Clinical Work . Culture

Dialogue is STILL not enough: further thoughts on power and multicultural therapy

On October 5, 2022 by sarmientoverano

^{Featured photo credit: Dima Pechurin}

By: Lucia Sarmiento Verano

I wrote about the idea of dialogue, dialogical relationship and working across cultures in psychotherapy a year and a half ago. In fact, it is that post that started this blog in a moment of frustration and despair about the state of things in our profession. I wanted to point at the glaring omissions, the limitations of our current theory and practice and how this reproduces oppression within our therapeutic work. The urgency felt around this matter is still present because through these dynamics harm is being actively done to people who seek support and find themselves in vulnerable positions. Things have not changed, only my anger has diminished and has left space for tiredness and what feels like resignation mixed with resentment. I don’t expect much difference from my profession anymore, so I’m trying to do something different myself, and with the people I know and respect.

However, I have continued learning and reflecting so hopefully I can offer a couple more insights on that very subject today. As usual, I was not the first to think about these issues and other, more experienced practitioners and researchers have conceptualised some of the things I attempted to convey in my first post better than I ever could. Let me share some of these ideas.

About the notion of Culture

The first point I’d like to expand on is the point I made about the definition of culture used in the article I was critiquing (which was Wheeler’s article published in Gestalt Press). I wrote:

“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.”

I asserted the main problem with it was that it was equating all differences with cultural differences. Meaning the author viewed age, class, professional differences, etc, on par with cultural ones. Part of the problem for me is that cultural identities are intimately intertwined with racial identities and thus, with a global matrix of power and hierarchies stemming from colonialism. This should not be omitted from the discussion as it affects our therapeutic relationships too.

R.T. Carter conceptualised and named various different approaches to cultural and racial difference which are stemming from fundamental assumptions about difference that are often covert. The one espoused by Wheeler corresponds to the approach Carter calls Ubiquitous (Carter, 1995). He states: “the ubiquitous approach to culture is essentially a liberal position. Virtually all forms of social or group identity and/or shared circumstances are treated as cultural.” (Carter, 1995, p.257). He then explains that mental health training using this approach insists that differences be acknowledged and celebrated, but that it can lead to avoidance and denial of socio-political histories and power dynamics.

Now we might also understand why such an approach nowadays is considered a “good thing” within the profession if we examine were we come from and what some practitioners still think about cultural difference. On this point, Carter also describes the Universalist approach to culture: it “equates difference with individual differences; assuming that all people are human beings and that differences within one group are greater than between groups. It is espoused by traditional theories and practice.” (Carter, 1995, p.257). On this basis, people are humans first, and members of a racial or ethnic group second. Does this ring a bell? How many times have we heard therapists repeating that they see their clients as “humans”, downplaying the reality of socio-political and historical power dynamics?

Our profession has been slowly stepping away from a universalist and openly oppressive approach to culture into a ubiquitous one, considering all differences as being fundamentally OK and adopting a stance of curiosity. This is usually celebrated as the best way to work with difference, especially in relational modalities.

However, there are several ways in which the ubiquitous approach many in this profession uphold is in itself problematic and oppressive:

• It equates all differences thus equating their impact on people’s lives. To put it plainly using an example, thinking that a difference in professional background has the same impact than difference in race or ability/disability is quite disingenuous. The potential for violence and exclusion are not the same and pretending so means participating in the minimisation or invisibilisation of oppression. Same happens with race and class, which are two axes of oppression that are often compared in order to derail conversations. Both have an impact depending on the context, they can also compound, but dismissing their respective particularities is of no help to anyone.

• In doing so it denies the specificity of racial differences, particularly the historical baggage of violence and colonialism that exists in society as well as in our unconscious (and this can’t be understated). It denies differences in power held by different groups and how power dynamics can also harm or prevent healing, even within the therapeutic relationship.

• Using this logic, professionals can then imply that there is only need for a Dialogical Relationship (Buber, 1958), curiosity, “open-mindedness” and celebration of identities in order to safely relate across differences, understand or connect with others. This is not only untrue but it betrays a profoundly privileged and powerful perspective of life by which the person believing this does not take into account differences in power and the unconscious material that exists as baggage in an unequal relationship.

• There is also another unconscious dynamic at play by which the privileged therapist, by adopting this belief, absolves themselves from the responsibility of doing deeper more uncomfortable work and allows themselves to adopt the identity of “good therapist” that adopts an open-minded, dialogical approach.

I’m not going to sugar-coat this: Minimisation, invisibilisation, denial or oppression and power and self-absolution, are all textbook dynamics betraying (often unconscious) racism and oppressive mentalities.

As Carter states, this is a liberal perspective. I would personally add, since we are talking about racism and coloniality, this is a White liberal perspective. By that I mean it thinks itself progressive and just, but it still adopts many aspects of the Capitalistic & Colonial mindset, namely and primarily:

• Individualism
• paternalism/saviourism
• notions of progress from a Eurocentric perspective

It remains safe and comfortable for white and otherwise privileged people. It places the responsibility and the possibility of change onto the individual with good intentions and the right attitude instead of focusing on the examination of one’s own shadow as well as the systems we need to dismantle. The latter often proves too distressing and potentially shameful when examining one’s own material, and too uncomfortable and scary when it becomes about truly disrupting the status quo.

Currently our profession’s most “progressive” thinking is thoroughly imbued with the ubiquitous approach to differences, effectively drowning the specificities of cultural and racial differences into a white puddle of pure intentions and saviourism. May I just add that I see this as a deeply gendered dynamic as well. Our profession is the domain of White middle-class women, and it is no coincidence that it is adopting these attitudes in response to injustice. However, explaining this point is out of the scope of this post. Perhaps for another time.

Part of the problem (or perhaps a consequence) might be that our practices do not usually teach us to consider mental health/therapy IN CONTEXT and to work with the impact of historical and structural oppression on our clients. We need to seek this information elsewhere, oftentimes out of the psychological field.

I tend to think the reticence to seriously considering the context in our work, is in part due to the spirit of moral purity and white saviourism of our profession, in which it becomes difficult to openly discuss and explore potential for harmful countertransference and harmful manifestations of privilege, more so than other forms of countertransference. Truly examining the specificities of racial and cultural differences and how the impact of these connect to histories of global extreme violence and exploitation goes directly against some of the reasons that motivate people to become therapists in the first place. The need to HELP others, and in doing so, see ourselves as good people which is for many of us part of our healing journey too.

I would argue therapists are especially prone, because of this, to be white saviours and to white fragility, defensiveness and various forms of active harm. At the same time, we may be less able to self-examine this specific aspect of our functioning as resistances are strong to protect our sense of (good) self. I have seen similar dynamics at play in groups of therapists, where defensiveness in the form of tears, rage, victimisation or shutting down have quickly silenced and stopped an uncomfortable conversation about group roles and power dynamics.

Denial of Power

All of this is also related to how we tend to view power, and how we embody it or refuse to embody it, as therapists. In the first part to this post, I wrote:

 “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’ […] 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.”

It is important to remember for this that the notion of power is complex and it is not a static thing at all. There can be different types of power such as historical, role and structural power (Proctor, 2017).

We can also consider that power is not something that is held but a dynamic relationship between people, as pointed out by Foucault (1979). For example, someone can have more power structurally or socially in a situation but others also have the power to resist. They have some agency and are not completely powerless.

With this in mind I’d like to speak more precisely of institutional/role and structural power within the therapeutic relationship.

Many modalities, especially the ones who focus on relational work, try to “equalise the relationship” by giving more power to the client and rejecting the therapists position as the expert in the relationship. Gestalt’s ideas of co-creation and Field theory (Lewin, 1951), or the Person-Centred approach are two examples of this. This stance is commendable and a good thing to strive for in my opinion, but it has limits and these limitations are seldom considered in depth.

By virtue of the nature of our work and the relationship in which one person (the client) comes for help and is vulnerable, and the other (the therapists) observes, holds the space and has more technical knowledge of the process, the relationship is and remains forever unequal.

No amount of “equalising the power balance” can deny the unequal nature of the relationship. It would not be a therapeutic relationship otherwise. In this sense there’s a certain amount of power that the therapist can never relinquish and this even if they are co-creating the work with the client, contracting in the process or being congruent.

That’s role power, given to us by virtue of our profession and our role in the room. By itself, role power is enough for therapists who do not properly consider it to be at risk of causing harm, especially when it is used reactively to reduce feelings of unsafety, discomfort, shame, or stuckness within the therapist. May I add that all of this can happen unconsciously and nobody is exempt from this potential outcome. It is also more common than we imagine: therapists seeking safety in the power of their theories to interpret something when feeling threatened, stuck or inadequate (Chinnock & Minikin, 2015), or locating the issue in the client’s process to avoid taking responsibility.

On top of the power of our role, there is also structural power to consider. Now the dynamics of this may be a little different depending on the therapist and client’s social positions relative to each other.

As you may have heard, the field of counselling and psychotherapy is primarily populated by white middle class women, mostly because of barriers to access, cost of training and unpaid work hours needed to complete our programs. This also means that a majority of therapists are socially and structurally in a position of privilege and power. That cannot be said of everyone of course, but in the many cases where the therapist is in such privileged position, we need to think about the implications it may have when working with less privileged clients.

Whether we think about it as manifestations of a collective unconscious, a social unconscious or internalised elements of social life into our individual unconscious, there’s no denying that social and historical (power) dynamics can get enacted, and often do, in our everyday relationships. How can then, historical realities of inter-group relations such as domination, extractivism, entitlement, subjugation, supremacy, cruelty, etc, exist and influence our transferential material?

I will leave you to join the dots as exploring this question in detail is way out of the scope of this piece. Before I go on though, I will just remind everyone that given our current (and historical) social hierarchies and the reality of oppression, a therapist member of a dominant group has effectively much more power to create unsafe spaces for clients of marginalised background, and this without even realising it. Their role power as professionals compounds with their structural power as privileged people.

There is something about admitting to our power that makes many therapists squirm in discomfort. “Who me? Holding power?” of perhaps even worse: “me? Power to harm?”.

The therapist’s power is not something I hear much about from people in the profession. And much like whiteness and oppressive attitudes or mentality, we have to accept it’s there and embrace it before we either dismantle it, or try to make sure it does not manifest in harmful ways. Despite us being taught to use counter transference in our work, this self-exploratory work is seldom done (not to the point of consciously naming and accepting our power and its effects or potential consequences). Leaving clients, especially the ones from marginalised communities, at the mercy of our privileged unconscious’ whims, defences and power plays.

We are all capable of making mistakes, of forgetting important things and as humans that we are, to react in ways contrary to our values at times. I invite everyone to notice what responses emerge when you think of your potential to harm others, especially vulnerable people and clients. What comes up first? What’s your embodied experience, feelings and thoughts? Do you immediately reject the idea? How do you think you would feel in that situation, once you realise that you might have done harm to someone? How would you react?

Therapists are uniquely positioned in the relationship and hold enough power by knowledge of theory AND of the client’s most intimate self, that it becomes easy, when we are feeling threatened or uncomfortable, to seek comfort in justifying our responses by locating the problem externally, or at times in the client. We may seek reassurance and comfort in our theories, or in what we know of the client to stop feeling like a bad person or a bad therapist. I hope I do not have to state why this is so damaging.

I am convinced that need to be aware of the power that we hold in our role and structurally in relation to our clients, of power dynamics within our work and how we may use them or misuse them in order to watch ourselves in this process.

Ambivalence

The last point I believe is related to this topic in general and I will invite you to consider is the very uncomfortable topic of our own ambivalence, whether it be conscious or not. I had not touched upon this in my first post so I’m doing it now.

I think this particular topic is harder to consider than the other two points and it is hidden from plain sight and often denied. It is tough because it speaks of our shadow, the part of us that resist positive change, perhaps the part of ourselves that we least want to accept.

Why does the article written by Wheeler as well as the discourse of “progressive” relational therapists remind me of the importance of examining ambivalence? Simply because they are the perfect illustration of it. We just need to know where to look.

In the first part of his article, Wheeler describes historical oppression quite well. He then starts to dismiss the systemic and historical elements of it in the second part when he adopts a ubiquitous and individualistic approach thus avoiding the question “what does it mean for us as individual practitioners to know that cultural and racial oppressions have been historical systemic and collective, and that these have a real impact on our relationships?”

To reflect upon this question, we mustn’t forget Wheeler’s own positionality because it is key. In my last article, I wrote:

“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’d like to emphasise the ignoring this is a CHOICE, and we often see this choice being made in the discourse and actions surrounding injustice and oppression. When we look at the harm done it is easy to consider its collective and systemic aspects. When it is time to consider our role in it and in changing things by taking concrete action, the perspective changes to an individual one and an ubiquitous approach to culture. I have seldom seen therapists truly engage with, acknowledge and work with their (and their community) role in enabling, enacting and reproducing that systemic oppression they were pointing at earlier.

We want things to change but we don’t want to acknowledge our role in them.

We want things to change but we don’t want to make sacrifices or give up power and comfort.

To me, this is a manifestation of ambivalence. The part of us that wants safety, comfort, privilege and power and would like to forget about changing the status quo. The part of us that has enjoyed and still does, the privileges we were afforded. Real and profound change is a threat to those things. So unconsciously there’s a tendency to seek ways in which we can do the work just enough to feel good, but superficially and not enough to actually change the status quo. This is more visible when we observe what institutions are doing: mostly superficial discourse and performative DEI activism.

This ambivalence lives in all of us and we might as well learn to embrace and understand it in order not to let it hinder our work. As therapists, this ambivalence might lead us unconsciously to react in oppressive ways. Do we confront and accept that supremacist tendencies and whiteness also live within us? Or are we incapable of facing our shadow and thus, we let it influence our behaviour and relationships insidiously?

In practice it is much less dramatic than it sounds. We must just face it, and it will feel terrible, but it won’t kill us.

There is much more to say about ambivalence. The constant individualising of anti-oppressive work, the superficiality of DEI initiatives that only focus on celebration of difference and inclusion… If you know you know. We might explore it another time.

Concluding thoughts

In my previous post on this topic, I also wrote: “Downplaying and distorting the notion of multicultural work in therapy to suit a white western framework is inherently colonising.” I would add to it today, it is not only to suit a white western framework but white comfort.

By catering to white comfort, the profession has been trying to apply the DEI rhetoric and practice by employing superficial ways of celebrating diversity. But usually, there’s no going beyond that, to examining power, historical constructions that play into our unconscious and transferential dynamics, and their impact on mental health.

Asserting, like Wheeler, that a Dialogical Relationship (I-Thou) as described by Buber (1958) is all we need to bridge these ‘cultural’ gaps between groups, and within ourselves is then simple a mockery of the reality of oppression and lived experience, and a denial of how harmful social dynamics get enacted in the therapeutic relationship.

What we need is more courage to go beyond ideas of Diversity and Inclusion and beyond the parroting of already established therapeutic theories and practices. Courage to confront painful truths and to explore ideas outside of our discipline. Confronting the reality of injustice and our role in it. It is too late to keep hiding behind our good intentions.

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References

Buber, M. (1958) I and Thou, New York: Scribner Classics.

Carter, R.T.  (1995) The Influence of Race and Racial Identity in Psychotherapy: Toward a Racially Inclusive Model. New York: John Wiley & Sons.

Chinnock, K. & Minikin, K. (2015) Multiple Contemporaneous Games in Psychotherapy: Psychodynamic and Political Perspectives. Transactional Analysis Journal, 45(2), pp141-152

Foucault, M. (1979) Discipline and Punish: The Birth of the Prison. NY: Vintage Books

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

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

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).