Clinical Work . Coloniality

Therapy as a site of resistance PART 2: the therapist’s stance

On August 21, 2023 by 
By: Lucia Sarmiento Verano

In the first part to this piece, I wrote about the therapist needing to always consider what the client brings to the work from a socio-historical perspective, in order to help clients recognise the origin of their distress accurately, and to prevent misrecognising elements of their reaction that can actually be crucial to their psychic survival in the long-term.

This time I’d like to invite readers to reflect on themselves, and their own stance as practitioners. The inner work we must do in front of clients is always extensive. That is the core of relational therapy. I believe there are some aspects of inner work that should also be considered as core to this process so as to limit risk of harm to marginalised people.

In this text, I invite you to reflect on the aspects of your positionality that might unconsciously be a risk for harmful transferential dynamics. I will also examine the processes of locating oneself within the structure and of actively resisting the internal split that ‘apolitical’ therapeutic work demands of us. These challenging reflections have the potential to influence transferential material and allow us to connect with clients more deeply and authentically.  

Working with our Positionality

I have written about this before. Being aware of one’s own social position in relation to the client’s is essential in helping us consider our working relationship, possible transferential material (from both sides) and possible oppressive dynamics. This can help reduce the likelihood of harm if we are open and candid about our potential to do such harm.

Charles R. Ridley conceptualised cultural-countertransference (1989) as an element that can have a negative effect in the work between a white counsellor and a black client. In the presence of unfamiliar cultural mannerisms and attitudes or values, strong feeling and discomfort may arise in the therapist. These difficulties are then easily attributed to the client instead of being correctly located within the therapist’s unconscious.

If we consider the relationship of a white therapist and a black client, within the wider socio-historical context, and as a potential repetition or enactment of historical relational dynamics, we can start truly reflecting on the potential for harm. Ridley’s research suggests that white counsellors often exhibit ambivalence in their motives when seeing black clients.

At times a high need for power and dominance (Jones and Seagull, 1977) is enacted unconsciously within the relationship, something which Clemmont E. Vontress calls the ‘great white father syndrome’ (1981). The paternalistic saviour’s attitude which can often be seen in helper professions, heavily discounting and disempowering clients and service users, out of the practitioner’s awareness. Just another way of asserting superiority and maintaining control, and thus perceived safety and comfort for the white therapist.

Digging deeper into this dynamic, and into what we know about Whiteness and the white psyche, we could consider that part of this might stem from feelings of fear, guilt and shame. Even though denial is potent, white people are not fully unaware of the violence the system inflicts on ‘Others’ and of the benefit they have reaped historically. This is bound to play a part, unconsciously at least, in the inner process. Maintaining control over the process by disempowering the client might be a way of avoiding confrontation to the reality of social inequalities and thus, the shameful truth.

In fact, Jones and Seagull (1977) suggest that some white professionals are motivated to counsel black clients as a result of their guilt about racism. They may be seeking security through gaining acceptance in their relationship with the black client, effectively feeling absolved of guilt, real or imagined, for being racist.

In all these cases, the process is lead from a place that seeks to fulfil the therapist’s needs instead of the clients. When this is done, even unconsciously so, there is a high likelihood for the process to be harmful.

Locating Oneself within the System…

I’d like to push this idea a bit further now and invite practitioners to consider not only their positionality relative to their clients’, but in relation to our surrounding oppressive structures (Sheehi & Sheehi, 2022). Let’s refuse the idea that power is not present and does not influence the therapeutic relationship. Both our role power as therapists, and our structural power conferred to us by our social position (which may, at times, depending on context, also be disadvantage), influence it and we will be better places to deal with this if we accept and examine it.

Let me explain one of the main reasons this is important. There are others, but let’s consider this one first: with social privilege and power (and a minimum of social consciousness and empathy) come inevitable shame and guilt. As I previously stated, that is normal as we are aware we benefit in some ways from a system that crushes others in worse ways that it negatively impacts us.

This guilt and shame which, I repeat, are very natural, are also sources of some potentially harmful unconscious dynamics which will impact on the work through our power as therapists in the room. Power to “know” or to “choose” what threads to follow and what to prioritise, power to “know” how we see or read client’s presentations, and where we go from there in the work.

Lara Sheehi and Stephen Sheehi speak of the concept of Ideological Misattunment (2022, p50) directly referring to a consequence in this difference in positionality between client and practitioner (or supervisor/supervisee dyad). “An inability to identify processes precisely because the analyst or clinician is implicated by and imbricated in the ideological matrix in which the patient is also entangled”.

Locating oneself and the potentiality of an Ideological Misattunment helps us reflect on the ways in which, due to our social position vis a vis client and our position in the social systems that oppress them, we might invisibilise (conscious or unconsciously) parts of their experience or the impact the social context is having on their mental health and symptoms. Lara and Stephen Sheehi explain further by stating that our own whiteness or privilege hides itself as a reaction formation to its own guilt.

Misrecognition via Ideological Misattunement is then a way of unconsciously deresponsibilise ourselves from our role (and from facing how we benefit) in the oppressive structure affecting our client. In this case, we as practitioners, would not be unconsciously seeking absolution from our client as previously described, but directly providing that for ourselves during the work while performing our professional role and thinking we are helping.

Ideological Misattunement and misrecognition are defence mechanisms driven by the powerful emotions of fear and guilt. They affect our capacity to attune deeply and work safely with marginalised clients and we ought to pay very close attention to this to work ethically and limit the potential for harm. These unconscious dynamics that will prevent us from truly standing in the client’s corner and helping them resist the crushing weight of oppression.  

Prompts:

May I offer a brief example of a road map for reflecting on these dynamics and how they could potentially influence our practice with the following questions:

  • Have you identified, from your id and social position, how this global system of colonialism, racism, capitalism and patriarchy benefits you as it destroys others?
  • Have you connected with the shame and guilt this produces? Can you hold them present without dysregulating or avoiding/deflecting from them?

Now to some more challenging prompts:

  • Have you imagined, if this system was to be dismantled tomorrow, how your life would change, or what you would lose? How does it make you feel (fear, anger, disgust)?
  • Can you hold those powerful feeling without dysregulating or avoiding them?
  • Are you still choosing to stand in your client’s corner to untangle and dismantle this system despite the fear/anger/disgust etc you might feel at the prospect?

…and Resisting the Split

I believe the two points above help us see more clearly how splitting is a prerequisite for apolitical clinical practice (Sheehi & Sheehi, 2022). It affects clients but also clinicians & practitioners. For those of marginalised backgrounds or those who come from the Global South this splitting into being an apolitical practitioner demands even more than just splitting the socially conscious, guilt-ridden, empathetic part of ourselves (as with the examples above). It demands self-alienation, and the swallowing of colonial introjections that place elements of our identity, our experience and our perspectives on the world as ‘less clinical/scientific/objective’ and thus inferior than so-called “apolicital” (Eurocentric) ways in our work.

Our entirety has no place in our work. This is often keenly felt by people from ‘different’ background during initial training, and later in their careers. As qualified practitioners, we might resist that in many ways. More often than not, it is done quietly, in our interiority, or in the privacy and confidentiality of the therapeutic process, and in ways of being and practices we dare not speak aloud in front of colleagues. We know we risk being harshly judged, and perhaps even punished for it.

I’d like to invite therapists in this situation to reflect on how they personally cope and resist in their personal and professional lives, how they refuse this self-alienating split. This insight can be invaluable when it comes to supporting clients. Liberating oneself is part of the work, the praxis, to also support clients in this process.

  • Have you become aware of how the structure impacts you?
  • Have you worked on your internalised shame and oppression?
  • Have you identified your own ways of resistance (including rage and disobedience or other strategies that are often pathologised)?
  • Have you disentangled those from self-destructive impulses and accepted them as they are?
  • Can you help clients do the same?
  • How can this help you firmly stand in your clients’ corner inside and outside the therapy room?

Concluding thoughts:

I will leave these reflections here, but as I said at the beginning of part 1: this is ongoing work. It will probably always be ongoing. My hope is that more counsellor become familiar with these reflections, these concepts and the knowledge I have very briefly presented here. I wish for these reflections to be present in all professional development work for mental health professionals in order to limit potential for harm towards marginalised clients and service users.

In the spirit of trying to drive this change I am planning to hold spaces for practitioners who truly wish to undertake this work. Training events will be help in September 2023 and in the future. You’ll find more information on the Events page of this website, or by subscribing to the newsletter. The deepest changes will happen when we come together to hold space, challenge and support each other to apply these anti-oppressive principles to our work.  

References:

Jones A. & Seagull A.A. (1977) Dimensions of the relationship between the black client and the white therapist: a theoretical overview. American Psychologist. 32. Pp850-855.

Ridley C.R. (1989) Racism in Counselling as an Adversive Behavioural Process. In P.B. Pedersen, J.G. Draguns, W.J. Lonner and J.E. Trindle (eds.) Counselling across cultures. 3rd edn, Honolulu: University of Hawaii Press.

Sheehi, L. & Sheehi, S. (2022) Psychoanalysis Under Occupation. New York: Routledge.

Vontress C.E. (1981) Racial and Ethnic Barriers to counselling. In P.B. Pedersen, J.G. Draguns, W.J. Lonner and J.E. Trindle (eds.) Counselling across cultures. 3rd edn, Honolulu: University of Hawaii Press.

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