Psychotherapy and Diversity
Cultural difference can offer moments of opportunity.
Posted Oct 06, 2013
Imagine you are a Black woman sitting across from your Jewish male psychotherapist in New York. You find much in common. You are both proud of your Brooklyn upbringing, went to similar liberal art schools, and share a traumatic history of being a minority. You feel hopeful and positive about your therapy.
The news about Trayvon Martin’s shooter's not-guilty verdict comes out on Saturday. You feel disgusted by the verdict. The following week, your therapist, in an off-hand comment, discloses a general belief in self-defense.
You freeze for a split second. He seems so distant from what Blackness, oppression and justice mean to you. What do you do when critical differences arise between you and your therapist?
Psychologists call such moments “ruptures.” Ruptures occur when there is a break in the connection between a patient and therapist, and potentially in the flow of treatment. Ruptures are very important. They introduce risk, as well as new possibility, for the therapeutic relationship, and for one’s identity and personality as a whole. And they are inevitable.
Beyond the psychotherapy office, we live in a diverse sociopolitical world where intergroup conflicts abound. Underneath every conflict is a rupture, a break in human connection around issues of identity and sacred values.
People clash in fundamental beliefs of right or wrong, just or unjust. Take for example the culture wars in the US and the passionate gridlocks on issues of gay marriage and abortion. People clash in the way they narrate historical truths. Nowhere is this more poignant than in the Israeli-Palestinian conflict, where each identity group struggles for recognition and legitimacy.
And yet despite differences, we have a strong impulse for cooperation. Humans have learned, like their hunter-gatherer ancestors, through cooperation, to maximize individual and group interests. For most people, belonging to friendships, families and complex societies is vital. With a relationship one ensures care, reciprocity and greater financial security. With a society, one secures a greater sense of affiliation, protection and purpose.
So when cultural differences arise between patient and therapist, what are the risks and possibilities at that juncture?
The risks involve our needs for affiliation as social beings. If we highlight differences over similarities, we fear losing an important relationship in which we feel liked, understood, and helped.
Research in social and developmental psychology tells us that preference for similarity is innate and even automatic and is most evident in the tendency for mimicry. People unknowingly mimic each other’s accents, mannerisms and emotions even when engaged in the most mundane conversations. This preference for similarity develops very early in humans: infants as young as 9 months old, even before developing friendships and language, are drawn to individuals who share their preference of toys or food more than those who differ.
Mimicry and seeking similarity have an evolutionary advantage for human beings. Attaching to a similar other increases one’s chances of being liked and of having a sense of belonging--this fosters social bonds and altruistic behavior. Fascinating research shows that people who are mimicked, compared to those who are not, tip more in restaurants and donate more money to charity.
To go back to the Black female patient and her Jewish male psychotherapist, the patient may, consciously or unconsciously, not directly address the cultural difference just revealed between her and her psychotherapist. Better to keep a veil on it and not risk losing the empathy and the help. But what about the possibility that this rupture holds?
Possibility might be found in her own curiosity—curiosity about her fear of speaking up. Instead of automatically and entirely falling prey to our evolutionary tendency, she can take a moment to ask herself the following questions:
- Is there shame in bringing up the subject?
- Am I worried about my anger?
- Am I worried about my therapist’s anger or that he will feel offended?
- Am I sensitive to authority figures?
- Am I worried that the insults and oppression I feel outside will be replayed here in therapy?
- Is my silence reminding me of other silences I endure in my other relationships like with my father, mother or boss?
Her curiosity may lead to new realizations about her deepest fears and wishes, and perhaps to new ways of approaching and resolving conflict.
But the greatest possibility—and my favorite—is the unique opportunity to negotiate meanings around identity, values, and events. This is an opportunity unique to psychotherapy. In our achievement-oriented lives, we often have to accept and comply with meanings imposed on us by history or those who hold power over us. We get stuck in dynamics with others that may be oppressive and suffocating, with little room to create our own voices and identities.
For our patient, her silence could be a replay of the oppressive dynamics in her life, a real cultural experience in relation to a predominantly White society. If she speaks up, she has the opportunity to negotiate her position vis-a-vis her therapist and define anew what Blackness and oppression mean to her.
Therapy is not a sanctuary. The external world seeps into the cracks of the office, knocks at our doors, sits in our chairs, and lies on our couches. Patients and therapists bring the outside world with them, with its differences and its clashes. But what therapy can be is a safe and unique place to negotiate what may be very important to our identities.
So, next time you freeze for a split second, hold onto the hope inherent in that which you have in common with your therapist. Take the risk. Dive into the possibilities of unveiling differences.
Nadine Obeid, Ph.D., is a clinical psychologist with a private practice in NYC. She is a postdoctoral candidate in psychoanalysis at William Alanson White Institute, supervising Faculty at The New School for Social Research, Ferkauf Graduate School of Psychology and Lenox Hill Hospital.
Dr. Obeid will be speaking at the Lost and Found in Translation: Psychoanalytic Roundtable on Asian, South-Asian and Middle-Eastern Cultures Conference to be held at the William Alanson White Institute on October 26, 2013. Click here to register.