same village.

It is evident that Arab families do not go to a stranger to solve a marital, family or psychological problem. There are various reasons for this. First, specialists in such professions are rare in relation to the needs of the population (Abu Baker, 2001; Moses, 1992). Second, since the first psychiatric services to be offered to the Arab population resulted in the hospitalization of psychotic patients, the stereotype emerged that psychological services are rendered to "crazy" people. This caused those in need of these services to delay seeking them, until the psychological problem worsened to the degree that it became complex, and needed longer therapy (Dwairy, (1) 1998; Meleis & La Fever, 1984). Thirdly, there are those in the Arab society who offer therapy such as Moslem sheikhs, palm readers and fortunetellers. A sector of the population believes these people have the capacity to solve crises of a psychological nature and turn to them when the need arises (Al-Krenawi, 2000; El-Islam, 1982). The fourth, and most important, factor is the role the extended family plays in the support and treatment of psychological, marital and family problems of its members. However this issue is not as simple as it might seem. The extended family, in itself, is also a source of all these problems.

THE TRADITIONAL TREATMENT OF MARITAL PROBLEMS AND THE PSYCHO-SOCIAL SUPPORT OF THE EXTENDED FAMILY

Marriage in the Arab family is a union of two individuals as well as the union of their two families (Barakat, 2000). This bolds true for all the religions (Islam, Christianity, and Druze) associated with Arab culture, as well as for all classes and sectors within it. Despite the fact that all religious norms and state laws of Israel allow adults to intermarry, social values require that the consent of the guardian or parents be won; otherwise until the marriage plans are followed through, a couple that has not won their consent, will find themselves looked down upon by all.

There is no complete independence for any individual in the Arab family away from the family of birth. However, it is possible to say that the younger the age of either member of a married couple, the lower the education and the lower their social class, the greater is found to be the role of the family of birth in intervening in their lives, even in decisions such as choosing the marital partner, deciding upon the appropriate age of marriage and setting the wedding date. There are cultural, religious, sociopolitical and economic factors that serve to influence this traditional outcome.

1. The monotheist religions educate their members in the obligation to respect and obey the parents. Religious ideology affects the everyday life of religious and non-religious Palestinians (Abu Baker, 2002).

2. Islam, which is the most widely spread religion in the Middle East, requires the parents to aid their offspring financially and psychologically for marriage and to do this at an early age in order to discourage adultery and to maintain a modest life style. Therefore, the goal of working towards the marriage of their children becomes a norm and the marriage of the offspring marks the self-actualization and success of the parents. It is no wonder that a father of a ten-year-old boy should be seen to put all his modest savings into building a simple home for his son. Once he has finished building the basic structure of the house for the first son he begins on the house for the next son (Barakat, 2000 (2)). This becomes his routine until he is flee of the responsibility of marrying off his children and "bearing the responsibility a parent should bear." This usually happens in middle class and poor families where the parents know that the son will never be sufficiently independent financially to get married without parental help.

3. The difficult economic situation of most of the Palestinian population and the rest of the Arab world contributes to institutionalizing the extended family pattern in modern times as in the past. This social symbiosis becomes the most economical group support particularly with regard to supporting the young married couple with their home and child rearing.

4. The structure of Arab culture ensures that the society is part of the everyday life of the individual. In the large cities young people who live far away from their families form social relationships that rebuild the framework of the extended family and its services in all their forms.

5. Many Arab societies, such as those in all the Gulf Countries, are living through a vast transition period that leaves them under two dominant cultures. The Palestinian population in Israel is also living in such a transitional period. This transition varies in its acuteness but it is similar in its dynamics. Arab society lives between a state of traditionalism and modernism and the influence of religion is transferred freely among all members of the society. It is indeed possible to find different lifestyles among siblings within the same family. The voice of tradition, however, still dominates the voice of modernism and this is a cause for many intra-psychic and interpersonal conflicts.

6. In the transitional period through which it exists, the Palestinian population finds ways to associate between the old and the new in a way which is functional for the particular but does not always serve the diversity. For instance, some adopt western ideologies, when dealing with the rights of men and women to get to know one another closely before marriage. Yet for most among the society, open and free relationships are criticized. This has encouraged endogamy where youth are able to get acquainted within the framework of high school at an early age or within the neighborhood or family clan. In effect they develop a boyfriend/girlfriend relationship and the extended family and society observes this internal relationship that resembles a first cousin relationship.

7. There is a distinct disparity between the status of males and females within a family and the status of women and men within society. Based on this there are functions expected of the wife and of the husband. Proud parents strive to marry their sons, making it one of their central aims in life. However, they hope that there will be someone to ask for their daughter's hand in marriage. A woman cannot ask a man to marry her. The society negatively judges a woman who becomes a spinster and when other families do not choose them as in-laws, her family feels that they were personally hurt. In order not to realize such a destiny, the family pressures young females into marriage at an early age (3) (Central Bureau Statistics, 2000; Moghadam, 1993).

Poor families see that an early marriage is better for a young woman who wants to complete her higher education. These families hope that the husband will pay the tuition and other educational expenses since he alone will benefit from the woman's work. Hence some families make it a condition of early marriage that the bride resumes her studies and that the groom is liable for the expense. In such a situation, one may find this condition documented in the marriage contract. The youth of the bride allows her family and the groom's family to intervene in her affairs and even to dominate her decisions.

8. For the reason that the society is patriarchal on the one hand and transitional on the other, it is accepted that some young men may reject some religious ideologies and traditions or some rules of their extended family. However, this tolerance vanishes in the case of women. In such cases, everyone co-operates, even modern youth, in dominating a woman whom society has decided to restrain.

THE EFFECT OF THE SOCIAL STRUCTURE ON THE WELL-BEING OF A COUPLE'S LIFE

The members of the extended family live as neighbors and spend most of their life together. The village family ensures, in most cases, a dwelling for its male members close to the family-of-origin home, which helps to control the behavior of the sons and their wives. Adults remain under the strict observation of the family of origin and the close social group and therefore cannot behave independently or enjoy freedom.

When psychological marital or family problems arise, the family of origin is the first to know; it observes, intervenes and proposes solutions. On the other hand, this closeness and heavy-handed control causes much psychological and marital stress, particularly when the wife is from outside the extended family (4) or when her expectations of marriage are different from those of her environment.

When an Arab woman chooses her husband by herself and marital problems arise, she deals with it as if these problems were a punishment for not involving her extended family in her decision. In particular her mental health will worsen if she challenged her family when she married despite their warnings. In such a case she puts up with the marital problems including psychological and/or physical abuse, often lacking the courage to reveal it to her family as it would be inferred from such a revelation that her behavior towards her family had been wrong.

In the case where her family forced the marriage upon the woman, whether via gentle or aggressive persuasion, the wife considers that the solution to these problems is within the scope of the extended family's responsibility. She returns to them and requests their intervention to find an appropriate solution.

The life of Shireen as a married woman closely followed the norms of young women her age. Her husband "Samir" worked as a taxi driver and his income was average for young men of his age. Samir's extended family helped furnish his home. Other needs of the couple were provided by the generous gifts they received from their uncles. The parents of Samir were separated when he was young and his uncles wanted to ensure a good future for the children of their brothers and to encourage them to marry within the family (5) (Al-Haj, 1992; Barakat, 2000; Granqvist, 1935).

Within six years Shireen gave birth to four children; none of the pregnancies was planned. She was very young and was tired from endless family responsibilities. She soon felt that she was unable to manage in any field. She became exhausted physically and psychologically. Since Samir's mother was divorced, she lived with her family of origin far away; his father lived in a distant big Jewish town. Shireen did not therefore find the daily support she needed to raise her children. Her mother and sisters tried to help; however, they had to support their married son. (6)

Shireen did not expect to ask for aid from Samir because he was not raised within an environment that encouraged the co-operation of the man in domestic chores or in the care of their young children. Samir was raised to believe that the good husband and father is one who works hard to provide for the needs of the family. He wanted to prove that he was hard working and caring and was not negligent towards his family as a father and so he started working overtime driving the taxi. This led to Shireen's spending longer hours at home alone with her four children. For Samir it meant longer tiring hours outside the home. When Samir came home from work he wanted a calm environment to rest. This request increased Shireen's upset feelings: she felt that she was there only to be complained to and she wanted her husband to enjoy her company. She asked him many times to sit and discuss things with her and to bear some of the responsibility for the children. She also wanted him to come home early so that she could go out with him or invite some friends or relatives to visit. Samir refused to do this and accused Shireen of looking for something about which to nag. She would cause misfortune in her marriage and could not appreciate his sense of responsibility towards the family, he said. Shireen became nervous and stressed and became verbally and physically abusive to her children. She quickly became a chronic shouter and criticizer of her husband.

Samir began to go straight to his grandfather's home, which was close by, on his return from work. He would often take a nap there and after awakening would return to his own home by which time the children were already asleep. Shireen complained to the grandfather and grandmother and accused them of encouraging Samir not to listen to her and not to meet her needs by receiving him on a daily basis. The result was that everyone blamed her for asking of her husband "more than he could give" and also for not providing him with the rest he needed. At this stage, Shireen's mother and aunts tried more to help her manage her household and children. They talked to her extensively about how to take care of her husband. Shireen tried for a while but she became more depressed and more hostile. "Providing rest for the Arab husband" means to let him chose what is best for him, regardless of the family conditions. In some cases, husbands prefer to work as married men do and yet behave in their leisure time as bachelors. Samir recognized his financial responsibilities as a father and yet did not want to feel the presence of his children when he returned home from work. He claimed that his wife should make him feel like a king even when he was very poor. He also forced her to behave as if he was the most attractive of men when she actually saw him as being repulsive physically. Shireen failed in this difficult task that was required of her as an Arab woman.

The intensive interference of the extended family and their assistance to Shireen legitimized Samir's negative criticism of her. He claimed that Shireen could not manage her affairs like other wives and mothers and he felt his position to be strong. So that he could avoid facing her, Samir began to go out to see his bachelor friends after he had rested at his grandfather's home; he then returned home at a late hour. Practically, home became a place for secondary sleep and changing clothes. The couples' sexual relationship vanished.

At this stage, her relatives proposed that she conceive and give birth to a new baby 'so that Samir would become more attached to the family and home.' Shireen heeded the advice to solve her marital and personal problem. (7) She became more tired during the pregnancy and the women in the family tried to support her. However Samir almost stopped returning home at all and slept most nights at his grandfathers' house. Whenever his wife blamed him he would curse her and curse the relationship and would leave the home in anger. Samir became constantly physically and psychologically abusive towards Shireen and sometimes also towards his children. Shireen gave birth and suffered postpartum depression and refused to care for the infant. Her mother was superstitious and believed someone had envied her daughter's marriage and health and busied herself for almost a month with superstitious prescriptions to cure her daughter. This helped Shireen, who felt a lot of attention and assistance from the women in her family.

Samir's relatives put pressure on him and blamed him for his lifestyle. However Samir at this stage had already become addicted to gambling, in which he spent most of his time after work. He was physically tired as a result of staying awake for long hours and his economic state became worse. He became more psychologically strained. In addition to the continual reprimands from family members, everyone helped provide for the basic needs of the family. (8) Shireen felt on the one hand that the family was on her side but on the other hand she felt she had to be satisfied with the basic necessities and that she could not indulge herself with the luxuries a young woman would like. Gradually, Shireen found that the aid she received from the extended family actually encouraged Samir to further his addiction. He ignored his work and stayed at the gambling table until the early morning hours. Thus the family solutions suggested became some of the factors contributing to the problem.

Shireen suffered a nervous breakdown. Leaving her other children, she took the baby and 'returned' (9) to the home of her parents. Samir's unmarried aunt moved the children to her parents' house where she took care of them. The children cried constantly for their mother. Samir would return home late and hear complaints against his children and he would blame their mother for 'abandoning them' and would then sleep at the house of a Russian lover he had met (10) (Abdo, 1999; Hasan, 1999).

Men from both sides of the family intervened and convinced Shireen's father of the necessity of her return to her 'husband's home.' The father took the opportunity to complain about the treatment his daughter received by her husband, who was his brother's son. All agreed that Shireen's father should make it his responsibility to advise the younger couple of their duties and to find a solution to their behavior, which was harmful to them and to their children and to the extended family's reputation. The visits of family and neighbors became more frequent and Shireen found herself between two states that contradicted one another psychologically and socially: Under social pressure on the one hand and surrounded by social support on the other. Whenever someone entered her home she had an opportunity to complain about her husband's behavior and to spill her heart out about 'appreciating her silence' and how she put up with him during previous years. The social narration emphasized the noble behavior of Shireen as a "Mastura," a "silent/respectable woman" (Abu Baker, 2002).

Shireen's male relatives assured her that they would take responsibility for correcting Samir's behavior. His uncles and grandfather spoke to him of the embarrassment he caused them and his relatives and of the harm he would cause his children in future. Samir promised to change his behavior and to return to a proper way of life. He had gambled away his licensed taxi as a result of his increasing debt and it was time to pay the debts. Samir begged for the sympathy of his relatives and collected from them the amount owed through gambling so that he could correct his lifestyle. He promised to pay them back as soon as possible. Samir stopped gambling for two months. However he gradually returned and became heavily addicted again. When Shireen complained of Samir to her relatives this time the unanimous answer was that they had tried to solve the problem for seven years, and that it was up to her to put up with it or to take whatever step she saw necessary. So Shireen came for consultation.

The psychological disorders that had developed in Shireen during the past seven years were: intense nervous agitation, depression, a lack of self confidence as a result of continuous physical and psychological abuse, frigidity, and hostility observed particularly towards herself and her children (11) (Ghubash, Hamdi & Bebbington, 1992; Racy, 1980; West, 1987). As for the psychosocial problems that developed in Samir within the same period, they were: addiction to gambling, verbal, physical and psychological abuse. As for his behavior with regard to the marriage, he contributed to the stress within the family due to the lack of economic stability, which was the main reason for the destruction of the love relationship and the removal of intimacy between him and his wife. Following this the marriage was deeply damaged by his openly committing adultery.

No one had proposed that they seek professional individual or marital counseling during the past seven years because such counseling does not have a priority in traditional society.

THE POLITICS OF GENDER-RELATED NORMS AS A PROBLEM WITHIN THE ARAB FAMILY

The Arab family judges the behavior of women and men differentially. A man can leave the house without others knowing his objective and can stay away from home for long hours without others knowing his whereabouts. He can also spend money on himself as he sees fit while depriving his wife and children. He may choose to go against religious and social norms without putting his life and his marriage at risk. As for a woman, any of the above mentioned behaviors could end in immediate divorce and the withholding of all her rights as a wife, a mother and a person within the Arab society (Abdo, 1999; Hasan, 1999; Shalhoub-Kevorkian, 1997). As a result of this treatment and of the woman being encouraged to "veil" and suppress her voice, the percent of Arab women requiring psychological treatment is much larger than that of Arab men (12) (El-Rufaie & Absood, 1993; Ohubash, Hamdi, & Bebbington, 1992; Ibrahim, 1999).

The patriarchal Arab society preserves not only the gendered marital roles, even when males make faulty decisions, it also preserves the nature of marital and psychological problems. The support of the extended family of a husband who abuses his wife causes society to judge the husband's behavior as being within the normative zone and the regression of the wife's behavior as pathological behavior.

Although when there is a marital problem, women within the family play the role of listeners to the complaints of the wife; however, they are not always empathic to her situation. In order to preserve the social order, older women have adopted the role of criticizing the younger women for their behavior and making them carry the responsibility for the shortcomings in marital matters. This group will therefore make the woman feel that they are on her side, on the one hand, while, on the other, in some cases they will suggest solutions which in themselves become additional problems, such as another pregnancy or surrender and silence so that the man will not marry another woman.

THE SOCIAL AND PSYCHOLOGICAL POLITICS TOWARDS "UPSET" WOMEN, "Z'ALANA"

Arab tradition allows the married woman to leave her home and her children and return to her parents' house announcing that she is "upset" (13) (Granqvist, 1935). With respect to the politics of the marital relationship this step transfers the problem from the private zone to the public zone. Alternatively speaking, the wife requests that everyone should know of her suffering from marital problems, not wanting to promote the politics of the Mastura "silent/respectable woman."

This announcement of marital conflicts outside the familial realm points to the role of the husband as contributing to the conflict and clears the conscience of the wife of the responsibility. Sometimes, it also serves to promote the desire of the wife to end the marital relationship. Generally, families try to keep their problems within the realm of the family to preserve the privacy of both partners. However when the wife despairs of the solutions offered and they fail her, she attempts to remedy the situation by using social pressure against the husband. Arab society uses gossip as one of the most important tools for social control and for the preservation of the social order.

The announcement of the wife as Z'alana, "upset," generates rumors and stories about the private life of the couple. Since this occurs many couples try to behave within the acceptable social norm so that they will not be subjected to such a difficult experience.

The public announcement of a problem serves to relieve the psychological stress that is caused by suppressing a large problem for a long time. This is similar to what White and Epson refer to as externalization (White & Epston, 1990). Hence the wife now invests the rest of her energies in attempts to change the situation. In comparison, her previous attempts were to focus most of this energy on hiding the problem from her environment.

The accusation inherent in her society's blaming her for failure in maintaining marital life shakes the wife's self-confidence. The culture of marriage in Arab family regards the wife as though she possesses a magical wand, which, if she knows how to take advantage of it, enables her to draw the man onto the path she desires. The family taking in their daughter as Z'alana "upset" after she has announced her failed attempts to prevent marital conflicts gives the wife the feeling that she can depend on her family for a stable and secure source of support. This need is very important and essential to her when she is sure that she is not able to depend anymore on the love of her husband or on the support of his family. The support of the parents towards their daughter rebuilds her confidence in the sincerity and the appropriateness of all her previous corrective attempts.

During this stage, the wife goes through a period of intensive marital training during which she will be acquainted with stories of marital conflicts. Friends, relatives, and parents' friends who hear of her "return" to her parent's home "upset" come to show willingness to assist in solving the problem. The wife reveals time after time the details of her conflicts, her previous attempts and their results. Sometimes she tells the story 3-5 times a day to various guests and with different emphasis. This helps her to put her problems into perspective after the anger and distress have dissipated with each retelling of her story. The guests in turn retell the stories of their own marital conflicts or of those of others they know. Everyone discusses solutions to overcome these problems and they learn from the experiences of others what helped rebuild families and, in contrast, what contributed to their dissolution. After she has heard many stories as bad as or worse than her own, and after she has gathered many suggestions and regained some optimism, she feels empowered and psychologically relieved. From a mental health point of view, the period of the wife being Z'alana "upset" is a period of venting emotions and a marathon of intense marital group therapy. The husband lives the same experience involving his relatives and friends in narrating his version of his marital conflict.

There are conditions for finding refuge as an "upset" wife Z'alana. The wife cannot announce herself as "upset" with respect to every behavior that the husband exhibits against her unless she has tried to remedy the situation in a way that convinces her social group of the sincerity of her attempts. Arab society respects the wife who is silent about her personal pain and her conflicts with her husband and does not involve others in them. Social judgment regarding the legitimacy of the "upset" woman depends on (a) the reasons for the marital problems, (b) history of marital problems, and (c) previous solutions tried by the couple. According to the above, the "upset" wife will be judged by her social circle as a psychologically stable and socially responsible or not.

In contrast, when the family of origin refuses to receive the "upset" wife she exposes herself to the criticism of family and friends. More important, the husband will be aware that his wife did not obtain social support and has no alternative to living with him. An immediate result of such a situation is the amplification of domestic violence in all its types against the wife and her family of origin.

DISCUSSING MARITAL PROBLEMS AS A REFLECTION OF THE POLITICS OF POWER BETWEEN IN-LAWS

When the wife is "upset" the discussion of conflicts will be transferred to all adult males in her family of origin with her husband. The discussions may put the future relationships between the in-laws at stake. Therefore, many couples change their behavior in response to such a threat, wanting to preserve a good relationship with their in-laws.

This stage is regarded as a reconsideration of the details in the kin alliance of two families. Therefore during this time it is not enough to speak only with the husband; men from his family or extended family that have the capacity to make decisions on his behalf are invited to discuss the marital relationship. If both extended families seek to preserve the marriage relationship they will glorify the alliance relation between them. In exchange they ask for the men in the wife's family to persuade her to withdraw from her "upset" stage and return to her home. Here the wife's family set their conditions or requirements and they discuss it with the husband and his relatives. In spite of the discussion being usually among men, the wife feels that she is actively holding the threads of the relationship. This, however, is not in effect the true situation for most cases. In conclusion, the public announcement of the conflict by the wife directly serves male empowerment in her family. She reconstructs the male dominance, directly in her social surroundings, and in the changing Arab society.

The pressure of males from the two extended families often forces the couple to live together again without having solved the roots of their problems. This return constitutes an unrealistic reassurance of the social order. The period of being "upset" varies from a few days to a few months or, in some rare cases, to years.

When male relatives force the wife to return to the same bad conditions that she had rejected, she has the right to leave as "upset" once again. Now she may leave to the house of her parents or to the house of any of the relatives who assured her of an improved state. Here the woman's "upset" state becomes a mechanism for obtaining marital rights from relatives, not only from the husband. This mechanism serves, when it succeeds, as an additional tool for exerting pressure on the husband. The wife stops demanding the husband's improvement: her relatives carry out this task.

Regardless of the age of the husband, the relatives give themselves the right to discipline him, scold, restrain, monitor, and embarrass him in public. If the extended family reaches this stage with the husband, the wife feels she has gained a measure of success.

At this stage men and woman have different roles. As aforementioned, the couple does not argue their problems directly after declaring the wife as "upset" Z'alana. After gaining a clear picture of the position of the wife, the men in her family and that of her husband discuss how to solve the conflict. In such meetings the husband promises, in the company of those present as witnesses, and being respectful of their status in the family and society, that he will correct the causes of conflict with his wife. The promises cover his psychological behavior, his nervous reactions, his social manners, his economic decisions and his emotional relationship with her. The extended families do not strive to intervene in the details of the promised behavior, out of respect for the sanctity of relationships in marriage, although discussion of these details is an asset in the treatment of marital problems.

If the wife or husband, by their own personal strength, did not gain insight from their experiences and from what they heard around them, they will never reach the stage of internalizing this experience. The extended family strives to erase the social announcement of the existence of marital conflict and achieves this end when the couple returns to their life together, under one roof, regardless of the actual nature of the current relationship between them. The extended family hopes that the couple, through their own personal strengths will solve the factors that led them into marital conflict. The husband's family assists in terminating marital conflict by asking the extended family of the wife to allow them to return the wife to her marital home with their personal guarantee. From that moment they take the responsibility for her satisfaction with marital life. This step ensures that marriage is a dynamic within the territory of the extended family, which is able to affect the psychological conduct within this marriage. From this scenario, it is clear that the dividing line between the individual and his or her family of origin is practically nonexistent within the Arab family (Dwairy, 1998).

IMPACT OF MARITAL CONFLICTS ON CHILDREN'S MENTAL HEALTH

Individuals in the Arab families in Israel get married at an early age, the majority having left school before the completion of secondary school studies (Central Bureau Statistics, 2000). Half the young couples are uneducated and cannot read one book on child psychology. On the other hand, when children are exposed to a climate of marital hostility, they are not treated for the harmful effect of this climate. The idea of psychological counseling as a necessary social service in these cases has still not penetrated the collective consciousness. The effect of the violence develops (a) horizontally, so that the child that was exposed to violence becomes violent to those around him or her, and (b) vertically so that he or she carries the violent character and transmits it to his or her marriage and children, establishing the next generation of violent families (Ayslon, 1998; O'Hagan, 1993).

When a mental health worker, or a school counselor remarks to parents that they should take their children to therapy they usually refuse. The common response is that they too witnessed marital problems and abuse as children and it did not have an effect on them. There is a denial on the one hand and a false understanding of the reality on the other.

The fighting couple is not satisfied with drawing the children into their conflicts, but also right to win the children's loyalty. When they sever all communication between them, they use one of the sons or daughters to transmit messages from one to the other. Older daughters take on the role of the parenting child and triangulation is formed with her by one of the parents.

The fighting parents use their alliances with the children as evidence among the extended family, and subsequently in the religious court, of their parental competency. In this case the parents try to provide for the basic material necessities of the children in order to win the competition between the couple. The children are not put in the center, regardless of the unstable state of the marriage. The case becomes worse when parents use the children to confirm their narration of the dispute to the extended family. By forcing the children to be in such a situation, they put on record their own understanding of the ecology of the family relations. These climates cause the hostile conduct to be inscribed deeply on the psychologically profile of the child.

During the period of marital distress it is possible to ignore the basic needs of the children and not to provide for them. This state of affairs is caused mainly by the psychological distress of the couple or by the absence of money in the household due to sanctions that one of them uses against the other. These conditions can exist for days or weeks without the intervention of any party outside the family, such as the extended family or the social welfare. The children get used to being raised in the margins of the family core. Consequently, this leads to a damaged self-concept.

One maneuver, which is used by disputing wives, in particular when the explicit causes for marital conflicts are the economic needs of the family, is to use the material needs of their children as a main source of pressure in the battle against their husbands. They try to draw a picture of the father as a failure who is not able to fulfill his responsibilities. It is not necessary that these wives win the game at this stage and their success would depend on the environment in which they live. It is possible that one extended family would encourage the wife with regard to her demands and support her. At the same time, another extended family may accuse a wife of greed and vanity and of demanding more than the husband can offer because she cannot appreciate his circumstances and does not support him.

When a woman becomes an employee outside her home, part of this image changes due to the existence of a stable income for her, some of which she can spend on her children. Since the work of the Arab woman is regarded as secondary income, and because Islam requires the man to cover all his wife's expenses, married working wives use this against their husbands. During marital conflict they announce that they are not obliged to cover the expenses of the children. Thus, this acts as another source of pressure on the husband, a value on which the children are raised as if it were a legitimate source of conflict. They know on the one hand that their mother loves them and yet on the other, that they cannot make any material demands of her. These arguments over the role of the husband and the role of the wife, which take into account the traditional view of society and of religion, forms the ideology and politics of gender in the Arab family (14) (Banahi, 1995).

Poor families strive to marry off their daughters at an early age in order to be assured of who will care for their material needs. These families reject having to meet the material needs of grandchildren when marital conflict arises. Women are aware of such a situation, hence they leave their children in the custody of the family of origin of the husband when they leave as "upset" Z'alana. Shireen took her infant baby and left four children in the care of her husband's aunt without previously preparing the aunt or the children for her decision.

In such cases the general family climate is distressed to the extreme. Despite the children's acquaintance with the adults around them, such a traumatic transfer is a shock to their sense of well being. Children are asked not constitute a burden on adults in the extended family. Thus they again experience being marginalized and not in the center. They soon learn to give in and suppress their emotions. The older children take care of the younger ones, feeling the situation in which their family lives to be in a state of emergency. Here they learn responsibility for the collective group, while the heavy demands damage their well-being.

The climate of the argument over the children would be one of blaming and anger over the marital conflict. The father's relatives would allow themselves to yell in his face as they discipline him in front of his children. The children also may see their father being cursed and humiliated and do not always understand the situation. However, overall, they live in anxiety, stress and an increased feeling of insecurity. Sometimes, children will be moved back and forth between the residences of the mother's and the father's relatives, as they try to divest themselves of the responsibility for the children. In extreme cases when the mother's family is not able to take the children in, she will be prevented by her husband from seeing them as a punishment and as a means of pressuring her to go back to her marital home.

Family laws within Israel assure the right of the parents to visitation in safe surroundings and at times agreed upon for the benefit of the children. However this does not guarantee that relatives will not try to harm one of the parents by setting the children against him or her. Their goal is to gain the children's support for one parent at the expense of the other.

The Arab family uses the children when marital conflicts exist as appears appropriate to the scenario in the marital scene. Sometimes mothers take their children with them when "upset," Z'alana, to prevent the husband from seeing his children as a way of exerting pressure on him: or of punishing him. However, all of this can only happen in cases where the wife's family of origin agrees to take on the expenses of her children. Women try this option especially when they leave the house for good with the intention of divorce. In other cases the wife leaves her children in the marital home purposely in order to "discipline" the husband and to cause him to have to "suffer" with them so that he can appreciate her and her work in the role of housewife and mother. R occurs frequently that the girls go with the mother and the boys are left in the husband's house and this shapes the degree of psychological security that each of the children feels upon the separation of the siblings from one another.

Israeli law permits an "upset" wife whose husband has ceased to provide for her to receive a monthly allowance via the religious court. The court usually requires that the woman keep her children with her to ensure their social and psychological stability. The religious and social pressures act as tools to encourage the return of the wife to her home despite marital issues being unresolved.

Marital conflict within the home creates a state of war where the extended family uses the children as tools to exert pressure without thinking of the psychological harm and distress they cause them. Because social norms do not focus on the individual well-being, the depth of the harm caused to each of the children will not be observed. Furthermore, adults will not pay attention to signs of distress, such as school failure, change in the regular behavior and so on.

CULTURAL THERAPY OF MARITAL CONFLICTS VS. FAMILY THERAPY

Therapy allows clients a unique chance to express their complaints, especially when their voices are silenced by society. Many Arab clients believe that the mental health clinic is a modern version of social interference in marital problems. Thus they have specific expectations of the therapist and they soon feel disappointed when these expectations are not fulfilled. For instance, when a couple comes to therapy, they would like to present their complaints as soon as possible in order to hear the therapist's "judgment:" who is to blame and who should surrender to the other, i.e., they come with the expectation that the therapist will behave as an extension of the extended family, whereas the difference between the two is in that the therapist behaves "according to his education."

Many couples go to a therapist as a result of losing confidence in the extended family after it has repeatedly failed to solve the marital conflict. Others go because they have detached themselves from the extended family of the spouse and refuse to accept its involvement in their lives or its decisions. Yet others go as a result of the woman having reported to the police that her husband is abusive. Similarly, they come in response to the requirements set by the lawyers in divorce eases. In some cases one of the partners makes the possible improvement of marital relationship conditional on marital therapy. In such cases, the spouse believes that sessions may be used as a means to control the other partner. This unhealthy situation reflects their marital problems. Some families see themselves as having an affinity for this kind of treatment due to their modernism and urbanism.

In a society in which there are all kinds of traditional and modern characteristics, reasons for seeking family therapy reflect the many different faces of the society. Among all the categories, the family and marital therapy clinic in Arab society is related to at the one polar extreme as an office for social complaints, and at the other as a place where people discover the deep roots of their problems.

Some couples came for counseling three weeks after marriage because they were sure they wanted no misunderstanding to arise between them. In contrast some came after 23 years of failed marriage when their daughter was at the point of getting engaged. It is possible to generalize that the more educated and more economically successful are the individuals, the more they believe that family and marital therapy will be beneficial for them. In most cases both partners come for therapy or counseling. However a spouse may refuse to participate in therapy. Often, when the spouse wants a divorce he or she refuses to invest in the therapy or to receive counseling towards a peaceful divorce.

Samir refused to come to therapy because he objected to confessing that he was responsible for what was happening in his marriage. On the one hand, Arab society does not admit that either addiction or violence is a psychological problem that needs therapy. Therefore neither Samir nor any of his relatives discussed the necessity of individual therapy with him. On the other hand, Shireen decided to begin therapy because she had ceased to feel that her family and extended family were listening to her problems as they had in the past, and, furthermore, they now stood empty handed having given all the threats, advice and wisdom, which they had to offer to the couple.

When Shireen was told that she could begin therapy immediately and that it was possible for Samir to join at a later stage she asked about the period of time that therapy would take. She was told that the therapy could be anything from short-term therapy lasting three to five sessions to a longer-term therapy, which would take a few months. It was difficult for Shireen at this stage to plan for herself how she would attend the sessions for months without receiving a "definite answer that would "discipline her husband right away." I told her that what she spoke about was the part pertaining to her in the story of the marriage, and that, in order for the story to be complete, it would be better if Samir would agree to attend therapy to add his input.

Shireen suggested that I ask her family about her behavior and his and judge for myself. I made it clear that I could not investigate her personal life in public out of respect for her privacy. Shireen interpreted my answer as not showing the necessary interest in her complaints. I told her that I would be willing to contact Samir and explain the necessity of his presence in therapy and to give him the chance to make this decision. She then asked me to order him to come to therapy and I informed her that I could not do that. This answer did not suit her either. She said that since she became "upset," Z'alana, she had shared her problems with many of her relatives and with his or her friends and immediately after she had voiced her complaints, they had offered to talk to him. In this statement she was blaming my reaction again. Shireen wanted to discuss her marital problems further. However I told her that the time for the session was over and that we could continue in a forthcoming session. Shireen was surprised that I asked her to "freeze" what she was talking about until the next week. She said that she was burning up inside and that I was as cool as can be; she was eager to find a solution and that I was calmly delaying it. She was afraid that delaying sessions in this fashion would keep her outside her marital home much longer than she had anticipated. I said that she could agree with Samir to return home and that they could continue therapy together. She asked me if I was ready to "return her home" as some respectful elder men would do in such a situation. (15) I told her that this was not within the sphere of my work but that I could bring up the subject for discussion when they will be in together in a session. She did not comment on this.

Shireen was on her way out of the clinic when I reminded her that she had not paid for the session. She looked perplexed and said: "but I have not received any advice from you. You will not do anything now to make Samir change towards me immediately. I will not return home a winner. I talked for most of the session and you listened for most of the time. You asked and I answered. I thought that I would ask you questions and benefit from your knowledge. You have not done anything for me in this session." I told Shireen that this was natural for the first sessions. It was clear that Shireen expected that, because of my specialty and expertise, I would be able to give her a proscription for peace and happiness in her marriage in one session. Assertively she announced at the door: "As I have not benefited from you I shall not return."

Misunderstanding of the nature of psychological and family therapy services developed in recent years has led to many expectations which are not in accordance with the nature of the profession. Traditions in society both cause and affect these expectations. In order for therapists to succeed in their work, they must understand the nature of the collective identity of the Arab society. Therapists would benefit from putting some emphasis on mass mental health education. They could then spread knowledge of the essence of their work. The similarities and differences between the therapists' type of intervention and the family and social one should be pointed out.

Sometimes therapy relationship is put at stake because of the clients' lack of previous experience in the culture of therapy. They expect the therapist to function as an extension of the traditional problem solving. As an alternative of blaming the client for her belief system, therapists may discuss with the client what had been beneficial for her from the cultural intervention. This helps to learn more about her expectations from family therapy. A family therapist will serve clients better had the therapist accepted herself or himself as an extension of the client's cultural environment. Shireen would benefit from co-planning an intervention in which the therapist invites the husband with significant figures from her and her husband's extended families. Those figures should be able to collaborate between the accustomed cultural intervention and the family therapy intervention. In the fast therapy meeting the wife and those who tried to intervene in according to cultural norms may be praised and empowered for their attempts to help the family. Family therapy plans may be shared with them out of respect to their contributions. Shireen would feel encouraged and secure in this procedure. She would be less tense since she would have the notion that she is using all strategies to solve her marital problems.

It is very important that the fast session should not end without some type of intervention, future plan, or significant advice, which will be implemented soon in the client's life. Arab clients expect that a family therapist should be more efficacious than the cultural support system. Therefore the client needs to feel immediate results of therapy or counseling.

In cases where the therapist comes to the conclusion that it is better for the family that the couple separate, having a therapy relationship with representatives of the two extended families helps to reduce the damage of divorce on all parties. Because marriage is a familial and social bond between two extended families, divorce is conceived as a declaration of war and enmity between these two sides. The complexity of the situation exacerbates if the married couple are first cousins. Here the aim of the therapist to achieve a peaceful divorce is perceived as a strange and misunderstood step. In such cases it is important that the therapists behave as educators of the public in mental health psycho-hygiene. They must make the effort to explain the importance of the psychological health of all family members, particularly the children. A therapist may ask family members to collaborate in taking responsibility for the psychological health of all family members, which includes the husband, wife and their children. Inviting extended family members in therapy may help in reducing the rejection of the husband to collaborate with the therapist. More important, he will approach family therapy as an attempt to help all extended family members rather than a cooptation between the therapist and the wife.

CONCLUSION

The population of the Arab world is characterized by a mixture of traditional and modern societies and sub-societies. The Arab family lives between its nuclear state, consisting of the married couple and their children, and its need for the support of the family of origin, the extended family, and sometimes of the whole clan, the Hamula. In most Arab societies one may find values that endeavor to include modernism and follow modern life style. At the same time, the influence of social values that safeguard the traditional family and social structure has a precious weight.

Psychological and family problems are seen as being personal, and to be solved secretly and in silence. Those in need initially try traditional remedies such as religious ceremonies, witch doctors, or ask the extended family for advice. People do not view some behaviors such as addiction, violence, depression, and sexual frigidity as psychological problems. Therefore, most of them do not reach individual, couple, or marital therapy in the first stages of the onset of the problem. On the other hand, their expectations from therapy are overstated. They expect to see changes occurring in their lives immediately during the first session.

For the benefit of the clients, it is prudent to include in family therapy sessions representatives of the cultural support network instead of misjudging the importance of their intervention. The expansion of the intervention to include extended family members expands the meaning of the 'privacy' of family problems and the meaning of 'cultural intervention.' It introduces the therapist as part of the ecology of the extended family instead of introducing him or her as an outsider who is in competition with the extended family and its culture.

ENDNOTES

(1.) In his analysis of cases he worked with during 15 years, Dwairy mentioned that 44.2% of all cases arrived at therapy after years of hesitation and delay, another 44.2% came to therapy months after the appearance of first symptoms, 11% arrived after a few weeks. Just 0.6% of all clients arrived immediately upon feeling the need.

(2.) The Arab family is a patriarchal institution where politics, economics, social and psychological life function in such a way as to pass on this type of institution for the next generations. Barakat conceives that beside the pivotal role of males, the Arab family socializes its children in believing and accepting the inferiority of females. A few Arab families give equal chances to females, leaning on some interpretations of Islamic laws that enforce female rights or as an adoption of modern democratic ideology, or as a result of nonexistence of males in the family.

(3.) The official marriage age in Israel among Palestinians for females is 17 and for males is 18. In 1998 the average age of marriage was 21.4 among Moslem females, 26.3 among Moslem males, 32.7 among Christian females, 29.3 among Christian males, 21.2 among Druze females and 25.9 among Druze males (Central Bureau Statistics, 2000).

(4.) The term, which describes a wife who is not from the husband's extended family gh'aribah, "a stranger." She will be described as a "stranger" regardless of the number of years she lives with the extended family. A woman who marries outside her village is also described as a "stranger."

(5.) Upon the turn of the twentieth century, the prevailing type of marriage was between first cousins. It was the preferred and respectful, and the least expensive (Granqvist, 1935). The ratio of first cousin's marriage in the Arab world at the end of the twentieth century varies between 3 to 8 percent (Barakat). This information does not deny that relatives other than first cousins get married. In a study regarding marriage traditions among Palestinians in Israel, it has been found that 30% of all marriages was among relatives (Al-Haj).

(6.) This is a typical support among females in the extended family. A group of women rotates to help young families. This help is reciprocal among all and decided according to the necessity and urgency. As a result, women do not feel used unless a mother-in-law uses her daughter-in-law's help without helping her in return.

(7.) According to Arab culture, children are believed to connect a hostile couple. Also it is believed that the birth of a new child brings with it a new livelihood and hope for the family. It seems that this type of solution forces a necessary change in the individual's life so that she or he will not continue focusing on their original problems. This is very similar to "displacement;" however, this approach never promises that the original problems will vanish. In most cases the original problems tunnel underneath which undermines the family foundations.

(8.) From among the roles of the extended family, according to Islamic laws, one is to support its females financially when they are in need. Shireen's family of origin, including her uncles from both sides should offer their financial help to her when they know her and her children's need because she is "waliyah," in their custody in case her husband is not able to support her financially.

(9.) This term is used when a dispute arises between a wife and her husband on the basis of which she decides to find refuge a her parents' home. R is not used when a wife visits her parents on a regular basis. This usage teaches that the collective conscience relates to Arab women's marriage as a temporary state, which never can be guaranteed. Therefore, the stable residence is the parents, which the wife may leave for her duties and to which she may then return.

(10.) Despite the influence of traditions in the Arab family, the demand to respect social values and norms varies between females and males, mainly with regard to sexual values. When an Arab woman makes a mistake that goes against the norms she may risk her life.

(11.) Because Arab women are brought up to be aware of the social, religious and marital laws and restrictions, when they are treated violently they turn back the violent behavior against themselves. They hurt themselves by hurting their nerves, their social status or their bodies. Most psychological problems transform into psychosomatic complaints.

(12.) For instance, the percentage of individuals suffering from psychological problems among women in the Arab Emirates is 32.9% and 20.3% among men. On the other hand, there are some psychological problems from which women suffer more than men, such as anxiety and depression (El-Rufaie & Absood, 1993).

(13.) This phenomenon was described also in literature as Hardana and 'Ghadbana. The usage of the concept varies according to the local accent, however, its meaning in all Arab countries is the same.

(14.) Economic independence gives Moslem women the ability to make decisions, especially, to leave a dysfunctional marriage. Islam put conditions on husbands to pay all their wives' expenses besides giving them the freedom to manage their own properties.

(15.) This ceremony indicates the final stage of leaving home as "upset," Z'alana. Several respectful male relatives of the husband visit the wife's family of origin, guarantees her well-being, and accompanies her to her marital home. Women who return home by themselves will be treated in the future as having no extended family or social support.

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Khawla Abu Baker is Director of "Mar'ah" Institute for the Study of Women in the Middle East, Emek Yezreel College, Israel.