Talking about race, culture and racism in family therapy
Systemic Theory and Therapist's Self
Systemic theory has moved away from the idea of neutrality as desirable or possible.
The therapist's self, with their complex history, is central to understanding the therapy process (McNamee & Gergen, 1992).
Reflection on one’s own identity and family experiences within social and political contexts is crucial for therapists.
This approach is a systemic response to structural racism, bringing the therapist's history into the work.
It advocates for reflexivity and a search for one's own experiences of culture and racism.
It breaks down barriers between the service user and the psychotherapist.
Personal Narrative: A Family's Experience of Partition
In August 1947, my mother’s family experienced the threat of kidnapping and rape during the partition of India.
To escape, my 13-year-old mother had to leave her home in Dhaka (now Bangladesh) and move to Calcutta.
This event is a "subjugated narrative" overshadowed by the grand narrative of India's independence.
The widespread rioting, inter-faith conflict, and killing are often excluded from the dominant Western narrative.
The likelihood of a therapist eliciting this trauma in therapy with my mother in the UK would be very slim due to the internalized Western narrative and the shame attached to the event.
Practitioner Points
Structural racism in society can enter the therapy room unless therapists examine their prejudices and unconscious assumptions.
This examination allows for practices more sensitive to differences in race and culture.
A systemic response to racism requires change at a social and political level.
Therapy Across Cultures and Races
The aim is to understand therapy across cultures and races, and how it can be helpful despite differing cultural backgrounds, histories, and experiences.
It involves exploring the meaning of culture, especially when an individual identifies with multiple cultures.
The focus is on the complex interplay of influences on individual subjectivity, resisting reductive accounts.
Systemic theory, with its 'not knowing' position and constructions of culture, is well-suited for this approach.
Promoting psychotherapy sensitive to cultural difference is an act of subversion, especially given the rise of xenophobia and far-right nationalism.
Systemic psychotherapy and clinical psychology must move away from Euro-American hegemony.
Changes in practice must be accompanied by structural changes in service delivery, involving local communities.
'Therapy' should not be imposed in a colonial manner but adapted to different communities.
Mental health constructions should move away from essentialist premises, considering social, cultural, and political contexts.
Social constructionist premises allow distancing from the trope of 'mental illness' as an individual, decontextualized phenomenon.
Critique of Individualization of Distress
Callaghan et al. (2016) highlight how the individualization of distress in CAMHS eclipses the impacts of poverty on young people, favoring simplistic parenting interventions.
A MIND survey (2013) showed that only 10% of ethnic minority users felt their therapist was culturally sensitive, compared to 75% of therapists who believed they were.
Khan (2020) argues that psychological therapies are not fit for purpose for people of color.
The paper advocates for transculturalism and movements across cultures.
Transculturalism and Identity
Salman Rushdie’s (1994) story in East West illustrates the challenges of living between cultures, with the character's heart 'roped by two different loves'.
The author refuses to choose between East and West, embracing both.
Personal Experience: Growing Up Between Cultures
The author recounts leaving Calcutta at 18 months to join their father in Glasgow, experiencing a shift from a comfortable middle-class life to hardship.
Parents implemented transcultural policies: speaking English at home and immersing in cultural heritage through frequent visits to Calcutta.
Racism was encountered in 1970s Britain, with classmates using prejudiced terms from popular sitcoms.
The author suffered in silence, lacking the language to describe their experiences.
Personal psychotherapy helped search for a cultural voice that was both English and Indian.
Father's illness and becoming a father offered opportunities to reconcile Indian heritage with English context, though tensions between cultural narratives persist.
The author references Roy-Chowdhury (2008) on struggles with fatherhood and masculinity, a 'tale of two cities'.
Defining Culture
The autobiographical account serves to locate the authorial voice and construct a theory of culture and transculturalism.
Culture is NOT a fixed, static set of characteristics attributable to a group (World Federation for Mental Health, 2007).
This static definition allows for stereotyped assumptions and prejudices.
It cannot accommodate transculturalism, where individuals position themselves uniquely to multiple cultural referents
The World Federation for Mental Health (WFMH) definition posits that culture is ‘programmed’ into the individual mind.
Alternative Definition of Culture
Krause (1998), drawing on Geertz (1993), defines culture as a 'web of meaning' rather than patterns of behavior.
Culture presents orientations toward behavior, providing contexts for understanding beliefs, motivations, and emotions.
Culture is interactional and contextually bound; individuals are uniquely positioned in relation to meanings and behaviors, enacted in specific ways.
Culture is constantly made and remade within interactions and social contexts (Laird, 1998).
Laird (1998) describes culture as '
a constantly evolving and changing set of meaning … always contextual, emergent, improvisational, transformational and political; above all it is a matter … of languaging, of discourse.'Krause (2010) draws upon Bateson’s ethnographic work, describes culture as '
another way of talking about expectations and about context as involving not just the present but the past and the future.'The contextually bound nature of cultural expression is illustrated by the author's partners remarking on their transformation in the Indian context.
Experiences, such as storytelling, are amplified within the family, demonstrating a different way of being in the world.
Culture in Therapy
The aim is to apply theoretical issues and ways of imagining culture to family therapy.
The paper indicates which approaches to culture the author finds therapeutically helpful.
It references Pakes & Roy-Chowdhury (2007), which describes part of a qualitative research study.
One of the findings concerned the effects upon participants of the reification of culture. Reification is regarding an abstract concept as a real thing.
The discursive effects in the therapy of assumptions relating to a reified account of ‘culture’ are shown to constrain the conversation through the construction of artificial dichotomies and limited and troubled subject positions. These constraining discursive effects can be linked to reduced cultural sensitivity … because the complexity of ‘culture’ and peoples’ positions in relation to ‘culture’ cannot be fully taken into account. (Pakes & Roy-Chowdhury, 2007: p. 281)
When culture is presented as a homogeneous set of beliefs, it limits the expression of complex positioning regarding cultural influences.
This reification does not capture cultural transition; only acceptance or rejection of cultural norms is available, echoing Derrida’s (1978) 'binary oppositions'.
A homogeneous view of culture is common, particularly in the Euro-American narrative.
Falicov (2005) highlights 'emotional transnationalism', where migrants feel the pull of cultures, mediated by inter-generational stories.
Drawing upon Stone et al. (2005), Falicov emphasizes the unpredictability of acculturation and advises clinicians to avoid stereotypes.
In most families, continuity and change are happening side by side, in creative non linear ways. Some family members may adhere to certain customs, such as home remedies, but the same members, or others, may oppose the arranged marriages favored in the culture. … More than ever, we have to tell ourselves not to stereotype but to ask about values and preferences with respectful curiosity. (p. 403)
Krause (1998) suggests that through travel, friendships, art, and literature, therapists can learn about others' lives and what they take for granted.
Drawing upon the work of the anthropologist and philosopher, Bourdieu (1990), she refers to this taken for granted assumptive base as ‘doxic’ material.
This 'doxic' material—the socially constructed basis of our place in the world—feels natural, making us only partially aware of it.
Meaningful contact with others allows glimpses of this material, helping clinicians develop awareness of their assumptions.
Clinical Examples
The following are shared accounts of clinical work, not as exemplars but in the spirit of shared thinking about therapy across cultures.
The work with these families differed in many ways that will become apparent, but there is a commonality in the nature of their loss.
Case Example 1
A family from Nigeria, referred for Ben’s paranoid schizophrenia, had disintegrated relationships after Ben's release from prison.
The family requested the author as their therapist, hypothesizing an understanding of their experience with cultural transition.
The therapist signaled the importance of migration, acculturation, and intergenerational differences early on.
Family therapy sessions included various subsystems, addressing the siblings' bereavement over their father's death.
The money Ben lost with his mother was re-framed for its symbolic significance, as a proxy for loss.
Cultural influences were referenced, implicitly and explicitly, regarding experiences 'back home'.
Siblings expressed anger at their mother for holding onto traditional attitudes.
The mother expressed her devastation at the loss of her husband, her feelings of loss and utter bewilderment on her own in this strange land with three children looking to her for guidance.
Cultural meanings were explored, with each family member positioning themselves differently within webs of meaning.
The therapist was open about their own cultural referents, allowing the family to ask about differences in Indian families.
Despite occasional misreadings, the therapist emphasized that they are the experts in their own lives.
The family discovered new ways of being a family, embracing both British and Nigerian identities.
Case Example 2
Sanjay and his family, all born in England except his mother Jaya, were referred after the death of Apu, Jaya’s husband.
Family problems consisted of feelings of anxiety and intense sadness. These feelings were complicated by the narrative among their other children that Apu had shown a preference for Sanjay in his will, which was confirmation to them that he was his father’s favourite child.
The narrative was Sanjay was his father’s favorite child; Sanjay felt isolated, and his mother feared the family would break apart.
The therapist listened to Jaya and Sanjay’s sadness, and discussed their relationships with each other, Apu, and wider family.
Sanjay, the only unmarried sibling, moved in to support his mother and was tasked with selling a family home in India.
The therapist asked questions about how these responsibilities were understood, noting cultural expectations about the oldest child taking charge.
The therapist validated each member's perspective and attended to the therapeutic relationship.
The family's increased understanding led to the end of sessions, with Sanjay remarking that relationships felt “almost normal”.
This supports the hypothesis that shared cultural referents can be helpful.
I recall an occasion where Jaya questioned the pre-suppositions that may have informed my questions, and indeed perhaps in doing so drew upon the culturally influenced expectation of a respect for elders to be found within Indian families. She drew my attention to the peculiar idiosyncrasies of relationships within her family. This particular interaction strikes me as a reminder that giving the therapist access to culturally influenced discourses might be helpful, and yet there is still the risk of making assumptions; hence, it is just as important as in therapies where there are cultural differences for the therapist to question their own beliefs and to ask about the lives of others in a tentative manner.It is important to keep in mind the earlier theoretical construction of ‘culture’ and one’s location within culturally influenced narratives as being idiosyncratic and enormously varied, the opposite of homogeneous.
In this instance, Sanjay corrected the application of a culturally influenced narrative, emphasizing the importance of provisional questions and accepting corrections.
The therapist adopted a deferential position, respecting the elder’s expertise on her own family.
Conclusion
Writers in this area worry about de-skilling readers by providing rigid prescriptions for cross-cultural practice.
Balancing openness and structure requires enormous skill from the clinician.
The author advocates for fostering a strong therapeutic relationship (Roy-Chowdhury, 2015) and taking a non-expert position (Anderson & Goolishian, 1992).
Racism should be acknowledged and confronted in therapy, but therapy alone cannot substitute for social interventions.
A social constructionist approach allows locating individual experience within social contexts.
Collaboration with other agencies is crucial for creating wider change and tackling inequalities and injustice.
Based on the article provided, several aspects of the counseling work context could affect the way postmodern, solution-focused principles (SFBT) are applied:
Structural Racism: The therapist's examination of their prejudices and unconscious assumptions is crucial to avoid structural racism entering the therapy room. Without this, practices may not be sensitive to differences in race and culture.
Cultural Sensitivity: A MIND survey (2013) indicated a significant gap between therapists' perceived cultural sensitivity and the experiences of ethnic minority users. This suggests a need to ensure therapies are genuinely culturally sensitive, moving away from Euro-American hegemony.
Individualization of Distress: The tendency in CAMHS to individualize distress, as highlighted by Callaghan et al. (2016), overshadows the impacts of broader issues like poverty. SFBT practitioners need to be mindful of these systemic factors rather than focusing solely on individual or family-level interventions.
Homogeneous View of Culture: The article warns against reifying culture into a homogeneous set of beliefs, which can limit the expression of complex cultural positioning. SFBT therapists should avoid stereotypes and instead explore values and preferences with respectful curiosity, acknowledging the unpredictability of acculturation.
Service Delivery Structures: Changes in practice must be accompanied by structural changes in service delivery, involving local communities. SFBT should not be imposed in a colonial manner but adapted to different communities, considering social, cultural, and political contexts.
To negotiate these constraints:
Reflexivity: Engage in continuous reflection on one’s own identity and cultural experiences.
Cultural Consultation: Seek supervision or consultation to enhance cultural sensitivity.
Community Collaboration: Work with local communities to adapt therapeutic approaches.
Advocacy: Advocate
As well as:
Addressing Power Imbalances: Be aware of power dynamics, especially in cross-cultural settings, and work to create a collaborative therapeutic relationship.
Language and Communication: Be mindful of language barriers and communication styles. Use interpreters when necessary and be sensitive to non-verbal cues.
Contextual Factors: Consider broader social, economic, and political factors that may be impacting clients' lives.
Continuous Learning: Stay updated on cultural issues and best practices in cross-cultural counseling through ongoing education and training.
Challenging Assumptions: Regularly question your assumptions and biases, and be open to learning from clients about their unique experiences and perspectives.
Flexibility: Be prepared to adapt SFBT techniques to fit the cultural context and individual needs of each client.