15 Dec Mental Health and Wealth: Healing and hope through cultural competency and clinical excellence.
Mental Health and Wealth: Addressing difficult family issues through cultural competence and clinical excellence*.
Dr. Paul Hokemeyer
Key words: Wealth, UHNW, mental health, narcissism, author, family therapist, addiction treatment, family governance, family office, depression, anxiety, addiction, empirically based, Harvard, global leaders, thought leader, innovation, mft.
When Tsitsi Mutendi approached me for a chapter on issues related to mental health for this book, I immediately said yes. Over the years, I’ve been inspired by Ms. Mutendi’s commitment to uniting individuals, communities, and cultures by their shared humanity. Through her work in local African communities and with UHNW families around the globe, Ms. Mutendi has proven to be an innovative thought leader and highly effective practitioner in the field of family business advisory and governance. She is also one of the few leaders on the global stage who is not afraid of delving into what are often messy and nonlinear mental health and relational issues related to a family’s holistic health. Unlike most people who see wealth in a binary of either a panacea that alleviates all psychic pain or an evil force that causes it, Ms. Mutendi realizes that wealth is a neutral energy that can be channeled towards good outcomes or in highly destructive ways. She is also highly cognizant that clinical interventions to provide relief and repair to UHNW individuals and families in the realm of mental and relational health (collectively referred to in this chapter as ‘behavioural health”) need to be crafted through culturally respectful psychotherapeutic interventions and delivered through an empathic and compassionate delivery system.
Mental health and UHNW Families
Central to the efficacy of this delivery system is the existence of psychological safety in a family enterprise. In my book, Fragile Power: Why Having Everything is Never Enough (Hazelden, 2019), I set forth a new paradigm for treating people of wealth and power for a host of behavioural health disorders. Since the book’s release, these clinical formulations have enabled family enterprises to resolve behavioural health issues that limit their financial and emotional well-being through a new standard of cultural understanding and empirically based, clinical formulations. I’m also proud that the book has found a deep resonance in collective cultures that value family coherence and traditional values. As such, it has enabled UHNW families and family enterprises to build on their traditional values by expanding the construct of psychological safety from the realm of corporate environments into the realm of holistic family health. Through this expansion, innovative families have enabled behavioural health issues to emerge from the shadows where they fester and grow into a reparative path lit by healing and hope.
Psychological safety extended.
In her best-selling book, The Fearless Organization, Harvard Business School professor, Amy Edmonson defines psychological safety as, “a shared belief held by members of a team that the team is safe for interpersonal risk taking.” In my work as a family therapist, I’ve extended Dr.
Edmonson’s definition from the boardroom to the family room by substituting the word ‘family’ for the word ‘team’. The net result is an expanded description of psychological safety that enlarges the construct from entrepreneurial success measured in quantitative values to a hybrid model that adds qualitative values measured by a family’s holistic health.
The value of psychological safety in the corporate realm is well established. According to McKinsey & Company, “(w)hen employees feel comfortable asking for help, sharing suggestions informally, or challenging the status quo without fear of negative social consequences, organizations are more likely to innovate quickly, unlock the benefits of diversity and adapt well to change. In the same vein, family members who feel safe enough to ask for help, respectfully challenge entrenched generational patterns and freely share their experience without fear of being harshly criticized or silenced are able to successfully negotiate disruptions and setbacks.
Case Vignette 
Andre is the eldest son of a Moroccan mother and Lebanese father. After graduating from the Massachusetts Institute of Technology, the mother created an internet concern that she sold for just over a billion USD five years hence. At the time of the sale, Andre was 15 years old, attending public school in an upper middle-class suburb of Boston and living, in his words, ‘a moderately privileged life.’ When the sale occurred, Andre’s life radically changed. The sale attracted significant media attention causing them to become the target of religious slurs and death threats. In response, the parents pulled Andre from his public school and moved the family to Zurich. But rather than keeping him in the new family home, Andre was enrolled in an international boys’ boarding school in the U.K. where he began to suffer from panic attacks and debilitating depression.
I was brought into the family by the chairman of the family’s office and Andre’s mother to assess the son and find appropriate clinical care for him in London. After engaging with Andre for over a month, he tearfully revealed to me that whilst he missed his family and mates back in America, he was being ‘tortured’ by his emerging adolescent sexuality. Terrified of what he felt could be a nontraditional sexual and gender identity, he found himself in a state of self-loathing and frequently entertained suicidal ideations.
Slow and Steady Wins the Race
Central to the efficacy of my work as an individual clinician and family therapist is addressing the pathology that exists on the three levels of our human existence. These levels consist of our intrapersonal experience, our interpersonal relationships, and the social cultural milieu in which every family member exists. The work requires a moving-in to understand each family member’s truth and a subsequent moving-out to understand and address the holistic context of their ideographic being. Over the past
two decades that I’ve had the privilege of doing this work, I’ve found that in this regard, every family member’s ideographic truth is valid. Behavioural health issues become acute, remain unresolved and damage a family’s holistic health, however, when there is a gap between a family member’s ideographic truth and the family’s idealized narrative. For this reason, maintaining family unity whilst the family engages in the work of repair is critically important to creating positive health outcomes for each family member and the family as a unit. Creating an environment of psychological safety in the family unit is critically important to maintaining family unity and attaining positive long-term outcomes.
Four steps to behavioural health:
Moving Andre’s family in a reparative direction by creating an environment of psychological safety was not a process that occurred overnight. It was a slow and steady process that ensued over the course of a year, and which involved me artfully implementing the four inter-related steps outlined below:
- Inventory the family’s intrapersonal and interpersonal dynamics: As a licensed mental health professional, I entered the family as a trusted advisor, ethically obligated to hold confidences, facilitate productive conversations, identify unhealthy and dismissive patterns of relating, and foster healthier interactions. In this role, I gathered information from individual family members they had not been comfortable sharing openly before.
- Create a strategic plan that was highly structured and outcome-focused: Based on the family data gathered, I identified patterns and prioritized issues that needed to be clinically and systemically addressed. From these priorities, I set out a strategic plan to engage the family in new ways of relating based on psychological safety rather than fear of rejection and reprisal. Central to his task was to set the stage for Andre to share his personal struggles with his parents in a culturally respectful way all the while coaching him that if he expected empathy and understanding from his parents, he would need to provide them the same.
- Work in a safe and contained frame to educate the family on existing relational patterns and give them the opportunity to engage in healthier, more productive ways of relating: While some of the initial work can occur from a distance over technology, the initial work is most effective when done in person over a predetermined period. As it applies to the dynamics in this case, I met with Andre individually and his parents as a couple for several months over a secured telehealth platform to glean where the family had points of connection and where fear and misunderstandings would cause individual and family pathologies to deepen. Once we had this baseline level of understanding and mutual trust, I worked in person with the family as a unit in the family’s vacation home in Bodrum, Turkey to deepen the work and connect them emotionally and physically.
- Engage in quarterly checkups to ensure the family is not relapsing back into old and toxic relational dynamics. The nature of reparative individual and relational work is that it occurs over time and in a nonlinear fashion. Lasting change occurs incrementally in advances and retreats. Accordingly, families must commit to the process over a period of time and be willing to tolerate the discomfort that growth entails.
As this relates to my work in the case above, the most important element of my engagement was to first earn Andre’s trust and steward it in a way that united the family on its shared values of love rather than spitting them off into ideological factions. In this regard, while families may share similar profiles, every family dynamic is different. The key to success in enhancing a family’s behavioural health is knowing when to push forward, when to allow families to lay fallow when issues get overwhelming and explosive, and when to concede to other family members’ seemingly immutable demands and expectations. Whilst the work needs to be based on empirically proven clinical strategies, the effective delivery of the science is an art form that the clinician must constantly hone.
Behavioral health issues in any family are messy and often difficult to treat, but there are highly effective and empirically based clinical protocols to address them. Central to the success of these protocols is the art of fostering a culture of psychological safety in families. Such ethos enables behavioral health issues to be discussed through a reparative rather than shaming lens. It’s also important to note that psychological safety is not a one-way thoroughfare.
In Andre’s case, just as he needed to feel safe in sharing his truth about his conflicted sexuality that emerged when he entered the tumultuous adolescence years, his parents needed to be honest about their fears for the safety and future of their son based on the cultural and religious paradigm within which they lived their lives. I’m pleased to report that 2 years into the process, the family has deepened their emotional connection by finding points of their shared humanity whilst simultaneously operating on a higher level of quantitative functioning. Andre got the clinical care he needed to manage his mood disorders and transferred to a more progressive boarding school in America where he is thriving. Relieved of the stress of the situation, his parents were able to set up a family office in Zurich as well as a foundation in which Andre is actively involved. While we had points along the way where things got ‘stuck’, family members felt angry, and hurt and devolved into tears, we paced ourselves and everyone saw the benefits of the endeavor.
That families from all socioeconomic classes struggle with issues related to their behavioural health is not a new clinical discovery. What is new is how there is emerging a new generation of behavioural health experts and family governance professionals who have begun to work together to bring empirically based clinical formulations into considerations of an UHNW family’s holistic health. As a clinician, I’m grateful to be on this journey with such esteemed family governance professionals such as Ms. Mutendi and those of you reading this book.
 https://www.mckinsey.com/capabilities/people-and- organizational-performance/our-insights/psychological- safety-and-the-critical-role-of-leadership-development
 The example used is a compilation of several cases I’ve worked on over the last decade. The identifying details havebeen changed to protect the confidentiality of all involved.
*This article first appeared as a chapter in the nonfiction book, Raising the Boabab. Edited by Tsitsi Mutendi (2024)