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Exploring the Unsaid

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The editors and contributing authors of this volume have taken a truly pioneering and courageously challenging look at the state of cross-cultural theory and practice. In confronting directly and honestly a broad range of cross-cultural issues they have succeeded in formulating a thoughtful and innovative framework for progress in this complex and demanding field. Amongst the numerous issues examined with thoroughness and insight, the following may be identified as of central importance: Perceptions and experiences of 'sameness' and 'difference'; 'collectivist' and 'individualist' cultural tendencies; internalised and institutionalised racism; religious beliefs and spiritualities; kinship roles and familial values; sexism, poverty and beliefs about mental health. Supported and illustrated with excellent clinical material these issues receive impressive exploration. Probing and perceptive about the relationships between clients and practitioners and between mental health professionals themselves, this volume offers both conceptually and practically a genuinely enriching and groundbreaking guide that points the way forward in a spirit of confidence and hope.

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10 Chapters

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1: “Race “, ethnicity, and child welfare

ePub

Ravinder Barn

Tlhe racial and cultural heterogeneity of Britain remains the subject of much debate and discussion. Terms such as multiracial and multicultural are employed without any consensual framework about the ways in which diversity could or should be sustained and developed. Moreover, the contested nature of concepts such as multiculturalism and ethnicity ensures fragmented thinking. The corollary of this is that within public and social policy, such fragmentation leads to disparate, often weak, strategies and approaches in meeting the needs of minority ethnic groups.

Minority ethnic groups, according to the last census in 1991, constituted 5.5% of the total population in Britain. Minority ethnic children constituted about 9% of the total child population. Overall, there are about a million children from a minority ethnic background in Britain. While many of the minority ethnic children will grow up to lead emotionally secure and healthy lives, a certain proportion will come to the attention of health and social services as a result of ill-health, poverty, poor housing/homelessness, racial discrimination and disadvantage, and family dysfunction-ality. This chapter focuses on the disadvantaged and vulnerable children who come to the attention of social and mental health services.

 

2: Culture, self, and cross-ethnic therapy

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Kwame Owusu-Bempah

Among ideas and practices that vary across cultural contexts are beliefs about health and responses to disease, and also perceptions of mental health and psychological well-being. This renders any attempt at a “universal” definition of health problematic, such as the World Health Organization’s: “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.“ This is an unrealistic state that any human adult or young person may be expected to maintain over time. Besides, spiritual well-being is missing from this definition despite its centrality and importance to conceptions of general well-being in most world cultures. Belief in mystical phenomena, in the influence of spirits or supernatural beings on a person’s health or even destiny, is the commonest explanation of psychological problems throughout the world (Richeport-Haley, 1998). Consequently, Richeport-Haley advises, clinicians practising in multi-ethnic settings must be mindful that beliefs in spirit possession will be involved in some of the presenting problems of ethnic-minority clients.

 

3: Uncertainty, risk-taking, and ethics in therapy

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Inga-Britt Krause

It is often observed that connecting, communicating, and being attached to others are fundamental biological processes and that human beings have developed capacities for these processes to the highest degree. Broadly, we refer to these complex human processes as social systems, society, language, or culture, and although all persons have these capacities they do not take the same shape and are not expressed in the same way everywhere. How these processes are expressed and what they mean varies according to local and specific conditions and relationships. However, at the same time as we recognize communication as a fundamental and primary process, how it is possible and can be achieved is also one of the most difficult problems for psychologists, anthropologists, physiologists, linguists, and philosophers to understand and explain. Connecting and communication is therefore an ontological problem; as such, it is not only a problem about which all cultural traditions provide a view, it is also a problem that becomes imbued with the politics of its context and changes according to prevailing power relations and ideologies. Thus, for example, capitalism as an ideology and a social system is underpinned and reinforced by rationalism, positivism, and economic theories that reduce persons to individual and autonomous “choosing machines” (Douglas & Ney, 1998), while other economies, cultural traditions, and historical contexts provide different views of individual persons and their connections with each other. Family therapy is a mode of treatment that aims at intervening in the way persons communicate with each other, in their connections and attachments and the way these are expressed. How, then, can family therapists who work cross-culturally think about this ontological problem usefully? I think that Gellner’s (1998) critique of Wittgenstein provides some useful clues about where to begin. The example is an intra-cultural one, but it applies to cross-cultural relationships and communication as well (Krause, 2001). Gellner criticizes the young Wittgenstein’s statement that “death is not an event in life” (Wittgenstein, 1921, p. 72) by pointing out that what exactly is it that people experience when they sit on deathbeds, when they minister to the dying, or indeed are present at executions or take part in battles? What exactly is it that happens at funerals and at cremations? If death is not an event in life, just how would you describe the events in the final act of Hamlet or Romeo and Juliet? [Gellner, 1998, p. 63]

 

4: Ethnic sameness and difference in family and systemic therapy

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Lennox K. Thomas

The question of same-culture or cross-culture practice in psychotherapy is interesting and has not seriously perplexed British-based therapists, yet it is a timely issue and needs to be debated. It is more likely that American colleagues are better acquainted with the issues because of their social and communal structures, which differ considerably from those in the United Kingdom. The question is not as simple as it first appears; the issues are, among other things, about the degree to which white therapists have an understanding of the internal and systemic effect of racism on black and ethnic-minority peoples, about the power of the majority to define the minority, as well as about the current and prevailing politics that determine the social proximity of black people to white people. If there are barriers between black and white people in our society, then the situation in therapy would reflect this. One of the problems with so-called inter-group relations is the fact that black and white are not perceived as equally different. There is a power hierarchy. The same issues about therapy and power hierarchies could be debated in relation to gender, sexuality, or disability. “Each to their own” therapy is not necessarily better, yet this therapy is the status quo in the United Kingdom. It is the case that overwhelmingly large numbers of white therapists work with white families and individuals. This, coupled with a lack of curiosity, has led to an impoverishment of the profession of psychotherapy. The unquestioning closed loop had been the norm in therapy for a very long time until the pioneering work of family therapist Annie Lau (1984). This paper was ground-breaking work in British family therapy. While issues of culture have, for a long time, been a feature in the clinical papers by African-American writers, references to cultural issues in the British context were to do with culture and social-class structures. The work of Lau (1984), Kareem and Littlewood (1992), and Boyd-Franklin (1989) were welcome voices that annotated practice and the theories on which this depend. The interests of black and white therapists have led to some invigorating questions that are, from time to time, aired at professional conferences designed to address issues around culture and ethnicity. For sustained change to take place, these questions need to be asked in the workplace and, more importantly, at conferences that are not designed with culture or race in mind. In order for the profession to progress, we have to adopt a position that affords greater success to black, mixed, and ethnic-minority families, who are not offered therapeutic help as often as majority white families. Similarly, this group has made few demands on family and systemic therapy, but this might not remain the case for too long.

 

5: The African Families Project: a black and white issue

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Am ma Anane-Agyei, Wendy Lobatto, & Philip Messent

Beginnings

When black families in the United Kingdom come into contact with “helping” agencies such as social services departments and child and adolescent mental health services, these encounters often do not go well. Black families are more likely than white families to receive “hard-end” interventions from such agencies, with their children being placed on the child-protection register, made the subject of a care order, or receiving serious diagnoses. Barn et al. (1997) found that more black children were the subject of child-protection investigations.

Other studies (Rowe et al., 1989; MacDonald, 1992; Barn, 1993) demonstrate the overrepresentation of black children in the public care system and a lack of appropriate preventative support services. It is not surprising that black parents are suspicious about such agencies, seeing social workers as making negative judge ments about their ways of parenting their children and mental health services as stigmatizing. Such agencies are seen as rep resenting the majority white culture and hence lacking understanding of black families’ values and ways of raising children.

 

6: ‘‘Strangers in foreign lands”

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Jocelyn Avigad & Jane Pooley

Everyone Sang

Everyone suddenly burst out singing;
And I was filled with such delight
As prisoned birds must find in freedom
Winging wildly across the white
Orchards and dark green fields; on; on; and out of sight.

Everyone’s voice was suddenly lifted, And beauty came like the setting sun.
My heart was shaken with tears, and horror
Drifted away…. O but everyone
Was a bird; and the song was wordless; the singing will never be done.

Siegfried Sassoon (1919)

This poem speaks to us of the joy of finding new possibilities and connections, the effect of such experiences on memories of earlier traumas and horrors, and the fear that such insight will bring only moments of peace that are tenuously held and may be shattered once again at any moment. It is our experience when working with refugees that the issues raised in the poem are present both for client and therapist.

In this chapter we share our experience of working with a refugee family in an inpatient psychiatric setting. We explore the impact of the work and the dilemmas it raised at a number of levels (self, therapeutic work, the institution, and the wider network). We also want to try to convey to the reader our experience when our personal and professional selves were challenged, often beyond words. And, finally, we explore implications for practice.

 

7: Visible differences: individual and collective risk-taking in working cross-culturally

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Shila Khan

Cross-cultural work poses many challenges to therapists, trainers, trainees, supervisors, and institutions alike. Discussions about how to attend to these issues—whether in therapy, training, or supervision or in relation to the life of organizations—can often engender individual feelings of vulnerability, anxiety, confusion, dissonance, and guardedness. Moreover, there may also be a collective and institutional unwillingness, whether wittingly or unwittingly, to delve into what can be experienced as the uncertain and unsafe terrain of race and culture. These individual and institutional reactions can often stifle the possibility of creative and constructive dialogue around these issues.

Recently, however, there has been an acknowledgement of the importance of attending to the socio-economic and political contexts, such as class, poverty, and culture, affecting individual experiences and the institutions that they inhabit. This has partly come about as a result of certain key debates in wider society, such as those on citizenship and social exclusion. A significant development in the United Kingdom in the area of race and cultural issues has been the Macpherson Report (1999), which has highlighted the damaging impact of racism on people’s lives and the need to create a legislative framework within which individuals and institutions are required to take responsibility to reduce racially discriminatory practices. Additionally, other attempts such as various publications, policy documents, ethical guidelines regulating the practice and training of psychotherapy (including family therapy), conferences, and changes to some course structures have been made to address issues of race, culture, and antidiscriminatory practices.

 

8: A risky balance: striving to merge professional white issues and personal black issues

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Cella Richards

First, I would like to put this chapter into a context to help the reader understand how I came to present a workshop that took place at the 1999 Institute of Family Therapy (IFT) conference. This context-setting involves selecting autobiographical details to help the reader understand where I am coming from. I also present clinical material to demonstrate how strong feelings from a case led me to develop the workshop. One of the workshop’s exercises is described, together with some feedback from the participants. I conclude the chapter with my personal recommendations.

When I was invited to write this chapter, I found myself facing my own personal dilemma. I was asked to be honest, to state my motivation and feelings for running such a workshop and to explore some of the risks I had taken. Initially, this seemed straightforward: after all, I had shared all of this with the workshop participants. However, the main difference was that it had been verbal and had been shared among a group of professionals who I believed respected confidentiality. I felt that in that environment, participants had been less judgemental; the atmosphere had been one of wanting to share with like-minded people experiences of dilemmas, risk-taking, and learning from each other. In that context, the words took on more of an “evaporated” quality, in that ideas were discussed and built upon and misunderstandings clarified. The process involved initial individual ideas and concepts being negotiated to produce shared ideas and concepts.

 

9: Getting it right, getting it wrong: developing an internal discourse about ethnicity and difference

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Gill Corell Barnes

A subject like this deserves a book from each one of us, rather than a chapter. I have been asked to contribute a personal chapter but this is part of a more extended exploration about difference and culture to which I return with different questions at different times. I shall focus here on selected aspects of my early family experience. I see this as contributing to my developing awareness that in order to respect and value ethnic differences between people, a context has to exist in which differences themselves, rather than conformity, can be acknowledged as of value. I have thought about “getting it right and getting it wrong” at the earliest stages in my life, both in relation to external conversations about “others who are different” as well as to internalized racist discourses, conversations held in the family when I was a child and dwelling therefore somewhere in my mind as I grew up, although not necessarily held in my conscious mind.

The time bites I have included here include times when conformity was the paramount value in the immediate context I was in: my pre-adolescent life with my family and friends, pre-political consciousness; working in another culture in the United States in the early 1960s, which was the proper dawn and development of conscious awareness of ethnicity as a political issue; the daily consciousness that difference also means disagreement; working alongside African-Caribbean men and women, from the 1960s (Arnold, 1974; Gorell Barnes, 1975) to the present day. Thinking about gender and power in the 1980s and developing antiracist-practice conferences in the 1990s are referred to and referenced but not discussed. The chapter also leaves out any detailed personal recounting of my experience of the English class system and the political influences of the men I lived with as a child and a young adult; from Fabian socialist father to Thatcher-supporter stepfather and husband. Such major influences and their impact are germane, but need another context for exploration.

 

10: Risky business: the rewards and demands of cross-cultural working with colleagues

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Liz Burns & Charmaine Kemps

This chapter is born out of our experience as colleagues attempting to work together across cultures on the subject of culture and ethnicity. We hope that our experience informs the working relationship between professionals and clients, but our main intention in this chapter is to address issues raised in peer-professional working partnerships. We have chosen to speak with our personal voices, sometimes separately and sometimes together, in the hope that this will convey what we think is the value of our experience. The liberty has also been taken of addressing the reader directly from time to time. It is our belief that directness is often an important part of crossing the barriers in transcultural working. Our hindsight learning is boxed up here in the form of recommendations for practice.

In the autumn of 1999 we heard of the conference “Exploring the Unsaid” and decided to present a workshop, expecting it to be along the lines of an intellectual and professional debate on “An invitation to explore institutionalized categories of ethnic and cultural identity with a view to releasing more creative and respectful possibilities”. We wanted to offer something on the cutting edge of practice but found ourselves instead on the dangerously sharp knife-edge of cross-cultural living. Our expectation was that we would have something interesting to say because we were taking a critical look at descriptive categories from two systemically informed, but ethnically distinct, viewpoints. We now think that the journey we undertook in our quest to be true to ourselves while planning the workshop reflects the title of the conference vividly enough to form the main focus of this chapter.

 

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