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Dialogues on DifferenceReview - Dialogues on Difference
Studies of Diversity in the Therapeutic Relationship
by J. Christopher Muran (Editor)
American Psychological Association, 2006
Review by Anca Gheaus, Ph.D.
Jul 22nd 2008 (Volume 12, Issue 30)

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.


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