This paper investigates the way different cultural backgrounds may impact upon the therapeutic process. It explores how the client and therapist may be influenced by their own cultural heritage. It asks the question; is the therapist really capable of separating their cultural values and beliefs during therapy and if they cannot, what are the possible ramification for the client?
One of the first questions that must be addressed in therapy is, “can a therapist assist the client without an innate understanding of the culture that influences their decision making process?” Is it possible for the Western therapist to appreciate the differences between individualistic and collective cultures and how they may impact upon the client or themselves?
What is culture? d’Ardenne and Mahtani (1999, p. 3) suggest that culture is any difference between one group of people and another which may include: shared history, practices, lifestyle, beliefs and values, family roles or religion. While McLeod (2003, p. 245) implies that culture is constructed through a process of kinship networks, ritual mythology and language. McLeod (2003, p. 245) goes further to suggest that the culture within which a person exists is complex and difficult to understand and has significant implication for counsellors.
DeVito (2007, p. 43) suggests that within individualist cultures the members are more likely to only be responsible for themselves and their immediate family. While in collective culture members are responsible for the entire group, (DeVito, 2007, p. 43). DeVito (2007, p. 43) goes further and suggests that within individualist culture individuals are responsible for their own conscience, and personal responsibility is largely an individual matter. In contrast members of collective cultures are responsible to the rules of the social group and responsibility for its success or failures are shared by all members (DeVito, 2007, p. 43). The United States has the highest individualistic orientation followed by Australia, Great Britain and Canada, (DeVito, 2007, p. 43). In general the individualist countries are wealthier and the collectivist countries are poorer, (DeVito, 2007, p.42).
Rakesh and Koushik (2013, p. 299) suggest that families do not exist in isolation and the context of their societal and cultural background influences the family size, rules for interaction, communication patterns, discipline and hierarchy. Rakesh and Koushik (2013, p. 299) go further and suggest culture is not an external passive influence and it’s the family members themselves that serve as the agent for the transference of culture within the family. The construct of self and others is fundamentally different in collective cultures where the concern is with belongingness, dependency, empathy and reciprocity, (Rakesh and Koushik, 2013, p. 299). Manickam (2010, p. 366) suggests that it is not possible for a therapist to have a dyadic relationship with clients from a collective culture as they are not considered equals this may be attributed to the status health professionals receive. While Fishman (1994, p. 77) implies that it is traditional for clients from collective cultures to address their emotional problems only within the family.
As psychotherapy was developed predominately in western individualistic cultures its particular focus is on the individual psyche which may also reflect the concepts and desires of that culture during the therapeutic process, (Totton, 2006, p. 72). The concepts of ‘personal growth’ and ‘individual development’ are generally perceived by the western therapist as positive, (Totton, 2006, p. 72). Within a collective culture ‘self-improvement’ through therapy may be perceived as selfish and going against the best interests of the family, (Totton, 2006, p. 72). Sayed (2008, p.445) suggests it is not possible for a western therapist to operate on a cultural-free intervention as they are inextricably bound to the Western notion of ‘mental health’ and ‘well-being’. Sayed (2008, p. 445) goes further to suggest that the notion that the Western model of psychotherapy is adequate to all patients across all cultures is questionable.
What perception do clients have of therapy? I believe that clients may hold the belief rightly or wrongly that therapy will require them to discuss their family of origin. This particular belief may stem from the popular media. An example of this is a movie like ‘Analyse This’ where the client Vitti (de Nero) discloses the issues he has with his father. Also cartoons have a long history of ridiculing Freudian therapy. Not all therapies require the client to disclose details from their family of origin. However there may be strong belief to disclose by the general public. Ironside (2005, p. 26) suggests that over the years visiting different therapists her sorrow was explained in terms of her mother while another therapist suggested that her sorrow was due to her father.
‘Family honour’ or ‘saving-face’ may play an integral part in the collective cultural psyche. Simonsen (2005, p. 93) suggests that ‘male honour’ and thus ‘family honour’ is intrinsically combined with hierarchy of age and gender. Male honour is associated with men/superior while shame is associated with women/inferior, (Simonsen, 2005, p. 93). A man’s honour is based around the purity of the women in his family, his mother, his sister and his daughter and to keep blood pure and to safeguard family honour is the reason often given in marrying a parallel cousin, (Van Eck, 2003, p. 255). Van Eck (2003, p. 255) goes further to suggest that when a man marries into his own family his wife will keep her husband’s honour and not reveal family conflicts and secrets.
As therapists from individualistic cultures it’s important that we understanding the importance of ‘family honour’ and how it may impact upon families. In June 2004 a newspaper article in the United Kingdom suggested that a suspected 117 women may have died to protect their family honour (Taylor, 2004, p. 37). Although these cases had already been solved they were to be re-examined to ascertain if there had been any relatives involved in the killings, (Taylor, 2004, p. 37). Although the largest proportion of victims were from South Asian communities others may have been from Africa, Middle East or Eastern Europe, (Taylor, 2004, p. 37). Das (2003, p. 48) quotes a young British woman named Zena:
“People in Britain don’t understand how a father could kill his own daughter, but keeping face in the community and maintaining the family’s honour and respect are above everything, even the love of their own children.”
United Nations estimates that there are 5,000 family honour killings a year, (Das, 2003, p. 48).
To further illustrate the power of family honour, Van Eck (2003, p. 190) suggests that honour killings are committed to escape from social isolation. Honour killers feel reborn after their deed which also puts an end to their feelings of social isolation and again feel accepted into their community, (Van Eck, 2003, p.190). Honour killers are not seen as committing a heinous crime but are compelled to restore family honour and purify the family name, (Van Eck, 2003, p. 190).
Honour killings may be an extreme example of maintaining family honour. This practice may only be condoned by a small minority of people within collective cultures. But it begins to highlight the complex difference between how family honour may be valued in collective cultures in comparison to individualistic cultures.
My first experience with family honour came from a young same sex attracted (SSA) male. During therapy he explained that when he came out to his parents they suggested that to restore family honour they should arrange an honour killing on him. Fortunately this did not eventuate.
The following case study highlights the impact that family honour may have on the therapeutic process:
The client is a male in his early thirties from a collective culture. His presenting problem was high levels of anxiety which lead to frequent panic attacks. During the course of therapy it became apparent that the client had experienced a traumatic childhood. Although there was never any mention of physical abuse. There where strong indicators of prolonged periods of regular emotional abuse. This may have led to the client being anxious and traumatised. He is the younger of two male children. He stated that as the youngest male he received very little attention and most of the praise went to his older brother. We only briefly discussed his family of origin and the possible experiences that may have led to his trauma. It became clear with each passing week that there was a strong resistance to discussing his family. He mentioned during a therapy session, that from an early age his mother enforced an historic family norm of non-disclosure of family conflicts or secrets. After several months he stated that he did not wish to discuss his past or his parents any further.
As a therapist I have an expectation that clients will discuss their family of origin. What happens when this doesn’t occur? Have I failed as a therapist? Did I not offer the client a safe, confidential and non-judgmental environment? Or is the client resistant to disclosure due to repressed or painful memories? In the past I may have believed that these were two potential possibilities. I now understand that there may be other possibilities including ‘family honour.’ Chang (2008, p. 229) suggests clients from collective cultures are: “often unaccustomed to talking about their families especially under circumstances that might throw a negative light on them.” In the past I have linked my effectiveness as a therapist to my client’s willingness to self-disclose, individualise and take personal responsibility. The concepts of disclosure, individualisation and personal responsibility are grounded in individual culture which may not be applicable to clients from a collective culture. Weiten, Lloyd, Dunn and Hammer (2009, p. 220) state that individual cultures emphasize the expression and disclosure of each person’s unique feelings and experiences. Carling, Duncan and Edwards (2002, p. 51) suggest that individualisation refers to the way lives have been less constrained by tradition and custom and more subject to individual choice. While Rutherford (2000, p. 36) states, “individualisation liberates people from traditional roles and constrains.” Gambheera and Williams (2010, p. 80) imply that in collective cultures individual choice is not valued and decisions are made in consultation with family and friends.
In conclusion the modalities and theoretical practice I utilise during therapy are based within individualistic culture. My family of origin, education, mythology, language, shared values and beliefs are derived from and experienced through an individualistic western lens. Even this article is based on an individualistic western educational approach to learning. Is it possible to separate who I am from my individualistic values and beliefs during therapy? As therapists we are all taught and possibly hold the belief that we must be non-directional and non-judgmental. Also to show our client unconditional positive regard to be empathetic and congruent. But all these concepts are derived from an individualistic culture. They are valid for me because I was born, raised and educated within a western culture. But not all clients who enter therapy hold these beliefs and values, even those born in a western culture. To be aware of my own cultural constraints and perceptions due my heritage may assist me to become a better therapist. It will be a difficult road and a challenging one. These are my first few steps in understanding the potential impact of cultural difference and its possible effects.
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