Canada (University of Montreal) Veteran psychiatrist crosses cultural boundaries

Dr. Vincenzo Di Nicola, full clinical professor in the Department of Psychiatry at UdeM’s Faculty of Medicine and president-elect of the World Association of Social Psychiatry (WASP), was born in Italy to a single mother, grew up in Hamilton speaking English, and now practices in Montreal in French at Maisonneuve-Rosemont Hospital.

He believes his professional career is intertwined with his personal history, which explains why, at age 69, he still spends his time caring for children and their families.

“My outsider perspective helped me build tools for understanding people empathetically through the lens of their culture, their country of origin and their languages,” he said.

That focus informs his practice and the Cultural Family Therapy (CFT) approach he has pioneered. Currently the only child psychiatrist at Maisonneuve-Rosemont, Di Nicola presents himself as an example of adaptation to children from immigrant backgrounds. He stresses it’s important to speak French in order to integrate into Quebec society but it doesn’t mean you have to renounce your roots.

“If a mother says ‘I have a right to spank my daughter, I’ll explain that it may be normal in her country but it’s not allowed here,” he said. “I’ll help her find a compromise that makes sense to her and is acceptable in Quebec. I help people adjust to their new world.”

Family as vector of a broader culture

It was during his residencies in pediatrics and psychiatry at McGill University that Di Nicola was introduced to the cultural approach through the work of Raymond Prince, a trailblazer in social and transcultural psychiatry, and to the family approach through Milan professor Mara Selvini Palazzoli, a leading figure in family therapy.

Building on the work of his two intellectual gurus, Di Nicola decided to try to join the two approaches. “I found that many families from minority ethnic groups experienced prejudice and lacked tools for dealing with differences,” he recalled. “This motivated me to synthesize transcultural social psychiatry and family therapy.”

In 1985, Di Nicola proposed a fundamental redefinition of psychotherapy with a new model which he dubbed “cultural family therapy” (CFT). Where individual therapy focuses on the individual and family therapy widens the frame to include the family and significant others, cultural family therapy goes further still: it looks at not only the family but also a person’s community, culture and society in order to understand their behaviour and reactions. “CFT adds cultural complexity to family therapy: the family is no longer considered as a system but as a culture,” he explained.

Paradigm shift

CFT is revolutionary in that it situates the individual in social context and values cultural diversity instead of pathologizing it. “If we don’t do this, we risk overdiagnosis and inappropriate treatment that will not be well accepted by families,” Di Nicola cautioned.

Di Nicola’s book A Stranger in The Family: Culture, Families and Therapy, published in 1997, revolves around three conditions of strangeness: the family that feels like a stranger in the society, the family member who feels like a stranger in the family structure, and the therapist, a stranger in the family setting. The clinical cases described in the book illustrate the tools of CFT, such as “spirals,” in which the therapist establishes respectful contact with family members, is open to their response, and then withdraws as needed to adjust the way he or she communicates, and “cultural and therapeutic translation,” in which a behaviour is translated across the cultures of individuals, their families and their communities.

Challenges for immigrant and native-born families

In 1998, a year after the publication of his book, Di Nicola joined the Faculty of Medicine at UdeM. He wanted to work at the teaching hospital “with the greatest youth mental health needs.” That was Maisonneuve-Rosemont, which serves the working-class neighbourhood of Hochelaga-Maisonneuve. “I grew up in a similar neighbourhood,” he recounted. “It’s a challenge to understand both people who come from elsewhere and native Quebecers, who must adjust to a changing environment. I empathize with the families in Hochelaga-Maisonneuve.”

Shortly after his arrival, Di Nicola set up a psychiatric unit at Maisonneuve-Rosemont. He served as its director for 20 years, until it was transferred to the Montreal Mental Health University Institute in 2018. His approach requires expertise, patience and openness—and a good dose of humility. “I ask families to be my teacher, to educate me about their country and culture,” he said. “People are always very happy to tell me about how things are done back home. It’s a technique that helps us quickly zero in on the problem.”

CFT is taught at the UdeM Faculty of Medicine and has been exported to the United States, Brazil, Sweden, Belgium, Italy and Morocco.