Therapy, Culture and Spirituality: Developing Therapeutic Practice

By W. West

This edited collection addresses how therapy can engage with issues of race, culture, religion and spirituality. It is a response to the need for practitioners to further their understanding and skills base in developing ways of appropriately responding to the interconnectivity of these evolving issues.

• Language: English
• Publisher: Palgrave Macmillan
• Release date: Dec 4, 2014
• ISBN: 9781137370433

Book preview

Introduction

Greg Nolan and William West

It is probably true that all societies have had something akin to counsellors and psychotherapists whatever labels they have operated under and in whichever context their work has occurred. We are aware of the dramatic social changes occurring in our world – the impact of the internet, climate change, globalisation and the impact and aftermath of the world banking crisis – and how these changes directly impact on all people and therefore affect and alter therapeutic practice. An inevitable consequence of these changes can be experienced as a distinct loss of control over life events, potentially problematic where the focus in Western nations is on the self-determining individual whose fate lies in their own hands. For the majority of the world’s population a ‘collective’ perspective on the self is challenged when dominant financial markets and cultural models influence the control and distribution of global resources, these in their turn being subject to interpretation from national political management and differing regional worldviews/belief systems. In these circumstances the wellbeing of people within both ‘developed’ and emerging nations can be perceived as coming under increasing stress, particularly when meanings are subject to ‘truths’ via social media and the internet.

Roy Moodley (Moodley & Oulanova, 2011) argues for a consideration of seven social identities when considering a notion of multiculturalism, a ‘Group of Seven’ that consists of gender, race, class, sexual orientation, disability, age and religion. In this book we are mainly focusing on two areas: religion–spirituality and race–culture. These aspects are distinctly interrelated and although often considered separately, it is useful to consider both together in relation to therapeutic practice whilst acknowledging the other five aspects.

We feel that a careful consideration of spirituality and religion in a therapeutic context requires that culture and race or ethnicity be also kept in mind and that cultural differences are nuanced in the context of spirituality and religion. Most of our contributors have largely focused on one of these aspects, or foregrounded it, but have also acknowledged the other aspect. To cover both in good detail would have led to unwieldy chapters and a briefer and perhaps less explored treatment would have not proved satisfying.

Counselling, like religion, is in part a response to human suffering and whilst suffering does vary from culture to culture it is a common feature of human existence. Our hope in writing and editing this book is that it might make a contribution however small to understanding and, above all, responding in a useful way to whatever human ‘being’ might mean.

Whilst mindful of the impact of culture(s) on the individual, family and wider community, we believe that within the spirit of counselling and psychotherapy there is the potential for the individual, family and community to step back and reflect on their lives. Indeed this is arguably what makes us humans human. Clearly our cultural backgrounds might well limit the extent to which we can self-reflect, indeed our native language will structure and potentially limit how we can verbalise and maybe even think about our lives. We notice here how counselling is all about supporting our clients in putting into their own words the struggles and challenges they experience in their lives.

Although we see this position as having at least some pragmatic usage we certainly are not claiming anything universal here. Indeed, given that both the editors of this book are male, educated, white and of a certain age then there are, and will be, assumptions underpinning our writing here, some of which will likely remain unconscious to us or subject to interpretation. In our attempt to address the issue of human diversity there may be similar limitations in our authors, although we have endeavoured to attract people from a spread of backgrounds as will be apparent from the list of contributors and their chapters. There remains a paradox in facing the challenge of attempting to differently articulate what we sense, and in the sensing ‘know,’ what is elusive in the ‘saying’, let alone the ‘said’ of words on the page.

In considering being and meaning ‘differently’ we need to be mindful of how meaning-making is processed through ‘language’ and speech and that how language forms its use is inevitably embedded within a cultural and social context. Psychological encounter through dialogue involves the engagement of mind/body in a neurophysiological construction of meaning through affect response, cognition and emotion (Porges, 2011). This process recognises the neurobiology involved in sequencing the image-symbol-emotion gut-response. This informs the semantic origin of a thought (e.g., Kellis et al., 2010; Leuthardt et al., 2011; Graham-Rowe, 2011) towards its cognition and verbal (or other language medium) expression. Some recent research suggests that communication through feelings and emotions between people from different culturally situated languages can be problematic (e.g., Connell, 2013; Costa, 2010; Pavlenko, 2005). However, Connell (2013) suggests that, in a relational encounter that generates ‘joint meaning making’, a ‘third language’ is co-constructed as ‘a result of integrating professional and language identities’.

Perhaps there is something of the essence of human interaction, communication and language that we are attempting to address through these explorations on intersubjective relating towards ‘mutual recognition’ (Benjamin, 1999). It is where those implicitly known moments (BCPSG & Nahum, 2008) are jointly witnessed, experienced as intrinsically affirming, and feed a shared human need to perceive meanings beyond our temporal existence.

Within the therapeutic frame a plurality of professional practice and ethical relational engagement is needed when considering clinical contexts of multiple ‘difference’. It is in this way, at a time of rapid social change likely to be seen by future historians as akin to a social and cultural revolution, that the reader might view ideas in these collected chapters.

What’s in this book?

The contributions here represent a rich seam of counselling and psychotherapeutic research, knowledge and experience relating to the themes of this book. Each author brings their own deep understandings of their topic to their writing. We have arranged the chapters in an order which we think will appeal to our readers. You are free of course to read the chapters in any order you choose.

We begin with Roy Moodley and Claire Barnes chapter on multiculturalism, religion and counselling, which in many ways sets the scene for the rest of this book with its exploration of the developing rapprochement between psychology and religion. They note the role of multiculturalism in this and tease out the overlapping relationship between multiculturalism and spirituality.

Jeni Boyd’s captivating chapter visits the Native American traditions of the Ojibwe, reflecting on her relationship with their teachings and with the work of Carl Jung. Jeni draws on her clinical practice working within the NHS to reflect on the part played by spirituality in counselling using the Ojibwe and Jungian traditions.

This link to Jung is continued in Christa Gorsedene’s chapter, which poetically leads us into exploring the interconnected world of synchronicity. There is a profound spiritual quality to her chapter, indeed to most people’s experience of synchronicity.

Nasreen Mansoor’s chapter invites us to enter the world of honour and shame as experienced within the South Asian British Muslim community. It is a candidly open observation of a painful journey where she meets with relational nuances in social and spiritual plurality – challenging factors we believe need acknowledging by all practitioners, and to be faced up to without prejudice and without flinching.

William West then poses the question ‘Does one Western size fit all?’ as he shares his experiences of interviewing trainers using Western models of counselling in Bangalore, Manchester, Moscow and Nairobi.

David Paul Smith returns us to the Native American traditions in North America, sharing some of his own journeying through sweat lodges, clinical psychology and hypnosis. He also invites us to take a critical stance in relation to ‘objectivity’ in science and Freud, offering perspectives on potential for a feminist paradigm in medicine.

Wayne Richards invites us poetically to ‘embrace the rainbow’ and heal the split between our self and others in which race would disappear, a ‘liminal space’ between the ‘illusory nature’ of black and white duality. He also reminds us that the therapeutic space is not neutral and that whilst some stories are not voiced they are still experienced.

Terry Biddington considers the challenges of working on religiousbased pastoral care programmes in higher education involving multicultural and multi-faith students and staff. He poses the question of ‘saving sanity or souls’ as he invites us to consider the overlap and differences between counselling and religious pastoral care and what each approach could learn from the other given the will.

Dori Yusef in her own poetic way asks us to engage with the idea of witnessing in an embodied way. Such witnessing involves deeply listening and dialoguing with self and with others. For many this will be seen as being at the heart of the therapeutic and pastoral encounter.

Greg Nolan then describes his research into therapeutic supervision, looking at significant events and phenomena in clinical supervision that challenged therapists’ and supervisors’ sense-making, meaning structures or theoretical approaches. By juxtaposing ‘spiritual’ with ‘psychoanalytic/psychodynamic’ and ‘natural science’ perspectives, insights are identified into relational complexity and factors that impact on effective and less good supervision relationships.

Staying close to training and practice issues, Valda Swinton explores the spiritual in counsellor training, drawing on her research into trainees’ experiences as well as her own experiences as a trainee and as a counsellor trainer. She considers the debate around the relative absence of spirituality within counsellor training programmes in Britain, observing how implicit phenomena within a training group may be witnessed explicitly.

Peter Madsen Gubi then invites us into the territory of counselling and spiritual accompaniment, drawing on his considerable research, scholarship and practice in this field and, with case examples, inviting us to see the many links and overlaps between the world of spiritual accompaniment and the world of counselling, especially from a person-centred perspective.

The world of Sikh men living in Britain and the challenges they face around acculturation is investigated by Kam Dhillon. He considers the relationship between spirituality–religion, ethnicity and mental health and common issues reported from the Eastern and Western perspectives of psychotherapy. He offers a brief history of Sikhism before exploring findings from a study on cultural marginality and mental health with Punjabi Sikh men living in the West Midlands accessing counselling. He concludes by inviting counsellors to act in ways that empower their (Sikh) clients.

Rachel Cleary and Robert D. Schweitzer’s chapter focuses on cultural challenges in working with people from refugee backgrounds. These include an implicit challenge to the practitioner to move beyond overly focusing on the individual to a consideration of the person in community. They invite us to see: therapy as a process for addressing shadow aspects of self; therapy as a relational process; ideas around cultural humility; an understanding of cultural safety; and the benefits of drawing upon knowledges outside the discipline of psychology, including those of myths, ancestors and a notion of the ‘storied self’.

Your editors Greg Nolan and William West consider the methodological issues that arise when researchers wish to explore the topics covered in this book, with a particular emphasis on philosophical matters. We need to find ways to ground what we mean, to challenge the use of ‘language’ when researching what might otherwise be perceived as phenomenologically abstruse.

The final chapter, by William West and Greg Nolan, concludes this book by reflecting on the ground covered so far and looking forward to future developments. Your editors reflect on the possibilities and challenges of addressing the complex challenges raised by the authors within this book. Whilst effectively addressing these issues can only be an incomplete work in progress we argue that this can be seen as a reflection of the current state of humankind.

References

BCPSG (Boston Change Process Study Group) & Nahum, J.P. (2008) Forms of relational meaning: Issues in the relations between the implicit and reflectiveverbal domains. Psychoanalytic Dialogues, 18(2): 125–148.

Benjamin, J. (1999) An outline of intersubjectivity. In S. Mitchell (Ed.), Relational Psychoanalysis. Vol 1: The Emergence of a Tradition, pp.181–201. Hillsdale, NJ: The Analytic Press.

Connell, G. (2013) Making meaning in a second language: A qualitative enquiry. BACP 19th Annual Research Conference Synergy in Counselling & Psychotherapy Research, Birmingham UK, 10.05.13. http://www.bacp.co.uk/research/conf_archive/research_conference_2013.php#q3. Retrieved 29.04.14.

Costa, B. (2010) Mother tongue or non-native language? Learning from conversations with bilingual/multilingual therapists about working with clients who do not share their native language. Ethnicity and Inequalities in Health and Social Care, 3(1): 15–24.

Graham-Rowe, D. (2011) Mind readers: Eavesdropping on your inner voice. New Scientist, 210(2814): 40–43. http://www.newscientist.com/article/mg21028141.600-mind-readers-eavesdropping-on-your-inner-voice.html?full=true#.VEiv5KNwaUk Retrieved 22.10.14

Kellis, S., Miller, K., Thomson, K., Brown, R., House, P. & Greger, B. (2010) Decoding spoken words using local field potentials recorded from the cortical surface. Journal of Neural Engineering, 7: 1–10. http://iopscience.iop.org/1741-2552/7/5/056007. Retrieved 15.06.11.

Leuthardt, E.C., Gaon, C., Sharma, M., Szrama, N., Roland, J., Freudenberg, Z., Solis, J., Breshears, J. & Schalk, G. (2011) Using the electrocorticographic speech network to control a brain-computer interface in humans. Journal of Neural Engineering, 8: 1–11. http://iopscience.iop.org/1741-2552/8/3/036004.Retrieved 15.06.11.

Moodley, R. & Oulanova, O. (2011) Clients who seek traditional healing alongside counselling and psychotherapy. In W. West (Ed.), Counselling, Spirituality and Healing. London: Palgrave.

Pavlenko, Aneta. (2005) Emotions and Multilingualism. New York, NY: Cambridge University Press.

Porges, Stephen W. (2011) The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation. New York, NY: W.W. Norton & Co.

1

Multiculturalism, Religion and Counselling: Freedom to Heal

Roy Moodley and Claire Barnes

Introduction

Religion and psychology have not always been comfortable bedfellows. Historically, religion has been marginalised in mainstream psychology (Emmons & Paloutzian, 2003). For example, Sigmund Freud presented religion and spirituality as neuroses and forms of denial that limited, rather than enhanced, insight into one’s inner world (Galanter, 2005). Psychologists emulated Freud’s anti-religious stance through much of the 20th century, regarding religion and spirituality as defence mechanisms used to justify or deny certain maladaptive behaviours and emotions (Aten & Leach, 2009). Even today, psychologists as a group are far less religious than the population as a whole. For example, an American survey found that compared to the rest of the population, psychologists are ‘twice as likely to claim no religion, three times more likely to describe religion as unimportant in their lives and five times more likely to deny belief in god ’ (Delaney et al., 2007, p.542). An overwhelming proportion of Americans (95%) believe in ‘god’ and almost half (40%) attend a weekly worship service (Plante, 2009), and 80% of Canadians claimed a religious affiliation on the 2011 census. Meanwhile, psychologists tend to adopt a scientific or naturalistic view of the world (Carone & Barone, 2001).

Indeed, in certain respects religion and psychology fundamentally disagree. The psychological model of health emphasises the client’s right to autonomy and self-determination. In contrast, most world religions emphasise the primacy of the collective good, a position that complicates, if not directly contradicts, the psychological model of individual wellbeing. Psychological perspectives on coping and change also differ greatly from religious models (Carone & Barone, 2001). The medical model, which remains the dominant paradigm in psychology, advocates biological or cognitive interventions as a basis for change, while a religious model or one that is within a multicultural framework allows for the intervention of a greater power in the path towards recovery.

This uncomfortable paradigmatic fit between religion and psychology prevented, for much of the 20th century, acceptance in the psychotherapeutic profession of religion and spirituality as avenues towards healing. In recent decades, however, this longstanding distrust has begun to ease. A renewed interest in the positive role of religion in psychotherapy has been evident since the early 1990s (Aten & Leach, 2009). Religion and spirituality have been given increased attention in the mainstream counselling literature (Hagen et al., 2011), and literature on the psychology of religion has steadily grown, providing a more complex and complete picture of how these two constructs intersect (Miller & Kelley, 2005). Therapists are increasingly embracing the role of religion and spirituality in their client’s lives, viewing it as integral to their clients’ identity, worldview, health and wellbeing. Anecdotal evidence suggests that most mental health practitioners are more tolerant of a client’s narrative of struggle and recovery if it is infused with religious ideas. Dual interventions are increasingly common, with clients visiting a Western psychotherapist and traditional healer concurrently (Moodley et al., 2008). This promising direction of treatment provides clients with access to both spiritual and scientific wisdom regarding psychological wellbeing, mitigating possible value conflicts with mental health providers (Moodley et al., 2008). Clinicians are increasingly recognising the points of compatibility between religion and psychology: the two domains share a focus on growth, inner experience and human flourishing. Tellingly, a recent study (Lawrence et al., 2013) suggests that, nowadays, physicians and psychiatrists are not in fact biased against religion. The authors found no evidence that psychiatrists are less likely than physicians to recommend religious involvement to their clients. Furthermore, primary care physicians are more likely to recommend that patients get involved in their religious communities when the physician or the patient is religiously observant, indicating that physicians and psychiatrists alike generally view religion as a positive force in their patients’ lives.

One reason behind this recent rapprochement of religion and psychology is the publication of numerous research studies revealing empirically validated associations between religion/spirituality and positive outcomes (Miller & Kelley, 2005). Some have questioned the conclusiveness of these studies (King et al., 1995). Indeed, a closer examination of the studies suggests that many have only examined the absence or presence of religious practice in relation to illness (Pressman et al., 1990), or the religiosity of terminally ill patients (e.g., Nelson et al., 2002), or the effects of prayer on depression and anxiety (e.g., Boelens et al., 2012); and some studies demonstrate negative as well as positive effects of religion and spirituality (Ano & Vasconcelles, 2005; Green & Elliott, 2010). These caveats notwithstanding, the association between religiosity and positive outcomes seems well-established: people who identify as religious, in particular those who hold liberal rather than fundamentalist religious orientations (Green & Elliott, 2010), tend to report greater health and happiness, even when controlling for religious affiliation, work, family, social support or financial status (see, for example, Brown et al., 2013; Ferriss, 2002; McCullough et al., 2000; Shafranske, 2005). Research on religiosity, illness, healing and life satisfaction has tended to report outcomes that are generally positive and acceptable to the current ideological and moral trends prevalent in post-modern societies, particularly in North America, and especially grounded in a Judeo-Christian set of beliefs and ethics.

Another reason for psychologists’ recent warming to religion/spirituality is the growth of multicultural counselling practices in professional psychology. Most training programmes now emphasise the importance of mental health practitioners’ awareness and sensitivity when working with clients from a range of social and cultural backgrounds, including diverse religious backgrounds. The old negative view of religion in psychology is increasingly seen to be equivalent to, and as unacceptable as, racism, sexism, queerophobia, classism, disableism and ageism. However, in the West, under the rubric of multiculturalism the picture has been somewhat complicated, in the sense that religion is also a site for ideological and political enactments within which the individual’s health and wellbeing can be compromised. Counselling and psychotherapy are places where such enactments are deciphered and analysed.

Indeed, to bring religion into psychology is necessarily to bring multiculturalism in as well. Religion is not a monolithic construct but a wide diversity of traditions, institutions, beliefs and practices, and therefore necessarily implicates issues of diversity, cross-cultural (mis)understanding and culture. According to Miller and Kelley (2005), culture lies at the root of any exploration of religion and spirituality, leading researchers to consider in more detail the intersections of religion, spirituality and multiculturalism. Given that religion and spiritual issues have had at least half a century of research and scholarship in multicultural counselling, clearly there are conceptual, theoretical and practice-based strategies from this scholarship that may benefit mainstream counselling and psychotherapy in its search for the value or healing potential of including religion and spirituality in therapy. Indeed, mainstream psychologists have begun to question the Western, individualistic values embedded within popular counselling approaches, calling for practitioners to develop greater multicultural counselling competence (Vogel et al., 2013).

In this chapter, we explore what these multicultural paradigms are and discuss how they can be incorporated into mainstream counselling, psychology and psychotherapy. We begin with a brief overview of how religion and spirituality have been incorporated into multicultural counselling.

Multicultural counselling and its quest for the spirit(ual)

Since the 1960s there has been a growing interest in integrating multicultural and diversity issues into counselling and psychotherapy. This infusion of multicultural ideas and ideologies, especially race, ethnicity and culture, into psychology, counselling and psychotherapy was prompted by socio-political and cultural changes that took place in the West, particularly the civil rights campaigns of the 1960s. Historically, psychology has been complicit in projects of oppression by positing fundamental psychological differences among groups. The pseudo-scientific racist theories that evolved and flourished in the late 19th century resulted in misconceptions about race, culture and ethnicity which in turn led to inappropriate assessments, misdiagnosis and over-representation of black and minority ethnicities in mental health. This resulted in misinformed and inadequate psychological and mental health services for racialised communities (see Fernando, 1988; Turner & Kramer, 1995). Lack of appropriate mental healthcare practices meant that black and minority ethnic clients did not seek counselling and psychotherapy and had low rates of participation (Sue, 1998; Vessey & Howard, 1993) and high levels of premature termination compared with majority culture clients. These inequalities prompted the multicultural counselling movement to critique mainstream psychology and counselling for being eurocentric, individualistic and focusing on psychopathology (Moodley, 2011). Initially, multiculturalism and diversity scholars were preoccupied with immigration, acculturation, adaptation, integration and culture-bound syndromes. However, over the ensuing decades, through evidence-based randomised control trials, the focus shifted to more complex and clinically related matters, such as racial identity theories (Helms, 1990, 1994), cultural competencies (Sue et al., 1992), intersectionality, cultural competency, Group of Seven stigmatised identities (Moodley, 2011; Moodley & Lubin, 2008) and integrating traditional healing into counselling and psychotherapy (Moodley & West, 2005). As a result of this rapid evolution and development, multicultural counselling, especially in North America, was widely considered to be the ‘fourth force’ in psychology after psychodynamic, cognitive-behavioural and humanistic psychology (Pedersen, 1991). Even without this ‘fourth force’ identity, multicultural and diversity counselling has been at the forefront of integrating religion and spirituality into psychotherapy.

Multicultural counselling finds its roots in part in the civil rights movement (see Funderburk & Fukuyama, 2001), which was profoundly connected to religion and spirituality: Dr Martin Luther King was a Baptist minister and the liberation songs used by his movement were adapted versions of spiritual hymns. Since culture and race were at the foundation of multicultural counselling, it could be argued that religion and spirituality have been incorporated into the movement from the very beginning. For example, Vontress, one of the founding fathers of multicultural counselling (e.g., Vontress, 1962), first highlighted issues of intergenerational trauma, black masculinities and black rage, and emphasised that culture, religion and spirituality were an integral and fundamental aspect of the black or African-American experience (see, for example, Vontress, 1979, 1986, 2001, 2002, 2010; see also, Moodley et al., 2012).

The 2000s were a period of increased growth of multicultural counselling and psychotherapy, particularly in North America. This period also saw an increasing tension within the diversity movement, most of it related to the Group of Seven identities (Moodley, 2007) and their place in what was fast becoming the new multicultural counselling movement, later reframed as critical multicultural counselling or diversity counselling and psychotherapy (Moodley, 2011). Some multiculturalists have been troubled by the inclusion of sexual orientations and disability as part of multicultural counselling, arguing that issues of race, ethnicity and culture have become marginalised and that a focus on homophobia, disableism and ageism has displaced racism. However, in terms of religion (one of the Big 7 social identities) there has not been too much concern, since it has always been a part of multiculturalism, although in certain contexts there has been an uneasy relationship between religion and multiculturalism; for example, while multiculturalism in general hinges on notions of plurality, some faith groups hold intolerant views and strong beliefs against LGBTQ (lesbian, gay, bi-sexual, transgender, queer) communities. Concurrently, another shift appeared to be taking place: the inclusion of ideas and healing practices from indigenous, Aboriginal and First Nation communities; for example, healing circles, storytelling circles, sweat lodge ceremonies and the medicine wheel (McCabe, 2007; McCormick, 2005, Poonwassie & Charter, 2005; Smith, 2005). The research into the integration of healing methods into counselling and psychotherapy has not been confined to Aboriginal or indigenous groups but has spawned a great deal of research on traditional healing methods across all cultures and communities in the diaspora and globally (see, for example, Moodley & Oulanova, 2011; Moodley & West, 2005; Moodley et al., 2008; Sutherland et al., 2014). At the core of this work is the concept of the spirit, which frames spirituality and spiritual experiences as central to the healing process; this is achieved with or without institutional religion as the site for metaphysical enactments.

Religion, spirituality and multiculturalism: Overlaps and tensions

Deep tensions often exist between institutional religion and multiculturalism. Historically, institutional religion and its ideologies have been most enduring and most persuasive in informing an individual’s subjectivity, group identity and national sense of belonging (Whitehead et al., 2013). Therefore, throughout the centuries religion, spirituality and culture have been interconnected in many ways, informing (and indoctrinating) people through language, literature and the arts. The rise of multiculturalism in the West reinforces this ideology of dominance within which multiple cultural groups that constitute a multicultural society make claims to belonging in a particular place through the enactments of religious ideologies; the iconicity of these cultural artefacts produces in effect a tension and fragmentation that multiculturalism itself was created to prevent in the first place. Some religious and spiritual traditions require their followers to adhere to a particular interpretation of the sacred text which is considered to represent the absolute truth, while multiculturalism assumes a post-structuralist understanding of ‘truth’, in which openness and acceptance of difference are paramount and all truths are acceptable with their inherent contradictions, ambivalences and ambiguities in a post-modern society. In North America, the power and privilege of Christianity has allowed some churches to impose oppressive values such as anti-homosexuality and restrictions on women’s freedom. Individuals interested in forwarding the philosophy of multiculturalism have been sceptical of religion’s place within this more liberal framework. The ‘multiculturalism’ within religions – for instance, the diversity of