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Maximizing Effectiveness in Dynamic Psychotherapy Self-Compassion in Psychotherapy101 Healing StoriesA Clinician's Guide to Legal Issues in PsychotherapyA Map of the MindA Primer for Beginning PsychotherapyACT With LoveActive Treatment of DepressionAffect Regulation, Mentalization, and the Development of SelfAlready FreeBad TherapyBecoming an Effective PsychotherapistBecoming MyselfBefore ForgivingBeing a Brain-Wise TherapistBetrayed as BoysBeyond Evidence-Based PsychotherapyBeyond MadnessBeyond PostmodernismBinge No MoreBiofeedback for the BrainBipolar DisorderBody PsychotherapyBoundaries and Boundary Violations in PsychoanalysisBrain Change TherapyBrain Science and Psychological DisordersBrain-Based Therapy with AdultsBrain-Based Therapy with Children and AdolescentsBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerBuffy the Vampire Slayer and PhilosophyBuilding on BionCare of the PsycheCase Studies in DepressionCaught in the NetChild and Adolescent Treatment for Social Work PracticeChoosing an Online TherapistChronic DepressionClinical Dilemmas in PsychotherapyClinical Handbook of Psychological DisordersClinical Intuition in PsychotherapyClinical Pearls of WisdomCo-Creating ChangeCognitive Therapy for Challenging ProblemsCompassionConfessions of a Former ChildConfidential RelationshipsConfidentiality and Mental HealthConfidingContemplative Psychotherapy EssentialsControlConversations About Psychology and Sexual OrientationCoping with BPDCouch FictionCounseling in GenderlandCounseling with Choice TheoryCouple SkillsCrazy for YouCreating a Life of Meaning and CompassionCreating HysteriaCritical Issues in PsychotherapyCrucial Choices, Crucial ChangesDeafness In MindDecoding the Ethics CodeDeconstructing PsychotherapyDeep Brain StimulationDemystifying TherapyDepression 101Depression in ContextDialogues on DifferenceDissociative ChildrenDo-It-Yourself Eye Movement Techniques for Emotional HealingDoing CBTE-TherapyEarly WarningEncountering the Sacred in PsychotherapyEnergy Psychology InteractiveErrant SelvesEssays on Philosophical CounselingEssentials of Wais-III AssessmentEthically Challenged ProfessionsEthics and Values in PsychotherapyEthics in Plain EnglishEthics in Psychotherapy and CounselingExercise-Based Interventions for Mental IllnessExistential PsychotherapyExpectationExploring the Self through PhotographyExpressing EmotionFacing Human SufferingFairbairn's Object Relations Theory in the Clinical SettingFamily TherapyFavorite Counseling and Therapy Homework AssignmentsFear of IntimacyFlourishingFolie a DeuxForms of Intersubjectivity in Infant Reasearch and Adult TreatmentFoundations of Ethical Practice, Research, and Teaching in PsychologyFreud and the Question of PseudoscienceFrom Morality to Mental HealthFundamentals of Psychoanalytic TechniqueGenes on the CouchGod & TherapyHalf Empty, Half FullHandbook of Clinical Psychopharmacology for TherapistsHandbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual ClientsHandbook of Evidence-Based Therapies for Children and AdolescentsHealing the Heart and Mind with MindfulnessHeinz KohutHelping Children Cope With Disasters and TerrorismHigh RiskHistory of PsychotherapyHow and Why Are Some Therapists Better Than Others?How Clients Make Therapy WorkHow People ChangeHow Psychotherapists DevelopHow to Fail As a TherapistHow to Go to TherapyHypnosis for Inner Conflict ResolutionHypnosis for Smoking CessationI Never Promised You a Rose GardenIf Only I Had KnownIn Others' EyesIn SessionIn Therapy We TrustIn Treatment: Season 1Incorporating Spirituality in Counseling and PsychotherapyInside the SessionInside TherapyIs Long-Term Therapy Unethical?Issues in Philosophical CounselingIt's Not as Bad as It SeemsItís Your HourLearning ACTLearning from Our MistakesLearning Supportive PsychotherapyLetters to a Young TherapistLife CoachingLogotherapy and Existential AnalysisLove's ExecutionerMadness and DemocracyMaking the Big LeapMan's Search for MeaningMetaphoria: Metaphor and Guided Metaphor for Psychotherapy and HealingMind GamesMindfulnessMindfulness and AcceptanceMindfulness-Based Cognitive Therapy for DepressionMindworks: An Introduction to NLPMockingbird YearsMoments of EngagementMomma and the Meaning of LifeMotivational Interviewing: Preparing People For ChangeMulticulturalism and the Therapeutic ProcessMultifamily Groups in the Treatment of Severe Psychiatric DisordersNarrative PracticeOn the CouchOne Nation Under TherapyOur Inner WorldOur Last Great IllusionOutsider ArtOutsider Art and Art TherapyOvercoming Destructive Beliefs, Feelings, and BehaviorsOverexposedPathways to SpiritualityPersonality and PsychotherapyPhilosophical CounselingPhilosophical Counselling and the UnconsciousPhilosophical Issues in Counseling and PsychotherapyPhilosophical PracticePhilosophy and PsychotherapyPhilosophy for Counselling and PsychotherapyPhilosophy PracticePhilosophy's Role in Counseling and PsychotherapyPillar of SaltPlan BPlato, Not Prozac!Polarities of ExperiencesPower GamesPractical Psychoanalysis for Therapists and PatientsPrinciples and Practice of Sex TherapyProcess-Based CBTPsychologists Defying the CrowdPsychology, Psychotherapy, Psychoanalysis, and the Politics of Human RelationshipsPsychosis in the FamilyPsychotherapyPsychotherapyPsychotherapy and ConfidentialityPsychotherapy As PraxisPsychotherapy East and WestPsychotherapy for Children and AdolescentsPsychotherapy for Personality DisordersPsychotherapy Is Worth ItPsychotherapy Isn't What You ThinkPsychotherapy with Adolescent Girls and Young WomenPsychotherapy with Children and AdolescentsPsychotherapy without the SelfPsychotherapy, American Culture, and Social PolicyRapid Cognitive TherapyRational Emotive Behavior TherapyRational Emotive Behavior TherapyRationality and the Pursuit of HappinessRebuilding Shattered LivesReclaiming Our ChildrenRecovery OptionsRelationalityRent Two Films and Let's Talk in the MorningSaving the Modern SoulScience and Pseudoscience in Clinical PsychologySecond-order Change in PsychotherapySelf-Compassion in PsychotherapySelf-Determination Theory in the ClinicSelf-Disclosure in Psychotherapy and RecoverySerious ShoppingSex, Therapy, and KidsSexual Orientation and Psychodynamic PsychotherapySigns of SafetySoul Murder RevisitedStaring at the SunStraight to JesusStrangers to OurselvesSubjective Experience and the Logic of the OtherTaking America Off DrugsTales of PsychotherapyTales of UnknowingTalk is Not EnoughTalking Cures and Placebo EffectsTelling SecretsThe Behavioral Medicine Treatment PlannerThe Body in PsychotherapyThe Brief Couples Therapy Homework Planner with DiskThe Case Formulation Approach to Cognitive-Behavior TherapyThe Challenge for Psychoanalysis and PsychotherapyThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Couch and the TreeThe Couples Psychotherapy Treatment PlannerThe Crucible of ExperienceThe Cure of SoulsThe Death of PsychotherapyThe Education of Mrs. BemisThe Ethical Treatment of DepressionThe Ethics of PsychoanalysisThe Gay and Lesbian Psychotherapy Treatment PlannerThe Gift of TherapyThe Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work The Healing JourneyThe Heart & Soul of ChangeThe Heroic ClientThe Husbands and Wives ClubThe Love CureThe Making of a TherapistThe Mindful TherapistThe Mirror Crack'dThe Mummy at the Dining Room TableThe Neuroscience of PsychotherapyThe Neuroscience of Psychotherapy: Healing the Social BrainThe New Rational TherapyThe Older Adult Psychotherapy Treatment PlannerThe Other Side of DesireThe Pastoral Counseling Treatment PlannerThe Philosopher's Autobiography The Pornographer's GriefThe Portable CoachThe Portable Ethicist for Mental Health Professionals The Present Moment in Psychotherapy and Everyday LifeThe Problem of EvilThe Problem with Cognitive Behavioural TherapyThe Psychodynamics of Gender and Gender RoleThe Psychotherapy Documentation PrimerThe Psychotherapy Documentation PrimerThe Psychotherapy of HopeThe Real World Guide to Psychotherapy PracticeThe Schopenhauer CureThe Sex Lives of TeenagersThe Talking CureThe Therapeutic "Aha!"The Therapist's Guide to PsychopharmacologyThe Therapist's Guide to Psychopharmacology, Revised EditionThe Therapist's Ultimate Solution BookThe Trauma of Everyday LifeThe Trouble with IllnessThe UnsayableThe Way of the JournalTheory and Practice of Brief TherapyTherapy with ChildrenTherapy's DelusionsTheraScribe 3.0 for WindowsTheraScribe 4.0Thinking about ThinkingThinking for CliniciansThinking for CliniciansThoughts Without a ThinkerThriveToward a Psychology of AwakeningTracking Mental Health OutcomesTrauma, Truth and ReconciliationTreating Attachment DisordersTreatment for Chronic DepressionTreatment Plans and Interventions for Depression and Anxiety DisordersUnderstanding Child MolestersUnspeakable Truths and Happy EndingsWhat the Buddha FeltWhat Works for Whom?What Works for Whom? Second EditionWhen the Body SpeaksWhispers from the EastWise TherapyWittgenstein and PsychotherapyWorking MindsWoulda, Coulda, ShouldaWriting About PatientsYoga Skills for Therapists:Yoga Therapy
Psychotherapy is often perceived as diminishing our capacity to criticize the world and uncover its many forms of injustice. After all, its goal is to empower clients to deal better with life's challenges, to pursue their dreams more efficiently, or, at very least, to accept and to cope with the world while leading lives as functional as possible. As Freud put it a long time ago, psychotherapy is supposed to enable people to love and work. An obvious hindrance to this project is blaming one's problems on the external world -- with its unfair institutions, cruel traditions and mischievous or evil others. Indeed, in order to (re)gain due power over one's life, one has to take responsibility for what happens to oneself as well as for how one is responding to external events. To focus on changing one's own self, one might need to take away one's energy and attention from what is wrong with, and what should change in, the world.
These truths, however, do not take away the fact that we are living in an unjust world, shaped by various legacies of marginalizing, oppressing and discriminating against many groups of people. Gender, race, class, sexual identity, age, bodily and intellectual ability as well as being a migrant are embedded in one's identity as well as in the way in which we live our psychological impasses. To complicate things further, these identities often intersect and many individuals have to live with multiple, and complexly interacting, histories of social exclusion. For a long time, psychoanalysis as well as other schools of psychotherapy have obscured or, even worse, mystified issues related to social exclusion and turned a blind eye to the many injustices involved in defining "normality" and "functionality". One of the best known examples is the long history of pathologizing and medicalizing homosexuality within psychoanalysis. The book edited by Cristopher Muran provides both an illustration of the recent turn, within psychotherapy, towards integrating and engaging previously ignored questions concerning difference, and an invitation to reflect on how this turn has affected both psychological theory and practice.
The book brings together 29 practitioners, engaged in conversations about the meaning of race, gender, sexual identity and cultural differences in therapy. It consists of eight similarly structured dialogues, each on a particular theme. Every dialogue starts with a paper, followed by two responses and a final comment of the author of the initial paper. Its general aim (which it successfully accomplishes) is, in the words of its author, "to encourage an open dialogue among a plurality of perspectives on a subject that is central to understanding the human condition and the possibility of change."
The first dialogue is centered on Neil Altman's article on therapists' need to understand and accept the differences of their clients -- with an emphasis on differences stemming from varied racial and cultural backgrounds. Altman makes a strong case in favor of the therapist's exercise in understanding difference by seeing herself/himself as different from the client's perspective. This involves renouncing to think about some expectations and values as being the norm. Instead, one should understand the relationship between client and therapist as one between two people coming from different cultures, without presuming what Altman calls a "God's-eye view", and by which he means something like "the way things should be."
The second dialogue starts with an article by Beverly Greene and stresses the importance of psychotherapy taking into consideration the intersection of various identities associated with marginalization, and of the fact that one and the same person can find herself at different ends of power relationships in different contexts.
The third dialogue, introduced by Jack Drescher, addresses issues of difference in working with homosexual clients, and includes a very welcome, if short, history of the difficulties that psychoanalysis as a discipline had with accepting homosexuality.
The fourth dialogue, around Anderson Franklin's introductory article, looks at race and gender in psychotherapy with African American men and it makes clear the particular dilemma this group of clients confronts. Many of them have to deal with especially high levels of anger; as men, they are expected to express this anger but, as Black people, such disclosure is, all things considered, riskier than it is for White people. The dialogue is useful in understanding how difficult it is to give social visibility to such "outlawed emotions" and to the racial identity of African American men in general.
The fifth dialogue, whose main article is by Mabel Quinones, discusses Latino identities in therapy and the need and vicissitudes of discussing differences within the therapeutic relationship.
Philip Wong, whose article starts the sixth dialogue, writes on Asian identities, discussing the so-called "Asian inscrutability". The dialogue addresses the important questions of the neutrality of the therapist in the context of the Asian cultural background as it is shaped by Confucianism and of the Asian clients' perceived need for more directive therapies.
The seventh dialogue starts with an article by Annabella Bushra, Ali Khadivi and Souha Frewat-Nikowitz and is about cultural differences in working with clients from the Middle East and their feelings of loss of social status and community as they migrate. As expected, the dialogue also discusses the perception of this group of clients in connection with the current international climate of aggression.
The last dialogue is organized around the editor's own essay and it is a more general discussion of the integration of difference in psychotherapy and how this had benefited from the relational turn. The fact that we actually have multiple selves, informed by multiple identities and created within relationships, emerges again in this dialogue.
A question that readers of many of the articles in this book (by virtually all readers of the chapters on cultural differences) will likely ask themselves, and which is indirectly raised by the very concept of the book, is whether we could analyze cultural norms and expectations themselves other than by adopting what Altman calls a "God's-eye view". And, supposing this is not possible, should we not however aim to analyze these expectations? A universalistic approach to at least some of the values might be, after all, necessary, no matter how risky.
A book, encompassing so broad a field, cannot, of course, go very deep in exploring in detail all the issues it addresses. But it can offer readers a taste of what it means to research the encounter between therapy and marginalized identities, both at the level of developing theory and at the level of practice -- and Muran's book does this well.
© 2008 Anca Gheaus
Anca Gheaus is working in moral and political philosophy, with a focus on the ethics of care and theories of distributive justice. Currently she is a postdoctoral researcher at the Universite Catolique de Lille.