Inés Sametband, Tamara Wilson, and Chee-Ping Tsai
Introduction
“Culture is the one thing we cannot deliberately aim at.”
—T. S. Eliot (1948, p. 19)
As clinicians, our (Inés, Tamara, and Chee-Ping) initial training was influenced by theorists promoting multicultural competence (e.g., Aron- son Fontes & Thomas, 1996; Bezanson & James, 2007; Falicov, 1995;
McGoldrick & Hardy, 2008). We believe that these guidelines helped in raising awareness of ethnocentric views that historically influenced therapeutic relationships and the mental health professions in general.
However, our view now is that more can be done to ensure that cultural differences are not only recognized but also spoken about and negotiated in therapeutic conversations. By doing so, we believe that therapists can identify and move beyond interpersonal patterns that promote and sus- tain discourses of unfair privilege and social injustice. We describe how practitioners at the Calgary Family Therapy Centre (CFTC) using the IPscope found ways out of rigid, reified cultural interactions (Pathologiz- ing Interpersonal Patterns or PIPs) to engage in culturally negotiated ones (Healing Interpersonal Patterns or HIPs) by bringing forth new therapeu- tic distinctions to the culturally-laden issues that are often part of their practice.1 In this chapter, we focus on how therapists may find ways to move forward in conversations with clients beyond seemingly irreconcil- able cultural practices.
About the Authors
I (Inés) am a Caucasian woman born in Argentina who comes from a family in which immigration has been a recurring practice. My maternal
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great-grandparents and grandparents moved from Lithuania and Ukraine to Argentina before World War I, my paternal grandparents and my father from Poland to Argentina before World War II, and part of my extended family moved to Israel and Spain in the 1970s. Growing up, it was not easy to understand or explain my cultural identity: a mix of mid- dle class, European, Argentinian, and non-religious Jewish values. When I moved to Canada, I was faced again with the complexity of explaining my cultural background and often experienced what it feels like to be ste- reotyped. Many assume that because I am from South America, I am of Spanish descent and Catholic. To make matters more complicated, when I go back to Argentina, many assume that living in Canada means that I am doing very well financially. How we relationally create, maintain, and manage our situated cultural identities is something that I am very interested in and hope to continue researching.
I (Tamara) am a Black woman who was born and raised in a small farming community outside of Edmonton, Alberta, Canada. My parents emigrated from St. Lucia, West Indies, and somehow found their way to Lamont, Alberta. Given that the population of this town was approxi- mately 1,700 people, we were the only Caribbean family to ever set foot in the community. This brought with it a myriad of questions and lim- ited understandings from some members of the community. However, it also presented some wonderful opportunities to educate and enlighten others about being Black. While the majority of my experiences with my peers were very positive, I recall feeling quite oppressed in my early school years by teachers and other school personnel. Although I am Canadian, I felt very different and at times isolated because of my cul- tural ethnicity. Interestingly, I also noticed some reoccurring stereotypes that emerged from family and friends from St. Lucia who assumed that life abroad meant instant success and riches, again leading to feelings of being misunderstood and isolated. It was these experiences that led to becoming more curious not only about others’ experiences but also about how their cultural uniqueness is addressed and utilized in thera- peutic settings.
I (Chee-Ping) am an Asian woman who was born and lived with my family in Hong Kong until my early 20s. My journey with culture began at birth, when I was given a traditional male name. Chee-Ping means leading a country and being the world peacekeeper. Also, growing up as the only girl and being the youngest child in my family, I enjoyed many privileges and freedoms, especially considering that, traditionally, Chinese sons are entitled to more privileges than daughters. My cultural experi- ences have been expanded by living in both Hong Kong and Canada.
Social interactions with people from other cultures not only allowed me to learn about cultures different from mine but also opened opportunities for me to reflect on my own culture, my own well-being, and my evolving
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identity. I appreciate that people were interested in my culture, which made me feel unique, even though I am a visible minority. Moreover, I appreciate and enjoy the similarities and differences across individuals.
Among many lessons learned, one that stays close to my heart is that cul- ture permeates through interactions with others every moment as we all are living in it. This first-hand lived experience has sparked my interest, awareness, and sensitivity to cultural issues within a therapeutic context.
Cultures as Degrees of Difference
We understand cultures as ways of living (Monk, Winslade, & Sinclair, 2008)—that is, as peoples’ shared practices and ways of relating, includ- ing the cultural discourses (see Chapter 6) through which these practices and relatings make sense. These cultural discourses are present in our conversations with each other (e.g., in the words of the language we speak), in how we understand and engage in different social practices (e.g., greetings, rites of passage, parenting activities), in how we perform our memberships in particular cultural groups (e.g., using a burka, or a Mohawk hairstyle), and in how we account for who we are as cultural beings. We usually assume that people around us share the same way of understanding and going about life, but when we encounter differences we are invited into foreign (to us) cultural practices, or when we are exposed to different Socio-Cultural Interpersonal Patterns (SCIPs) than the ones we are accustomed to, tensions over what those differences mean may become more apparent.
How we do things culturally (or locally) can be seen in simple prac- tices such as setting the dinner table: some people use bowls or light candles, and others have specific rules about who sits where. Sitting at a dinner table is not usually a controversial issue, and even if we do not like the dinner setting rules, it is quite easy for most of us to adopt them as a courtesy toward our hosts. However, when the cultural practices are more contentious or hold opposite or varied meanings for different people, engaging in doing things together becomes more difficult. The parties involved are then faced with alternative options for how to go forward; these could include ignoring the differences and keeping the ten- sion inside, acknowledging differences from their own culture, explaining what these differences mean to themselves and to others, negotiating a new meaningful way forward, passing demeaning judgments upon oth- ers, protesting in ways that are respectful, protesting in ways that could lead to increasing conflict, or blatantly imposing one’s cultural prefer- ences upon others (guaranteed to generate conflict).
It could be said that every encounter is intercultural2 to some degree.
Cultures, as ways of living, may be only slightly different (i.e., how
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partners set the dinner table, understand parenting, or participate in a classroom) or drastically different (i.e., speaking different languages, holding opposite values, embracing different religious beliefs, or enact- ing different citizens’ rights and obligations within different political systems). When the degree of cultural differences among people is sig- nificant, we believe that new, negotiated HIPs and Wellness Interpersonal Patterns (WIPs) may need to be created to develop and maintain mean- ingful relationships. It may be necessary to push ourselves out of familiar Interpersonal Patterns (IPs) (i.e., influenced by SCIPs we are accustomed to) to unknown or unaccustomed ways of relating with one another. At times however, the degree of difference in how we understand and do things culturally is so important or vital to us that we feel unnerved by the prospect of altering them, sensing that it is too risky to venture into unknown IPs.
In therapeutic conversations, we see ourselves (as therapists) and cli- ents habituating to each other’s responses according to what we under- stand to be culturally appropriate or fitting, consistent with how all of us orient to, and are influenced by, particular socio-cultural discourses. For example, family members may view their relationship with a clinician as one in which advice-giving is coupled with receiving and accepting advice (e.g., influenced by a discourse of expertism). In contrast, a therapist may try to orient his or her interaction with clients from a collaborative and discursive stance (e.g., being curious and inviting openness or sharing).
When these differing cultures about therapy meet, family members and therapists may need to work out their understandings of the therapeutic encounter (e.g., collaborative, advice-giving, or something else) to engage effectively. By keeping their interactions acceptably familiar (see Chap- ter 4) therapists and clients may orient more easily toward more TIPish (from Transforming Interpersonal Patterns) and HIPish conversations.
Developing a Relational Intercultural Sensitivity
In the same way that we recognize our sensitivity to heat, and learn not to put our hands directly into a fire when we want to get warm, as therapists we may need to learn what we call relational intercultural sensitivity to avoid getting burned by cultural differences. In our conversations with others, we see ourselves as relationally sensitive in how we sense and make sense of each other’s responses when we become curious (e.g., ask questions) or are moved (e.g., become teary) as a response to someone’s story that evokes values that are important to us. In contrast, we may respond in a relationally insensitive manner by becoming dismissive or disengaged (e.g., dismissing the other person’s account in favor of our own ways of making sense about an experience) when someone’s story
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evokes something that is too strange, or that we see as reproachable. In our work, we use Tomm’s (1987) interventive interviewing approach for developing a heightened consciousness while interviewing clients, which involves developing a sensitivity to ongoing cues within the therapeutic system. We feel that developing this sensitivity to actual effects can be particularly useful as a way to orient to, and acknowledge others’ and our own, understandings of the tensions between cultural sameness and differences and the influence of those tensions in our interactions.
Developing a relational intercultural sensitivity may help therapists prevent or find ways out of Deteriorating Interpersonal Patterns (DIPs) and PIPs, especially when peoples’ cultural ways of being and doing things are seen in absolute terms (e.g., correct/incorrect or true/false). We see these seemingly inescapable traps or objectionable conversations as what is commonly called a “culture clash.” We view these culture clashes as maintaining and promoting differences in privileges and entitlements (Tomm, 2011), and associated with discourses of certainty, privilege, and violence (see Chapters 6 and 11). Sadly, at a macro social level, we see many devastating examples of these culture clashes (e.g., slavery, West- ern colonization, the Holocaust). The magnitude and complexity of these historical examples exceed the scope of this chapter; however, on a more micro level, we believe that in some occasions conflicting socio-cultural discourses operate at the forefront in therapeutic interactions (see Chap- ters 5 and 6 for an extended discussion and examples of SCIPs associated with PIPs), and we will focus on these occurrences for the remainder of this chapter.
We believe that a useful way to develop or enhance relational inter- cultural sensitivity is to first recognize and acknowledge that clients’
and therapists’ interactions are oriented to and influenced by a variety of different cultural discourses. Any particular cultural discourse can effectively explain some behaviors and interactions but may also limit generative dialogue, perhaps unintentionally leading to oppressive prac- tices. For example, people from Western societies are often described as individualistic and as putting their individual interests first, while non-Western groups are often defined as collectivistic and as placing family or community first. While these depictions could resonate as accurate for many, their generalizing and stereotyping effects limit how people from these cultural groups understand and relate to one another (Waldegrave, 2012).
Totalizing cultural assumptions can lure participants into discursively captured systems (see Chapter 2) whereby behaviors are interpreted and responded to as fitting only into rigid categories (e.g., “individualistic” or
“collectivistic”). When, in conversations together, our responses to each other are experienced as unacceptable (see Chapter 4)—that is, when our cultural views “clash”—we may find ourselves reacting strongly to
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other people’s attitudes and actions. This may lead us (e.g., therapists and clients) to engage in DIPs (e.g., misunderstanding and failing to clarify coupled with responding with ambiguity or confusion), which could dete- riorate into PIPs (e.g., defining the other’s beliefs and practices as wrong coupled with rejecting the judgments with indignation and contempt).
Thus, we need to continually orient our intercultural relational sensitiv- ity to the SCIPs that are being sustained, developed, or challenged in our conversations with clients. With a process of turn-by-turn negotiating of objectionable meanings into acceptable meanings (Strong & Tomm, 2007), we can reorient to our conversations in culturally respectful ways.
We will focus on such possibilities next.
From Culture Clashes to Acceptable Intercultural IPs
We find that by developing a habit of looking at problematic cultural issues through the lens of the IPscope, we are much less likely to become polarized by cultural differences and are more likely to jointly find ways forward. No matter how experienced or skillful we may be as therapists, it is easy for us to recall times when we felt stuck in our efforts to develop constructive conversations with our clients, times when we needed to turn to further resources (e.g., supervision, consultation, videotape review) in order to find a way forward. It has also been our experience that on some occasions, the tension between clients’ and our own cultural ways of being and understanding was quite challenging—to the point that the emotional charge was surprising, sometimes frustrating, and even powerlessness- inducing. We understand these tension-filled conversations or culture clashes as occasions in which SCIPs enacted by clients and therapists in conversations may seem radically unfamiliar, almost invasive, and hence too disagreeable to be negotiated. When the resultant PIPs (and associated SCIPs) are not recognized, the apparent irreconcilability of these differing ways of understanding and being between parties in the therapeutic con- versation may draw us further into a DIP or a different PIP, rather than allow movement toward a TIP, a HIP, and eventually a WIP.
We find it useful to differentiate between two types of PIPs (see Chapter 1):
those that are mutually and bilaterally destructive, and those that are unbalanced in that one party seems to benefit from occupying a more dominant position in the pattern. We focus in this chapter on the latter kind of PIPs, as we view these more closely related to culture clashes, due to their association with discourses of certainty, privilege, and vio- lence, as discussed earlier. For example, in one of the most malignant PIPs that maintains injustice (i.e., oppressing coupled with submitting) we see the person engaged in oppressive practices as benefiting (in terms of maintaining privilege and access to resources) compared to the per- son who submits to those oppressive practices (with a caveat that the
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benefits that accrue to the oppressor may also be limiting and harmful to him/her when adopting a larger contextual perspective). An example of this may occur when as therapists, we presume we possess greater knowledge than clients, focus on all their problems and deficits, and initiate a PIP of imposing our “professional truth” upon them. Within this discourse of professionalism, we maintain a position of privilege that contributes to disempowering clients, implying that they need con- tinuing help from us as professionals. By submitting to our “superior”
knowledge, they unwittingly diminish their own potential generativity for preferred changes in their own lives. Within this unbalanced PIP, we live the illusion of winning as they lose, when in fact we both lose (in that poor client outcomes imply ineffective therapists).
We believe that becoming more sensitive to practices related to injus- tice and inequality can be very helpful in our work with clients. In trying to recognize and become more aware of PIPs associated with inequality and injustice, we started using the phrase “pulling the culture card” to refer to a process of claiming a position of entitlement and dominance in certain domains of interaction. Although the action of pulling a card may be seen as individually-oriented at first, we see this move as someone’s last-resort power play in an interaction involving a culture clash. For example, when a person experiences his or her cultural values or practices as misunderstood or disrespected, he or she may utter something like
“this is the way we do it in my culture” to strongly assert the importance of one’s preferred position and values. This seemingly closed remark or conversation stopper (T. Strong, personal communication, May 29, 2013) may be pointing to how some cultural practices or discourses are (mis)understood or disrespected by conversational partners.
It may appear as if the action of pulling a card (by invoking a particular SCIP as the only way to understand a situation) puts an end to a certain conversation. We propose, instead, that pulling the culture card be seen as an invitation to revise and re-orient an interaction, calling the respon- dent’s attention to how totalizing assumptions about him- or herself or others may be influencing his or her interaction (e.g., people from col- lectivistic cultures defer to authority, or Canadians are distant). That is, rather than responding to pulling the culture card by pulling another card, which would further sustain a PIP or slip into DIP, we see these occur- rences as opportunities for therapists to consider how SCIPs invoked in the conversation may be limiting possibilities of understanding. In our work, we found it useful to keep in mind some of the following questions when trying to implement some relational intercultural sensitivity:
• What might I (the therapist) be missing in this situation?
• If someone asked the family I was working with if I was respectful/
sensitive to their cultural ways of being and relating, what might they