We shared memories and experiences which were moving to hear and to witness. This was especially so when Golnar, an existential psychotherapist, shared a little of her background. She came to the UK for a second time not, as in the first, a bright, accepted foreign student of academia, but as a refugee from somewhere that seriously threatened her wellbeing and her life. She said regrettably that some still might think of refugees as ‘scroungers’, less than, unacceptable. This second part of her journey involved deep emotional and psychological pain, which meant it took a long time for her to feel safe again.
‘Difference when it is staring you across the close up face of a fellow human being, always contains an element of violation’.
Eva Hoffman, 1991.
In small groups we explored our experiences of being different and the emotional impact on both speakers and listeners. It was important to Golnar that we paid particular attention to these ‘in the moment’ reactions and what they might reveal to us about how we see difference.
To help us understand how cultural differences could impact client work, Golnar explored some of the ten assumptions that might be made by therapists, consciously or unconsciously. (Pedersen, 1987). Pedersen had argued that ‘what is considered normal behaviour will change according to the situation, the cultural background of a person ….. and the time during which a behaviour is being displayed or observed’.
Another of these assumptions for therapists might involve a failure to understand that in some cultures discussing family issues with strangers is not permitted. Such issues would be discussed ‘in house’ so to speak. A more culturally aware therapist would not necessarily see this as an invasion of their private client space, and so could encourage a client, who felt this to be healthy and quite natural, to seek comfort and input from family or friends, ensuring that client has as wide a support network as possible. Golnar said that it is important for counsellors to understand the relevance to the client of, not only their personal history, but that of ‘their ancestors, religion, ethnic and tribal history’ with its potential impact on the ‘here and now’ of their lives. This aids understanding of clients’ processing of emotional and psychological issues. Interestingly, Pedersen’s 10th key point is an ‘assumption that counsellors already know all of their assumptions’!
We explored a little of the Self and its ego boundaries which are often experienced differently in different cultures. Alan Roland, 1996, used a diagram of two circles each with another smaller one within it to explain this more succinctly. The first, using the West’s North America as the example, showed an external circle with a solid circumference and an inner one with a dotted line around it. It suggests that independence of being and thinking, autonomy and self-actualisation of the individual are most important and experienced as positive within that cultural context. The emphasis being on ‘me’ which may indicate that the smaller inner circle is not openly accessible or seen as perhaps a protection for a potentially vulnerable ego. In the second, using the East’s Japan and India as examples, the external circle has a dotted circumference and its inner one has the solid line. Roland is quoted as saying these ‘cultures were family orientated and probably more spiritual and more open’. Maintaining harmony is valued in all situations, particularly in reference to authority. In the East, the emphasis is on the ‘we’, community and ‘fulfilment of the human spirit’. The potential clash and misunderstandings of and between cultures could by default be a source of pain and suffering for those who need to negotiate the boundaries between them. As therapists, It may be difficult for some-one from one culture to fully appreciate the nuances and beliefs of the other.
A tape measure was the object of use in exploring how close we normally preferred to be from another person (discounting families or close friends). As this was via Zoom a wall was our companion for this experiment. People of the West might prefer a distance of about 53 cms. (20 inches) which for some felt comfortable and for others a little too wide; People of Southern Europe, say, might be comfortable with 35 – 38 cms. (14 to 15 inches) which certainly suited some. Golnar said if you lived in South America the accepted distance would be 23 cms. (9 inches) which felt a little too close for most of this audience. Standing close, however, does not always mean you are deliberately intruding on another’s space, nor, if you normally prefer the wider distance does it necessarily signify that you are avoidant or stand offish. Indeed, Hall, 1976, suggested that people mostly adhered to chosen degrees of personal distance linked to the norms of behaviour in their cultural backgrounds. ‘Haptics’ covers the extent to which people are comfortable with touch when speaking and in the manner of their first greeting. He explained that people and their cultural way of being could be thought to have similarities with icebergs, where the external/conscious 10% is on the surface and clearly seen, but the internal/unconscious 90% is hidden below that surface. This ‘hidden’ part may often hold beliefs or values that underpin and influence peoples’ behaviours.
Golnar said there is a need to understand that time may mean different things to different cultures. Hall, 1976, said Monochronic time refers to the 24 hour day and Western Cultures easily follow this guideline accepting the importance that a 10.00 a.m. appointment on a particular Monday means they will need to attend on time and in readiness for it. However, Polychronic time is not so rigid, or expected to be so. This might mean that some-one, from South Asia, South America or parts of Africa, juggling various tasks or obligations may feel it is perfectly all right for 10.00 a.m., Monday to be attended at 2.00 p.m., Wednesday, which is a completely different notion of time. Therapists may need to explore in some detail the ‘timed’ elements of their contracts in order to identify and agree a supportive working alliance that underpins therapeutic need whilst demonstrating respect and understanding of the clients’ cultural background. Effective time taken on this part of contracting would enable a client to understand the West’s cultural ethos in which their therapy will take place and so make an informed choice as to how this might be made to work for and with them.
It was clear after this discussion the benefits in offering clients time and an open space in which to take their time before sharing their particular history and the story they wish to explore. However, to also keep the possibility of the space ‘open’ for later use if the time is not the right time now demonstrates a sense of empathic understanding of where the client’s life choices currently are.
In discussing ‘categories of difference across cultures’ Hall also explored, ‘verbal and non-verbal behaviour’ and the ‘context’ in which it is offered’, such as an ‘uh-huh’ in conversation would be seen as an illustration of encouragement in America, but in China, for example, it would be a sign of arrogance. So even if people speak the same language, the meanings may actually be very different.
It was helpful to share some thoughts of how to support clients when difficulties in cross cultural dialogue meant that identifying need is extremely difficult. A colleague said she had returned the bow of greeting which a very tentative Chinese client had given her. The client, for the first time, smiled having felt he had been respectfully acknowledged as a person. It was agreed modelling respectful greetings and listening behaviours were the cornerstones needed to encourage the potential movement of client and therapist into the beginnings of a safe therapeutic space.
We explored in small groups culturally challenging case studies and were again asked to notice the immediacy of our emotional reactions as each case unfolded. These were sometimes different in aspect, but always deeply felt. The stories highlighted the dangers of misunderstandings, assumptions, cross talking, transference and counter transference that might, in the clients, engender feelings of powerlessness, potential shame, ruptured dialogues and unmet needs. Any therapist ‘holding the power differential’ in this conversational dance needs to be empathic, accepting and non-judgemental whilst being tentatively, attentive to the needs of the client. This slower pace and focus will illustrate a clear intention to try and walk in the other’s shoes and to support them as they explore together a possible way forward
It is, of course, not always easy to raise issues around difference, diversity or disability as well as cross cultural work, sometimes, for fear of sounding racist, judgemental, inexperienced or completely lacking in a wider understanding of such issues as the Equality Wheel. We explored our own internalised values and those of the types of client we most enjoyed working with. This highlighted how important our core values were in cross cultural counselling. (Fernando S. 2003). This led us to also explore the types of client we found more difficult to warm to and what this might say about a possible or probable need for reflection and/or learning, and, in particular, supervision.
The use of the ‘Cultured Self’, Golnar said, means therapists need to always keep in mind the ‘three interlocking circles of the ‘universal, cultural and unique’ and their overlapping nature.
‘To gain the fullest understanding of individuals it is necessary to explore the unique and simultaneous influence of cultural specificity, individual uniqueness and human universality’
Angus Igwe in Dupont-Joshua, 2003 p.227
The insights and the sharing of experiences and time just flew by so quickly. The feedback contained comments such as: ‘gave everyone an opportunity to contribute their ideas and thoughts; in-depth handouts; ‘the opening of the door’ to the client; to hear the ‘we’ thinking of many cultures as opposed to the ‘I’ thinking which prevails in the UK; I felt very included in everything – a rare treat; although a serious subject, Golnar managed to make it fun; sensitive and engaging; the small break-out groups; I was surprised by how much I gained from the day’. Helen supported us seamlessly with the Zoom function and our fellow travellers for the day supported each other through the sharing of wisdom, empathy, humour and a good deal of self-reflection.
A huge thank you, though, goes to Golnar, for all the work she put into creating and delivering this engaging and inspirational day, it was a pure Master Class in all its elements!
Some Recommended Reading:
Atkinson D.R. et al: Sue D. & Sue D.W. 1981 ‘Counselling the Culturally Different’
Dupont-Joshua A. 2003 (Ed.) ‘Working Inter-Culturally in Counselling Settings’ Routledge
(Igwe A. ‘The Impact of Multicultural Issues in Supervision’.
Fernando S. 2003 ‘Cultural Diversity, Mental Health and Psychiatry’. Brunner-Routledge, E. Sussex.
Hall E.T, 1976 ‘Beyond Culture’ Anchor Press
Hoffman C. 1991 ‘An Introduction to Bilingualism’. Longman Linguistics Library.
Hoffman E. 1991 ‘Lost in Translation’. Minerva Mandarin Paperbacks.
Lago C. 1996 ‘Race, Culture and Counselling’.
Pedersen P. 1987 ‘Journal of Multicultural Counselling and Development’
Ponterotto J.G. 1988 ‘Journal of Multicultural Counselling and Development’
Roland A. 1992 ‘In search of Self in India and Japan Toward a Cross-Cultural Psychology’. Blackwell.
Roland A. 1996 ‘Cultural Pluralism and Psychoanalysis’. Routledge, New York.
Siegel D. 2010 ‘The Mindful Therapist: A Clinicians Guide to Mindsight and Neural Integration’.
W.W. Norton & Co., New York.