Clinical Work . Culture

Dialogue is not enough: the issue of power and multicultural therapy in humanistic theory and training.

On January 12, 2021 by 
 By: Lucia Sarmiento Verano

Finishing a humanistic psychotherapy course in a leading institution while personally exploring issue of oppression, white supremacy, and colonialism has proved to be harder than expected. I have found myself regretting my choice of degree, and wishing for more discussions about the reality of many people’s lives. I became aware of how the experiences of the white middle class repeatedly take centre stage in the theory and our discussions.

I have been unable to find psychotherapeutic theories in the modalities that I’m training in, which would describe without pathologizing the experiences I am most interested on:  ethnic and cultural mixing and the colonial wound.

In our final taught year, and after the murder of George Floyd and the Black Lives Matter movement, my training institution finally decided to dedicate more than half a day to issues of diversity, and to complement them with some notions on power and privilege.

Unsurprisingly, I found many of the things we were presented with during that teaching to be problematic.

Power in Humanistic Psychotherapy

I am training in three different Humanistic modalities. I chose this course in part because I greatly appreciate the philosophy behind Humanistic practice, the idea that there is inherent value in all humans, respecting all perspectives, and striving for mutuality and as much equality as possible in the therapy room. I am attracted to these ideas because they correspond to my personal values and principles. I also personally experienced the benefits of such therapy.

But over the past three years, I have come to see that there is something lacking in the way these theories are presented in training. An explicit discussion on the realities of social privilege and power, and how they may influence the relationship between therapist and client, including risks of harm, was never facilitated. This important gap in knowledge will also influence their application for practice, especially in cross-cultural therapy.

Let me explain. Not all questions of power are always excluded from Humanistic psychotherapy. As Humanistic therapy promotes a sense of equality and mutuality in the relationship, much care is put into reflecting on how to step out of the role of the ‘expert’ as a therapist and how to avoid interpreting the client’s experience, creating space for them to discover their own answers. As I said, I appreciate this way of working and I have a strong belief that an ethical framework based on these principles is important to make sure therapists don’t abuse their power.

Thus, a lot of emphasis is put on the ethical framework and rightly so. To me, the issue lies in the way in which issues of power are discussed in training, and generally within the profession, or rather, never discussed.

Please note that when discussing issues of power in therapy, I mostly use Proctor’s categorisation of power in three distinct types: Role power, Societal power, and Historical power (2017). I consider Role and Societal power two aspects of structural power, that is, the power given to an individual due to their social position and affiliation to institutions.

I have personally found that structural power is often completely omitted from the conversation in Humanistic training. It is as if our ethical stance of mutuality was assurance enough that power differentials will not influence the relationship. I personally find this view unethical and dangerous.

Rogers’ radical political ideas and the way in which he tried to change the power balance in therapy with the person-centred approach were indeed, revolutionary for their time. The issue is that they seem to constitute enough protection against abuse of power for us humanistically trained therapists, without the need for further reflection on social realities. Similarly, Gestalt’s ideas of co-creation and Field theory (Lewin, 1951) are presented as a way of equalising the power balance between client and therapist, especially when practicing relationally.

And yet, in my personal exploration of the Humanistic framework I have encountered strong critiques of this point of view in the literature (Masson, 1989; Fish, 1999, Waterhouse, 1993). They all bring attention to important things to. Abuses of power, gaslighting and missing the client’s perspective are still all too often occurrences in Humanistic therapy, something that was seldom mentioned by tutors. Yet, how can we prevent harm if we never explicitly discuss what causes it?

It is my belief that the avoidance of the topic of power in Humanistic theory and training, especially structural or societal power and privilege plays a big part in perpetuating harm in therapy. Even if Rogers’ somehow took into account structural and social oppression later in his work (Rogers, 1978), these social and political ideals do not translate into the way the Person-Centred approach is taught.

Others have written more complete discussions on power in counselling and psychotherapy (Parker, 1999; Proctor,2007). I won’t repeat what they have said here. I would like to focus on one of the consequences of this omission. The way in which “working with Cultural diversity” has been presented to us, in training, and the literature we were expected to read are to me, upon reflection, lazy and problematic.

Multicultural work and Dialogue

To discuss my argument, I’d like to use the article we were sent as reading on the topic of multicultural work for our training day on Privilege, Power and Diversity.

I am talking about Gordon Wheeler’s “Culture, Self and Field: A Gestalt Guide to the Age of Complexity”, published in 2005.

The first part of the article is a well-structured recount of the racist and Eurocentric origins of Anthropology and Psychoanalysis, and the evolution of the study of other cultures by Western theorists. He rightly says that since their inception, these disciplines were the way in which Western thought theorised and justified its superiority, and the superiority of White European peoples.

The second part of the article focuses on Gestalt theory and practice in regards to working multi-culturally. Here, Wheeler describes how Gestalt theory and practice is perfectly adapted for multicultural encounters. The first inconsistency I noticed is in the transition between the first and the second parts, which seems to imply a clear cut between a ‘racist past’ in these disciplines and a more open and egalitarian present. There is no discussion on the racists attitudes that may still play a part in today’s knowledge production. Such a discussion should of course include Gestalt knowledge.

Moreover, Wheeler seems to adopt two different definitions of Culture between the first and second part of his article. Indeed, he tries to re-define Culture from a Gestalt perspective as an introduction to the second half of the article. I will try to explain why this is so problematic.

He starts by explaining how society is always divided into different interest groups and how each individual belongs to many social groups at the same time, with the need to negotiate these affiliations. He declares that age, class, and professional groups are ‘cultural groups’, essentially conflating any and every social group we may belong to with a Culture. It may be easy to see why he makes that parallel.

The issue with this point of view if that if we stick to the definition of Culture as “the customary beliefs, social forms, and material traits of a racial, religious, or social group” (Merriam-Webster dictionary) instead of Wheeler’s definition, then we start to see how Culture is usually tied to ethnic and racial background. This factor brings into the picture a whole set of historical and geographical considerations, including power dynamics that are not equally present between different ages, classes or professional groups.

He then seems to use his own definition of culture to explain how a Dialogical Relationship (I-Thou) as described by Buber (1958) is all we need to bridge these ‘cultural’ gaps between groups, and within ourselves, as we negotiate affiliation to different groups.

By saying that “all contact is cultural contact”, that “all culture is multiculture” or even that “each of us is inherently multicultural”, he is wrongly conflating multicultural work with every other category of similarity and difference such as gender, class, professional identity etc. This conflation is not innocent, it serves the purpose of downplaying the specificity of multicultural work and helps ascertain the author’s theory that no extra skills or knowledge are needed for it, only our usual relational and Dialogical way of working. It’s as if a cultural encounter happened in a vacuum, disconnected from an external social and historical context. I have seen this view reflected in our teaching multiple times and by different tutors.

If we keep using this example, we can consider that explaining Culture as the Ground that makes meaning for the Figure and which may not be conscious, may be useful. However, it ignores the idea that there is a bigger, global system of Cultural hierarchy. What does the author make of this global cultural Ground in which all Cultures occupy a position in relation to their proximity to central White Western Culture? Why does he, as a white western man, chose to ignore this? I cannot, of course, answer this question for him. However, I do know one thing: privilege usually does not see beyond its own comfortable reality. Which brings me to the bigger issue of multicultural work and diversity in the profession.

This is not an issue limited to Gestalt theory. The reason why I am critiquing this article is because it exemplifies the attitude and the discourse, I have heard many times throughout my training. Person-Centred theory and discussions are also imbued with this attitude.

As I have said, what is completely missed and puts us at risk of harm, is that Culture in this world is almost always intertwined with ethnicity or race. This necessarily adds another layer of material to consider in the relationship between two people. A certain type of Power dynamic is necessarily present in a relationship that does not happen in a vacuum, but in a world in which cultures are ranked hierarchically and colonialism has created power relations between them. These hierarchies live deep in our psyches and colour our relations with people from different cultural backgrounds. Wheeler’s conspicuous change in the definition of Culture he uses serves him well as it makes it so it is possible for him to avoid mentioning his own privilege and power, and the effects they may have in a multicultural encounter.

Working multiculturally in psychotherapy requires different skills, and a certain body of knowledge that involves power dynamics, an awareness of the global matrix of colonial power, racism, language, cultural background etc. It is dangerous to pretend otherwise, because it increases the risk of harm via microaggression, missing, gaslighting, inaccurate interpretations etc. An acute awareness of cultural cues and, also, a baggage of knowledge about the client’s culture needs to be acquired by the therapist to limit these risks, as well as a permanent awareness of the existence of these structural power dynamics and the effects of oppression and privilege. This has been theorised and presented by many (Lago, 1996; Mackenzie-Mavinga, 2009). These theories are available for us out there, but curiously, not during the delivery of training, which continues to be thoroughly inadequate on the topic of multicultural therapy.

An oppressive attitude

It has been implied during my training that everyone has an experience of rejection or humiliation, thus we can all begin to understand client’s experiences of discrimination. Coming from a white person, statements like these oversimplify and miss the experiences of entire communities that are marginalised by our society. Whether this stems from laziness or ignorance, it is worrying to witness such disregard for the tangible effects that difference has on people’s experiences. Especially because it teaches trainees that it is OK to adopt such an attitude in our work.

As a person that has grown up between two cultures and have lived in different countries in my adult life, I know deep within me the profound changes and the identity issues that living multiculturally may bring. Reading and hearing white westerners say that cultural differences are just the same as age or class differences borders on the offensive for me. Just like I, as a white person, will never pretend that the cultural displacement I have experienced can help me understand the experience of being on the receiving end of racism. These are different experiences which cannot be compared, especially by someone that holds power and privilege. Pretending otherwise is adopting a colonising attitude.

This is why, terms and concepts are important to understand precisely what we are talking about. I believe it is important to respect their definitions, especially when they talk of people’s lived experiences. They are sometimes redefined to suit a particular framework’s needs, like in the article I just discussed. We need to be aware of this and question it when it is done by a person that holds significant privilege and when it distorts the meaning of something like Culture, which is paramount to understand a diversity of experiences and oppressions. Downplaying and distorting the notion of multicultural work in therapy to suit a white western framework is inherently colonising.

This attitude is present in the Humanistic discourse I’ve been presented with during training, and I am willing to bet it is not the only place this happens. This was, by far, not the only problematic way of thinking I have encountered in the profession. Other examples of colonising attitudes are the appropriation by white people of concepts that were initially created to describe the experience of racialized people, such as W.E.B Du Bois’ Double Consciousness (1903), or the tendency to write and teach about working multiculturally and with racism, power and privilege by referencing white western authors exclusively. I have also witnessed deep misunderstandings of the concept of Intersectionality, which has been used by privileged people to explain how they too, can understand experiences of oppression. But all of this is out of the scope of this particular post. 

More is needed

The mainstream discourse in humanistic practice is one that downplays the specificities of cross-cultural and cross-racial work in very insidious ways. An important body of work on this topic is available out there, but this somehow never made it to many training courses. In my experience, the discourse we have been presented with by tutors and fellow counsellors was one of ‘unseeing humanism’. One that avoids talks of power and structural inequalities. One that minimises our own capacity to do harm from whatever privileged position we hold if only we are able to stay “open minded” and engage in a Dialogical Relationship.

Humanistic theory offers the framework to dethrone the therapist from the expert position, doing its best to equalize the relationship and deal with issues of power. But the avoidance of explicitly naming power puts it at risk of doing the exact opposite. Much work is needed and training needs to evolve urgently so as to stop producing cohorts of professional cross-cultural gaslighters.

A second part to this post was recently published: Dialogue is STILL not enough

References

Buber, M. (1958) I and Thou. Edinburgh: T&T Clark.Ltd

Du Bois, W.E.B (1903) The Souls of Black Folk. Chicago: A. G. McClurg.

Fish V. (1999) Clementi’s Hat: Foucault and the politics of psychotherapy. In Parker I. (ed). Deconstructing Psychotherapy. London: Sage (pp54-70).

Lago, C. (1996) Race, culture and counselling, Milton Keynes: Open University Press.

Lewin, K. (1951) Field Theory in Social Science. New York: Harper & Brothers

Masson J. (1989) Against Therapy. London: Fontana.

McKenzie-Mavinga, I. (2009) Black Issues in the Therapeutic Process, London: Palgrave Macmillan.

Parker I. (1999) Deconstructing Psychotherapy. London: Sage.

Proctor G. (2017) The Dynamics of Power in Counselling and Psychotherapy. Monmouth: PCCS Books.

Rogers C. (1978) Carl Rogers on personal power: inner strength and its revolutionary impact. London: Constable.

Waterhouse R. (1993) Wild women don’t have the blues: a feminist critique of person-centred counselling and therapy. Feminism and Psychology. 3:55-71

Wheeler, G. (2005) Culture, Self and Field: A Gestalt Guide to the Age of Complexity. Gestalt Institute Press. Available at: http://www.gestaltpress.com/culture-self-and-field-a-gestalt-guide-to-the-age-of-complexity/ (Accessed 14 December 2020).

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