‘What is the cost of overlooking cultural heritage in therapy?’

I was born in the UK to parents from Guyana, which was then part of the British West Indies and the only English-speaking country in South America. Guyana is known as the land of six peoples, with descendants from Africa, India, China and Europe, as well as the Native Americans and a sizeable mixed-race group. My own inherited stories from my parents and grandparents have, over time, got somewhat lost and slightly blurred. I never really paid attention to my cultural heritage until I was at sixth-form college. My English teacher took an interest in my background after I wrote an essay on my family life. Her curiosity and genuine interest made me question why I wasn’t more curious about my eclectic heritage. My working experience is that culture is always in the room. Looking back at my training, I do not feel this area was fully covered. So it begs the question, what is the cost of overlooking cultural heritage in therapy? My experience is that salient ethnic and cultural components were often missed. My approach now has to be in the context of a client’s identity, culture, beliefs and, of course, relationships. My hope is that my level of awareness keeps growing with meeting different clients from diverse backgrounds.

Sharmila Dutt, psychodynamic counsellor, Basingstoke Counselling Service, and private practice

‘I use my countertransference as a tool when working with clients of different cultural heritage’

I am a white woman of British heritage. I converted to Judaism after marrying. My parents-in-law, German Jewish refugees from Hitler’s Europe, were another influence on my identity. In my therapy work, I chose to work with care leavers and asylum seekers, many of whom struggled with identity. In private practice, Jewish and Asian clients chose to work with me because of my sensitivity to minority cultures and patriarchal traditions. It is likely that we all have some conscious as well as unconscious bias towards other races and other cultures. As a therapist, I feel I have an obligation to work to understand my own biases and to see myself through the eyes of others. I use my countertransference as a tool when working with clients of different cultural heritage. For example, working with a young man and becoming increasingly aware of his black skin, I asked him how he felt seeing a therapist with white skin. He was then able to begin talking of past trauma when experiencing racist abuse by white people. I encourage supervisees to bring cultural issues and difference openly into therapy. Fear of cultural insensitivity can lead to turning a blind eye to practices that may be abusive or harmful.

Frances Bernstein, psychoanalytic psychotherapist (retired), supervisor in private practice

‘I cannot hide my skin colour, which may influence which clients choose me’

My mixed origins mean I do not fit into a ‘box’ and this helps me empathise with clients who live in the margins, the liminal spaces. I can name the experience of not belonging, of being different, of wanting to blend in yet not wanting to betray one’s origins or family loyalties, of being able to move between cultures and groups while not fully belonging to either and maybe not wanting to. Clients make assumptions about my cultural heritage, which can raise dilemmas. I work in Perth, and I don’t advertise as being English or mixed race or Christian, since I don’t acknowledge these aspects of my identity as significant in my identity as a therapist. But I cannot hide my skin colour, which may influence which clients choose me. I cannot hide my accent once they meet me. In my training decades ago, I don’t recall exploring our cultural identities. Later, I did a very useful module as part of my MSc with John McLeod at Abertay University, which helped me to acknowledge my cultural identity. It opened my eyes to the fact that we all have a cultural heritage that influences us, and hence our work as therapists, more than we realise.

Rachel Weiss, counsellor, coach and trainer and founder of the Rowan Consultancy

‘Clients who view my cultural identity as different from theirs often use me as a bad object’

I am a queer British Arab, but my cultural heritage is often a mystery to clients, as it can be hard to place my origin. What is visible, however, is my brown skin tone, young age and transatlantic accent. Despite these giveaways, it is still always interesting to see where each client will place me. This can be very helpful for their process, as quite often it is an unconscious facilitation. ‘I came to you as I thought you would get it,’ is something I often hear during client consultations. For some clients, it is important that they feel a sense of alliance, to understand what it is like to have certain experiences or be raised in certain cultural heritages. Of course, depending on the client’s needs, this can fluctuate. Clients who view my cultural heritage and identity as different from theirs will often use me as a bad object. These can be projections of people they’ve felt conflict with or even parts of themselves that they deem bad or unhealthy. For me, it is about being able to contain these uncomfortable feelings, being able to hold projections that at times render me the opportunist immigrant – selfish, inconsiderate and ungrateful. It’s important when we are in this position to often wonder who we are to the client, what is the function behind their projections and how can we process it together? As much as possible, I try not to give clients any information about my nationality, sexuality, relationship status or age so I can be what the client needs me to be at that particular moment.

George Andrawis, psychodynamic psychotherapist

‘Clients can end up paying to educate the therapist about their culture’

People, both BAME and non-BAME, often ask me if I was ‘born here’ (in the UK). From my experience, the inference is that ethnic minorities who were born here are ‘better’, perhaps seen as more Anglicised and acculturated. When I first came across this condition of valuing, I used to react defensively, trying to protect my self-image. Through supervision, I am now able to open up a dialogue with clients instead, which has always resulted in a positive therapeutic relationship. As a trainee counsellor, I struggled to build trust with my counsellor on the university campus because I felt she was never going to understand me. In the end, it only took one line of questioning to justify my mistrust in the process. As a counsellor myself, I experienced more rejection and DNAs with my white clients in my first year post-qualification than with my BAME clients. However, with supervision and reflection, I realised that my world view impacted on my empathic response and was a hindrance. Now, as a seasoned counsellor, I focus on acknowledging difference, and this has empowered clients to be the expert. My cultural background encourages shaking of hands and hugging, which is at variance with my professional ethos. Also, eye contact is seen as disrespectful, whereas in Western culture, when you don’t make eye contact, people may think you’re lying. I feel a counsellor’s empathic response is enhanced by their knowledge of the client’s culture and the appropriate application of that cultural knowledge. Otherwise the therapeutic process is delayed in trying to establish and resolve communication barriers and the client just ends up paying to educate the therapist about their culture.

Adisah Azumah, counselling psychologist and person-centred counsellor

Next in this issue