Current Status of Marriage and Family Therapy Education in Uzbekistan

Abstract

Although the practice of marriage and family therapy in the former Union of Soviet Socialist Republics (USSR) has been gaining popularity since the late 1990s, the establishment of formal marriage and family therapy education in Uzbekistan has proceeded much slower than the other regions of the former USSR. The purpose of this study was to ascertain the quality and quantity of marriage and family therapy education in Uzbekistan by studying a sample of current practitioners. This article provides (a) an overview of Uzbekistan’s culture and family dynamics, (b) the status of current psychotherapeutic services provided, and (c) the availability and quality of education in psychotherapy and marriage and family therapy in that country. Implications for curriculum development and training are included.

Keywords

family family therapy marriage and family therapy education culture Uzbekistan

When the Soviet Union disintegrated in 1991, Uzbekistan, as well as other former Soviet countries, experienced significant social, political, and economic challenges. For example, the shift from a socialist- to a market-based economy created enormous financial stress for the Uzbekistan population (Cockerham, Hinote, & Abbot, 2006) and had a significant psychological impact on the country’s citizens (United Nations Children’s Fund [UNICEF], 2001). Economic hardship also impacted families and increased relational difficulties among married couples. Additional psychological stressors included those created by increases in unemployment, poverty, domestic violence, and environmental disasters (Stone, 1999). Baykal (2007) noted the unique needs, challenges, and problems faced by Uzbek families that have not been met with any consistent efforts by the existing social welfare system. In fact, prior to the 1990s, many social issues, such as alcohol and drug dependence and mental health illnesses, were primarily responded to with a medical intervention with little attention given to working with people at the individual or family levels (Baykal, 2007).

A systems approach to psychotherapy with couples and families has been widely accepted by the treatment community in the United States (Gladding, 2011). However, as Havenaar, Meijler-Ilina, Bout, and Melnikov (1998) indicated, clinicians in the former Soviet Union republics (the majority of whom are psychologists and psychiatrists) continue to focus treatment efforts solely on the individual and rarely consider the interaction between family members as a necessary component of therapy. Marriage and couples counseling, when it is available, is often approached in a similar fashion, with the primary focus of intervention on the individual rather than on the system (e.g., the interfamilial relationships between spouses and other family members; Havenaar, Meijler-Ilina, Bout, & Melnikov, 1998). As a result, clinicians can miss significant system malfunctions and thus offer little in the way of help directly to the individual and for the family as a whole. Although efforts have been made to create formal training opportunities for preparing clinicians to work with struggling clients, the availability of formal training related specifically to couples and family therapy in Uzbekistan remains quite limited.

The purpose of this study was to ascertain the availability and quality of marriage and family therapy education in Uzbekistan by assessing the professional backgrounds of practicing clinicians in Tashkent, the capital of Uzbekistan. We begin this article with a context for the study, most notably by exploring the history, culture, and demographics of the population living in Uzbekistan. From there, we describe the current status of psychotherapeutic services provided in the country before discussing the skills of treatment providers themselves. We conclude with suggestions for the creation of new training modules for this population of clinicians.

Historical Background and Demographics

Uzbekistan is one of the largest countries in Central Asia, with a population of approximately 27 million people. Eighty percent of the population is comprised of Uzbeks, with the other 15% being those of other nationalities (Baykal, 2007). The greatest proportion of the population is made up of individuals who are eligible for government-sanctioned social services, which includes women over 55 and men over 60 years old, families with more than four children, disabled individuals, women with children under 3 years of age, students, and those who are indigent. In 2005, 27.5% of Uzbekistan’s population was classified as “impoverished” (Zagirtdinova, 2005).

Uzbek as a formal “nationality” was a product of Soviet policy that divided Central Asia into five republics in the 1920s based on ethno-linguistic criteria. At that time, Uzbekistan was a part of the Union of Soviet Socialist Republics (USSR; Mundt, Heinz, & Strohle, 2009). Following the collapse of the Soviet regime, the independent republic of Uzbekistan was founded in 1991. The people are predominantly of Turkic origin with Iranian and Turkisized Mongol elements and the Uzbeks belong to the Sunni sect of the Muslim faith (Allworth, 1990). It is important to note that approximately 88% of the population is Muslim (World Health Organization, 2010).

Characteristics of Uzbek Families

The collapse of the USSR and the establishment of an independent state brought new possibilities as well as constraints for Uzbekistan families. These possibilities and constraints included shifts in gender roles due to economic and financial difficulties, family separation issues resulting from overseas work, the impact of neighborhood support committees, and the unique aspects of collectivistic and paternalistic family values, structures, and traditions. It is important for clinicians to recognize the influence of each of these, as they guide efforts to help couples and families in crisis (Baykal, 2007).

The Uzbekistan society is patriarchal, with Uzbek men serving as the traditional breadwinners and women fulfilling the primary duties of homemakers. This patriarchal hierarchy derives its origin from traditional Muslim values as well as Uzbek culture (Yakushko, Razzhavaikina, & Horne, 2009). However, the economic and industrial shifts that occurred since the 1990s have resulted in more women entering the workplace either to supplement the family’s income or as the sole source of income for single-parent families (Bacon, 2008). Women’s roles have thus become multifaceted and more stressful, leading to, among other things, role confusion for the family as a whole. These changes must be taken into consideration before any helping efforts can be effective.

The emigration of young, talented, and highly educated Uzbeks during the mid-1990s to other countries in search of more lucrative job opportunities is another change that impacted the country’s family structure. This exodus was a way to financially supporting nuclear and extended families, but the separation and dissemination of the family changed cultural norms that had been developed over centuries, thus putting marriages and families at further risk.

When faced with adversity, many families seek assistance from local neighborhood communities, or mahallas, which is a neighborhood organization specific to countries in Central Asia and the Middle East. Bacon (2008) described mahalla, or ward, as the strongest social unit in cities, towns, and large villages, consisting of a system of streets and neighborhoods with the mosque serving as the central guiding unit. Mahalla members form a cohesive community and help with life cycle ceremonies, such as weddings and funerals (Allworth, 1990). Additionally, mahalla committees provide assistance to members of the community affected by poverty or any type of crisis, such as family illness. Thus, clinicians must consider the impact of the mahalla committees on any attempts at intervening with family systems.

One of the main values central to Uzbek families is that marriage is fundamental, with all young men and women being expected to get married (Baykal, 2007) without any premarital counseling. Another crucial dimension to marriages is childbearing, with young brides being expected to become pregnant in their first year of marriage (Pavin, 2007). Given the heavy emphasis on pregnancy and childbearing, other dimensions of the couple and family’s life can be ignored (e.g., communication, conflict resolution, and intimacy) and, thus marriages can be put at risk. Conversely, divorce is rarely condoned, with only 0.7 divorces per 1,000 people being reported (UNICEF, 2003). These low numbers are explained but factors such as family and community pressures to maintain marriage and the reluctance of the judicial system to grant divorces (Baykal, 2007). These marital values are important for clinicians who conduct couples counseling. For example, a woman who is verbally and physically abused may not agree to press charges against her husband, preferring to seek ways to cope with her marital situation.

Another important dimension in Uzbek families is the support system found within the family and the extended family. Although the average family is comprised of an average of 5.1 members (4.4 members in urban setting and 5.8 in rural settings; UNICEF, 2003), this does not account for the fact that family members often reside in adjacent homes or on the same street. In fact, it is not uncommon for two or three generations to live under the same roof. Although there is strong emotional and financial support between the members of the extended family, there are challenges unique to this type of family arrangement. For example, while such a structure can help support those with financial difficulties (e.g., extended family members can support one another), this can also foster dependency problems. If the nuclear family (father, mother, and child/children) borrows money from their extended family members, then that nuclear family can become vulnerable to those who provided the money and thus experience a decrease in power and decision-making ability within the family hierarchy. Similarly, extended family members can have negative influences on the husband and wife subsystem. This can be exemplified by relatives inserting themselves into the daily life of the married couple on a regular basis when no assistance or inclusion has been requested, as well as affecting the ability of the adults to parent their children (e.g., extended families, as well as relatives and neighbors tend to take on parenting roles that may not be theirs to take).

The institution of marriage in Uzbekistan is something to consider before any helping efforts are devised. Traditionally, marriage unions are arranged by the elder members of the family, with things such as family background, social status, and (in some cases) the physical and mental health of the future bride or groom playing significant roles in the decision-making process. The new couple is then viewed as an extension of the parents’ families and thus it is these pragmatic concerns (rather than romantic love) that serve as the basis for traditional marriage. In modern-day Uzbekistan, however, an increasing number of young couples have sought autonomy from their parents in choosing their mates and have emphasized love as the guiding force for marriage (Baykal, 2007). This shift in tradition has caused strife among couples and their extended families. Thus, for the counselor working with a female client who “quietly” disagrees with her parents’ decision to marry a man that she barely knows, it would be imperative that the counselor not impose his or her beliefs on the client, but rather help the client to explore the situation and process the associated thoughts and feelings.

Another distinct feature of Uzbek family traditions is consanguineous marriage, which is generally defined as marriage in which the two partners have at least one ancestor in common, no more distant than a great-great-grandparent (Kurter, Jencius, & Duba, 2004). Thus, it could also be defined as a “group marriage” in which the partner for either the man or woman is chosen from among his or her own relatives. Although consanguineous marriages are not common in Western European countries, the first author’s informal discussion with health care providers in Tashkent (the capital of Uzbekistan) revealed that this practice is prevalent in both Uzbekistan and many regions of Asia and Africa. Prabhu (2003) indicated that the purpose of consanguineous marriages is 2-fold: It keeps family property from being further distributed and it provides a familiar and supportive environment for the bride. An unfortunate result of consanguineous marriages is that children born to parents who are related can carry forward genetic concerns and thus be born with obvious physical defects. These children frequently become the center of ridicule and can eventually withdraw from society (which would become another concern for counselors working with Uzbek families).

Abuse and domestic violence are two other outcomes of the financial and psychological challenges experienced by Uzbekistan families. The Human Rights Watch Report (2001) noted that domestic violence is a significant problem in Uzbekistan, with women having little to no outlets for assistance or protection. Given that (a) divorce remains a social stigma, (b) married women generally live in the home of their husbands’ extended family, and (c) economic factors make it difficult for women to survive on their own, battered women are discouraged from leaving their abusive spouses (Baykal, 2007). To complicate matters, perpetrators of domestic violence rarely face criminal convictions in Uzbekistan. Local authorities, under orders from the central government, try to reconcile the difficulties in married couples, thus sacrificing women’s safety in favor of maintaining the nationally low divorce rates. This corresponds to an underlying discourse of family values, which views marital separation as a social stigma for women (Ismailov, 2004).

The Historical Development of Psychotherapy in the USSR and Uzbekistan

Given the aforementioned unique characteristics of Uzbek families noted previously, it should be obvious that the application of an Western-based therapeutic approach should be done with caution and careful adaptation. Little is known about the current status of psychotherapy in the Republic of Uzbekistan. More specifically, the development of couples and family therapy in Uzbekistan cannot be discussed apart from the overall development of counseling and psychotherapy as a profession in the country. Additionally, since Uzbekistan was part of the former USSR for 70 years, the development of psychotherapy in Uzbekistan must be discussed in conjunction with the history of psychotherapy in the USSR. Although the terms “counseling” and “psychotherapy” are used, they are interchangeable, with little differences in their existing definitions. For the purposes of this article, the term psychotherapy will be used, as it more closely mirrors those practitioners (psychiatrists and psychologists) who employ its techniques in Uzbekistan.

Psychotherapy had a long-standing tradition in Russia prior to the Bolshevik Revolution of 1917 (Yakushko et al., 2009). The work of Freud (1989), for example, exerted its influence on Russian psychology and psychotherapy, with many of his books being translated into Russian and with Freud himself paying great attention to the country (Sosland, 1997). Traditional Western mental health counseling services, however (i.e., those provided by counselors, therapists, and clinical social workers), were nonexistent in the Soviet Union, with psychiatry as the only discipline taught and made available to the public.

During the Soviet era, individuals with mental illnesses were treated solely with a medical model by psychiatrists within medical settings, with psychotherapy being outlawed as it emphasized the individual over the collective (Yakushko et al., 2009). Furthermore, Havenaar and colleagues (1998) noted that group and family psychotherapy was classified as a “weapon of bourgeois ideology” by adherents of the Soviet view on psychiatry that dominated from the 1930s through the 1960s. During the early 1980s, the renewed development of psychotherapy simply picked up from where it left off in the early 1920s, with the profession of psychotherapy being officially recognized in the early 1980s (Havenaar et al., 1998). The development of psychotherapy in Russia since the late 90s has, essentially, copied the development of psychotherapy in the West in terms of the emergence of varied approaches (Journyak & Pare, 2007). The seeds of this change were planted during Carl Roger and Virginia Satir’s visit to Russia in the 1980s, when the humanistic approach to the treatment of the mentally ill was introduced. The visit of these two master representatives of the humanistic school of thought in psychotherapy motivated many Soviet psychotherapists to continue Roger and Satir’s important work despite the lack of organizational and financial support from the government.

Interest in psychotherapy and counseling in former USSR republics is rapidly increasing. However, psychotherapy in these countries, as it emerged during communist era and under conditions that were generally unfavorable to the field, still struggles to find an identity as a profession. The development of family therapy as a professional discipline is also in early stage of development and its emergence is given a special focus in the next segment.

Development of Family Therapy in the Former USSR and Uzbekistan

In the West, the major growth of family therapy began during the 1950s, and it has become a primary therapeutic tool in providing help for families in distress (Prabhu, 2003). The emergence of systemic family therapy in the USSR occurred more than 20 years later, during the late 1970s and early 1980s. The Center for Psychological Assistance in Moscow was one of the pioneers in providing psychological support services to families (Varga, 2003). Around the same time, the Behterev Institute located in St. Petersburg (formerly Leningrad) began to invite families of mentally ill individuals to join the therapeutic process and became one of the first state mental health hospitals that recognized the importance of the family system.

In the late 1980s, many family therapists from the West, such as Hannah Weiner, Gianfranco Cecchin, and Florence Kaslow came to Russia to provide trainings and demonstrate how to work with the family system (Varga, 2003). Growing interest in systems psychotherapy led to the creation of the first association of family therapists in Moscow in 1998. The association assisted members with professional networking experiences and provided support and consultation for clinicians. Despite the lack of formally trained therapists, family therapy continues to gain popularity among mental health practitioners in the Russian Federation and former Soviet Union republics and is beginning to be seen among Uzbekistani clinicians (Budinaite, 2009).

Despite the slow advance of marriage and family approaches seen in Russia, little has been seen of this movement in Uzbekistan. Mental health professionals (i.e., psychiatrists and general practitioners) receive their training through the Uzbekistanian educational system (Mundt et al., 2009), which emphasizes such things as developmental psychology, psychodiagnostics, and psychology. Degree-granting programs in family therapy are nonexistent in Uzbekistan, with graduate programs in psychology and social work having few, if any, courses in marriage and family counseling/therapy. Although there is no formal practice of conjoint systemic family therapy (as Westerners define it), there are pockets of recognition and isolated practitioners who are increasingly utilizing a systems format for their work with patients and clients (E. Dubovisckaya, personal communication, May 5, 2010). As there is no way to determine the efficacy of the training for those working with families in Uzbekistan, there is a great potential for clients to receive less than adequate care.

In an effort to address the gap that exists in the training of clinicians and the practice of marriage and family therapy in Uzbekistan, the current study sought to answer three research questions. First, what are clinicians’ current professional identities, clinical work environments, and theoretical orientations? Second, where do clinicians receive education and training in marriage and family therapy and how competent do they feel to work with families? And third, would clinicians be willing to receive additional training in marriage and family therapy? This was accomplished through the development of a needs assessment survey designed by the authors and distributed in Uzbekistan by the first author. The results of this needs assessment will be to develop a training program that will be designed to equip Uzbekistanian clinicians with the tools they need to provide competent care to Uzbekistanian families.

Method

Sample and Procedures

Participants for the current study were mental health practitioners (psychologists, psychotherapists, and psychiatrists) who registered for a 1-day workshop on marriage and family therapy/counseling that was conducted by the first author at the Psychological Services Center in Tashkent, Uzbekistan. Flyers that detailed the purpose of study and participants’ rights were distributed to workshop attendees. Attendees were informed that completing the survey following the workshop was voluntary and that they could leave the room prior to the survey being distributed. Finally, participants were informed that they could skip any question and could withdraw from responding at any time.

Of the 42 attendees, 38 expressed interest in participating in this anonymous study (i.e., no identifying information was provided by participants). The research study procedures conformed to standard research protocols and were approved by the authors’ university institutional review board.

Measures

Participants were administered a 15-item questionnaire, modified from the “Brief Demographic and Opinion Survey” for counselors and clinicians (Hagedorn, 2009). To create the survey, the first author used experts’ (clinicians and educators) feedback for the English version and then translated the questionnaire into Russian. Then, two bilingual individuals (both with experience as Russian and English language teachers at universities in the former Soviet Union) evaluated the questionnaire for clarity (face validity) and grammatical and meaning equivalence. These experts’ feedback was incorporated in the process of revising and modifying the translated version of the instrument. The final versions were analyzed for content validity in order to determine that there was adequate representation of the content of the instrument. Questions were designed to assess participants’: (a) demographics (e.g., gender, age, and nationality); (b) professional identity, work environment, and orientation; (c) self-reported training and competence levels; and (d) desire for additional training and professional development. Questions related to parts (a), (b), and (d) were check box answers (or fill in the blanks). For part (c), participants were asked to assess their self-perceived competence (defined as professional and self-identified comfort when working with couples and families) in working with couples and families using a Likert-type scale, with 1 noting not competent and 4 indicating very competent.

Results

Demographic Characteristics

The 38 participants represented a sample of mental health professionals working in Uzbekistan. Ages ranged from 24 to 70 years, with the majority of participants (28.9%) being between 30 and 39 years. Most of the participants (89.5%) were women. In terms of nationality, 15 (39.5%) were Uzbek, 14 (36.8%) were Russian, 3 were Tatar (7.9%), and the remaining 6 (15.8%) participants identified themselves as “other” (e.g., Korean, Ukrainian, and Kazakh). Finally, as for highest degree earned, 18 (47.4%) of the participants held a bachelor’s degree in psychology, 14 (36.8%) indicated having a master’s degree, 4 (10.5%) had a PhD, and 2 (5.3%) had an MD.

Professional Identity, Environment, and Theoretical Orientation

Among the 38 participants, the majority (25 or 65.8%) indicated psychology as their professional identity, with the remaining participants identifying themselves as psychotherapists (7.9%), social workers (5.3%), or substance abuse specialists (2.6%). In terms of working environment, 42.1% reported practicing out of their home, 21.1% worked in private outpatient clinics, and the rest (36.8%) worked in hospitals or outpatient government agencies. As for the number of years of professional experience, the majority of participants (63.2%) had up to 10 years of experience in the field of psychology or psychotherapy, with 22 participants (57.9%) reporting having provided services to between one and five couples per week, and the remaining 16 (42.1%) indicating that they rarely, if at all, saw couples. Finally, a variety of theoretical orientations were reported. The most-often listed theoretical orientation was Eclectic (12; 31.6%) followed by Psychodynamic (10; 26.3%). Interestingly, family systems as a theoretical orientation was indicated by eight (21.1%) participants, which was the third-most popular theoretical orientation endorsed in this study. The rest of participants (8; 21.1%) indicated that behavioral, cognitive-behavioral, and existential theories were their primary theoretical approaches.

Self-Reported Training and Competence Levels

Participants were asked to share the source of their knowledge in marriage and family therapy. The majority (18; 47.4%) of participants indicated that they learned about marriage and family therapy via self-study, 10 (26.3%) educated themselves by attending professional workshops, 5 (13.25%) learned through Internet resources, 3 (7.8%) had never been exposed to marriage and family educational materials, and only 2 participants indicated that they had attended a graduate training program in the Russian Federation. Self-reported training levels were low among the study’s participants. Of the 38 who completed the survey, 20 (52.6%) participants perceived their training in this field as “poor,” with another 8 practitioners (21.1%) noting no training whatsoever. Only 10 (26.3%) participants indicated that they were “well” or “adequately” trained in marriage and family therapy.

The self-perceived competence in marriage and family therapy correlated with the quality of perceived training in this field. That is, 20 (52.6%) participants did not feel competent to address marriage and family issues with their patients, and 8 (21.1%) indicated that couples and family work is out of their area of expertise. Only 10 (26.3%) participants indicated that they felt competent in treating couples and families.

Finally, as it relates to receiving formal supervision in marriage and family therapy, none of the participants reported having received supervisory experience related to marriage and family therapy.

Additional Training and Development

Participants were asked about their preferences for additional training in marriage and family therapy. All 38 participants indicated a need for additional training in the area of marriage and family therapy, with the majority (19 or 50.0%) indicating a desire for additional training through a formal certificate program. Three participants (7.9%) expressed a preference to go to a graduate program in marriage and family therapy, 11 (28.9%) indicated that a workshop would be an appropriate method of receiving future trainings, and 5 (13.2%) preferred on-the-job training.

Discussion

Since the late 90s, the practice of marriage and family therapy has gained popularity in the former Soviet Union republics (Varga, 2003). Despite this increased interest, the establishment of formal marriage and family therapy educational programs in Central Asian countries (e.g., Uzbekistan) has proceeded much slower than in the Russian Federation itself. In this section, the authors share their conclusions regarding the results from the study of practicing clinicians in Uzbekistan. Following this, we offer suggestions for the design of a training program that would help meet the needs that were identified by participants. Finally, we note some of the study’s limitations that should be considered when interpreting the results.

Demographic Characteristics

As this was the first known research study conducted in Uzbekistan, where mental health professionals provided their background in marriage and family education and provided information regarding their experiences in providing marriage and family therapy to clients, this research produced a number of interesting findings. Demographically, the majority of participants (89.5%) were women, which was different from the numbers found in a similar survey of 134 psychotherapists in the Russian Federation for which the majority (52.7%) of the sample were men (Karavaeva, 2005). However, the prevalence of female workers among health care professionals is not an unusual phenomenon for Uzbekistan. Historically, the woman’s role in the Uzbek society labor force was described as an educator, nurturer, or caretaker. In fact, in a study by Alimdjanova (2005), the percentage of women in education-related professions was 83.3% and in health-related professions was 81.8%. When comparing the demographics of this study to the demographics collected by the Uzbek Psychological Society (majority of members are female [85%]; between ages 29 and 35; most of them are Uzbek and Russian; and 5% hold a bachelor’s degree in psychology; Usmanhodjaeva, 2009), it appears that our sample was representative of the population under investigation (i.e., those who provide psychological services in Uzbekistan). The predominance of female clinicians may be a potential problem for male family members who, as noted earlier, would not likely be comfortable sharing their personal problems with a female professional. In order to provide marriage and family services to all members of Uzbek society, more work should be done to recruit male clinicians into the fields of psychology, psychotherapy, and family services.

Professional Identity, Environment, and Theoretical Orientation

The large number of self-identified psychologists/psychotherapists (28 or 73.7%) in this sample may reflect upon the unclear identification of psychotherapeutic services in Uzbekistan, particularly when these numbers are coupled with the reported locations where such services occur. In order to provide counseling and psychotherapy services to the general public, the most common work environment reported by participants was home-based practice (42.1%). Practicing from one’s home is one method to provide a less overt method of treatment and that helps practitioners to avoid government taxation (Kabanov, 2005). Therefore, most psychotherapists provide services at private rates in a practice that is out of the public eye. A minority of the sample (10.6%) indicated that they practiced in inpatient or outpatient clinics. According to a World Health Organization (2010) report on Uzbekistan, all mental health workers, except for a small proportion (1%) of psychologists, solely work for government-administered mental health facilities and thus there are limited opportunities for psychotherapists in the public mental health sector. This discrepancy in a number of psychologists may be an indication of not only identity confusion among clinicians but also the lack of available, reliable statistical data from government sources.

There were some interesting similarities in theoretical orientation among the participants and clinicians in the United States. For example, 12 participants (31.6%) described their theoretical orientation as “Eclectic,” which is similar to practitioners in the United States where 29% of surveyed psychologists indicate an eclectic approach (Norcross, Karpiak, & Santoro, 2005). Similarly, a “Psychodynamic” theoretical orientation was indicated as preferential by 26.3% of the participants, compared to 21% claiming that orientation in the United States (Norcross, Hedges, & Castle, 2002). Even though family therapy is in its infancy in Uzbekistan, the third-most popular theoretical approach in this study was “Family Systems” (21.1%). Given the lack of formal education and training opportunities in marriage and family psychotherapy in Uzbekistan, these numbers likely indicate that clinicians are interested in this field.

Supervision is an important part of a marriage and family therapist’s professional development, as it provides clinicians with an opportunity to reflect on his or her work (Gladding, 2011). In the United States, licensing laws mandate the use of supervision, as it leads to competent practice in the helping professions. One of the survey questions asked participants about their experience with supervision by a trained professional; alarmingly, no participants responded affirmatively. This result may indicate that local practitioners may be engaged in substandard and/or unethical practices. This highlights one of the central differences between psychotherapeutic practices in Uzbekistan and other former Soviet Union countries (and Western nations). Yakushko, Razzhavaikina, and Horne (2009) indicated two significant problems in the former USSR, namely that psychotherapy and marriage and family educational programs lack an established accreditation process and that the practice of psychotherapy lacks ethical guidelines that guide the profession.

Without accredited programs and a set of ethical guidelines, practitioners may face professional dilemmas that may be harmful for clients. For example, uninformed clinicians may ignore the importance and value of recognizing their own values, not to mention noting the importance of exploring their client-families’ same values systems (Gladding, 2011). As a result, clinicians may very well attempt to “use therapy as a means to campaign for the revisions [of values] they favor” (Wendorf & Wendorf, 1992, p. 316). Overall, the lack of both properly educated and trained clinicians and the monitoring of professional organizations have resulted in a professional environment with limited to no feedback or supervision (Karavaeva, 2005).

Self-Reported Training and Competence Levels

Most of the clinicians (47.4%) in this study reported acquiring knowledge about marriage and family psychotherapy by self-study. When asked for clarification, participants acknowledged gaining the necessary knowledge by (a) reading Western psychotherapeutic professional textbooks that had been translated into Russian, (b) consulting with colleagues, and/or (c) utilizing the Internet for their professional needs. Inevitably, the utilization of questionable sources of education in order to assist couples and families may lead to harmful situations for clients. Only two participants (5.3%) indicated that they received most of their marriage and family therapy training by attending a graduate study program in one of the universities in the Russian Federation. For many practitioners, it is too financially problematic to travel to other countries in order to receive quality psychotherapeutic education.

In terms of reported competence levels, a surprising 10 participants (26.3%) indicated that they were well or adequately trained and felt competent in providing services to couples and families. A plausible explanation for why these practitioners feel confident about their skills is that either they have more experience or they have observed positive results of their therapeutic practices. Without these practitioners receiving supervision and feedback, it would be challenging to objectively determine whether the clinicians could actually demonstrate the skills necessary to provide effective treatment (Bernard & Goodyear, 2004).

Additional Training and Development

All of this study’s participants indicated an interested in additional training in marriage and family therapy, with most expressing an interest in a professional certificate program and/or attending professional workshops. According to the professional experiences of the first author, the availability of trainings in marriage and family therapy trainings is inconsistent, often sporadic, and is heavily dependent on visits by professionals primarily from the Russian Federation (where marriage and family therapy is still in its infancy stage). To date, there is a significant lack of uniformity across the institutions that train clinicians in the practice of marriage and family therapy in Uzbekistan. From the results of this needs assessment, the authors conclude that academic preparation program in Uzbekistan need to include sufficient knowledge and skills, research foundations, practicum and supervision trainings, and internships to ensure the professional practice of marriage and family therapy. As a move in this direction, the authors offer some recommendations for future training opportunities for Uzbekistanian clinicians.

Recommendations for Future Training

In designing future trainings for Uzbekistanian clinicians, the authors note the need to adapt the Western approach to marriage and family therapy by incorporating the context of the unique Uzbek culture in order to successfully address the family needs of that population. Based on the results of this study, and adapted from the work of Ahmed and Reddy (2007) and Haque (2004), the authors offer several recommendations for the development of marriage and family therapy education and training programs in Uzbekistan. First, education and training programs should begin with an exploration of the history of marriage and family therapy and a description of the family life cycle. Second, information related to assessment strategies should include clinical interview formats suitable for use with systems, family assessment instruments, and semistructured approaches such as genograms and lifestyle analyses. Next, special factors that affect Uzbek family functioning should be integrated into the curriculum. This may include divorce and remarriage, blended families, sexual dysfunction, adjustment to stress, terminal illness, infidelity or other traumatic events, domestic violence, and possible health consequences of consanguineous marriage for children. A fourth component of the curriculum should incorporate elements of family law, including issues having to do with custody, parental competency, child maltreatment, and family forensic counseling. Supervision by trained professionals in marriage and family therapy education is critical and must also be included in the curriculum. Peer supervision or consultation can substitute in the absence of professional supervision, but supervision techniques need to have a place in the training regimen. Two final pieces have been noted from the beginning. First, any approach to training clinicians in marriage and family therapy should place culture in the forefront: Clinicians must be taught to consider cultural and individual differences within larger systems within where these differences are embedded. And second, educational and training programs should direct clinicians to focus on the family as a collective whole rather than on treating each member individually. Patterned interactions within the family should be identified in order to gain a comprehensive understanding of how the family functions.

It is important to strengthen the psychotherapy and marriage and family therapy professional identity in Uzbekistan, in order to enhance the professional credibility within the country and also enable practitioners to collaborate with those in other countries to advance psychotherapy as a profession. Licensing and certification will also help to maintain the level of expertise within the profession through regulations that require continuing education and research. Finally, as the marriage and family therapy profession continues to evolve and develop in Uzbekistan, the authors hope that purposeful and intentional collaboration with related disciplines, such as primary care medicine and psychiatry, will further strengthen and foster the best care for families in Uzbekistan.

Limitations and Future Research

The authors believe that the unique qualities of this study merit its inclusion in the professional literature. At the same time, the study has its limitations and thus the findings must be interpreted accordingly. The primary limitation of this study was the small sample size that does not permit a generalization of the findings to all clinicians in the former Soviet republics. Investigations based on larger groups of psychologists and psychotherapists will be needed in order to draw more precise conclusions about the status of marriage and family education and training in Uzbekistan. Next, given that the sample was purposeful, our results may not be generalizable to other groups of clinicians in Uzbekistan, as well as other former Soviet Union republics (even though Usmanhodjaeva’s [2009] demographics indicated some strong similarities to our sample). Given these two limitations, future research should replicate this study with larger numbers of diverse populations of psychotherapists and psychologists, to include multidisciplinary clinicians such as social workers and psychiatrists, in order to verify and generalize the findings of this study. A final limitation was that the survey utilized in this study relied on participants’ self-reported, subjective responses. As Wong and Agisheva (2007) suggested, self-reported evaluations lack objectivity, may include a social desirability component, and may not represent the true and honest opinions of the participants. Thus, future research should include an instrument that measures social desirability in order to rule this out.

The authors offer one additional suggestion for future research, which they themselves will likely implement, namely the creation and evaluation of a research-based, ethically sound, culturally sensitive, and standardized training program in marriage and family therapy delivered to Uzbekistanian clinicians. We believe that such training could have significant positive impacts on the treatment of Uzbek families and have additional impacts on the society as a whole.

Conclusion

The aim of this study was to depict and compare the current status, trends, and transformations of marriage and family therapy in Uzbekistan, one of the former Soviet Union republics. The evaluation of current marriage and family therapy provision in Uzbekistan is inevitably incomplete, but developmental processes have started and will continue. With particular reference to family therapy in Uzbekistan, past, present, and new practices with the Uzbek family should be systematically documented and examined. For this to happen, the effective and cooperative collaboration between frontline practitioners and researchers in academic institutions is essential.

The need for overseas experts to spend concerted time and effort on working with/training/supervising Uzbek clinicians in a more systematic and intensive manner cannot be overemphasized. This might not be altogether impossible with the availability of current technological innovations such as videoconferencing and telecommunications. The Western psychotherapeutic methodologies can be implemented with Uzbek families, but the emphasis of Uzbek traditions (such as those noted as they relate to family and social bonds) rather than on the Western emphasis on individuality and self-concern must be taken into consideration. With a healthy balance of cultural sensitivity and an understanding of quality practice, Western institutions can assist Uzbekistan with its emerging professional marriage and family movement, including improved education and training, supervised practice/experience, and the development and institution of ethical standards and guidelines (Leung et al., 2009). The authors believe that, with further development, the future of marriage and family therapy in Uzbekistan is filled with hope and excitement.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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