Black Identities + White Therapies: Race, Respect + Diversity 1910919896, 9781910919897

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Colin Lago and Divine Charura

Praise for Black Identities and White Therapies This book speaks of the profound need to address the shortcoming of racial competency in therapeutic training and professional practice. It represents both a call and an opportunity to challenge the profession on its lack of awareness and inclusion. It offers contributions from Black, brown and people of colour, providing a range of thinking on race and ensuring this remains a fundamental element of professional practice. It offers us the opportunity to change, to progress, to recognise the vast gaps in our knowledge and to become anti-racist and fit for purpose. Integral to this book is a recognition of the role of intersectionality and how the lived experience is reflected in complex identities. This insightful book will hold its value and usefulness long after the first read, reminding us to challenge exclusion, reflect on our practice and address our own positions of power and privilege. Susan Cousins, author of Overcoming Everyday Racism Divine Charura and Colin Lago have brought together many of the leading thinkers and practitioners in multicultural counselling to review how we prepare ourselves to work with racial difference. The truth is that for many of us, this is the uncomfortable territory of power and privilege, of unsettling lack of knowledge and experience. As counsellors, we may limit our authenticity through fear of offending. As tutors, we may lack the sure-footedness to lead our students into this difficult terrain. This must change. Janet Tolan, counsellor/psychotherapist, supervisor, tutor and author This impressive book makes a major contribution to theory and practice in an area that has been ignored or neglected for far too long. It considers this systemic failure as well as suggesting ways forward for the profession. A wealth of experience, diverse trainings and experiences as counsellors/therapists and a multiplicity of helpful perspectives are presented. It will encourage debate, critical review and consideration of some long-held assumptions and contribute to ensuring that Black lives do matter in counselling and training. The book is packed full of information presented in a clear, accessible and informative manner. It should be on the bookshelf of every training institution and counsellor. Rachel Tribe is a chartered counselling and occupational psychologist and professor of applied psychology at the University of East London and Queen Mary, University of London This book carries a bold message that revolves around one word, ‘change’. The unique contribution of each author lies in the variety of practical, innovative, experiential and imaginative ways they offer, based on their own research and practice, to meet the varying needs of racially and ethnically different clients. The authors invite therapists, trainers and supervisors alike to reflect and question their practice critically, examine the roots of their values and beliefs and, most importantly, learn and unlearn continually to change their way of working. This exceptionally good  book will be inspirational and beneficial to both new and

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experienced practitioners in the field of psychotherapy, a useful guide for individual therapists and a tremendous resource for trainers. Shukla Dhingra, counsellor, supervisor and trainer Black Identities + White Therapies speaks to the urgency of addressing the impact of racism when training counsellors and psychotherapists. Those who are racially marginalised are already over-represented as patients in the mental health system but under-represented as clients  in counselling and psychotherapy. Racially marginalised communities have  borne the brunt of the Covid pandemic. If the profession is to have any hope of meeting the needs of those who are grieving and suffering long-term  illness, burn-out and severe economic stress, on top of the psychological  stress that results from living in a hostile atmosphere, we need  to knuckle down and do the work now. This book could not be more timely. Rose Cameron, author of Working with Difference and Diversity in Counselling and Psychotherapy What an emotive and thought-provoking read! The authors are unapologetic in their call for accountability, challenging colour-blindness, highlighting implications for therapists, trainers/trainees, supervisors and therapy organisations. We agree with the contributors that it would be grossly negligent for us not to critically explore issues of identity, oppression and race in all therapeutic relationships. These explorations call upon us to continually consider how we are with our own and others’ identities, and what this means personally, interpersonally and structurally. The authors give us guidance on how we might validate experiential realities as we work towards inclusive models of practice. Their guidance is peppered with examples and references that resonate on a personal and professional level while attempting to de-colonise and dismantle hierarchies with the turn of each page. The sensitive facilitation of these necessary conversations makes this book essential reading for practitioners. Kerese Collins, lecturer (counselling & psychotherapy),  Keele University, and co-host of ‘My Wife is a Therapist’ podcast; Sally Chisholm, lecturer (counselling & psychotherapy), Keele University, and tutor, Metanoia Institute  Yet another splendid book jointly edited by Divine Charura and Colin Lago and demanding not just a place on our bookshelves, but nothing less than the undivided attention of the therapeutic community. This book is testimony to the harm caused by the failure of therapeutic professions to adequately address the complexities of encounter with diversity in more than theoretical terms. Particularly those of us who are trainers have the option of jealously guarding our current mode of teaching or hearing the call of this book to think more broadly and act more creatively. Collectively, the contributors provide insight and encouragement to face uncomfortable encounters and difficult conversations in order to traverse a bumpy but promising terrain and also facilitate a more relevant training environment. Andrea Uphoff, primary tutor, Metanoia Institute

Colin Lago and Divine Charura

Black Identities + White Therapies Race, respect + diversity

Edited by Divine Charura and Colin Lago

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First published 2021 PCCS Books Ltd Wyastone Business Park Wyastone Leys Monmouth NP25 3SR [email protected] www.pccs-books.co.uk This collection © Divine Charura and Colin Lago, 2021 The individual chapters © the contributors, 2021

All rights reserved. Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, this publication may be reproduced, stored or transmitted in any form, or by any means, only with the prior permission in writing of the publishers, or in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. The authors have asserted their right to be identified as the authors of this work in accordance with the Copyright, Designs and Patents Act 1988.

Black Identities and White Therapies: Race, respect and diversity

British Library Cataloguing in Publication data: a catalogue record for this book is available from the British Library. ISBNs

Paperback 978 1 910919 89 7 ePub 978 1 910919 90 3

Cover design Jason Anscomb

Colin Lago and Divine Charura

Contents Preface Colin Lago and Divine Charura

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Race, culture and ethnicity: A systemic failure of attention in the psychotherapy profession? Colin Lago and Divine Charura

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The cultural complexity of training counsellors abroad: The case of Afghanistan Lucia Berdondini, Ali Ahmad Kaveh and Sandra Grieve

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Can you talk about race without going pink or feeling uncomfortable? Delroy Hall

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Exploring the racial self in counselling training Billie-Claire Wright

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An anti-racist counselling training model Courtland C. Lee

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‘Look in the mirror... and just below the surface’: Critical reflection, personal stories and training implications Valerie Watson

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‘Where are you from?’ The effects of racism and perceived discrimination on people of colour Priscilla Dass-Brailsford

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Re-imagining the space and context for a therapeutic curriculum – a sketch Robert Downes and Foluke Taylor

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Twin tribes: Exploring unconscious privilege and otherness in counselling and psychotherapy Dwight Turner

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Lifting the white veil of therapy Neelam Zahid

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The legacy of colonial history and the ongoing challenge to therapist training and practice Vedia Maharaj

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Towards the re-emergence of meaning: Existential contributions to working with refugee clients Benjamin Mark Butler

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Who is transforming what? Ideas and reflections on training, practice and supervision in radical mode Carmen Joanne Ablack

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Negotiating the Faustian pact: A psycho-social approach to working with mixed-race people Yvon Guest

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Developing a diversity-sensitive psychoanalytic and psychodynamic psychotherapy: Personal and professional reflections Lennox K. Thomas

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Colour blindness as microaggression: Perspectives on race and ethnicity in counselling and psychotherapy training and practice Mark Williams

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Towards a decolonised psychotherapy research and practice Divine Charura and Colin Lago

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Religion, therapy and mental health treatment in diverse communities: Some critical reflections and radical propositions Rachel-Rose Burrell

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Race and cognitive dissonance: Could supervision be a way of connecting tutors to students? Fiona A. Beckford

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Postscript Divine Charura and Colin Lago

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About the contributors

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Name index

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Subject index

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Dedication This book is dedicated to the memory of Lennox Thomas, who sadly passed away while it was still in preparation. Some months previously, Lennox had enthusiastically responded to our invitation to contribute a chapter and, right on time, he delivered a first draft, professional as ever. As his chapter in the book demonstrates, from a young man onwards, he was always deeply motivated and concerned that all psychotherapists – indeed, all caring professionals – should pay great attention to their work with people from all communities. He was one of the early pioneers in the UK to stimulate thought, reflection and, subsequently, training in this arena. He is sorely missed.

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Acknowledgements Our thanks go to Catherine (Jackson, our commissioning editor), who has been an enthusiastic and committed supporter of this book, to Pete and Maggie (Sanders, of PCCS Books), who have long championed the publication of critical texts in counselling and psychotherapy, and to all the PCCS Books team. As you will have noticed on the Dedication page, we were deeply saddened by the passing of one of our chapter writers as we were preparing the final text. Lennox Thomas has been a distinctive voice in the professional field of counselling and psychotherapy for more than four decades and we both deeply respected and valued his continued commitment to effective and sensitive therapeutic practice with clients of all diversities. He is sorely missed by his family, friends, immediate colleagues and all those privileged to have been taught and known by him. We are, of course, deeply grateful to all the colleagues who have contributed their thoughts and experiences to this volume. While committing enthusiastically to the project, some authors remarked on the anxiety and fear they experienced in writing their critiques and developments. Growing beyond our inherited theoretical models and daring to envisage and publish modified and radical developments based on our own clinical and life experiences is a courageous and valuable act. We thank you, the authors. Colin writes: Working with Divine on this project has been such a source of stimulation and joy. Since first meeting at a weekend training seminar in 2006, we have co-operated on several training programmes, various writing projects and even made an academic visit to Cambodia in 2019, where we lent support to the first university-based, two-year counselling training programme there. At the time of writing, Divine has recently been appointed to a Chair in Counselling Psychology at York St. John University – a position that fully reflects and merits his professional commitment and passion to the mental health and therapeutic needs of others. I am deeply grateful for his friendship, support and enthusiasm. He is a joy to be with and to work with. Thank you, Divine. As always, I am continually grateful to my wife, Gill, who puts up with my absence on many evenings while I am trying to write. To my immediate family – James, Rebecca, Martin and grandson Luke – I am indebted for their support, love and care. In the preparation of this project, I have inevitably cast my mind back to the early days of my career (the 1980s), in which I became involved with dear colleagues like Jean Clark, Joyce Thompson, Roy Moodley, Josna Pankhania, Bill Hall, Shukla Dhingra, Christine Rowe, Shantu Watt (and many more), in the Race and Culture Sub-committee of what was then the British Association for Counselling. Since then, I have enjoyed co-operations with many colleagues in the field committed to diversity sensitivity. I hope they forgive me for not mentioning them all by name, but their spirit, dedication and commitment continue to sustain me in this pursuit of enhancing and improving our therapeutic activities across the wide range of diversity within society.

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Divine writes: There are so many people I need to express my gratitude to, but space does not allow me to name them all individually. First, I would like to say thank you to Colin, whose passion for diversity has taught me so much. Your work, writing and commitment to equality, difference and human rights are a true gift to our profession. As always, a special dedication goes to my supportive and loving family: my father, Alois, and mother, Letisia, who have lived through many revolutionary movements, including experiencing apartheid. Their commitment to continue to champion love, respect and equality for all in our community in Leeds and beyond is exemplary. I am deeply grateful to Helen, Elizabeth Rudo, Alois Rufaro, David, Tatenda, Krisandra, Talent, Elizabeth, Enock, Naomi, Dawn, Hannah, Steve Paul and Courtland Lee for their unending support and teaching me so much about the importance of speaking and writing about identity, equality and diversity. Last, I am thankful to my colleagues at York St. John University and the Tower Clinic, whose values on social justice speak truth.

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Preface Colin Lago and Divine Charura

During the 1980s when I tried to promote the work of Soweto artists in Europe and the United States, a Belgian gallery owner bluntly told me to advise the African artists not to paint people so often. I wondered how it would be possible to redirect the motif of artists for whom the core of existence was anchored in belonging? Len Holdstock, Love: Carl Rogers, my wife and I (In review) If we do not know how to meaningfully talk about racism, our actions will move in misleading directions. Angela Y. Davis, Freedom is a Constant Struggle (2016)

The genesis of this book is inevitably embedded in the lived experiences and personal philosophies of the joint editors, of the publishers and of all the contributors. Early and enthusiastic conversations with PCCS Books envisioning such a book initially took place in the early summer of 2019, some time before (but perhaps, in some way, anticipating) the worldwide uprisings of anger and disillusionment that followed the murder of George Floyd (and, sadly, many others since in the US) and the world-wide invigoration of the Black Lives Matter movement. We suspect that historians in the future will note the momentous international shifts in awareness, attitudes and actions that have taken place, and are continuing, following these landmark events in the pursuit of equality and the eradication of discrimination across many societies. While the background to this book lies within this broader sociological reality of gross social injustices over centuries to peoples of minority identity, its specific focus is on the world of counselling and psychotherapy. Our intention has been to include chapters written from a range of therapeutic perspectives that critique current training and professional practice in the context of diversity generally, and more specifically in relation to issues of ethnicity, culture and race. As joint editors, we deliberately sought writers who, in the main, were

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of ethnic and culturally diverse heritage, living in the UK, and who, through their personal and professional experiences, had come to consider and develop critiques of how contemporary therapist activity and training were delivered. We wanted to stimulate debate on the existing theories and practice of therapy and how these are restrictive and discriminatory within the context of a multicultural and multi-ethnic society. We wanted to invite writing about ideas and pioneering developments in professional practice to inform training curricula that more adequately prepare therapy students to respond sensitively and in culturally appropriate ways to clients of diverse cultural and racial identities. We chose these contributors because we knew and respected them and their work and could see how the overarching aspects of their particular perspectives and interests could link together in this volume. In some cases, they are colleagues with whom we have co-operated over many years through writing, training and so on. Others we met during their research programmes and/or their attendance at training courses with which we were involved. Some colleagues, through their professional contributions over decades, have demonstrated a life-long commitment to the overall subject of this book. Some were recommended to us. Others impressed us through their publications. With some, we shared commonalities professionally (student counselling, university lecturing, supervision). With others, we were initially brought together through our work with professional bodies, such as the United Kingdom Council for Psychotherapy (UKCP), the British Association for Counselling and Psychotherapy (BACP) and the British Psychological Society (BPS). The spread of authors in this book ranges from colleagues relatively new to writing through to those who have published extensively. All are deeply committed to improving and enhancing the sensitivity and quality of therapy delivery specifically within the arena of ethnic, race and cultural diversity. Hailing mainly from ‘minority’ cultural/ethnic origins, they draw on their early life experiences and combine these with their thoughts, ideas, visions and assertions that are both appreciative and critical of what has been and innovative and radical in their arguments for change, innovation and development. A continuing theme throughout the book is the view that there is a general lack of quality training in general and content in introductory and foundation courses on diversity, culture and ethnicity. This is despite a generally supportive, strong, verbal and ethical commitment to addressing issues of diversity within such courses that is repeatedly declared by the various professional bodies. One weekend – or indeed just one day – on ‘diversities’ across the board may be all that students experience on courses of three years’ duration or more. Thus, current and future professional practice is stagnating due to the neglect of issues pertinent to increasing both the numbers of people from diverse backgrounds entering and completing training and the numbers of clients of diverse backgrounds and ethnicities using counselling and psychotherapy. There is a parallel paucity of workshops and courses offered for continuing professional development. This vacuum leaves practitioners of the future ill equipped and insensitive to the multiplicity of relational dynamics and power issues

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potentially present in working with diverse clients. And yet we live in a society where equality of opportunity has been fought for and legislated extensively – a society rich in diversity. It is a contradiction in terms to claim that the helping professions aspire to be helpful to all clients when we are, as a profession, apparently systematically ignoring the needs of those from diverse communities. With such a situation, the combined psychological helping professions could be accused of serious philosophic, practice, moral and ethical negligence. This book, then, constitutes a collation of chapters that are a call and challenge to the profession to consider, discuss, debate and develop more inclusive models of theory and practice; to move beyond the cultural zeitgeist in which the theories first emerged and fully embrace and reflect the contemporary composition and needs of society today, and to put what emerges into practice, both in our own education and training and in our work. This book really does set out to decolonise the profession from its roots and origins. Each chapter raises questions and challenges for all therapeutic practitioners, whatever their specialist roles (trainers, therapists, supervisors, researchers), to attend to and reflect on their personal and professional attitudes and behaviours in relation to clients of all heritages and origins. The overarching themes underpinning the book are related to issues of race,1 ethnicity and heritage and aim to instigate enhanced therapist sensitivity, knowledge, awareness and competence. We, the editors and authors, share a fear of a perpetuation of discrimination, racism, oppression and other discriminatory behaviours by counsellors and psychotherapists unwilling to address their relational attitudes towards different ‘others’. A review of the chapters reveals an emerging constellation of interconnected themes. Not unlike the astronomer who studies a particular part of the night sky, the deeper one looks, the more stars, planets, comets, asteroids and moons are revealed. Implications and recommendations for the enhanced training of therapists feature in many chapters (those by Delroy Hall, Billie Claire-Wright, Courtland Lee, Val Watson, Dwight Turner, Neelam Zahid, Carmen Joanne Ablack, Fiona Beckford and Mark Williams). These recommendations are proposed in the context of the experience of discomfort with race as an extremely challenging issue, particularly for white people, leading frequently to avoidance or rationalisation of the issue in training settings. Courtland Lee’s chapter uses an anti-racism training perspective that was briefly popular in the British context in the early 1980s. British proponents of that training were deeply convinced then that some of the conceptual ideas and training methods originally envisaged by early writers such as Judy Katz (1978; Katz & Ivey, 1977) were both creative and pertinent. Courtland’s chapter revives and updates this ‘anti-racist’ training perspective. Under the ‘umbrella’ of the training dimension, ideas are suggested, approaches are offered, content is envisaged and context and relevance are discussed. 1. In referring to ‘race’, it is important to note that we do not regard it as a physiological entity, a fact, but rather as a sociological construct.

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Contextual congruence – that is, aligning, modifying and creating new theories of practice that incorporate the multicultural, multi-identity nature of contemporary society – is strongly advocated. Professional practice is also discussed from a multiplicity of angles. Many chapter authors reference their own autobiographical origins and experiences and note their transitional movements of theoretical perspective during their careers (Lennox Thomas, Mark Williams, Vedia Maharaj). Some use fictional imagination (Robert Downes and Foluke Taylor). Poetry illuminates. Stories and incident reflections are examined (Val Watson). Issues related to belief systems and spirituality are brought forward (Benjamin Mark Butler, Rachel-Rose Burrell, Delroy Hall). Supervision and therapy case examples are discussed (Carmen Joanne Ablack). Concepts are drawn from world influences other than white, European, colonialist ideas and philosophies (Vedia Maharaj, Neelam Zahid, Delroy Hall). Val Watson’s compilation of the factors that clients have taught her they want from therapy importantly draws our attention to the centrality of the client’s experiencing. And all the contributors have offered poetry, quotes and extracts they have found inspirational in their own personal and professional journeys. These we have gathered together in the short postscript that closes the book. Within this panoply of writings, a myriad of issues is discussed and explored. They include unconscious privilege, ‘othering’, microaggressions, broaching, racism, discrimination, the search for meaning, identity complexity, intersectional understanding, heritage, biases and projections, trauma, intergenerational trauma, introjections, projection and decolonisation of the curriculum. Several chapters consider the context within which colleagues work. In the international arena, Lucia Berdondini, Ali Kaveh and Sandra Grieve describe their work in Afghanistan. What are the implications and considerations for conducting training courses in other countries? Given that this context is often one of war, terror, trauma and consequent psychological distress, yet also one of strong government support for counselling training, important and thorny questions are raised for Western trainers as to how they respond to such invitations, what they might teach and how they can ensure the transmission of culturally appropriate curricula and the maintenance of such trainings after they have left. Others look closer to home to ask how one might positively benefit the mental health of particular communities in their own context where they naturally assemble. Rachel-Rose Burrell gives an account of her community activity work within the Black majority churches. Benjamin Mark Butler focuses on the refugee community and the importance of their search for meaning against the backdrop of the trauma of their journeys and the continuing fear, insecurity and material deprivation of their lives now. To conclude, we believe this is an urgent call to the profession to develop more inclusive models of theory and practice – a call that extends to every counsellor, psychotherapist and counselling psychologist to review their professional practice to ensure a truly sound fit between the aspirations of our professional calling, our theories and the contemporary needs of our multi-ethnic, multiracial and multicultural society.

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A note on terminology We have used a range of descriptive terms in the following pages that, to some extent, reflect the complexity of language usage over time. Various descriptors, such as ‘Black, Asian and minority ethnic’, ‘minority groups’ and ‘diverse communities’ are used by the contributors to the book. We have not used the common acronym ‘BAME’ as we believe it collapses the wealth of diversity in the communities this book addresses into an unhelpful shorthand and runs contrary to the celebration of that wealth to which we hope this book contributes. Over time, descriptions such as ‘cross-cultural counselling’, ‘multicultural counselling’, ‘transcultural counselling’, ‘therapy across culture’, ‘diversity-sensitive practice’ and ‘anti-discriminatory counselling practice’ have all been used in the counselling and psychology literature. We have, where relevant, retained the descriptions used by the originating theorists. We have also variously used terms such as counselling, psychotherapy, counselling psychology and therapy as descriptors of the professional activities we are discussing. We are aware of the varied perspectives and attitudes practitioners and theorists bring to the meaning of these terms but have deliberately chosen to use them all as broad descriptors of the psychological therapeutic activity that occurs between professional practitioner and their clients. In all the above usages, we have tried to use the terminology sensitively, appropriately and creatively, to avoid inappropriate repetition in the text. Colin and Divine

References Davis, A.Y. (2016). Freedom is a constant struggle: Ferguson, Palestine and the foundations of a movement. Haymarket Books. Holdstock, L. (Under review). Love: Carl Rogers, my wife and I: a biotherapy. Katz, J.H. (1978). White awareness: Handbook for anti-racism training. University of Oklahoma Press. Katz, J.H. & Ivey, A.E. (1977). White awareness: The frontier of racism awareness training. Personnel and Guidance Journal, 55(8), 485–488.)

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Race, culture and ethnicity: A systemic failure of attention in the psychotherapy profession? Colin Lago and Divine Charura

And so we lift our gazes not to what stands between us, but what stands before us. We close the divide because we know, to put our future first, we must first put our differences aside. (From ‘The Hill We Climb’ by Amanda Gorman, presented at the inauguration of Joe Biden as the 46th President of the US)

I woke up this morning with the following words rattling round in my brain: ‘Rage is the name, protest is the game.’ These were swiftly followed by memories of images of protesters in Bristol, in the summer of 2020, pulling down the statue of the slave trader Edward Colston in the Black Lives Matter protests that took place in more than 260 towns and cities in the UK – ‘the largest anti-racism protests in Britain for centuries’ (Mohdin & Storer, 2021). Then I remembered yesterday’s news item on Holocaust Memorial Day, the UK’s national day of commemoration in memory of the victims of the Holocaust. The TV screen was filled with views of concentration camps and old film footage of Jewish prisoners herded together. The interviews with survivors were heart-wrenching. Such gross human atrocities are not just something that happened in the long-time past. Almost a quarter of the Cambodian population were brutalised and murdered between 1975 and 1979; an estimated 800,000 Tutsi people were massacred in the Rwandan genocide in 1994; some 80,000 Muslim men and boys were slaughtered in Bosnia in 1995; inestimable numbers died in Darfur in 2003, and more recently we have witnessed the persecution and genocide of the Rohingya people in Myanmar in 2017, and so many other such acts of inhumanity besides. Yesterday we were told that the number of deaths in the UK in the Covid-19 pandemic had exceeded 100,000. It is widely reported that the combination of impoverished circumstances and ‘minority identity’ has had a discriminatory impact on those who have caught the virus and died, including a disproportionate number of NHS staff of Black, Asian and minority ethnic backgrounds.

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These words were written by Colin as we were finalising the chapters of this book in early 2021. The history of institutionalised hate, oppression and discrimination goes back throughout time and they continue, sadly, to live on today. The above paragraphs graphically, though briefly, illustrate the social context against which we put this book together. They sketch the stark backdrop of the transmission of negative attitudes within society that have been systematised, sanctioned and authorised over centuries. Such attitudes and behaviours have perpetuated the projection of ‘othering’. They have ensured the dire consequences of gross social injustices and violence. The contrast between the opening positive lines from Amanda Gorman’s poem and Colin’s waking thoughts encapsulate the spectrum of attitudes and behaviour, of dreams and nightmares, of actions and consequences that are embodied in the dynamics of society and in every one of us, as individuals – we are all inextricably connected to cultural and ethnic groupings. And this book is born from and all about the interactions of individuals. More precisely, the book aspires to disseminate ideas and perspectives drawn from the combined experiencing of all the chapter authors, all counsellors and psychotherapists, with the aim of contributing to enhanced, humane, sensitive and respectful professional therapy practice with all members of contemporary society. The following chapters, many written by colleagues from diverse communities, are testimony to the resilience, perseverance and sheer commitment of colleagues in the professional field of counselling and psychotherapy who have undergone, in recent decades, a variety of differing traditional trainings before becoming trainers and therapists themselves. This book evidences, first, how the broad professional sector of counselling, psychology and psychotherapy has frequently failed to meaningfully incorporate multicultural diversity into its training, theory and practice (Turner, 2021), and second, how ‘minority voices’ have, on their own, often outside the mainstream, forged ahead and developed new perspectives and ideas. In this chapter, we will briefly look at: • the challenges to counselling and psychotherapy posed by issues of race, ethnicity, diversity and difference • the contradictions between ethical commitment and actual training practice within the profession • some early British contributions to the literature and training (1980–2010) • the American influences on the UK as regards sensitivity to multicultural diversity in therapy (from the 1970s onwards) • more recent developments in ‘transcultural therapy’ emerging from within the British cultural context • the contributions made to practice and research by writers of Black, Asian and minority ethnic backgrounds • the more recent explosion of writings (2015 onwards) reflecting various life issues faced by those in minority ethnic groups and the

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ongoing resistance from white people to fully acknowledging their defensive reactions to these issues. • the continued challenges within training in this arena and the emergence of newer theoretical concepts.

Early ‘multicultural’ initiatives in the profession You are not providing a service to anybody if you are not providing it to everybody. (Williams, 2019)

The sole delegate of Asian heritage attending a national conference on counselling in education in the late 1970s made an impassioned plea to her fellow participants to make the field of counselling more open and accessible to all members of our society. She was ‘sick of being the only one’ and criticised attitudes and stories in the profession that were discriminatory, oppressive and hurtful. Familiar claims of the universality of counselling approaches as applicable to all people held little sway for her and did not reflect her own (and many others’) experiences. This brave speaking out garnered the support of other participants, who joined together with others similarly concerned to form what eventually became known as the Race Awareness in Counselling Education (RACE) division of the British Association for Counselling (now, with the addition of psychotherapy to its title, BACP), which, incidentally, subsequently dedicated its 1979 annual conference to the theme of ‘Counselling and Minority Groups’ (Clark, 2010). From these various initiatives emerged cross-disciplinary discussions (with social work and transcultural psychiatry) and several early articles and ideas about approaches to training, including video-based training resources developed by Clark and Lago (1984),Lago and Thompson (1994)and Dhillon-Stevens (2004a). While space constrains any substantial exposition of this ‘history’, we want to briefly acknowledge these early expressions of professional concern, creativity and interest in the British ‘multicultural’ counselling arena. Parallel trajectories of special interest groups within the United Kingdom Council for Psychotherapy (UKCP) and the British Psychological Society (BPS) also occurred during this period. This heightened awareness of need also translated into the formation of dedicated organisations, including Nafsiyat in London, which was formed in 1983 to provide a specialist psychotherapy service to Black and other ethnic and cultural minorities (Kareem & Littlewood, 1992, p.14). It is interesting and desperately sad to us to note that all these working groups in three of the main professional counselling and psychotherapy bodies in the UK – BACP, UKCP and BPS – have long ago been discontinued. Of course, a more precise, detailed exploration of the emergence and then ultimate disappearance of these various groups might reveal specific and different factors that affected their longevity. Nevertheless, as a parallel process of organisational emergence and decline, we can only note this coincidence. And, as Jung noted, ‘there is no such thing as coincidence’. It is also welcome news that all three have, at this time of

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writing, initiated equality, diversity and inclusion working groups. We hope for some positive steps forward here. Contained within the apparently simple term of ‘difference and diversity’, there lies a myriad social issues that are complex, have long histories and are substantiated by attitude, perception, ‘othering’ and projection, all fuelled by social behaviour that has been and is frequently judgemental, oppressive and discriminatory. It is our contention that perhaps the demise of the several dedicated working committees detailed above reflects the enormity of the challenge, discomfort and pain that the subject raises upon deeper examination, particularly with reference to matters of ethnicity, heritage and culture. While we recognise that the details and complexities of each working group referenced above might be quite different, we cannot help but surmise that their disestablishment was caused by the complexity of addressing and achieving equality within organisations, the management of power and the continued fact of discrimination in society. Robin DiAngelo’s term ‘white fragility’ (2016) offers us in retrospect a significant lens through which to understand how some of the early focus on issues of race, ethnicity and culture in these organisations proved too uncomfortable and challenging. Significant changes in national and organisational policy towards the concepts of ‘diversity and equality’ around the turn of the millennium served to shift attention away from the ‘cross-cultural’ arena. We return to this aspect later. The earliest moments of concern and action within the British ‘multicultural therapy’ milieu, briefly described above, were substantially energised and informed by ideas, research and publications emanating from the US. Our narrative therefore switches there before returning to reflect on how those advances have and have not influenced the UK context of multicultural training and practice.

Lost (or found) in cultural transition? All counselling is multicultural. Each client comes to the session embodying multiple voices from the past. (Pedersen et al., 1976) Our mental health systems are not designed for women of colour like me. That has to change. There is little or no recognition of the complexities of life for a Muslim woman of colour. (Abu el Magd, 2019)

Impelled by the struggles and developments of the Civil Rights movement in the US, dating right back to the 1920s, American colleagues commenced scholarly and professional work into what initially became known in the 1970s and 1980s as cross-cultural counselling. Early among these luminaries was Clemmont E. Vontress, whose significant contributions were later professionally recognised by the American Counseling Association (ACA), which honoured him with two of their highest awards: the Presidential Award and the ACA Fellow’s Award in 2010. These were granted in recognition of his courage and conviction in ‘raising our field’s consciousness about the role of culture and racism in the therapeutic relationship and in the counseling

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profession itself ’ (Moodley et al., 2012). Clemmont’s life was eventful, to say the least. His great-grandfather had been killed by the Klu Klux Klan for having taken as his common-law wife a former slave (Vontress, 2010). In the aftermath of the Great Depression, his grandfather had to sell the family farm, so the family were reduced to impoverished sharecroppers. Clemmont, with his family’s help, managed to escape these origins in the deep American south and embark on study at college. Drafted into the army soon after commencing postgraduate studies in French and English literature, he was stationed in Europe. This was an opportunity to experience different cultures, countries and languages and ‘see the world in a different light’ (Vontress, 2010, p.21). While stationed in Paris, Clemmont met Jean Paul Sartre, whose existential philosophy made an enormous impact on him, and he incorporated these ideas into his later work in cross-cultural counselling. His publications spanned some 50 years, and Moodley has identified five main themes in his writing: issues of self-hatred, cultural differences, existential counselling, historical hostility and traditional healing (Moodley, 2010, p.43). Clemmont argued that culture and race can be transcended in counselling if the counsellor works on seeing each client’s humanity. This assertion that such differences could be transcended is crucially evidenced in the later research conducted by Robert Carter (1995). Carter took as his basic unit of research outcomes from the ethnic identity development models (about which, more later). Moodley (Moodley et al., 2012) reflects that Vontress ‘strived to deepen the profession’s guiding theories by reminding us that good multicultural counselling theories take account of the inequities of society; the suffering inherent in the human condition; and the imperfections and limitations of the counsellor applying those theories. His ideas were often bold and ahead of their time yet bore the quiet humility of a scholar’. While Vontress’s theoretical contributions were always significant, we suggest they have since found increased resonance in current British trends concerning existential therapy, reflections on transgenerational trauma and increased consideration of traditional healing (all recommended, incidentally, in chapters in this book.) Other American theorists whose work influenced British colleagues in the last decades of the 20th century include Paul Pedersen, Janet Helms, Anthony Marsella, Derald Wing Sue, Nancy Boyd-Franklin, Robert Carter, Peggy McIntosh and Charles Ridley. Such a list is always going to be idiosyncratic and somewhat limited; there were many other key theorists and practitioners active at that time. Colin was fortunate to meet Paul Pedersen at an International Round Table for the Advancement of Counselling (IRTAC) conference in 1982. After Pedersen’s death in 2017, Patricia Arrendondo, a past president of the American Counseling Association (and another contributor to the early canon of American texts dedicated to multicultural professional practice) acknowledged that Paul was ‘key in the development of multiculturalism and intersectionality’ (Ivey, 2017). In the same obituary, Derald Wing Sue (more recently renowned for his extensive work on ‘microaggressions’) wrote that ‘Paul was one of the few voices that challenged

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the Eurocentric theories of counselling and psychotherapy, indicated how they were culturally biased, chided mental health professionals for not understanding the socio-political nature of their practice and warned that traditional approaches to counselling and therapy could easily become forms of cultural oppression’. Earlier in the same obituary, Alan Ivey (another significant ‘multicultural’ counselling psychologist) noted that Paul had developed a ‘triad’ training model, which disrupted the more traditional dyadic interviewing model by bringing the varying cultural perspectives into the counselling space. Billie-Claire Wright refers to developments within this model in her chapter later in this book – a model first demonstrated in the UK in the early 1990s by Courtland Lee, another of our contributors.

The impact of writings from across the Atlantic Racism is about a myriad of denial for both the recipients and the perpetuators. (Bains, 2008)

Few British counsellors and psychotherapists had Colin’s good fortune to meet such American luminaries in person. Most were only known in the UK through their writing, in pioneering books such as Counseling Across Cultures (Pedersen et al., 1976), Cross-Cultural Counseling and Psychotherapy (Marsella & Pedersen, 1981), and the Handbook of Cross-Cultural Counseling and Therapy (Pedersen, 1985). While various relevant articles were published in the UK from the late 1970s, the first British books published on the subject didn’t appear until those by D’Ardenne and Mahtani (1989), Kareem and Littlewood (1992), Eleftheriadou (1994), Lago and Thompson (1996) and Krause (1998), all of which referenced the above classic American sources. At an academic level, the Americans preceded the British by about a decade, more of which later. Simply reviewing the contents lists of the above American texts reveals a wide range of professional issues that continue to have relevance today in the UK with regard to philosophic, ethical and practice-based developments. Key among these are concerns about cultural inclusiveness, racial and ethnic barriers to therapy, the therapist’s awareness of their own value systems, cultural identity, conducting research, the implications of intersectionality, the challenges of training, and much more. The therapeutic use of traditional support systems is also considered and this subject is dynamically interlinked with the references in this book to the incorporation of traditional healing. Theoretical implications of particular approaches (behavioural and psychoanalytic) were also considered. Such classic theoretical considerations have also, not unsurprisingly, become one facet of later British contributions, as evidenced in the psychoanalytic sphere by Kareem and Littlewood (1992), in anthropological perspectives (Krause, 1998), and with reference to existential ideas (Eleftheriadou, 1994). Inevitably, these early American texts also featured discussions on professional issues relevant to the US that have not proved so applicable within the UK. These include careers counselling, specific needs of and interventions with defined client

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populations specific to the US, and client evaluation and psychological testing. However, these latter two areas are today increasingly used in clinical psychology, employee assistance programmes and the NHS Improving Access to Psychological Therapies (IAPT) counselling service.

America and the UK: Some comparisons and contrasts You can’t separate peace from freedom because no one can be at peace unless he has his freedom. (Malcolm X, 1965, Chapter 12)

While paying homage to these transatlantic inspirations, one has also to bear in mind the considerable cultural differences between the US and the UK. Not everything written about and researched there has equivalency here. Already above, we have noted some elements of transcultural therapy practice that have not transferred to the British milieu. There is no doubt that the impact of racism and discrimination on minority groups in the UK is frighteningly well evidenced. While some of these oppressive dynamics may have cultural differences in their modes of expression between the US and the UK, the core judgemental tendencies and discriminatory behaviours have been repeatedly recorded in both British academic literature and UK government reports in the last five decades. The evidence for these practices is spread right across the fields of education, law, employment, health, mental health and policing. (Search online, for example, for and you will find a considerable resource of UK government reports exploring police discrimination, institutional racism, race-hate attacks, human rights abuses, and so on. Likewise, a search online for produces a massive list of government policies and other reports of discriminatory practice that have seemingly made little difference to people’s experiences on the ground.) In societal terms (beyond the disciplines of counselling and psychotherapy), the murder of George Floyd and others since (and many before) and the Black Lives Matter protests have resonated worldwide, including in the UK. The adoption of ‘taking the knee’ by English football league players before every game is but one example of society publicly recognising the parallel injustices and discrimination rife in the UK.

Multicultural counselling competences I felt I had three prejudices against me. My anxiety, which weakened me, and the therapist’s perception of my culture and my colour. I had to fight to retain the latter two. (Jenkin, 2004)

In the early 1990s, the leading American professional bodies for counselling and psychotherapy combined to argue for recognition of multicultural counselling as the ‘fourth force’ in counselling and psychotherapy (after psychoanalytic, behavioural and humanistic). This (somewhat unique) combined professionalorganisational initiative argued that this ‘fourth force’, as an approach to therapy

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practice, should underpin the three main theoretical perspectives. That is, attention was drawn to the skilled and sensitive practice of counselling/psychotherapy with clients of all diversities in society. In a landmark moment of great significance, these same professional bodies also coordinated, across several counselling/ psychotherapy journals, the simultaneous publication of an agreed set of ‘multicultural competences’ for therapists (Sue et al., 1992). Later versions were published by Sodowsky and colleagues (1994) and Moodley and Lubin (2008). Inspired by these earlier systematic reflections on the desirable arenas of knowledge, awareness and skills recommended for enhanced multicultural sensitivity in counselling relationships, Lago (2010) published an initial roadmap of what he considered to be desirable competences from a British perspective. More recently, the Association for Multicultural Counseling and Development, a division of the American Counseling Association, has published a set of Multicultural and Social Justice Counseling Competencies (Ratts et al., 2015). In an article critical of the competencies perspective, Patterson (2004) argued that the world is now so complex and the diversity of identity so broad that the notion of particular interventions for particular groups is too simplistic and not workable. In support of his position, he quotes the American psychiatrist Harry Stack Sullivan, who wrote: ‘We are all more basically human than otherwise’ (1947), and Stephen Pinker (1997, p.32), who noted that ‘surveys of the ethnographic literature show that peoples of the world share an astonishingly detailed universal psychology’. Patterson argued that the common nature of all human beings provides the basis for a solution to the challenge of multicultural counselling. In his view, focusing on the centrality of the therapeutic relationship is paramount. Suffice to say, these opposing points of view continue today. On the one hand, we have witnessed dedicated, conscientious colleagues arguing strongly from the latter, essentialist, relational position, and on the other, different colleagues arguing equally strongly for a more detailed, nuanced approach that is sensitive to and knowledgeable about cultural difference and diversity issues. Between these two theoretical positions, when applied to the therapeutic dyad, are found the biographies of the lived experiences of the client and therapist. And it is within this ‘middle territory’ that the therapist may either manage to meet and relate to the client in a manner beneficial to that client or behave and/ or respond in ways that prove dismissive or even harmful to them, leading, at worst, to the early termination of the counselling process. It is this latter concern that sits at the core of this book.

From race and ethnicity to difference and diversity Diversity is not the enemy of quality, it is the realisation of it. Right now, diversity is something that is said more than done: all talk and no action. (Ramaswamy, 2019)

In the 1990s and 2000s (and in parallel with the US), there was a governmental

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– and subsequent organisational – policy trend in the UK towards embracing the full panoply of human diversity within a single equality law. While this new policy justly brought attention to the broad spectrum of diverse lives and identities (age, race, gender, sexuality, disability, faith, ethnicity, class) that have experienced discriminatory behaviours, this broad focus shifted attention away from concerns directly related to race, culture and ethnicity, thus sidelining the historical and everyday realities of racism, oppression and discrimination. We contend that this governmental/organisational shift, while acknowledging the broader impact of structural oppression, was a deliberate ploy to reduce the financial cost and political discomfort of confronting and acting to address endemic racism. This shift of focus has led to an oversimplified view that we are all different, equal and diverse. While this respect for individual uniqueness is fundamental to and completely embodied within the world of counselling and psychotherapy, it does not take into account the structural and personal power and privilege differentials manifest in society and how these are deeply embedded and expressed within the identity, attitudes and behavioural responses of both therapist and client. These potent differentials are recognised in, for example, a working definition of difference and diversity produced in 2004 by BACP’s (short-lived) Equality and Diversity Forum, which proposed two lists of those groups deemed to hold power in society and those categorised as ‘diverse’ (Lago & Hirai, 2012, p.437). The definition stated: ‘There are particular groups which are privileged in U.K. society. These groups represent the often-unexamined norm from which “difference” is defined.’ The ‘Advantaged/Norm’ groups included ‘white people, heterosexual people, able-bodied people, men and people of working (income generating) age’; the ‘Disadvantaged/Different’ groups were listed as ‘Black and minority ethnic people, lesbian, gay and bisexual people, disabled people, women, young people/ older people/unemployed people’. Reflecting these debates that were happening nationally at that time and anticipating the BACP conceptualisations above, in 2003 Lago and Smith edited a book devoted to exploring ‘anti-discriminatory’ practice and featuring separate chapters across the above defined range of intersectional identities. Two more recent books that also address this broader spectrum of diversity and difference in relation to counselling and psychotherapy have caught our attention. The first is by Rose Cameron (2020), who not only explores and offers contemporary thinking on the complete range of diverse identities (race, ethnicity, gender, sex, sexuality, disability, age and class) but also includes many reflective exercises and case examples. The other is by Dwight Turner (whose chapter you will find later in this book), who writes powerfully about intersectional difference, the unconscious experience of privilege and how privilege plays a role in the construction of ‘otherness’ (2021).

Theoretical conceptualisations related to transcultural work Racist trauma crucially affects therapeutic trust. (Bains, 2008)

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Despite the absence of the working groups dedicated to improved multicultural therapy within the major counselling and psychotherapy professional bodies and the policy shift towards the broader definition of diverse considerations, important contributions to theory and practice have continued to be made within the transcultural arena in the early decades of the new millennium. Proctor (2017) has researched power and its manifestations within the therapeutic relationship. Alleyne (2004, 2005) has developed her understanding of racial oppression in terms of its creation of a complex internal dynamic in Black people. Conceptualised as the ‘internal oppressor’, it impacts self-esteem, attachment patterns and relationships with white people. She also cites a list of values and principles underpinning good practice with issues of difference and diversity (2011). McKenzie-Mavinga has explored ‘Black issues in the therapeutic process’ (2009). She proposes an ‘emancipatory’ training approach for both Black and white trainees in which the myriad concerns, problems, dynamics and experiences in relation to ‘Black issues’ could be addressed. Tuckwell (2002) and Ryde (2019) have both explored the challenges of white identity for therapists. Tribe (2007, 2011; Tribe & Raval, 2003) and Costa (2020) have contributed extensively to the research on and therapeutic practice with non-English speaking clients. Moodley and West (2005) have explored the integration of traditional healing practices into counselling and psychotherapy.

An increase in students and therapists from diverse communities From the early 1990s onwards, despite the considerable economic demands of therapy training, an increasing number of trainees of diverse ethnic heritages began to enrol on counselling/psychotherapy courses, particularly in the metropolitan areas of the UK. Their presence inevitably raised awareness of (and discomfort in relation to) issues of race and the exercise of power in therapy, as well as presenting deeper questions about the unthinking blanket application of the mainstream theories of psychotherapeutic engagement to all people, regardless of ethnicity and culture. Some of these early students continued on to carry out doctoral research programmes and produce publications that further explored and sought to explain the experiences and complexities of living in a white-majority society for people from minority ethnic communities. For example, Valerie Watson (2004), who writes later in this book, conducted her doctoral research programme on the impact of therapy training on students of diverse identity. Sadly, the conclusions of her research revealed that such students learned through their training experiences to either ‘put up or shut up’ in relation to addressing racial difference and its impact within therapy. Dhillon-Stevens (2004b) also explored counselling students’ experiences in training. Her research revealed the considerable contrast between the white students and students from ethnic minority groups: the latter almost always considered the nature of their identity, while the former seldom addressed it. Based on her findings, DhillonStevens proposed a personal and professional integration of the anti-oppressive

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practice and multiple oppression models in psychotherapeutic education (2004c). Sara Bains (2008) explored the traumatic effects of colour racism on the self and how it impacts on self-concept and identity. Yair Maman (2008), Beverley Costa (2012, 2020) and Rachel-Rose Burrell (2018) all approached the issue of race and diversity in counselling from a developmental, community-based perspective. Maman’s research focused on the involvement of local communities in therapist training. Costa’s work looked at multilingualism in therapy and the need for skilled interpreter services to open access to local minority ethnic communities. Burrell discusses her work in her chapter later in this book.

The creation of professional home bases for therapists of minority heritage When people treat you differently to what you think you are, it is very confusing. Communication is difficult if not just impossible: they are always talking to someone else… it is the visibility to others of my supposed ‘foreignness’ that gives rise to the problem. The fact that the very seeing of this difference is also unmentionable in polite society renders the problem insoluble. (Adonis, 2004)

There is no doubt that there is very real pain and anger among Black therapists relating to their experiences in training and the workplace and at their continued exclusion from training and professional forums. The Association for Black Counsellors (ABC) emerged in 1983, emanating originally from the British Association for Counselling’s (as it then was) RACE division, and became an important support community for its members for about a decade. The Black, African and Asian Therapy Network (BAATN) formed in 2003 and organised its first conference in 2006. It is now the UK’s largest independent organisation for people who specialise in working with clients who identify as Black, African, South Asian and Caribbean, with the explicit aim ‘to give a voice to a “Black empathic approach” in therapy and therapy education’ (BAATN, undated). The Black and Asian Counselling Psychology Group (BACPG) is dedicated to raising the profile of Black and Asian counselling psychologists in the UK. Its aims include: influencing and shifting the dialogue on race, ethnicity and difference; increasing the visibility of Black, Asian and minority ethnic practitioners in order to improve access to appropriate resources for the Black, Asian and minority ethnic community; promoting critical thinking and the invitation of different narratives and consistently highlighting and eliminating silence around the experiences and impact of racial and ethnic discrimination. Both of the organisations described above have emerged to fill the vacuum created by the failure of the major psychology, psychotherapy and counselling organisations to provide a home for Black therapists. Symbolically, practically, clinically and theoretically, these professional membership groups represent a significant development in the therapeutic world.

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A radical call to the profession One thing remains constant about our humanity… that we must never stop trying to tell stories of who we think we are. Equally, we must never stop wanting to listen to each other’s stories. If we ever stopped, it would all be over. (Behar, 2003, p.37)

Since 2015, there has been a considerable explosion of new literature by writers of minority group heritage, some of which we list below. They are a call to us all to persevere with seeking understanding, compassion, communication and resolution to matters of difference. The topics featured in these new books cover a wide span of subject matter, which we have broadly divided into two main categories: the societal context and the therapeutic context. Inevitably, this is an oversimplified separation as, in truth, events and issues occurring within society will obviously have resonances with clients and therapists in the therapeutic environment.

The societal context From within this broader context, there are texts illuminating an extensive Black history (Fryer, 2018; Olusoga, 2016; Hondius et al., 2019); highlighting the shocking statistics of discrimination and racism (Akala, 2019; Booth et al., 2018); dedicated to the exploration of ethnic and national identity (Hirsch, 2018); searching for a deeper sense of belonging (Pitts, 2019); recording the creeping and sinister increase of ‘race science’ (Saini, 2019); addressing the visibility and invisibility of heritage (Lennon, 2018); considering colour and language (Boakye, 2019); exploring the challenges of white awareness (Bhopal, 2018; DiAngelo, 2016; Eddo-Lodge, 2017; Wekker, 2016); relating contemporary political issues (Gentleman, 2020; Grant, 2020); on media bias (Unigwe, 2019); on stop-and-search police powers (Dodd, 2019); on the use of interpreters in therapy (Dillsworth, 2019), and many more.

The therapeutic context Race within the therapeutic context has been addressed in professional journals that have dedicated special issues to diversity in therapy. These include the October issues of Therapy Today in 2018 and 2019; the December 2011 issue of the World Journal of Person-Centred and Experiential Psychotherapy, and the January 2015 issue of The Psychotherapist. Additionally, researchers, practitioners and writers in this field have conceived and developed a range of valuable theoretical concepts that describe the consequences of living within a discriminatory society for members of minority ethnic groups. Many of these ideas, inevitably, are interconnected with each other. These concepts include the ‘proxy self ’ – that part of the self that is considered acceptable to be shown to the outside world (Thomas, 1995); the experience of ‘internalised oppression’ and resulting ‘identity wounding’ (Alleyne 2004, 2005); suffering ‘continuous trauma’ (Straker, 2004); living a form of ‘existential crucifixion’ (Hall, 2009); experiencing an avoidance of issues related to minority identity from

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white therapists (Thompson & Jenal, 1994); the importance of developing a ‘Black empathic approach’ (McKenzie-Mavinga, 2009), and experiencing the long-term consequences of ‘transgenerational hatred’ and ‘transgenerational trauma’ (Apprey, 1998; Vontress & Epp, 1997). More recently, there has been some noticeable theoretical attention paid to microaggressions and their impact on personality and relationships (Sue, 2010); the exploration of unconscious bias in therapists (Mohdin, 2019); the challenges of intersectionality and privilege (Adames et al., 2018; Turner, 2021), and the debate about cultural competences vs cultural humility (Tervalon & Murray-Garcia, 1998). In later chapters in this book, reference is made to the ‘ethnic identity development’ models emerging in the US. Building on their use as descriptors for attitudinal movement in relation to identity (and thus providing valuable self-reflective templates for therapists), Robert Carter has validated a direct connection between therapist identity awareness and therapeutic success or failure (1995). Therapeutic interventions following on from Carter’s work recognise the importance of deeply accepting and respecting the identity of the client and the therapist’s capacity to broach the topic in therapy (Day-Vines et al., 2020).

Concluding thoughts Where is the consciousness of the training organisations and their commitment to look at their own unconscious white fragility and supremacy? (Raja-Helm & Kohli, 2019)

Anyone and everyone who has been involved, whether as a student, training course participant or trainer, in training sessions dedicated to the exploration of diversity is likely to have experienced varying levels of discomfort, defensiveness, shame, guilt, denial and distress. This phenomenon is widely referred to in many of the chapters that follow. What is very clear from these training experiences is that a) the issue of personal identity, when raised for exploration and reflection, is of deep importance and significance to each person; b) one’s attitudes towards others of differing identities, once recognised and articulated, can become most distressing and disturbing; c) this is most likely to happen through open dialogue. The capacity to listen to others’ perspectives and personal histories can become severely inhibited by one’s own reactions of anxiety, guilt and shame. There is no shortage of harrowing personal stories and theoretical ideas in the literature. Yet the wider dissemination, discussion and internalised reflection of them has not really taken place in training and professional development activities. BillieClaire Wright and Delroy Hall both explore in their chapters how to move beyond the anxiety by acknowledging, exploring and sitting with the discomfort, as opposed to avoidance or camouflage. This is a major training challenge for the coming years. As to the future, there is no doubt that the societal/political landscape will influence lived relations and power differentials across and between different ethnic groups. Inevitably, more concepts will emerge as a consequence of research and evolution of practice. The language and terminology will evolve and change.

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Crucially, however, the professional field must fully embrace these issues ethically and morally and individual therapists of all theoretical perspectives must work on themselves and their identities to maximise the potential for sensitive and efficacious practice with all clients. Humans can no more survive psychologically in a psychological milieu that does not respond empathically to them than they can survive physically in an atmosphere that contains no oxygen. (Heinz Kohut, 1977)

References Abu el Magd, N. (2019, October 10). Our mental health systems are not designed for women of colour like me. That has to change. HuffPost. www.huffingtonpost.co.uk/author/dr-noha-abu-el-magd Adames, H.Y., Chavez-Duenas, N.Y., Sharma, S. & La Roche, M.J. (2018). Intersectionality in psychotherapy: Experiences of an Afro LatinX queer immigrant. Psychotherapy, Research and Practice, 55(1), 73–79. Adonis, I. (2004). Black history plus Black identity. Asylum, 14, 4. Akala. (2019). Natives: Race and class in the ruins of empire. Two Roads. Alleyne, A. (2004). Black identity and workplace oppression. Counselling and Psychotherapy Research, 4(1), 4–8. Alleyne, A. (2005). Invisible injuries and silent witness: The shadow of racial oppression in workplace contexts. Psychodynamic Practice, 11(3), 283–299. Alleyne, A. (2011). Overcoming racism, discrimination and oppression in psychotherapy. In C. Lago (Ed.), The handbook of transcultural counselling (pp.117–129). McGraw-Hill/Open University Press. Apprey, M. (1998). Reinventing the self in the face of received transgenerational hatred in the African American community. Mind and Human Interaction, 9(1), 30–37. Republished in: Journal of Applied Psychoanalytic Studies, 1999; 1(2), 131–143. Bains, S. (2008). An autoethnographic exploration into transforming the words of racism: Implications for psychotherapy. Unpublished PhD thesis. Metanoia/Middlesex University. Behar, R. (2003). Ethnography and the book that was lost. Ethnography 4(1): 15–39. Bhopal, K. (2018). White privilege: The myth of a post-racial society. Policy Press/Bristol University. Black, African and Asian Therapy Network (BAATN) (undated). Welcome to BAATN. [Online.] www.baatn.org.uk/about/ Boakye, J. (2019). Black, listed: Black British culture. Dialogue. Booth, R., Mohdin, A. & Levet, C. (2018, December 2). Bias in Britain: explore the poll results. The Guardian. www.theguardian.com/uk-news/ng-interactive/2018/dec/02/bias-in-britain-explorethe-poll-results Burrell, R.R. (2018). The Black minority church: Exploring the impact of faith and the faith community on mental health and well-being. Unpublished PhD. thesis: Metanoia/Middlesex University.

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Cameron, R. (2020). Working with difference and diversity in counselling and psychotherapy. Sage. Carter, R. (1995). The influence of race and racial identity in psychotherapy: Towards a racially inclusive model. Wiley & Sons. Clark, J. (2010). And then it happened that... A life fully adventured. Watershed Publications. Clark, J. & Lago, C. (1984). Multi-racial videoscenes. Leicester Polytechnic Audio Visual Department. Costa, B. (2012). An audit of the organisation Mothertongue multi-ethnic counselling service. Unpublished PhD thesis. Metanoia/ Middlesex University. Costa, B. (2020). Other tongues: Psychological therapies in a multilingual world. PCCS Books. Day-Vines, N.L., Cluxton-Keller, F., Agorsor, C., Gubara, S. & Otabil, N.A.A. (2020). The multidimensional model of broaching behavior. Journal of Counseling and Development, 98(1), 107–118. D’Ardenne, P. & Mahtani, A. (1989). Transcultural counselling in action. Sage. Dhillon-Stevens, H. (2004a). DVD programmes on anti-oppressive practice. Dhillon-Stevens Ltd. Dhillon-Stevens, H. (2004b). Healing outside and inside: An examination of dialogic encounters in the area of anti-oppressive practice in counselling and psychotherapy. Unpublished PhD thesis: Metanoia/Middlesex University. Dhillon-Stevens, H. (2004c). Personal and professional integration of anti-oppressive practice and the multiple oppression model in psychotherapeutic education. British Journal of Psychotherapy Integration, 1(2), 47–62. DiAngelo, R. (2016). What does it mean to be white? Developing white racial literacy. Peter Lang. Dillsworth, D. (2017). In more words: The first international anthology of interpreters’ stories. Mothertongue. www.pasaloproject.org Dodd, V. (2019, January 26). Met police ‘disproportionately’ use stop and search powers on black people. The Guardian. www.theguardian.com/law/2019/jan/26/met-police-disproportionately-usestop-and-search-powers-on-black-people Eddo-Lodge, R. (2017). Why I’m no longer talking to white people about race. Bloomsbury. Eleftheriadou, Z. (1994). Transcultural counselling. Central Books. Fryer, P. (2018). Staying power: The history of black people in Britain (2nd Ed.). Pluto Press. Gentleman, A. (2020). The Windrush betrayal: Exposing the hostile environment. Guardian/Faber. Gorman, A. (2021). The hill we climb: An inaugural poem. Chatto & Windus. Grant, G. (2020). Homecoming: Voices of the Windrush generation. Jonathan Cape. Hall, D. (2009). The middle passage as existential crucifixion. Black Theology: An International Journal, 7(1), 45–63. Hirsch, A. (2018). BRIT(ish): On race, identity and belonging. Vintage. Hondius, D., Jouwe, N., Stam, D. & Tosch, J. (2019). The Netherlands slavery heritage guide. LM Publishers. Ivey, A.E. (2017, February 7). In memoriam. Paul B. Pedersen. American Counseling Association. www.counseling.org/aca-community/in-memoriam/in-memoriam/2017/02/07/dr.-paul-b.-pedersen Jenkin, C. (2004). Black women’s mental health. Asylum 14, 4. Kareem, J. & Littlewood, R. (1992). Intercultural therapy: Themes, interpretations and practices. Blackwell Scientific. Kohut, H. (1977). The restoration of the self. International Universities Press. Krause, I.B. (1998). Therapy across culture. Sage.

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Lago, C. (2010). On developing our empathic capacities to work inter-culturally and interethnically: Attempting a map for personal and professional development. Psychotherapy and Politics International 8(1), 73–85. https://doi.org/10.1002/ppi.213 Lago, C. & Hirai, T. (2012). Counselling across difference and diversity. In M. Cooper, M. O’Hara, P.F. Schmid & A.C. Bohart (Eds.), The handbook of person-centred psychotherapy and counselling (pp. 436–452). Palgrave MacMillan. Lago, C. & Smith, B. (Eds.). (2003). Anti-discriminatory practice in counselling and psychotherapy. Sage. Lago, C. & Thompson, J. (1994). Issues of race and culture in counselling settings. University of Leicester Audio Visual Department. Lago, C. & Thompson, J. (1996). Race, culture and counselling. Open University Press. Lennon, A.E. (2018, November 10). Yes, I have white parents. But I have African ancestry too. The Guardian. www.theguardian.com/commentisfree/2018/nov/10/white-parents-african-ancestryanthony-ekundayo-lennon Malcolm X. (1965). Prospects for freedom in 1965. Speech delivered in New York City, 7 January, 1965. In G. Breitman (Ed.). Malcolm X speaks: Selected speeches and statements. Grove Press. Maman, Y. (2008). A community approach to training therapists from under-represented groups. Unpublished PhD thesis: Metanoia/Middlesex University. Marsella A.J. & Pedersen, P.B. (1981). Cross-cultural counseling and psychotherapy. Pergamon. McKenzie-Mavinga, I. (2009). Black issues in the therapeutic process. Palgrave MacMillan. Mohdin, A. (2019, January 26). Racism in Britain: How we revealed the shocking impact of unconscious bias. The Guardian. www.theguardian.com/membership/2019/jan/26/racism-inbritain-how-we-revealed-the-shocking-impact-of-unconscious-bias Mohdin, A. & Storer, R. (2021, January 30). The reckoning: The toppling of monuments to slavery in the UK. The Guardian. www.theguardian.com/uk-news/2021/jan/29/the-reckoning-the-topplingof-monuments-to-slavery-in-the-uk Moodley, R. (2010). In the therapist’s chair is Clemmont E. Vontress: A wounded healer in crosscultural counselling. In R. Moodley & R. Walcott (Eds.), Counseling across and beyond cultures: Exploring the work of Clemmont Vontress in clinical practice (pp. 43–56). University of Toronto Press. Moodley, R. & Lubin, D. (2008). Developing your career to working with multicultural and diversity clients. In S. Palmer & R. Bor. (Eds.), The practitioner’s handbook: A guide for counsellors, psychotherapists and counselling psychologists (pp.156–175). Sage. Moodley, R. & West, W. (Eds.). (2005). Integrating traditional healing practices into counselling and psychotherapy. Sage. Moodley, R., Epp, L. & Yasuf, H. (Eds.). (2012). Counseling across the cultural divide: The Clemmont Vontress reader. PCCS Books. Olusoga, D. (2016). Black and British: A forgotten history. Macmillan. Patterson, C.H. (2004). Do we need multicultural counselling competencies? Journal of Mental Health Counseling 26(1), 67–73. Pedersen, P.B. (1985). Handbook of cross-cultural counseling and therapy. Praeger. Pedersen, P.B., Draguns, J.G. & Lonner, W.J. (Eds.). (1976). Counseling across cultures. East-West Center. Pinker, S. (1997). How the mind works. W.W. Norton & Co. Pitts, J. (2019). Afropean. Allen Lane. Proctor, G. (2017). The dynamics of power in counselling and psychotherapy (2nd ed.). PCCS Books.

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Raja-Helm, P. & Kohli, S. (2019). Let’s all get uncomfortable. Therapy Today 30(1), 44–45. Ramaswamy, C. (2019, October 12). ‘Box-ticking’ took the shine off my award. The Guardian Review. Ratts, M.J., Singh, A.A., Nassar-McMillan, S., Kent Butler, S. & Rafferty McCullough, J. (2015). Multicultural and social justice counseling competencies. American Counseling Association. Ryde, J. (2019). White privilege: How to be part of the solution. Jessica Kingsley. Saini, A. (2019). Superior: The return of race science. Fourth Estate. Sodowsky, G.R., Taffe, R.C., Gutkin, T.B. & Wise, S.L. (1994). Development of the Multicultural Counseling Inventory (MCI): A self-report measure of multicultural competencies. Journal of Counseling Psychology, 41, 13–148. Stack Sullivan, H.S. (1947). Conceptions of modern psychiatry. William Alanson White Psychiatric Foundation. Straker, J. (2004). Trauma and disconnection: A transtheoretical approach. International Journal of Psychotherapy, 7(2), 145–158. Sue, D.W. (2010) Micro-aggression in everyday life: Race, gender and sexual orientation. Wiley & Sons. Sue, D.W., Arrendondo, P. & McDavis, R.J. (1992). Multicultural counselling competencies and standards: A call to the profession. Journal of Counseling and Development, 20(2), 64–88.  Tervalon, M. & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117–125. Thomas, L. (1995). Psychotherapy in the context of race and culture: An inter-cultural therapeutic approach. In Fernando, S. & Keating, F. (Eds.), Mental health in a multi-ethnic society (pp.172–191). Routledge. Thompson, C.E. & Jenal, S.T. (1994). Interracial and intraracial quasi-counseling interactions when counselors avoid discussing race. Journal of Counseling Psychology, 41(4), 484–491. Tribe, R. (2007). Working with interpreters. The Psychologist, 20(3), 159–161. Tribe, R. (2011). Working with interpreters and bicultural workers. In C. Lago (Ed.), The handbook of transcultural counselling and psychotherapy (pp.81–93). McGraw-Hill/Open University Press. Tribe, R. & Raval, H. (Eds.). (2003). Working with interpreters in mental health. Routledge. Tuckwell, G. (2002). Racial identity, white counsellors and therapists. Open University Press. Turner, D. (2021). Intersections of privilege and otherness in counselling and psychotherapy: Mockingbird. Routledge. Unigwe, C. (2019, October 5). It’s not just Greta Thunberg: Why are we ignoring the developing world’s inspiring activists? The Guardian. www.theguardian.com/commentisfree/2019/oct/05/ greta-thunberg-developing-world-activists Vontress, C.E. (2010). Culture and counseling: A personal retrospective. In R. Moodley & R. Walcott (Eds.), Counseling across and beyond cultures: Exploring the work of Clemmont Vontress in clinical practice (pp.19–42). University of Toronto Press. Vontress, C.E. & Epp, L.R. (1997). Historical hostility in the African American client: Implications for counseling. Journal of Multicultural Counseling and Development, 25(3), 170–184. Watson, V. (2004). The training experiences of black counsellors. Unpublished PhD thesis. University of Nottingham. Wekker, G. (2016). White innocence: Paradoxes of colonisation and race. Duke University Press. Williams, D. (2019). Quoted in C. Jackson. Black spaces, Black faces. Therapy Today, 30(8), 21–24.

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The cultural complexity of training counsellors abroad: The case of Afghanistan Lucia Berdondini, Ali Ahmad Kaveh and Sandra Grieve

Over recent years, numerous studies and intervention programmes have been developed in the Middle East to introduce counselling, psychosocial counselling and counselling training, especially ones addressed to vulnerable groups like refugees, young people and adults affected by severe trauma. These have highlighted the importance of developing culturally adapted models (Gilbert, 2009; Halaj & Huppert, 2017). One of the main aspects of intercultural awareness, often stressed in previous studies, is that Western definitions of mental health and the possible causes of mental illness do not necessarily coincide with Eastern ones, with the risk of missing and misinterpreting how different communities perceive and respond to psychological distress (Miller et al., 2006; Halaj & Huppert, 2017). Equally, the possible emotional and psychological resources of diverse cultural realities are often overlooked when designing psychosocial interventions and counselling training (Gilbert, 2009). It has also often been argued that the expansion of counselling and counselling services is inhibited in the Middle East by the stigma attached to mental health issues, inducing a reluctance among individuals and families to attend talking therapy (Ciftci et al., 2012; Halaj & Huppert, 2017). Despite these points, mental health, especially in countries affected by longterm conflicts such as Afghanistan, has now become one of the priorities of humanitarian intervention by governments and donors. The levels of stress and mental health issues in Afghanistan have been consistently reported as very high in comparison with other international contexts (Miller &Rasmussen, 2010; Wildt et al., 2017). Studies of the mental health of university students and lecturers have revealed alarming results (Babury & Hayward, 2013; Panter-Brick et al., 2008). In 2003, ‘Mental Health in Afghanistan’ became part of a basic package of health services developed by its Ministry of Public Health, and psychosocial counselling was incorporated in 2010 (National Mental Health Strategy, 2009–2014). Since

Lucia Berdondini, Ali Ahmad Kaveh and Sandra Grieve

then, several intervention programmes have sought to develop mental health training and service resources for the Afghan population (Sayed, 2011). This chapter presents the authors’ experiences of introducing and implementing humanistic counselling and counselling training in Higher Education Institutes (HEIs) in Afghanistan, through a series of projects that started in 2010 and is ongoing. The chapter will identify what we encountered as particularly challenging in the process, what was a more natural integration of cultures and philosophies and how these translated into counselling training and practice. We will reflect on ethical aspects related to counselling training in Afghanistan and how we have been working with them. We will also discuss the lessons learnt from this experience and how they can help others to replicate similar projects in other contexts.

The INSPIRE project and its long-term development The project described here started in 2010 with funding offered by the British Council under its INSPIRE scheme for a four-year project, in a collaboration between the University of Strathclyde (UK) and the University of Herat (Afghanistan). The original project was focused on designing and developing an intercultural counselling training based on a humanistic therapeutic approach for Afghan practitioners such as doctors, nurses, lecturers and students (Berdondini et al., 2014; 2019). Over time, the model was continually evaluated and modified until its final version became the basis for the BA courses in counselling at the universities of Herat and Kabul. This led to the setting up of the first student counselling service at the University of Herat and the training of hundreds of counsellors who now work for local NGOs, mental health centres, refugee camps, schools and prisons across Afghanistan. The project is still ongoing as we continue to assess and evaluate its impact on clients and monitor what seems to work particularly well and what doesn’t. The theoretical framework that we used as a basis for the therapeutic model was humanistic. Humanistic theory and practice, and in particular the personcentred (Rogers, 1961), Gestalt (Perls et al., 1951) and psychodrama (Moreno, 1953) modalities, were considered the most appropriate for a pioneering intercultural initiative where an effective therapeutic model needed to be co-constructed between trainers and trainees, as it was the first of its kind in Afghanistan. The trainers were both European (one British and one Italian) and neither had a particular knowledge or experience of the Afghan culture. The trainees were, over the four years of the project, a mixed-gender group of 20 individuals from different parts of Afghanistan with varied social backgrounds and various professional roles and experience. The basic challenge of the original project was to create the right circumstances for a meaningful and effective encounter between a variety of cultures where it was possible for everybody to feel included, recognised and welcome to participate and contribute. It was, first of all, important to establish a climate of inclusiveness and creativity where ‘problem solving’ and group work could occur (the actual training was yet to be designed and developed (Berdondini et al., 2014)). The humanistic,

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phenomenological-existential theoretical framework was considered the most appropriate to establish that climate where a student-centred ethos was a priority and bracketing personal assumptions and engaging with the ‘unknown’ were a necessity. The contents of the course were negotiated between trainers and trainees according to what the group thought were essential learning outcomes. The delivery of the individual sessions was, most of the time, co-created, using what was considered to be the most useful and meaningful methods in the moment. The final course was structured as follows: •

lectures on the theory of person-centred counselling

•

skills-practice sessions (in English and Dari)

•

activities focused on developing self-awareness and reflexivity

•

creative therapeutic techniques derived from approaches such as Gestalt therapy and psychodrama in order to meet different cultural needs and values

•

supervision sessions (also used as a form of assessment) using interpersonal process recall (IPR) (Kagan & Kagan, 1997)

•

regular revision of the training through feedback and evaluation forms, in order to modify/adjust/amend the course according to the participants’ experience and learning needs across the four years

•

follow-up/long-term Skype supervision sessions, individual and in groups, to monitor, support and deepen counsellors’ practice and keep reflecting and working on ethical dilemmas, challenging clients, intercultural clashes and so on.

From the very beginning, trainees asked to work a lot with live demonstrations. They preferred to watch trainers demonstrating how to address specific issues in therapeutic sessions with individual participants in front of the group, rather than to be told about it and then try it out themselves in skills practice. This was also requested with the intent of exploring what local cultural resources could be integrated into the therapeutic model so clients felt able to express themselves in a familiar and comfortable way, which in turn enhanced the therapeutic relationship. Gestalt and psychodrama offered the right tools to approach the development of therapeutic interventions as they both include creative and projective practices, such as role-play and using objects such as dolls, stones and scarves (Berdondini et al., 2014, 2019). In the Afghan culture in general (in education, in health settings, as a form of common expression of emotions), the use of poems is significant and very common (Saghar, 2018), and so it felt natural to integrate use of poems and arts in general (such as painting and drawing) to explore topics and as a medium for therapeutic interventions. The use of metaphors and arts generally was particularly important because most of the problems presented by the students were considered ‘taboo’ (such as being secretly in love with someone or experiencing family pressure to take on certain social roles) and so could not be openly discussed in front of the group (Berdondini et al., 2014).

Lucia Berdondini, Ali Ahmad Kaveh and Sandra Grieve

A typical session of the training would be as follows: 1. Exploration of the topic of the training (for example, working with trauma or with reluctant clients or ‘taboos’) in the group, either in a theoretical way or in an action/psychodrama way, to encourage reflection and discussion on how humanistic theories and Afghan cultural beliefs and values could explain and make sense of it and how it might be possible to integrate different views. 2. Live demonstrations with volunteers to explore how this could be translated into practice in a therapeutic way. 3. Feedback and discussion on the demonstrations. 4. Video-recorded skills practice in triads where trainees carry out real sessions with each other (in Dari) on the same topic, applying the theories and practice discussed during the day. 5. Feedback, watching the videos, live supervision, reflections. 6. Closure of the day. The co-construction of the training programme with the trainees was its most important and successful element. Co-construction allowed us to consider and respect local cultural values. Involving and engaging the participants throughout the process and valuing their inputs and ideas made the model very powerful and of itself demonstrated experientially to the participants the core of the humanistic approach. Another successful element introduced from the second year onwards (for security reasons) was that the training was carried out in the form of a residential course in New Delhi, India. Each group received a total of 120 hours’ training divided into two blocks of 60 hours each (Berdondini et al., 2014). The residential structure allowed an intensity and depth that was not there during the first year, where the training was run daily in Kabul, inside the compound of the British Council. The fact of being ‘elsewhere’ (India, rather than Afghanistan) and staying together in the same accommodation for the whole length of the training allowed a fuller immersion and a greater level of connection between the participants, which was invaluable. An initial evaluation showed that the experience of the training was ‘life changing’ for all the participants (Berdondini et al., 2014). Five years after the conclusion of the training programmes, feedback collected from the participants who were now working as counsellors in Afghanistan showed how the experience of the training had influenced their capacity to relate to themselves and others in a much more compassionate and non-judgemental way and had allowed them to use the core conditions of person-centred therapy, and in particular empathy, to establish mutual trust and collaboration with clients (Berdondini et al., 2019).

Integrating humanistic therapy with the Afghan culture Integrating the humanistic philosophy with Afghan cultural beliefs and norms has been challenging, for a number of reasons. A first point is that, in the Afghan

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culture, unlike in the West, the individual is seen as an integral part of their family and their wider community. Meaning and value is derived from their community, not from their ‘uniqueness’ (Farooqi, 1983; Iqbal, 1984; Moghaddam & Marsella, 2004; Rizvi, 1994). In this context, people’s specific roles within the community and the expectations of them are very strongly defined, and one typical example is gender. Although all cultures and societies associate different characteristics and stereotypes with femininity and masculinity, Afghan cultural norms and values are very strict in this regard. Women are often constrained by a weight of social and cultural values and expectations that are far more limiting than those placed on men (Saghar, 2018). At the same time, cultural norms allow women to express their emotions, such as sorrow and grief, easily and publicly, but men are expected to hold their emotions inside and not disclose them to the outside world, to avoid humiliation and shame (Al-Krenawi, 2005). Additionally, the very concept of counselling and the act of disclosing and sharing one’s feelings and griefs or admitting to ‘mental issues’ present a cultural problem because of the stigma associated with mental illness in the Afghan culture (Ciftci et al., 2012). However, there is also some important common ground between humanistic/ existential philosophy and Afghan culture that offered us a key to integrating the two perspectives in practice during the training. In the Islamic culture, human beings are created by God, but they have also been given freedom of choice and the responsibility for deciding whether they do good or evil (Farooqi, 2006). The Rogerian concept of ‘self-actualization’ (Rogers, 1961) has been said to be comparable, if not equivalent, to the Islamic belief in human potential to grow and evolve, with will and determination, towards perfection and divine revelation (Farooqi, 2006; Afrasibi & Fattahi, 2017). From this perspective also, the importance of empathy in the human relationship and its fundamental role in fostering another’s growth and self-actualisation is shared between the Islamic and the Western philosophies (Farooqi, 2006; Afrasibi & Fattahi, 2017). Reflecting on these aspects, we can see how, during our experience of cocreating and adjusting the training course in humanist counselling, an encounter between our different cultures was actually possible and humanistic theories and practices were meaningful to participants. The theoretical principles were very naturally shared and discussed in class, and also challenged. For example, our trainees reflected on the fact that the Rogerian core conditions, while necessary, were not sufficient to implement an effective therapeutic process. They explained that limiting the process to ‘talking about an issue’, without connecting the discussion to experiential activities, was not enough for them to engage with it fully. The use of Gestalt and psychodrama techniques, where internal conflicts were brought to the here and now by acting a dialogue using the ‘hot chair’, or where different parts of self were represented by using dolls, scarves or other members of the group, allowed participants to cross the gap between ‘talking about’ an issue and ‘expressing it’ through other means, thereby overcoming the issue of explicitly and verbally articulating certain topics. Moreover, these methods allowed the counsellor to inhabit the space with the client in a much more creative and active way.

Lucia Berdondini, Ali Ahmad Kaveh and Sandra Grieve

We also experienced consistently how being non-judgemental towards the client and not offering advice or solutions are hard to apply in the context of Afghanistan, where counsellors feel very strongly the cultural pressure and the ethical value of trying to ‘fix’ the client and judge their attitude or behaviour by the sociocultural norms and values. Again, the experiential nature of our training, where live individual therapeutic sessions were carried out in the group, with trainers in the role of therapists and trainees in the role of clients, was the powerful key. Trainees were able to watch a demonstration and themselves experience the power of empathy and of a dialogical and active therapeutic process where the counsellor ‘facilitates’ the client’s process without offering any advice or solution (Ginger, 2007; Berdondini et al., 2014, 2019).

Ethical issues and considerations Several ethical considerations have emerged since the beginning of this initiative. There is no national social security system or social services in Afghanistan. Afghan citizens rely heavily on their immediate and extended families rather than on mental health professionals. This is also largely based on the collectivistic way of living. However, while families can be a source of support, there are also instances where they can be repressive and create barriers to an individual’s treatment and progress. This can be due to stigma, limited knowledge of mental health, not believing in efficacy of psychotherapy/counselling, and strong reliance on faithbased practices (praying and seeking the guidance of pastors/mullahs) (Ciftci et al., 2012). As such, ethical issues may arise due to family involvement, secrecy and a limited system of checks and balances to follow up concerns with the relevant safeguarding authorities. The creation of counselling training and courses in Afghanistan required that we create an ethical framework that, at the moment, is in the form of a ‘counselling protocol’, and this has been under constant revision and progression. This protocol is mainly based on the American Psychological Association ethical principles and code of conduct (APA, 2017) and, at the time of writing, has not been finalised or approved by a legal body such as the Ministry of Public Health, which is responsible for developing and approving similar standards and frameworks. (Berdondini et al., 2014, 2019; Bragin & Akesson, 2018). Another ethical concern that emerged almost immediately after the conclusion of the INSPIRE project was the realisation that we were introducing the role of counsellor in Afghanistan without also creating a training for and professional role of clinical supervisor. This was a huge problem for the wellbeing of both clients and counsellors, as highlighted in the long-term study (Berdondini et al., 2019). So far, this issue has been addressed by creating peer supervision groups among those graduating from the training and offering individual and group supervision by videolink from the UK. However, this is not sustainable in the long term and we are searching for further funding to establish and develop theoretically consistent intercultural training in humanistic supervision so that experienced Afghan counsellors can be professionally prepared to provide this.

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Cultural challenge and creative collaboration We approached the project from a place of not-knowing and trust in the students’ ability to learn what was useful for them. We offered a non-hierarchical relationship in a culture where vertical power relationships are the norm. We had a framework and timescale, but no fixed curriculum; rather, we began each day with the question, implicit or explicit, ‘What do you want to learn and how do you want to learn it?’ In particular, we attended to the nature of learning in the person-centred approach. Essentially there are two strands to this: cognitive/intellectual learning and prereflective learning. The former involves ideas, thoughts and opinions, while the latter can be described as an unstructured, non-discriminatory, holistic, nonrational, direct experience of reality (Natiello, 2001). We were being congruent. We were being accepting and empathic with the students and their culture while being transparent about our own. In those early days of the project, the focus was on pre-reflective learning while we stayed in that often uncomfortable place of not-knowing. One of the students who was very fluent in English articulated the challenge of the skills practice sessions, saying, ‘I can think in English, but I feel in Dari.’ Our response was to conduct the skills practice in Dari and to work with the group to offer feedback when viewing the recordings. We spoke no Dari, but we could still observe what was going on between counsellor and client and we could listen for tone. The students provided any translation we required. It was a powerful learning experience for us. Sharing what goes on in the family with someone outside of the family is a cultural taboo in Afghanistan. In response to this, we focused on working with metaphors, stories and imagery. We offered theory, learning opportunities and creativity, and when cultural empathy grew, we were able to understand and accept each other. Any adaptations to what we offered were made by the students themselves. In between training sessions, they were out in placements and so were able to report back on what had been helpful and what was less helpful. Each morning we had a check-in and each evening a review of the day. The course was very organic and we learned to dance to its various tunes. Recent feedback from students who participated has been positive and consistent. Several have indicated that the self-exploration parts of the course were powerful and really helped them focus on themselves and understand themselves and one another more fully (Berdondini et al., 2019). They all continue to use the core conditions in their counselling and remain clear that the core conditions alone are not sufficient. They have fed back that, in the Afghan culture and social context, individuals are seen and exist not merely for themselves but as part of a bigger circle of the family or the wider community. When working with clients, they are conscious of the sociometry and sometimes other family members are present in sessions. One of them works in a mental health hospital and is sceptical about humanistic counselling being at all useful with uneducated Afghan people who have serious problems. He finds CBT very useful and that is his preferred modality. We all met each new challenge in a spirit of openness, and this spirit guided the whole project. Not all challenges were resolved, but often ways forward were

Lucia Berdondini, Ali Ahmad Kaveh and Sandra Grieve

found because we were creative in our thinking and ways of being, and were not bound by any expectations of the outcomes.

Conclusions The experience we have described in this chapter allowed us to learn a lot about intercultural counselling training and counselling training in general. Being culturally aware is paramount for almost any therapeutic modality to be effective and this includes existential and humanistic psychotherapy. A review of the data on the efficacy of this project may prove useful, given it has been implemented in Afghanistan for a number of years now. A further learning point was the power of experiential learning and how the whole process of a student-centred approach with a consistent and radical co-construction of content and methods of delivery can be the key to the integration of different cultural epistemologies and practices. Particularly effective were the live demonstrations of authentic therapeutic sessions in front of the group (which, in Gestalt and psychodrama courses, is very common practice), the residential training (Quattrini, 2013) and harnessing the power of the group itself as a pedagogical platform for the experiential learning. One crucial aim for the creation and implementation of counselling training in a country like Afghanistan is to make sure that the project is sustainable over the long term. This needs to take into consideration several issues, including the involvement of Higher Education Institutions (Babury & Hayward, 2013) and the government and its ministries, and a robust and meticulous series of assessments, evaluations and adjustments over time (Berdondini et al., 2019). It also needs to include ‘training for trainers’ and ‘training for supervisors’ courses, as the clinical supervisor is a crucial element of any system of mental health provision.

References Afrasibi, S. & Fattahi, Z. (2017). A comparative study of self-actualization perspective in psychology and Islam. World Family Medicine, 15(9): 104–111. Al-Krenawi, A. (2005). Mental health practice in Arab countries. Current Opinion in Psychiatry, 18, 560–564. http://dx.doi.org/10.1097/01.yco.0000179498.46182.8b American Psychological Association (APA) (2017). Ethical principles of psychologists and code of conduct. APA. Babury, M.O. & Hayward, F. (2013). A lifetime of trauma: Mental health challenges for higher education in a conflict environment in Afghanistan. Education Policy Analysis Archives, 21(68), 1–22. Berdondini, L. Grieve, S. & Kaveh, A. (2014). The INSPIRE project: Using the ‘unknown’ to coconstruct a training course on humanistic counselling in Afghanistan. International Journal for the Advancement of Counselling, 36(3), 305–316.

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Berdondini, L., Kaveh, A. & Grieve, S. (2019). Counselling training in Afghanistan: The long-term development of the INSPIRE project. International Journal for the Advancement of Counselling, 41, 230–239. 10.1007/s10447-018-9369-4 Bragin, M. & Akesson, B. (2018). Towards an Afghan counselling psychology: A partnership to integrate psychological counselling into the university curriculum at Afghanistan’s flagship public universities. Intervention, 16, 261–268. Ciftci, A., Jones, N. & Corrigan, P.W. (2012). Mental health stigma in the Muslim community. Journal of Muslim Mental Health, 7(1). DOI: http://dx.doi.org/10.3998/jmmh.10381607.0007.102 Farooqi, Y.N. (1983, November). Muslims: The pioneers of psychotherapy. Paper presented at International Conference on Science in Islamic Polity. Islamabad, Pakistan. Farooqi, Y.N. (2006). Understanding Islamic perspective of mental health and psychotherapy. Journal of Psychology in Africa, 16(1), 101–111. DOI:10.1080/14330237.2006.10820109 Gilbert, J. (2009). Power and ethics in psychosocial counselling. Intervention, 7(1), 50–60. Ginger, S. (2007). Gestalt therapy: The art of contact. Karnac Books. Halaj, A. & Huppert, J.D. (2017) Middle East. In S.G. Hofman (Ed.), International perspectives on psychotherapy (pp.219–239). Springer. Iqbal, S. (1984). Islamic rationalism in the subcontinent. Islamic Book Service. Kagan (Klein), H. & Kagan, N.I. (1997). Interpersonal process recall: Influencing human interaction. In C.E. Watkins, Jr. (Ed.), Handbook of psychotherapy supervision (pp.296-309). John Wiley & Sons. Miller, K.E., Omidian, P., Quraishy, A.S., Quraishy, N., Nasiry, M.N., Nasiry, S., Kariya, N.M. & Yaqubi, A.A. (2006). The Afghan symptom checklist: A culturally grounded approach to mental health assessment in a conflict zone. American Journal of Orthopsychiatry, 76(4), 423–433. Miller K.E. & Rasmussen, A. (2010). War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks. Social Science & Medicine, 70(1), 7–16. Moghaddam, F.M. & Marsella, A.J. (Eds.). (2004). Understanding terrorism. American Psychological Association. Moreno, J.L. (1953). Who shall survive? Beacon House. Natiello, P. (2001). The person-centred approach: A passionate presence. PCCS Books. Panter-Brick C., Eggerman M., Mojadidi A. & McDade T. (2008). Social stressors, mental health, and physiological stress in an urban elite of young Afghans in Kabul. American Journal of Human Biology, 20, 327–641. Perls, F.S., Hefferline, R.F. & Goodman, P. (1951). Gestalt therapy: Excitement and growth in the human personality. Dell. Quattrini, P. (2013). Per una psicoterapia fenomenologica esistenziale. Giunti Editore. Rizvi, A.A. (1994). Muslim traditions in psychotherapy and Muslim trends. Institute of Islamic Culture. Rogers, C.R. (1961). On becoming a person. Houghton Mifflin. Saghar L.N. (2018). The Afghan women’s writing project: A critical discourse analysis of poetry and narrative as conflict resolution tools. Doctoral dissertation. Nova Southeastern University. https:// nsuworks.nova.edu/shss_dcar_etd/93 Sayed, G.D. (2011). Mental health in Afghanistan: Burden, challenges and the way forward. International Bank for Reconstruction and Development/World Bank Wildt, H., Umanos, J., Khanzada, N.K., Saleh, M., Rahman, H.U. & Zakowski, S.G. (2017). War trauma, psychological distress, and coping among Afghan civilians seeking primary health care. International Perspectives in Psychology: Research, Practice, Consultation, 6(2), 81–100.

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Can you talk about race without going pink or feeling uncomfortable? Delroy Hall

Black people and White people are having two conversations which never meet. The White person will talk about policies and the abstract and their agreement of equality, but the Black person’s starting position is not abstract, but located in the reality of their experience. They too believe in the policy, but their lived experience dictates to them the harshness of injustice. (Bell, 2009)

In this advanced age of technology, artificial intelligence, driverless cars, drones, same-sex marriages, diverse sexualities and other immense complexities, racial matters remain a difficult conversation for most people. To define Black is problematic. It is more than skin colour and has significant political implications. Cornel West, philosopher and social critic, states: The notion that black people are human beings is a relatively new discovery in the modern West. The idea of black equality in beauty, culture, and intellectual capacity remains problematic and controversial within prestigious halls of learning and sophisticated intellectual circles. (West, 1982, p.47).

West’s comment is not only evidenced in privileged domains but is felt throughout society. In this chapter, I will describe my grounding in psychodynamic counselling. I will comment on my departure from my psychoanalytical moorings into solution-focused therapy and pastoral studies as I reflect on my various sources of inspiration. Turning to racial matters in counselling training, I will emphasise a listening leadership and the inner work tutors must do in order to become effective facilitators in an increasingly complex environment. I will suggest ways to make the teaching and the counselling learning experience more compelling, exciting, provocative and meaningful for the students so they are better prepared for an increasingly diverse world outside the classroom.

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Therapeutic approach My counselling foundation was psychodynamic, which I found insightful, but the turning point for leaving psychodynamic counselling was based on three reasons. First, studying at Master’s level in psychodynamic psychotherapy was far too abstract for my practical proclivities. Instead, I went on to study pastoral theology: ‘the branch of Christian theology dealing with the office and function of the pastor’ (Oden, 1983, p.x). An alternative perspective is offered by Emmanuel Lartey, a Ghanaian pastoral theologian. He argues that pastoral theology is ‘reflection on the caring activities of God and human communities’ (Lartey, 2006, p.14). He goes on to state: Pastoral theology in the twenty-first century has to lie beyond the confines of the geographical boundaries of Europe, the United Kingdom and the United States. The scope has to be what is now described as the ‘global village’. (Lartey, 2006, p.29)

Second, the final straw for leaving psychodynamic counselling occurred when I dared to ask a question about race during my training. Thirty years on, I cannot recall my exact question, but the response, interpreted as an unconscious conflict, disillusioned me from pursuing psychodynamic studies any further because it failed to take into account those who experience racism as their lived reality. To quote Jafar Kareem and Roland Littlewood (1992), in Intercultural Therapy: Themes, interpretations and practice: Psychotherapy is about human beings and therefore must be about humanity. A psychotherapeutic process that does not take into account the person’s whole life experience, or that denies consideration of their race, gender, culture or social values, can only fragment that person. (p.16)

Building on Kareem and Littlewood’s observation, I wanted to develop as a holistic practitioner; I wanted to understand how the world impinges on people and how suffering people can be helped. I found a home in pastoral studies/theology, which respected and drew insights from humanity’s rich resources while offering further understanding through a theological lens. Although I considered psychodynamic theory to be weak in some areas, it remains an invaluable diagnostic tool in therapy’s initial stages. Third was my attraction to solution-focused brief therapy (SFBT). Apart from its practical and empowering nature, I found that SFBT helped clients to see themselves not as victims but as human beings with strengths and the ability to live autonomous lives (Winbolt, 2011, p.47).

Sources of inspiration My route to counselling came from an innate desire to care for people and through the church I attended. As a youth leader in the local church, you were automatically

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made a counsellor at our annual national youth camp. After occupying the role, I recognised how ‘counselling’, despite the church’s laissez faire attitude back in the 1980s, was a serious endeavour. Writing specifically about Christianity in the West at present is not easy as people tend to view you in a particular light. Christianity tends to be labelled as irrelevant or having little to say of relevance to people today. Nevertheless, it is the Christian faith that has shaped and inspired me. Other inspirational sources are the many human beings who have dared to bare their souls and have trusted me with their apparent insurmountable life distresses. My clients have not known that I am an ordained minister. They do not need to know. However, I know some clients have looked me up on social media, and it is now almost impossible to hide such information. Understanding human beings as Imago Dei, created in the image of God, helps me in my work, whether clients subscribe to a faith or not. What matters is that I accept them and how the therapeutic alliance is developed. In the university setting, I do not see clients as ‘customers’ vying for an academic product, important as a degree may be. I do not see humans as a bundle of cells living life as an awful experiment. We are far too complex a species to be described in such reductionist terms. I see all clients as human beings on a spiritual path, known or unknown, struggling to live, or at least trying to find out how to live. A book that has been acutely inspirational for me is Parker Palmer’s Let Your Life Speak: Listening for the voice of vocation (2000). Palmer understands life as being much more than material accumulation and contends there is ‘a life within us as human beings that is wanting to live through us’. He argues that it is ‘possible to live a life that is not ours’, and he admits that seeking such a path, rather than material acquisition, is ‘hard and demanding’. He believes in ‘letting your life speak’: ‘Let your life speak’ means something else to me, a meaning faithful to both the ambiguity of those words and to the complexity of my own experience. Before you tell your life what you intend to do with it, listen to what it intends to do with you. Before you tell your life what truths and values you have decided to live up to, let your life tell you what truths you embody, what values you represent. (Palmer, 2000, p.3)

The therapist’s role is to create a space for a client’s life to speak, but it comes at a cost. I will now explore how leadership is important in developing how we address race in counselling training in the UK.

Leadership – from above and from the roots By leadership in the context of counselling/psychotherapy training, I mean those who are in decision-making positions with regard to course design and content. While there are drivers influencing courses, one cannot ignore student voices, constantly changing demographics and market forces. Leadership needs to transcend these drivers and have vision and courage to take action to make new things happen.

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The other facet of leadership is the tutor’s role in the classroom. Tutors are more than information dispensers for students to obtain qualifications. Rather, their role is a guiding and challenging presence for students as they encounter significant life-changing moments during counselling training. However, before that takes place, there is an important process that tutors must undergo, especially when dealing with matters relating to race.

Tutors – creating a deeper level of availability The major question is, what are the tutor’s feelings around race and diversity? Some tutors, it seems, are more comfortable talking about diversities in sexualities; they are ‘still uncomfortable talking about race over a sustained period’ (Turner, 2018). There is often discomfort experienced by Black students too when talking about race. It is more evident in many white folks via their body language and skin tone – in the varying pink and red shades of their faces when they address difficult subjects. This changing colouration may be due to the fact they do not want to offend or get it wrong; nevertheless, the conversation must be had. Gregory Ellison II, a Baptist minister, has developed a methodology called ‘Fearless Dialogues’. Ellison conceptualises the term fearless as a compound word – (‘fear’ + ‘less’): With a compound structure in mind, ‘less’ means ‘to a smaller extent’, suggesting when fears are named, they have less of a stranglehold on hard conversations. Further, ‘less’ evokes images of a disciplined posture of lessness between conversation partners. Thus, as a compound word, ‘fear + less’ dialogues offer greater possibilities for unlikely partners to engage in challenging subjects together. (Ellison, 2017, p.8)

It is only by talking and reflecting that we learn to become more comfortable with prickly subjects like race. There is no other way. It is through having such ‘fear + less’ conversations within themselves at a deeper level that tutors must develop the capacity to be the catalyst in the kind of talking about race that is a significant part of the learning process for trainee counsellors. A tutor is unable to lead the trainee any further than they have explored their own interior – in this case, in exploring their own beliefs on race. Only if we dare to walk within and carry out such an inner excavation to discover what is contained within ourselves can we grow our ability to hold students safely through their inner explorative journey, which can be very frightening for them when you think about the dread many hold about discussing race issues. The non-white tutor is not exempt from this monumental internal task of exploring their inner world in relation to race. It is imperative they do, especially when living in an increasingly nationalistic Western context where you are likely to have internalised the negative portrayals of your non-white sensibility. The necessity of doing such inner excavation work cannot be overestimated. Highlighting introspection, Alyss Thomas states:

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Some of what is stressful about being a counselling trainer is the result of the intense demands it makes on our inner resources, (Thomas, 2002, p.23)

The work required to develop one’s inner resources in dealing with race transcends simply being self-aware. One can be self-aware, but the tutor must live this new selfawareness in practical terms, if they are to be able to lead their students towards becoming effective practitioners and better human beings. While implementing such self-awareness is important, there remains a dearth in academic research that focuses on the development of the inner life of the therapist. This point is reinforced by the psychotherapist Tony Rousmaniere, when he states: Precious little guidance has been provided on how therapists can develop their intrapersonal (inner) skills and psychological capacity to use these skills, particularly when helping clients whom the therapist finds provocative or interpersonally challenging. (Rousmaniere, 2019, p.4)

We do not know what is within us until we begin to look. Whether the tutor is Black or white or whatever way they describe themselves, it is often a difficult and complex road to navigate. Such matters are further problematised if a trainer has students from an ethnic background who are doing their utmost to ‘fit into’ a white framework. Talking about race heightens their anxiety levels, affecting their ability to learn, as do other anxieties. Similarly, anxiety and fear are experienced by white, Asian or Black tutors who bristle at issues around race and ethnicity. Hylda Taylor-Smith, a former university counsellor, writes about her experience as a Black counselling trainee wanting to deepen self-understanding. She comments: I needed assurance that becoming a counsellor would expand what it meant to be me – that I would experience a welcoming of diversity from the course community. But it seemed that the behaviour of the tutors and students changed whenever the black students raised issues around race and cultural difference. I believed that their personal fears and anxieties around race negatively affected their responses in discussions. (Taylor-Smith, 2004, p.27)

In a more recent personal conversation with me, she expressed her view that awkward behaviour around race talk ultimately affects the courses’ content and quality and the students’ learning experience (November 22, 2019). Anecdotally, I recall a Caribbean male counselling trainee who, as part of his counselling qualification, decided to talk about his experience of being Black and male in the UK. He conveyed his anxiety to me as he had never been involved in presenting such matters before and he wanted a level of assurance in how to go about it. The presentation went well, but what happened later threw him totally. He said that, after his presentation, some folks never spoke to him again throughout the rest of the course.

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Self-other – the danger of self-dismissal for non-white students Building on all of the above, it is easy to see why Black, Asian and minority ethnic students might attend classes but withdraw from active participation or drop out from the course altogether (Watson, 2004, 2005). All too often, one reads about these students just ‘going through the motions’, doing what is needed to get their qualification, which effectively requires them to ‘other’ their selves. This, according to psychotherapist and lecturer Dwight Turner, is ‘particularly destructive’ (Turner, 2021). Referring to the contexts of war, violence and conflict, Slavenka Drakulić writes: I understand now that nothing but ‘otherness’ killed Jews, and it began with naming them, by reducing them to the other. Then everything became possible. Even the worst atrocities like concentration camps or the slaughtering of civilians in Croatia or Bosnia. (Drakulić, 1993, p.144)

‘Othering’ is about who belongs and who does not. Ta-Nehesi Coates, in his foreword to Toni Morrison’s book The Origins of Others, sums up ‘othering’ in stark terms: To lose one’s racialised rank is to lose one’s own value and enshrined difference. (Coates, 2017, p.xiii).

To deny one’s self while desiring to be another is corrosively destructive to one’s self and one’s entire existence. Such complexity is deepened by white people who do not see themselves as racist. Sometimes this is because they have never or seldom met non-white people or have had minimal contact with people from different racial backgrounds, but it can be the white, middle-class, liberal thing to say. Social scientist Robin DiAngelo refers to this as ‘a social taboo against openly talking about race and white solidarity’ (DiAngelo, 2019, pp.37–38). If the tutor is non-white, the white student can feel they are being accused and identified as racist; if the tutor is white, such matters can remain unexplored by the white student. However, if the white tutor has carried out extensive introspection on their own racial understanding, not the ‘political correctness’ kind, they could be seen as challenging by white students. Regardless, this turbulent racial landscape must be personally faced and traversed. I was once challenged by my supervisor, an African Caribbean clinical psychologist, who asked me if I intended to ‘continually escape or take flight into books, or learn from experience?’ His comments left an indelible mark on my being and practice. Through responding to the supervisor’s question, I discovered journalling and self-reflection as indispensable resources for experiential learning. The psychologist Joan Rosenberg offers insight into how allowing unpleasant feelings can lead to gaining wisdom. Unpleasant feelings are experienced by all human beings in life. Rather than use defences to avoid such difficult emotions, she argues:

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If there has ever been a time in your life that you have said, I never want to experience that again, it is probably some of those feelings you should move towards and start to embrace. (Rosenberg, 2016).

This occurs when the white person does not dare to have the race conversation (Ellis, 2021), regardless of their reasons or motives – it may simply be the fear of ‘saying the wrong thing’ or causing offence. Nevertheless, that troubling terrain has to be crossed.

The student experience Race issues are more than an abstract phenomenon; students must learn, understand and be able to be honest about their feelings about race and ethnicity. Possibly, many students are still in the closet when it comes to talking about race. It will be helpful if a student admits to their personal views on race, but pledges to commit to their self-development to learn how to accept the other. Writing from outside the counselling world and furthering our argument, the theologian James Perkinson states: For white people to get a real sense of black experience they must encounter a ‘reverse minoritisation’ in which they occupy the place of the racial ‘other’ without relief for an extended period. (Perkinson, 2004, p.46)

This could achieve a full initiation into a deeper racial experience and meaning. Perkinson also reflects the growing trend to use terms such as ‘diverse’, ‘urban’ and ‘multicultural’ to neutralise the potency of Blackness when he writes: ... the attention on the black/white divide is still representing the most fraught racial flashpoint for racial encounter historically in the country and constituting the most difficult site for racial confrontation for white people, both externally and internally. Part of coming to consciousness of oneself as white, as I then argue, involves daring to look into black eyes and not deny the reflection. (Perkinson, 2004, p.3)

Perkinson’s conceptualisation is demanding and calls for more than a couple of experiential exercises. He goes on to say: In my estimation, only a lifetime of unrelenting struggle against the ideology of white supremacy and the materiality of white control… could ever qualify one for embrace as an ally. (Perkinson, 2004, p.19; original italics)

Moving forwards – focused learning To get an insight into race and its lived ramifications, students must participate in multiple exercises where they engage and reflect on their feelings, thoughts, images and other possible experiences that emerge for them. Such sessions have

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to be experiential as it is easy for people to hide behind philosophical debate and conceptual ideas while learning little or nothing about the other, or themselves. Learning will come from lectures and reading, but one must not neglect or ignore the effectiveness of processing one’s feelings through reflective journals, peer support, small group discussion and tutor input. In Carl Jung’s words: Learn your theories as well as you can, but put them aside when you confront the mystery of the living soul. (Jung, 1928)

The tutor must refrain from simply delivering a lecture, ‘death by PowerPoint’ style; they need to be more facilitative to help the student learn. There are various useful learning mediums. American primary schoolteacher Jane Elliott’s classic ‘Blue Eyes, Brown Eyes’ experiment1 can be a good starting point for discussions with new students. Videos, film excerpts, literature and vignettes can be used. The film Get Out (Peele, 2017) offers a powerful critique of how white liberalism seemingly espouses racial acceptance. Poetry can be very powerful in helping us think through and work with difficult subjects. For example, Savanna Hartman, a white American woman, wrote ‘My skin is my privilege’ in response to seeing Alton Sterling, an African American, being murdered by the police (Itkowitz, 2016). A method I have used to explore feelings and tease out different perspectives is to devise a scenario, divide the student cohort into smaller groups, give each group specific roles from the scenario, and ask each group to discuss the same questions. The scenario comprises a person or group of people who are marginalised and another group who hold the power. After the exercise, the whole group is brought back together to share their findings. The results can be electrifying! In the words of Craig Barnes, a theologian and poet, poetry enables one to ‘express the truth behind the reality’: Poets see the despair and heartache as well as the beauty and miracle that lie beneath the thin veneer of the ordinary, and they describe this in ways that are recognised not only in the mind, but profoundly in the soul. (Barnes, 2009, p.17)

One thing is certain, the issues around race are not going to disappear anytime soon and it cannot be taught in a single, one-off lecture. There is now a push for universities to decolonise the curriculum. This requires an in-depth unpacking to understand what is meant by the phrase and what it means in reality. What it does not mean is simply adding a few Black theorists to a book list. It requires tutors in general, and white tutors in particular, to use non-white theorists as equal interlocutors in their training sessions. In other words, Black, Asian and minority ethnic theorists must not be used as secondary or side-line conversation partners. Moving forward, all training courses in the UK must have racial matters 1. See, for example, www.youtube.com/watch?v=ebPoSMULI5U

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interwoven throughout the curriculum so they become integral to what is considered normative. The truth is that, for the majority of counselling trainees still, their experience is that they will be taught by white tutors in a class that is at least 80–90% Caucasian and female; their placements will expose them to very few non-white folks, and if their therapist or supervisor is white, it is highly unlikely that racial matters will be discussed in any meaningful way, other than a cursory mention in a session looking at ‘diversity’. The Johari’s Window exercise (Luft & Ingham, 1955) is another excellent and personally challenging exercise that can usefully highlight areas for personal development with regard to race. It can be used to explore our own blind spots and what we hide from others and ourselves, either in groups with peers or individually, by asking the question, ‘What is it I do not know about race that is hindering an authentic interaction/relationship/understanding with the other?’ In order to grow, our ‘blind spots’ and what is ‘hidden’ from ourselves and others require acknowledging, but they also need acting on and embracing, as Rosenberg (2016) says.

Conclusion Counselling training in the UK has arrived at an interesting kairos moment. Kairos (καιρός in the original ancient Greek) means ‘a time when conditions are right for the accomplishment of a crucial action. The opportune and decisive moment’ (Merriam-Webster, undated). If we continue on the same trajectory as we have done to date, we will get the same results: the vast majority of students who graduate will be woefully unprepared to serve an increasingly diverse community. Black, Asian and minority ethnic students will continue to leave themselves outside the training room and continue to leave training courses where they do not feel they belong. Diversity is included as a composite aspect of all training courses, but one may ask whether issues around diversity are handled well. Certainly, matters around racial potency and Blackness are still difficult to negotiate. In considering the course design and content, effective leadership is key. It requires a leadership with a sharp ear that is attuned to the changing political and social environment and to the needs of our much more racially and ethnically diverse communities and students requiring training in counselling. We should be able to expect a willingness among both white and non-white tutors to engage in a lifelong commitment to deal with race and ethnicity issues while acknowledging and embracing their hidden biases that they have yet to confront and acknowledge. Finally, there are considerable teaching materials available on which to draw and use to develop counselling students’ capacities to work with the other. If steps are taken to include matters relating to race and ethnicity in counselling courses in a more robust and intentional way, it will begin to scuff the surface of the racist ideological construct that has been entrenched within the British psyche for many centuries.

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References Barnes, C. (2009). The pastor as minor poet: Texts and subtexts in the ministerial life. William B. Eerdmans Publishing Co. Bell, C. (2009, November 23). Dr Carl Bell. YouTube. www.youtube.com/watch?v=jHwVyFzCiJs Coates, T.-N. (2017). Foreword. In T. Morrison, The origins of others (p.xiii). Harvard University Press. DiAngelo, R. (2019). White fragility: Why it’s so hard for white people to talk about racism. Penguin Books. Drakulić, S. (1993). The Balkan express: Fragments from the other side of the war. W.W. Norton & Company. Ellis, E. (2021). The race conversation. Confer Books. Ellison II, G. (2017). Fearless dialogues: A new movement for justice. Westminster John Knox Press. Itkowitz, C. (2016, July 25). ‘My white skin is my privilege;’ This woman’s viral poem about race started a difficult conversation. Washington Post. www.washingtonpost.com/news/inspired-life/ wp/2016/07/25/my-white-skin-is-my-privilege-this-womans-viral-poem-about-race-started-adifficult-conversation/ Jung, C. (1928). Contributions to analytical psychology. Kegan Paul. Kareem, J. & Littlewood, R. (1992). Intercultural therapy: Themes, interpretations and practice (2nd Ed.). Blackwell Science Ltd. Lartey, E. (2006). Pastoral theology in an intercultural world. WIPF & Stock. Luft, J. & Ingham, H. (1955). The Johari window, a graphic model of interpersonal awareness. Proceedings of the Western Training Laboratory in Group Development. University of California, Los Angeles. Merriam-Webster (undated). Dictionary. (Online). www.merriam-webster.com/dictionary/kairos Oden, T. (1983). Pastoral theology: Essentials of ministry. HarperCollins. Palmer, P. (2000). Let your life speak: Listening for the voice of vocation. Jossey Bass. Peele, J. (Dir.). (2017). Get out. Universal Pictures. Perkinson, J. (2004). White theology: Outing supremacy in modernity. Palgrave Macmillan. Rosenberg, J. (2016, September 21). Emotional mastery: The gifted wisdom of unpleasant feelings. YouTube. www.youtube.com/watch?v=EKy19WzkPxE Rousmaniere T. (2019). Mastering the inner skills of psychotherapy:  A deliberate practice. Green Lantern Press. Taylor-Smith, H. (2004). The consequences of clarity. In: V. Harding-Davies, G. Alred, K. Hunt & G. Davies (Eds.), Experiences of counsellor training: Challenge, surprise and change (pp.24–35). Palgrave Macmillan. Thomas, A. (2002). The stresses of being a counselling trainer. In: H. Johns (Ed.), Balancing acts: Studies in counselling training. Routledge. Turner, D. (2018, May 10). Being the other: Diversity symposium keynote. YouTube. www.youtube. com/watch?v=OgLhRDwBybM&t=673s Turner, D. (2021). Intersections of privilege and otherness in counselling and psychotherapy: Mockingbird. Routledge. Watson, V. (2004) The training experiences of black counsellors. Unpublished PhD thesis, University of Nottingham. Watson, V. (2005). Key issues for black counselling practitioners in the UK with particular reference

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to their experiences in training. In C. Lago (Ed.), Race, culture and counselling (2nd ed.). Open University Press-McGraw Hill Education. West, C. (1982). Prophesy deliverance! An Afro‐American revolutionary Christianity. Westminster John Knox Press. Winbolt, B. (2011). Solution-focused therapy for the helping professions. Jessica Kingsley Publishers.

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Exploring the racial self in counselling training

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Exploring the racial self in counselling training Billie-Claire Wright

There is a growing body of literature and research exploring the effects of lack of racial diversity in therapeutic training models. However, there is still insufficient impetus to address the gaps, leaving clients from non-majority race groups vulnerable to further harm or trauma from clinicians ill-equipped to work with the racial self. But if we therapists are not secure enough in our own racial identity, how can we appreciate difference and the rich tapestry of our clients’ worlds to support them in moving forward from their difficulties, whether or not they bring race-related issues, differ in racial identity or are of the same race as our own? Without knowing where we stand racially, which must be examined and constantly reviewed at a deep level, we are on uncomfortable territory. If we are to work ethically as therapists, it is our duty to ensure we have clear knowledge and understanding of our biases, prejudices, triggers and racial stance to appreciate how our views might impact on those different from our selves. This, of course, extends across the range of diversities (Turner, 2021), but the area I would like to focus on, because of its relevance to my own growth as a Black British therapist, is race.

Internalised racism My own internalised racist tendencies were exposed within me several years ago, when I was a student and undergoing therapy to support my studies.  The term ‘appropriated racial oppression’ recognises the impact of oppression in causing individuals to internalise dominant group values and ideology, while also providing a rationale for why someone from a minority group might hold such tendencies. When I first sought therapy while I was training, I was clear that I specifically wanted to work with a white British psychotherapist. When the therapist asked me why, I answered, ‘Because I don’t feel that a Black therapist would be up to the job.’ The silence that filled the space between us was palpable and I remember feeling deep discomfort under his scrutiny. Finally, after what seemed like an eternity, he responded: ‘So, I wonder how you feel about yourself?’

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My therapist’s curiosity to try to understand my world view had the most profound effect on me; I felt rage, shame and despair. I could no longer pretend to be blind and numb to the daily hurts that I encountered because of the colour of my skin. I struggled to remember a time when I had not thought in an internalised racist way. Throughout my life, my parents had prepared my siblings and I, who are first-generation Black British, to adapt and excel in a white-majority society. This meant talking and behaving in certain ways and avoiding mixing with our own race, because, in my mother’s words, ‘Black people will bring you down.’ Having been thus primed to act out these presumptions of how Blackness was perceived by society, I created a version of the me that I hoped would be more acceptable and would allow me to do well in life. However, this version of me would restrict my capacity to inhabit an authentic Black self. I chose to develop a greater understanding of internalised racism by making it a focus of research for my MA in counselling and psychotherapy. Studying internalised racism in Blackness (Wright, 2019) has taken me on a non-linear journey of self-discovery, accompanied by the wish to bring greater awareness of race to the way we work therapeutically in the UK. The desire to create an open, sensitively managed space where therapists are able to consider more closely racial identity’s relevance in therapeutic practice has led me to look back at the writings that inspired areas of understanding in my research and also allowed me to see a glimmer of hope that integrating race in therapeutic training might be achievable. Several pieces of writing and research that informed my study still continue to resonate whenever a situation arises that forces me to consider what other dynamics might be at play. For example, I have worked in situations where I have found myself becoming hypervigilant in ensuring I arrived early and worked later than required, while observing what appeared to be a far more laid-back approach in my white peers. At times, in supervision with white supervisors, I have reflected on my capacity for self-denigration, my tendency to subservience, to over-extend myself, to never say ‘no’, to allow myself to be silenced and to adopt a lightness in tone when requesting anything. Are these patterns of behaviour solely down to me? Is this behaviour due to the normal pattern of hierarchy, regardless of race, or might there be a subtle interchange between white privilege, white racial identity and a colour-blind racial attitude from my white peers and superiors that changes my way of being among white peers? Such questions, which might lead to meaningful conversations, remained unexplored. Was it for me to raise them and my superiors to acknowledge them, or some other form of intervention that might help facilitate these discussions? So, here I am today, inviting you to join me in considering how we as a profession might make a more concerted effort to address the shortcomings of racial competency in therapeutic training.

Authenticity Throughout the entirety of my foundation training and postgraduate diploma, the subject of racial identity was barely explored, except for an informative, deeply personal residential weekend towards the end of my second year in training. This

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module had been tagged on at the end, yet the relevance of the subject had the potential to effect profound change in our way of working, not only with difference but also with same-race clients, whether Black, white or brown, who hold a different outlook to our own. The lead facilitator on this residential workshop was a white male. Throughout my working career, almost every training in diversity that I attended had been led by a white male facilitator. I remember the cynicism and ennui I experienced as he spoke, doubtful that a member of a privileged group would have the capacity to appreciate what it is to belong to a minority group. The facilitator was in fact Colin Lago, co-editor of this book. He demonstrated great sensitivity to the subject matter and was mindful of each word he spoke, as if they were living, breathing things. But I was most struck by his co-facilitator, seated alongside him, who was the same colour as me. As Colin spoke, I kept my eyes on her. She was compact in her posture, appearing to be holding herself together, yet she filled the space with her energy. Her gaze rested somewhere between the floor and our knees, but there was a mischievous glint in her eyes and a gentle smile on her lips. I wondered why she was not leading the group; after all, she embodied the subject matter of this discourse. One of the first activities was a role-play exercise addressing difference, in which we worked in triads: client, therapist and observer (the role I volunteered for). During feedback with my triad, the ‘client’ expressed feeling anxious and stressed that the clues they were giving to their distress were not being picked up by the ‘therapist’, causing disconnection in the therapeutic relationship. As ‘observer’, I noted the therapist’s facial and physical tensions; they appeared to register what was said, but did not seem to process this knowledge; they neither acknowledged nor validated the client’s experiencing. If we exclude an obvious attribute such as race when working with same- or different-race clients, we risk provoking a less transparent response in our clients towards the therapist. It was the final activity that day that proved the most challenging for me. We were working in pairs, using sand trays, and I was shaken out of my safety net by my white partner’s emotional responses to what she saw in my narrative. Although I had not spoken of what the images fully represented for me, through her tears I felt able to trust that I was safe enough to let go and that, in doing so, I would finally connect with and acknowledge the painful racial experiences of what it is to be Black in the UK. This acknowledgement was important in helping me expose what lay beneath my protective layers and essential in enabling me to create a more authentic Black self. Until recently, I had little experience of working with clients of colour, and those that I did work with, I approached in line with my training, using Westernised ideas and thinking. However, two years ago, I attended a weekend workshop run by Isha McKenzie-Mavinga with the Black African and Asian Therapeutic Network (BAATN), which explored racial issues in therapeutic practice. There were around 20 participants from Black backgrounds, a few brown people and two who were white. One of the white attendees did not return for the second day. It became clear

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that she had struggled to engage openly but, given the focus of the training on minority race, I could appreciate how difficult it might have been if you were not from this group. The other white participant appeared reflective, thoughtful and curious of her process in relation to minority groups. I wonder whether perhaps the white participant who left the group felt a sense of alienation as we became immersed in a race-specific model and the issues that might arise within that. Perhaps her feelings mirrored those of many Black trainees in therapeutic training where there appears to be lack of forethought and we are expected to assimilate to a majority group way of being. Isha’s workshop was my first professional experience of being in a group of people belonging to the same race as me. I had mixed initial feelings about this: partly discomfort – would they notice my Westernised presentation and judge me unfavourably? Would I have enough theoretical knowledge on Blackness to stand up with these women? Would I feel safe enough to reveal myself, and would they and Isha be ‘up to the job’? These feelings quickly subsided and were replaced with a feeling of unity and awe; I felt fully accepted and strangely complete as honest feelings were shared and processed compassionately in that space. I returned home emotionally exhausted from those two days; all I could do was collapse in front of the TV and sleep, but on waking I felt alive, brimming with ideas and more competent and capable of working with racial difference and issues that might be thrown up from a client belonging to a minority group.

Silence The same year, I was fortunate to work with my first Black client in private practice. She was aged 25 and was having difficulties with her white partner that centred around their racial difference. As I worked with her, a growing realisation dawned on me that themes similar to this client’s difficulties happen in therapeutic training spaces when racial difference and diversity are not acknowledged fully. Her partner initially appeared empathic to her negative Black experiences but, over the months of their relationship, became both deaf and mute to them, and eventually withdrew from the relationship. They seemed to arrive at a tacit agreement that, if the relationship was to last, there was no place in it for her racial experiencing. I would argue that this is very much what happens not only in therapeutic training but also in therapeutic practice. How often, on courses, do Black people find an air of ennui in their white colleagues if they raise ‘the race issue’? We are invited to attend, but only if we leave our racial difference outside the door. I can recall over the years the many times I have denigrated my own race to other Black and non-Black people, but have only once ever been called out on it. That is all it takes to make a real and positive difference. By not allowing difficulties to be voiced, the silence around racial difference creates a greater gap, with widereaching implications, and this same unspoken tension may exist in therapeutic spaces between client and therapist. If we as therapists do the necessary work on exploring a racial self, an open space is created that facilitates a natural dialogue on racial self. We are able to notice an invisibility or a part of self that is cut off.

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White is a race too Literature and research have explored the difficulties white therapists have in viewing themselves as racial and the ‘othering’ of Blackness as a problem. Most therapeutic curricula ensure that there is a stock workshop on difference (or ‘diversities’) thrown in but fall short on integrating race throughout the course content. How might we progress if we were to shift the emphasis in training from how to work with minority racial groups to acknowledging and engaging with whiteness as a racial identity? Below are some of the challenges that emerge when this is done. A detailed experiential focused-group study explored the dyadic relationship through the responses of white counsellor trainees in supervision (Utsey et al., 2005). Using nine possible case scenarios, trainees were asked to share, through discussion and commentary, their thoughts and feelings of the case material presented. The study found white trainees ‘incomprehensible, rhetorical and incoherent on discussions of racial/racism issues’, which suggested that masking internal racism has become more of a psychological challenge since racism has moved from the explicit to the implicit (p.470). The findings also demonstrated the difficulty white trainees had in viewing themselves as racial beings, instead shifting the emphasis onto ‘ethnicity’ or seeing race as ‘other’. There appears to be little motivation or incentive for those born into white privilege to explore or understand what it ‘means’ to be white, or the impact of ‘whiteness’ on others. Instead, the tendency is to deny skin privilege and consequently oneself as a racial being (Utsey et al., pp.470–471). So, while the ideas thrown up in this study might generate rich material for deeper contemplation and exploration, to begin rolling out training focused solely on personal responses to case-study material would achieve very little in facilitating reflective practice on racial experiencing. It would also require a facilitator who is not only astute in addressing defensive posturing but also highly sensitive to the anxieties that might be thrown up in such a training model. It might also be counterproductive in influencing how trainees approach race in therapeutic practice. A study by Strous and Eagle (2004) expands on Paul Pedersen’s triad model (1979) for training in multicultural psychotherapy. Pedersen’s triad included a counsellor, a client from a different racial or cultural background and an ‘anticounsellor’, whose purpose was to represent the client’s difficulties and intentionally provoke the counsellor by providing ongoing feedback on the racial experiencing of the unexpressed views and thoughts of the client and counsellor. In their extension of this framework, Strous and Eagle aimed to highlight and examine conscious and unconscious racism in the ‘thoughts, feelings and fantasies’ of white South African therapists working with Black clients and gain a deeper understanding of ‘counsellors’ self-talk in interracial counselling contexts’ (p.27). By the end of the study, what became clear was the extent to which white therapists’ openness and capacity to self-analyse uncomfortable feelings and responses impacted on the treatment. A pro-client stance required the ability to acknowledge the privileges enjoyed by the white race and its propensity to exploit this by discriminating

Billie-Claire Wright

against Black racial groups or others, while also being mindful of the potential impact their race might have on those unlike them. Some time ago, a white work colleague who had become a valued friend shared with me her despair at the challenges she had recently found in a new job, working under the guidance of a young Black manager, who supervised her clinical workload. She tentatively spoke to me of these challenges as being perhaps linked to an as yet undefinable, unconscious resistance to the race of her new manager. We tried to explore this together, and to me my friend’s defensiveness was clear, even though she talked of wanting to make the relationship better. I found myself instinctively drawn to support the young Black manager, who I knew very little about, rather than my friend. My friend seemed to be saying what I have heard from other white therapeutic practitioners in relation to Black people. But I sensed that any input I might add in favour of the new manager might cause a rupture to our friendship. How could I support her to reflect objectively on her situation without causing defensive posturing? This dilemma seemed to echo much of the research literature I had read for my MA. Utsey and colleagues’ study (2005) examined such reactions closely, finding that the desire to be seen as liberal and accepting led therapists to deny a highly influential and important factor and inhibitor in authentic communication between people of different races. But, by opting for a colour-blind stance, they rendered the person of difference ‘raceless’. In their study, a colour-blind approach resulted in unconscious negative attributes, misdiagnosis and failure on the part of the client to connect with therapy and the therapeutic relationship. Reactions such as anxiety, fear and guilt all stemmed from the projection of these feelings and were heightened in white therapists due to an inability to view themselves as racial beings. Watts-Jones’ (2002) concept of a sanctuary for Black women is rich in a historical context, and resonant of survival from slavery through storytelling and the same-race community as a safe space. It centralises authenticity in self-expression through the process of validating same-race similarities rather than presenting a masked version of self, while also allowing shaming, painful ideas and experiences to be shared and helping to dispel the taboo subject of internalised racism. I tried to imagine how this might be applied in today’s training programmes, but here lies a problem: it feels to me that only half the work is being done. It is providing healing to Black people but does not engage those from the white majority group who have contributed to many of these painful experiences, so does nothing to prevent re-traumatisation. We still have to live in our Blackness within a majority white society; there is no learning from our racially painful experiences by the racial group responsible for them. Additionally, something in such an approach felt quite threatening to me, which is also something Watts-Jones speaks of in depth. The reaction from white people when a group of Black people gather is often one of fear; a throwback to slaves potentially plotting their master’s demise, perhaps. Such an approach would not be appropriate to the mainstream training setting. Therefore I have filed away

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Watts-Jones’ ideas against the time when we have been able to quell the fears, anxieties and resistance of the white majority sufficiently for such an approach to be enriched by the inclusion of the racial other.

Developing racial awareness in training After reading Lowe’s book on racial and cultural psychotherapy (2013), I felt encouraged by the accounts from white therapists who actively wished to contribute to addressing the challenges they encountered when working with Black clients through sharing honest accounts from their work. What stood out for me was the transparency required of white therapists to acknowledge the personal racial assumptions and biases that influence how they regard a client purely from the colour of their skin. By their doing so, an authenticity between the racially different dyadic relationship of client/therapist was enhanced, becoming the strongest influencer in the success of the therapy. So, by their actively working with race, we could see the therapists’ commitment to the client’s whole self. Lowe’s book allowed me to think outside of creating a specific working model that addressed race to look at the clinician as the main influencer of success or obstacle to positive outcomes in racially different therapeutic dyads. Therefore, as a Black therapist, I needed to be clear about the roots of my racial heritage, the challenges faced and the person I have become through those challenges. Then I began to look at the challenge itself: namely, the system and the people who perpetuate this system – or, rather, the predominant race of the individuals who perpetuate that system. And here lies the success of Lowe’s book. It draws together the voices of white clinicians who are able to hold their hand up and say, ‘I’m trying, it might not be perfect but I’m willing to give it a go and share with you how it went. It’s okay to get it wrong; we recover and move on.’ White people who get it wrong will recover, like many Black people continue to recover from the daily slights they receive in the form of micro- and macroaggressions: being followed around a store by security guards, and ignored, overlooked or marked out as aggressive when asserting thoughts or feelings that may differ from those of the majority race. I appreciate it may be a new and uncomfortable experience for many white people; it requires giving up the position of dominance. But the world does keep turning and we grow from this place of trying and failing and getting back up and trying again. What Lowe’s book appears to reinforce through these therapists’ accounts, however, is the view of me and the group to which I belong as racially ‘other’, and as such problematising us. I wonder whether it would be more productive to encourage and support white trainees to engage with and explore their feelings about their own racial identity in training, rather than the racial ‘other’. In this respect, I wish instead to focus on the source of racial tensions between Black and white racial groups, which is predominantly the perceptions, long-held beliefs and consequent ways of behaving towards Black people by those who belong to a majority white racial group. I am aware, even writing this, that it feels strange to write the words ‘white’ and ‘race’ together, because we are so used to thinking of every other colour but white as

Billie-Claire Wright

being racial. In her book on Black and white racial identity, Helms (1990, p.3) sets out some wonderful exercises to help us become more aware of the feelings that words associated with Black and white elicit. She suggests that the list of negative adjectives for the former will far outnumber those for the latter and contemplates what might it be like if we removed words such as ‘darkness’ or ‘Blackness’ from our vocabularies. She makes us realise how everyday conversations, verbal exchanges, reporting and commentary are littered with words synonymous with negatives in relation to Black. As I see it, the primary challenge for those devising counselling and psychotherapy training courses is how to get white trainees to engage as equals in the racial conversation by considering themselves as racial beings and sharing their own racial experiencing. What thoughts and feeling emerge, how is this shared or processed, what is acknowledged or suppressed and how is supervision used to address any discrepancies in their racial understanding?

A framework from which to safely explore race A model that I feel has the most potential to bring about change in how we approach and think of race therapeutically is to be found in Richard’s (1996) dynamic exploration of racial identity, which uses character study analysis from film and literature for counselling and psychology training. To me, this model might find a way around this defence by offering a way to create a safe space for reflection where both white and Black therapists can come together and think about the development of racial identity without focusing on themselves. I have a background in performance art and so I was particularly drawn to Richard’s use of film and literature to offer trainees this more objective way of discussing race. They are not the subject of the exploration, with all the threat and exposure that implies. The exploration of racial experiencing in a fictitious character provides opportunities to gain different perspectives and new understanding of racial experiencing in a less threatening way. Painful aspects of self in Blackness and self in whiteness become more readily available through character analysis using Cross’s racial identity development model for Black people (1978) (see Table 4.1) and Helms’ model (Table 4.2) for white people (1990). The objective of the exercise is to gain ‘understanding of what task race plays in our psychological make-up’ (Richard, 1996). It is important to add that, while both these racial identity development models are presented in stages, the individual may move through them in a non-linear way, shift back and forth, or remain fixed in a particular stage for the entirety. Richard’s study was undertaken with 38 American psychology students, 37 of whom were white and one Black. Fifty-five per cent of the students used Cross’s model of Black identity development and 45% used Helms’ model of white identity development. Helms’ book (1990) explores the development of white identity in much the same way that Cross’s nigrescence model allows us to understand Black racial identity development, and thus enables the reader to appreciate the complexity and challenges for those from a white majority race in accepting themselves as

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racial and ethnic beings. Within the wider educational perspective, Anderson (1992), Bolt (1976) and Boyatzis (1994) all extol the benefits and value in analysis of film for training psychology students, although these studies do not cover controversial issues. Richard’s study found that open analysis and critique were facilitated through exploring certain statements and motives of the characters that demonstrated how they were moving through these various stages of racial development. Table 4.1: Cross’s nigrescence model of Black racial identity development (1978) Stages

Characterisation

Function

1. Pre-encounter

Denigration of Blackness and race

Assimilation to majority society in order to achieve

Blindness to racism/racist experiences Idealisation and adoption of white perspective and culture 2. Encounter

An occurrence to make one question identity and way of being (this may happen many times before reaching tipping point)

Reconciling conscious/unconscious inner turmoil, incongruence in self and/or conflict in way of being in Blackness

Relinquishing a non-Black ego identity Questioning self-identity/past experiences Reorganise structure of racial identity 3. Immersionemersion

Re-assimilation of black identity to incorporate Black historical culture and perspectives

Search for authentic self in Blackness

Shunning white culture and outlook 4. Internalisation

Appreciation of both Black and white perspectives Comfortable with being authentic in Blackness within group and in white majority groups.

Pro-actively making a difference to raising Black or oppressed groups to positions of equality Inclusion Collectivism

For Richard’s study, the students were first introduced to the two racial identity models, and then asked to choose a character from film or fiction and trace their racial identity development, using either the Cross or Helms models, depending on the person’s race. They were asked to complete a written assignment of some four or five pages and give a short oral presentation to the whole class. For the final stage, they were asked to complete a multiple-choice exam on theories of racial identity development.

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Table 4.2: Helms’ model of white identity development (1990) Phase 1 Internalising racism (Maintaining status quo) Schemas

Themes

Self-protective strategies

Contact

Naïve curiosity

Denial

Timidity about other races

Neutral stance Colour blindness

Disintegration

Confusion – consciously acknowledge whiteness and racial privilege Contend with imperfections and contradictions of whiteness

Distorting reality Blame victims of racism

Moral dilemma – uncontested membership to politically, socially and economical most powerful racial group requires immoral treatment of racial other Reintegration

Consciously white Considers white to be superior to all other racial groups

Displacement/scapegoating – resolving inner turmoil by blaming racial other for one’s condition rather than whites

Phase 2 Evolving non-racist identity (Challenging some aspect of white racial socialisation norms) Schemas

Themes

Self-protective strategies

Evolving non-racist identity

Pseudo-independence

Intellectualisation

Liberal views

Denial

Immersionemersion

Effort to understand un-sanitised version of white history in UK

Positive view

Active exploration of racism, white culture and assimilation and acculturation of white people Assumes personal responsibility for racism/realistic self-appraisal and awareness of assets and deficits of being white Motivator – moral re-education of whites

Sensitisation – seeks out experiences of like-minded whites that will help them understand meaning of being white and grow beyond racism

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Seeks within-race and cross-racial experiences to develop equalitarian/ humanitarian attitude Feels safe and secure within oneself when engaged in experiences to nurture his/her whiteness as personally defined

Confrontation Inclusion Collectivism

Students reported that the project had been ‘lively, memorable and objective’. The results of the exam showed that they had learned more about racial identity development than previous students who had taken the exam without first taking the course on racial identity development. However, the evaluation, which was given a week after presentation, showed only a moderate rating for their development in understanding of a different race to their own. This might have been due to the white students never having considered themselves as racial beings, so this was for them a new experience. The greatest impact for the students was witnessing the character in film/literature moving from one stage of development to another. Richard concludes that removing personal, racial self-experiencing provided a ‘non-threatening or self-incriminating’ (1996, p.160) opportunity for students to think more critically about racial issues and how race defines our worldview and subsequently our selves through its influence on our attitudes and behaviour towards the racial other.

Challenging defensiveness I was approached by an organisation that was actively working on bringing greater racial awareness and understanding to staff. They asked if I would speak with a team of clinical staff on race. An hour had been allocated for this activity, and I knew it would have little meaningful impact if I were just to lecture them on racial difference, so I decided to devise a brief workshop based on Richard’s study. The team comprised 12 staff – managers, clinicians and administrators, 65% white and 35% Black and brown. None had previously undertaken any training in working therapeutically with race. I used a scene from the film The Help (Taylor, 2011). The story is set in 1960s Mississippi; a young white writer is commissioned to write about Black women’s experiences of caring for white families. I gave each participant printouts of both racial identity development models, and briefed them to make notes on where the two characters – Aibileen, a Black maid, and Hilly, a white socialite – were positioned on the models in a particular scene in the film. While the group were able to engage with the exercise and expressed curiosity, I experienced a palpable tension and silence in the space that continued for some time before I intervened. This silence seemed to be filled with apprehension about saying the ‘right’ thing. As facilitator, I became aware of my own apprehension and subsequent freeze response in witnessing the participants’ unease. I was mindful of how little time we had: do I name it or continue with the exercise, to allow participants to identify the stages of racial identity development?

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Fakhry Davids (2011) describes this reaction as a type of political correctness that leads to an incapacity to think. While I acknowledge that the participants had little time to prepare and the scene was not particularly light viewing, I question whether their responses would have been any different had the recommended outline been followed, given how difficult the subject matter of race is to address. Such reactions appear to be necessary in order to make progress in our own understanding of where we sit racially. Indeed, seeking to avoid such responses renders the training meaningless. It is by highlighting and naming unease, defensive posturing or overly conciliatory positioning when they arise that we are given opportunities to recognise and be faced with our own discomfort, which creates room for meaningful self-exploration. Such training might prove to be the breakthrough needed to bring race into therapeutic discourse and training. What appears to have been critical to the success of Richard’s study in respect to the learning experience is the removal of judgement from self by using external source material to explore and gain greater understanding of racial experiencing. In my condensed version with the small group of therapeutic professionals, it did not prevent the difficult feelings arising, but I believe that, with time, this could be worked through and incorporated as reflective practice alongside the character study. I feel there is potential to build on this, by gradually sharing personal experience through a written or presented account of an important event or happening concerning a racial other that might be considered differently with an understanding of racial identity development. To facilitate this type of exploration, racial identity development would need to be integrated and threaded throughout the full course of study. The students involved in the Richard’s study felt it would have been more beneficial to them if the topic had been introduced at an earlier point in the course. I echo their sentiments. Had the residential workshop I attended on difference and diversity during my postgraduate training been held in the first year and then incorporated as a thread throughout the rest of my learning, it would have had far greater meaning and relevance to my self-development and subsequent work. It is easy to see how, with the study of racial identity development, it would be possible to think more critically about race within the self and move beyond this initial phase into exploring cause and effect, such as blind spots caused by personal biases, prejudices and therapy-hindering statements. Richard’s model could be used for both Black and white trainees, together or separately. Once the module on specific racial identity development was finished, the model could be incorporated into case studies involving the dyadic client/therapist or therapist/supervisor relationship, each operating from, moving through or flip-flopping through various stages of racial identity development.

Concluding thoughts To work successfully with the racial self demands that we bring our whole self to the therapeutic space. Without a commitment to understanding our own personal racial identity and its social and societal impact, the concept of racial awareness

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remains an abstract idea, causing apathy, confusion and defensive posturing and rendering the topic void of meaning and quickly forgotten. Watson (2006) hypothesised that Black counsellors learn race-avoidant attitudes in training, which are then reproduced through their work with both Black and white clients. Creating an open forum with facilitators who are racially attuned and resilient enough to manage students’ anxieties around racial issues might normalise anxiety and defence as natural to the evolution of racial identity (Utsey et al., 2005). There are clear gaps in racial awareness in therapy professionals’ training, and many therapists are reluctant to engage with racial issues. However, by integrating both Black and white theory on racial identity development throughout training, we stand to improve racial competency in all practitioners. The creative use of film in the Richard study above has the potential to create a meaningful vehicle through which to safely explore our racial self and our responses to the racial other, creating more availability, understanding and knowledge in ourselves as racial beings. By doing so, we contribute to crossing the racial divide, bringing quality to racial conversations and, although we are travelling from different directions, bridging the gap between racial experiencing and therapeutic practice. I argue that it is impossible to understand the full impact of racism and develop working models to facilitate training professionals without white therapists, supervisors and trainers exploring their own race in relation to self and the racial other. Without an appreciation of all racial experiencing, the issue of race and difference can be kept safely in the realms of academic research and theory, a disembodied concept devoid of meaning or understanding in therapeutic spaces.

References Anderson, D.D. (1992). Using feature films as tools for analysis in a psychology and law course. Teaching of Psychology, 19(3), 155–158. Bolt, M. (1976). Using films based on literature in teaching psychology. Teaching of Psychology, 3(4), 189–190. Boyatzis, C.J. (1994). Using feature films to teach social development. Teaching of Psychology, 21(2), 99–101. Cross, W.E. (1978). The Thomas and Cross models of psychological nigrescence: A review. Journal of Black Psychology, 5(1), 13–31. Davids, F. (2011). Internal racism: A psychoanalytic approach to race and difference. Red Globe Press. Helms, J.E. (1990). Black and white racial identity: Theory, research and practice. Westport: Greenwood Press. Lowe, F. (2013). Thinking space: Promoting thinking about race, culture and diversity in psychotherapy and beyond. Karnac Books.

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Pedersen, P.B. (1979). Counselling clients from other cultures: two training designs. In M.K. Asante, E. Newmark & C.A. Blake, Handbook of intercultural communication (pp. 405–419). Sage. Richard, H.W. (1996). Filmed in black and white: The concept of racial identity at a predominantly white university. Teaching of Psychology, 23(3), 159–161. Strous, M. & Eagle, G. (2004). Anti-client and pro-client positions in interracial psychotherapy. South African Journal of Psychology, 34(1), 25–54. Taylor, T. (Dir.). (2011). The help. Walt Disney Studios Motion Pictures. Turner, D. (2021). Intersections of privilege and otherness in counselling and psychotherapy: Mockingbird. Routledge. Utsey, S.O., Gernat, C.A. & Hammar, L. (2005). Examining white counselling trainees’ reactions to racial issues and supervision dyads. The Counselling Psychologist, 33(4), 449–478. Watson, V. (2006). Key issues for black counselling practitioners in the UK. In C. Lago (Ed.), Race, culture and counselling: The ongoing challenge (2nd ed.) (pp187–197). Open University Press. Watts-Jones, D. (2002). Healing internalized racism: the role of a within-group sanctuary among people of African descent. Family Process, 41(4), 591–602. Wright, B.-C. (2019). Internalized racism in blackness: How do therapists make sense of the psychological injury of racism? Unpublished dissertation. University of East London.

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5

An anti-racist counselling training model Courtland C. Lee

Note from the editors: This chapter is about a course developed for counselling students in the US and is therefore specific in its references and some details to the US context. However, its principles and the overall content are applicable to a UK context. We have provided a parallel reading list for the UK reader with the references at the end, although that shouldn’t stop anyone exploring the US texts, if they are readily available and affordable. Racism as a construct can be defined as prejudice, discrimination or antagonism directed against someone of a different race based on the belief that one’s own race is superior (Essed, 1991). Significantly, racism can be perceived at both an individual and an institutional level. At an individual level, it can be seen in the beliefs, attitudes, and actions of individuals that support or perpetuate the ideas of racial superiority, while institutionally it is prejudice and discrimination expressed in the practices of social and political structures (Feagin, 2013). For Black, Asian and other minority ethnic people, individual and institutional racism has historically resulted in marginalisation and oppression (Feagin, 2013; Goldberg, 1990). Importantly, racism continues to affect the wellbeing of Black, Asian and minority ethnic people in contemporary society, as is evident in the inequity of access to social services and opportunities such as education, health care and employment. While much has been written about the impact of racism on Black, Asian and minority ethnic people, often overlooked is the fact that individual and institutional racism can also have an impact on the wellbeing of those in the dominant racial/ ethnic group – white people (Hunt & Bowser, 1996; Spanierman et al., 2009). While there is no comparison with the effects of racism on Black, Asian and minority ethnic people, white people have also been negatively affected by racism. For example, racism often fosters the development of a distorted perception of self and others among white people. In particular, their dominant racial position in society can often generate feelings of superiority among whites that perpetuate stereotypes about and discriminatory actions against minority ethnic people (DiAngelo, 2018).

Courtland C. Lee

Given the historical and contemporary impact of racism on the wellbeing of both Black, Asian and minority ethnic people and whites, it is important for counsellors to develop the competency to address the challenge of racism in their clinical work with clients. The purpose of this chapter is to present an anti-racist counselling training model to address the issues of both the victims and the perpetrators of racism. This model is based on a course entitled ‘Racism and Trauma: Cross-cultural perspectives on antiracist counseling and psychotherapy’, which was developed as part of the curriculum of the Master’s programme in clinical mental health counselling at the Washington DC campus of the Chicago School of Professional Psychology. The model offers perspectives on the awareness, knowledge, skills and actions required of counsellors to confront the mental health challenges associated with individual and structural racism. I will start with a discussion of the theoretical foundations of the model. This is followed by an exploration of important components of the training experience, including a description of the training, the learning outcomes, an overview of the training curriculum and the assignments given, and suggested training resources. The chapter concludes with an account of my own experience with and insights on the impact of the model on student development.

Antiracist counselling training: the theoretical foundations The theoretical foundation for this training experience is derived from psychological and ideological perspectives on race. The model also rests on the concept of crosscultural counselling competency.

Racism: a trauma perspective When racism is considered from a psychological perspective, it can be perceived as trauma (Carter, 2007; Helms et al., 2010; Kirkinis et al., 2018). Trauma is a direct personal experience of an event that involves actual or threatened death or serious injury, threat to one’s physical integrity, witnessing an event that involves the above experience or learning about unexpected or violent death, serious harm, threat of death or injury experienced by a family member or close associate (Green, 1990). Trauma can be caused by a wide variety of events, but there are a few common aspects. There is frequently a violation of the person’s core assumptions about the world and their human rights, putting them in a state of extreme confusion and insecurity. This is often seen when institutions depended upon for survival violate, humiliate, betray or cause major losses or separations (Green, 1990). Within this context, racial trauma refers to the events of danger related to real or perceived experience of racial discrimination, threats of harm and injury, and humiliating and shaming events, in addition to witnessing harm to other individuals because of real or perceived racism (Franklin et al., 2006; Carter, 2007; Helms et al., 2010).

Racism: an ideological perspective In his book Stamped from the Beginning: The definitive history of racist ideas in

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America, the noted historian Ibram X. Kendi details the historical evolution of racist ideology (Kendi, 2016). This ideology is grounded in beliefs that members of a race possess characteristics or abilities specific to that race that distinguish it as inferior or superior to other races. Importantly, these philosophical ideas weave their way through the intellectual history of white, Western, industrialised and colonising nations from pre-colonial times to the present day. The foundational concepts of racist thought have influenced a number of academic disciplines including psychology, theology, anthropology, sociology, biology, and arts and literature (Kendi, 2016). In reviewing the evolution of racist ideas in white Western, colonialist nations, they can be seen as falling into one of three schools of thought. The first of these can be identified as segregationist. This school of thought places an emphasis on the idea that Black people are responsible for the racial disparities that exist and that Black oppression is caused by innate Black inferiority. This intellectual position can be seen as forming the foundation for both individual and institutional racism (Kendi, 2016). The second school of thought is labelled assimilationist. This ideological position posits that Black people and racial discrimination are responsible for racial disparities. Assimilationist thought acknowledges that societal factors contribute to racial disparities. However, this position asserts that Black culture is inferior to white culture and that racial disparities will ultimately be alleviated if Blacks assimilate as much as possible into white society (Kendi, 2016). The anti-racist school of thought is the third intellectual position. This position is in direct opposition to the segregationist school of thought in that it states that racial discrimination is responsible for racial disparities. This position refutes the idea of Black inferiority. Rather than put the responsibility for racial disparity on the supposed inferior biology or culture of Black people, anti-racist thought states that individual and institutional racism causes racial disparity. Importantly, anti-racist thought can be seen as the basis of true Black social and cultural empowerment (Kendi, 2016). An anti-racist perspective is crucial for counselling intervention because it provides a modality for addressing the notions of white superiority that are often implicit in the theory and practice of counselling. These inherent racist traditions within the field have often had a negative impact on both people of colour and whites (Sue et al., 2019). An anti-racist perspective, therefore, offers direction for healing the psychosocial wounds inflicted by racism on both victims and perpetrators. Further, an anti-racist perspective is underscored by cross-cultural counselling competency, which has become a hallmark of contemporary professional counselling.

Cross-cultural counselling competency Cross-cultural counselling competency is a concept that has received significant attention in the counselling literature (Sue et al., 1992; Ratts et al., 2016). Cross-cultural counselling competency identifies a set of attitudes and behaviours indicative of the ability to establish, maintain and successfully conclude a counselling relationship with clients from diverse cultural backgrounds (Lee, 2019). Counsellors who strive for cultural competency in their work with clients exhibit attitudes and behaviours

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that indicate heightened self-awareness, an expanded cultural knowledge base and a commitment to use helping skills in a culturally responsive manner.

The training course The course I am describing here, ‘Racism and Trauma: Cross-cultural perspectives on antiracist counseling and psychotherapy’, offers a cross-cultural perspective on the competencies required of counsellors to confront the mental health challenges associated with individual and structural racism. It explores the historical evolution of racism and racist ideas in relation to their impact on mental health and wellbeing. It also examines the impact of racism on both victims and perpetrators. In addition, the course seeks to provide students with a culturally competent and anti-racist perspective on counselling interventions to address the trauma associated with racism at both the individual and structural level. By the end of this course, students are expected to have a good understanding of the evolution of racism and racist ideas, and to be able to critically assess the impact of racism on their own lives and psychosocial development, delineate and discuss racism as a mental health issue, assess how racism impacts both victims and perpetrators of racism, and address the trauma of racism from an anti-racist perspective by developing culturally competent mental health interventions for people negatively impacted by racism.

The curriculum Topic I: Introduction to racism Students explore an operational definition of racism as prejudice, discrimination, or antagonism directed against someone of a different race based on the belief that one’s own race is superior. They consider both individual racism (i.e. the beliefs, attitudes and actions of individuals that support or perpetuate racism) and institutional racism (i.e. racist beliefs and attitudes expressed in the practices of social and political institutions). To provide context to the state of racism in contemporary American society, students view a documentary titled Charlottesville: Race and terror (ViceNews, 2017). This chronicles the 2017 race riot in Charlottesville, Virginia that was prompted by the proposed removal from a public park of a statue of the Confederate general Robert E. Lee. Students then discuss their reactions and insights to the issues of racism and inequality displayed in the documentary. They consider how both individual and institutional racism are evident in the Charlottesville events and their relevance to professional counsellors. Students next explore the effects of racial power and privilege. They discuss their perspectives on the concept of racial privilege by sharing reactions and opinions to Peggy McIntosh’s (1989) article ‘White Privilege: Unpacking the invisible knapsack’, which explores how she (and white people generally) ‘enjoy unearned skin privilege and have been conditioned into oblivion about its existence’, and sets about counting those privileges in her own life.

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Topic II: Personal reflections on racism In small groups, students share personal narratives on racism in response to the following questions:

1. What was your earliest experience with racism? 2. Where did this happen? 3. What impact did this experience have on you at the time? 4. Does this experience still have an impact on you? 5. Will this experience have an impact on your work as a counsellor? Topic III: The evolution of racist ideas Students examine the evolution of racist ideas within the US with a synopsis of Stamped from the Beginning: The definitive history of racist ideas in America (Kendi, 2016). Students deconstruct and discuss the three ideological perspectives on racism: segregationist, assimilationist and anti-racist. The evolution of the academic discipline of psychology is examined through these three ideological perspectives. Topic IV: Racism as trauma – individual perspectives Students are introduced to racism as a mental health issue. Two questions are posed to begin the discussion:

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Has the US been collectively traumatised by racism?

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Is racism a health problem or a social problem?

Racism is then discussed from a trauma perspective. The following operational definition is introduced: Racial trauma refers to the events related to real or perceived experiences of racial discrimination, threats of harm and injury, and humiliating and shaming events, in addition to witnessing harm to other individuals because of real or perceived racism. (Comas-Díaz, 2016)

Using a case study approach, students assess how racism contributes to trauma for both victims and perpetrators of racism. The impact of racism on the mental health of minority ethnic people

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Internalised devaluation: a sense of inferiority to other human beings resulting from personal encounters and structural realities that question and attack one’s full humanity because of one’s racial background (Crocker et al., 2001).

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Generalised anxiety disorder – racial battle fatigue: minority ethnic people constantly worry, have trouble concentrating, become fatigued and develop headaches when navigating personal and professional spaces that have historically favoured white people (Smith et al., 2008).

Courtland C. Lee

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Historical hostility: in their collective experience, Black people harbour conscious and unconscious negative emotions produced by centuries of brutality and frustrations that they and their forebears suffered at the hands of white people (Vontress & Epp, 1997).

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Microaggressions: brief and commonplace daily verbal, behavioural or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative cultural slights and insults (Sue et al., 2007).

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Cultural dysthymia: after years of enslavement, oppression, prejudice and discrimination, dysthymia is reflected in chronic low-grade sadness, anger, hostility, aggression, self-hatred, hopelessness and self-destructive behaviours among many minority ethnic people (Vontress et al., 2007).

The impact of racism on the mental health of white people

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White fragility: a state in which even a minimum amount of racial stress becomes intolerable, triggering a range of defensive moves. These moves include the outward display of emotions such as anger, fear and guilt, and behaviours such as argumentation, silence and leaving the stress-inducing situation. These behaviours, in turn, function to reinstate white racial equilibrium (DiAngelo, 2018).

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Superiority complex: a sense of privilege and entitlement based on race; the belief that white people are superior to people of other races and therefore should be dominant over them (Bonilla-Silva, 2001).

Topic V: Racism as trauma – structural perspectives Students are introduced to the concept of structural racism: the macro-level systems, social forces, institutions, ideologies and processes that interact with one another to generate and reinforce inequities among racial and ethnic groups (Powell, 2008). To begin the discussion of structural racism, students watch the television miniseries When They See Us (DuVernay & DuVernay, 2019) and the documentary The Central Park Five (Burns et al., 2012). These programmes deal with the infamous 1989 case in which five boys (four Black and one Latino), ages 14–16, were falsely accused of a brutal attack on a young white woman in Central Park in New York City. They would be found guilty and jailed for the crime. Eventually, they were cleared of all charges, having served almost their full sentences. After watching the programmes, students process their reactions to the events. They explore the implicit structural racism in the case – specifically, how the inherent racist forces in the criminal justice system conspired to wrongly accuse five innocent boys of colour. Students then explore and discuss aspects of structural racism in five social systems: employment, education, housing, criminal justice and immigration. They

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then engage in a discussion about how aspects of structural racism impact on the mental health of both whites and minority ethnic people. Topic VI: Anti-racist counselling interventions Students are introduced to models for counselling from an anti-racist perspective – one for whites and one for minority ethnic people. Counselling whites: an anti-racist perspective

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Stage I: the counsellor exhibits cultural competency as evidenced by an understanding of the multicultural and social justice counselling competencies (MCSJCC) (Ratts et al., 2016).

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Stage II: the counsellor conceptualises the etiology of client’s racist ideas and actions and their impact on the client’s worldview and wellbeing.

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Stage III: using broaching, the counsellor encourages the client to talk openly and candidly about race.

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Stage IV: using an integrative psychoeducational narrative therapeutic approach, the counsellor helps the client: ∙

assess and explore their stage of white racial identity development (Helms, 1990)

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explore both their explicit and implicit racial biases

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explore and process the extent of their racial privilege

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explore and process aspects of their racial fragility – e.g. anger, fear and guilt

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explore and process the intersectionality of identity development, bias, privilege and fragility

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conduct a personal racist attitude and behavior inventory

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identify cultural strengths that could be used to challenge personal racist ideology

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explore their motivation for confronting and changing racist attitudes and behaviours

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explore personal dimensions of anti-racist attitudes and behaviours.

Counselling minority ethnic people: an anti-racist perspective

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Stage I: The counsellor exhibits cultural competency as evidenced by an understanding of the Multicultural and Social Justice Counseling Competencies (MCSJCC) (Ratts et al., 2016)

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Stage II: The counsellor recognises the role of racism in the etiology of the client’s concern/issue.

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Stage III: Using broaching, the counsellor encourages the clients to talk openly and candidly about race.

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Stage IV: Using a trauma-informed racism-sensitive narrative therapeutic

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approach (Hardy, 2013; Malott & Schaefle, 2015), the counsellor helps the client: ∙

explore personal dimensions of racial battle fatigue and/or cultural dysthymia to assess the impact of individual and structural racism on the aetiology of presenting issues/concerns

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explore the nature and extent of internal devaluation caused by individual and structural racism

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identify cultural strengths and inner resources that contribute to resilience and provide a defence against racism

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explore the nature of racial microaggressions that contribute to internal devaluation and promote anger and/or self-defeating and self-destructive behaviour

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explore ways to redirect anger that result in personal empowerment.

Students work with case studies to gain awareness of and competency with the two anti-racist counselling models.

Course assignments Assignment 1: Paper – personal reflections on racism This paper is an opportunity for students to explore their own experience with racism and how it has shaped them by answering the following questions:

1. What was your earliest experience with racism? 2. Where did this happen? 3. What impact did this experience have on you at the time? 4. Does this experience still have an impact on you? 5. Will this experience have an impact on your work as a counsellor? Assignment 2: Final paper – Healing racial trauma: anti-racist mental health interventions This is a 15–20-page paper on racism and its effects on mental health and wellbeing. The paper should reflect a cross-cultural perspective and include a discussion of what students have learned about racism and mental health. It should explore how counsellors can effectively address the trauma associated with racism at both the client and societal levels and should include relevant literature on the topic of racism. Assignment 3: Required readings

DiAngelo, R. (2018). White fragility: Why it’s so hard for white people to talk about racism. Beacon Press. Franklin, J. (2016). Racial microaggressions, racial battle fatigue, and racismrelated stress in higher education. Journal of Student Affairs at New York University, 12, 44.

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Geller, A., Fagan, J., Tyler, T. & Link, B.G. (2014). Aggressive policing and the mental health of young urban men. American Journal of Public Health, 104(12), 2321–2327. Hemmings, C. & Evans, A.M. (2018). Identifying and treating race‐based trauma in counseling. Journal of Multicultural Counseling and Development, 46(1), 20–39. Kendi, I.X. (2016). Stamped from the beginning: The definitive history of racist ideas in America. Nation Books. Kendi, I.X. (2019). How to be an antiracist. One World. Malott, K.M., & Schaefle, S. (2015). Addressing clients’ experiences of racism: A model for clinical practice. Journal of Counseling & Development, 93(3), 361–369. McIntosh, P. (1989). White privilege: Unpacking the invisible knapsack. Peace and Freedom. Mouzon, D.M., & McLean, J.S. (2017). Internalized racism and mental health among African-Americans, US-born Caribbean Blacks, and foreign-born Caribbean Blacks. Ethnicity & Health, 22(1), 36–48. Nadal, K.L., Griffin, K.E., Wong, Y., Hamit, S. & Rasmus, M. (2014). The impact of racial microaggressions on mental health: Counseling implications for clients of color. Journal of Counseling & Development, 92(1), 57–66. Oluo, I. (2018). So you want to talk about race. New York, NY: Seal Press. Ratts, M.J., Singh, A.A., Nassar‐McMillan, S., Butler, S.K. & McCullough, J.R. (2016). Multicultural and social justice counseling competencies: Guidelines for the counseling profession. Journal of Multicultural Counseling and Development, 44(1), 28–48. Turner, E.A., & Richardson, J. (2016, July 14). Racial trauma is real: The impact of police shootings on African Americans. Psychological Benefits Society. https:// psychologybenefits.org/2016/07/14/racial-trauma-police-shootings-on-africanamericans/

A personal reflection This course on anti-racist counselling for addressing racial trauma grew out of an encounter that I had with Ibram X. Kendi at the 2018 National Book Festival in Washington, DC. Dr Kendi was a discussant on a panel about race relations as a way to promote his book (2016), Stamped from the Beginning: The definitive history of racist ideas in America. I was so impressed with Kendi and his ideas that I bought his book. As I read it, I saw its relevance for counsellors in their quest for cultural competency. It provides a cogent exploration of how racism developed as an ideology and impacted all academic disciplines, including psychology. Kendi’s book provided the impetus for an idea I had been germinating for several years – developing a training experience for counsellors on racism as a mental health challenge. The training would focus on racism as a form of trauma

Courtland C. Lee

and how counsellors could address it in a culturally competent manner. The training experience would provide students with an understanding of the evolution of racist ideology so they would understand that racist behavior and its impact on both victim and perpetrator has its basis in ideas that emerged from a number of academic disciplines across several centuries. I taught this course for the first time in the summer of 2019. It was a studyabroad course for 11 Master’s counselling students. The course explored the historical evolution of racism and racist ideas in the US and South Africa in relation to their impact on mental health and wellbeing. It provided the opportunity for students to compare the dynamics of mental health challenges associated with individual and structural racism in the US with those in South Africa through a 10-day cultural immersion experience in Cape Town. This experience exploring racism from a mental health perspective underscored several things for me as a counsellor educator. First, studying the evolution of racist ideology provides students with a greater understanding of the theories and models of multicultural counselling, cultural identity development and social justice and advocacy. Second, as they contemplate the impact of racism on their own lives, students better understand the impact of their own heritage, attitudes, beliefs, understandings and acculturative experiences on their views of others. Third, in exploring the aspects of power and privilege inherent in racism, students better understand the effects of these constructs for counsellors and clients. Finally, in being introduced to anti-racist counselling models for both victims and perpetrators of racism, students can better employ strategies for identifying and eliminating barriers, prejudices and processes of intentional and unintentional oppression and discrimination.

References Bonilla-Silva, E. (2001). White supremacy and racism in the post-civil rights era. Lynne Reiner. Burns, K., Burns, S. & McMahon, D. (Dirs.). (2012). The Central Park five. Sundance Selects. Carter, R.T. (2007). Racism and psychological and emotional injury: Recognizing and assessing race-based traumatic stress. The Counseling Psychologist, 35(1), 13–105. Comas-Díaz, L. (2016). Racial trauma recovery: A race-informed therapeutic approach to racial wounds. In A.N. Alvarez, C.T.H. Liang & H.A. Neville (Eds.), Cultural, racial, and ethnic psychology book series. The cost of racism for people of color: Contextualizing experiences of discrimination (pp.249–272). American Psychological Association. Crocker, J., Major, B., Steele, C. & Quinn, D.M. (2001). Psychological consequences of devalued identities. In G. Brown & S. Gaertner. Blackwell handbook of social psychology: Intergroup processes (pp.238–257). Blackwell Publishing.

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DiAngelo, R. (2018). White fragility: Why it’s so hard for white people to talk about racism. Beacon Press. DuVernay, A. (Prod.) & DuVernay, A. (Dir.). (2019) When they see us. Netflix. Essed, P. (1991). Understanding everyday racism: An interdisciplinary theory, Vol. 2. Sage. Feagin, J. (2013). Systemic racism: A theory of oppression. Routledge. Franklin, A.J., Boyd-Franklin, N. & Kelly, S. (2006). Racism and invisibility: Race-related stress, emotional abuse and psychological trauma for people of color. Journal of Emotional Abuse, 6(2–3), 9–30. Goldberg, D.T. (1990). Anatomy of racism. University of Minnesota Press. Green, B.L. (1990). Defining trauma: Terminology and generic stressor dimensions 1. Journal of Applied Social Psychology, 20(20), 1632–1642. Hardy, K.V. (2013). Healing the hidden wounds of racial trauma. Reclaiming Children and Youth, 22(1), 24–28. Helms, J.E. (1990). Black and white racial identity: Theory, research and practice. Greenwood Press. Helms, J.E., Nicolas, G. & Green, C.E. (2010). Racism and ethnoviolence as trauma: Enhancing professional training. Traumatology, 16(4), 53–62. Hunt, R.G., & Bowser, B. (Eds.). (1996). Impacts of racism on white Americans (2nd Ed.). Sage Publications. Kendi, I.X. (2016). Stamped from the beginning: The definitive history of racist ideas in America. Nation Books. Kirkinis, K., Pieterse, A.L., Martin, C., Agiliga, A. & Brownell, A. (2018). Racism, racial discrimination, and trauma: systematic review of the social science literature. Ethnicity & Health, 1–21. Lee, C.C. (2019). Multicultural competency: A conceptual framework for counseling across cultures. In C.C. Lee (Ed.), Multicultural issues in counseling: New approaches to diversity (5th ed.) (pp.3–13). American Counseling Association. Malott, K.M., & Schaefle, S. (2015). Addressing clients’ experiences of racism: A model for clinical practice. Journal of Counseling & Development, 93(3), 361–369. McIntosh, P. (1989). White privilege: Unpacking the invisible knapsack. Peace and Freedom. Powell J.A. (2008). Structural racism: Building upon the insights of John Calmore. North Carolina Law Review, 86, 791–816. Ratts, M.J., Singh, A.A., Nassar‐McMillan, S., Butler, S.K., & McCullough, J.R. (2016). Multicultural and social justice counseling competencies: Guidelines for the counseling profession. Journal of Multicultural Counseling and Development, 44(1), 28–48. Smith, L., Constantine, M.G., Graham, S.V. & Dize, C.B. (2008). The territory ahead for multicultural competence: The ‘spinning’ of racism. Professional Psychology: Research and Practice, 39(3), 337– 345. https://doi.org/10.1037/0735-7028.39.3.337 Spanierman, L.B., Todd, N.R. & Anderson, C.J. (2009). Psychosocial costs of racism to whites: Understanding patterns among university students. Journal of Counseling Psychology, 56(2), 239–252. Sue, D.W., Arredondo, P. & McDavis, R.J. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Counseling & Development, 70, 477–486. Sue, D.W., Capodilupo, C.M., Torino, G.C., Bucceri, J.M., Holder, A., Nadal, K.L. & Esquilin, M. (2007). Racial microaggressions in everyday life: Implications for clinical practice. American Psychologist, 62(4), 271–286.

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Sue, D.W., Sue, D., Neville, H.A. & Smith, L. (2019). Counseling the culturally diverse: Theory and practice. John Wiley & Sons. ViceNews. (2017). Charlottesville: Race and terror. Vice News. Vontress, C.E. & Epp, L.R. (1997). Historical hostility in the African American client: Implications for counseling. Journal of Multicultural Counseling and Development, 25(3), 170–184. Vontress, C.E., Woodland, C.E. & Epp, L. (2007). Cultural dysthymia: An unrecognized disorder among African Americans? Journal of Multicultural Counseling and Development, 35(3), 130–141. Suggested supplementary UK resources for use with the training ideas in this chapter Andrew, K. (2018). Back to Black: Retelling Black radicalism for the 21st Century. Zed Books. Bogues, A. (2003). Black heretics, black prophets. Routledge. Carter, R. (1995). The influence of race and racial identity in psychotherapy: Towards a racially inclusive model. John Wiley & Sons. Casse, P. (1981) Training for the cross-cultural mind. Society for Intercultural Education, Training and Research. Cousins, S. (2019). Overcoming everyday racism: Building resilience in the face of discrimination and micro-aggressions. Jessica Kingsley. Dabiri, E. (2019.) Don’t touch my hair. Allen Lane. DiAngelo, R. (2016). What does it mean to be white? Developing white racial literacy. Peter Lang. Dyer, R. (1997). White. Routledge. Eddo-Lodge, R. (2017). Why I’m no longer talking to white people about race. Bloomsbury Circus. Ellis E. (2021). The race conversation. Confer Books. Galbraith, J.K. (2016). Inequality: What everyone needs to know. Oxford University Press. Katz, J.H. (1978). White awareness: Handbook for anti-racism training. University of Oklahoma Press. Helms, J. (1995). An update of Helm’s white and people of color racial identity models. In J.G. Ponterotto, J.M. Casas, L. Suzuki & C. Alexander (Eds.), Handbook of multicultural counseling (pp.181–198). Sage Publications. Hirsch, A. (2018). Brit(ish): On race, identity and belonging. Vintage. Kareem, J. & Littlewood, R. (2000). Intercultural therapy. Blackwell Science. Lago, C. (2006) Race, culture and counselling: The ongoing challenge (2nd ed.). McGraw Hill/Open University. Lago, C. (2007). Counselling across difference and diversity. In M. Cooper, M. O’Hara, P.F. Schmid & G. Wyatt (Eds.),  The handbook of person-centred psychotherapy and counselling  (pp.251–265). Palgrave Macmillan. Lago, C. (2010). On developing our empathic capacities to work inter-culturally and interethnically: Attempting a map for personal and professional development. Psychotherapy and Politics International 8(1), 73–85. Lago, C. (Ed.) (2011). The handbook of transcultural counselling and psychotherapy. Open University Press/McGraw-Hill. (See Chapters 3 (Valerie Watson), 4 (Isha Mackenzie-Mavinga) and 5 (Yair Maman and Simon du Plock) – all focused on issues of training for multicultural therapy. Lago, C. & Barty, A. (2003). Working with international students: A cross-cultural training manual. United Kingdom Council for International Student Affairs.

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Lago, C. & Haugh, S. (2006). White counsellor racial identity: The unacknowledged, unknown, unaware aspect of self in relationship. In G. Proctor, M. Cooper, P. Sanders & B. Malcom (Eds.), Politicizing the person-centred approach (pp.198–214). PCCS Books. Lago, C. & Smith, B. (2003). Anti-discriminatory counselling practice. Sage. Moodley, R., Lago, C. & Talhite, A. (Eds.). (2004). Carl Rogers counsels a black client: Race and culture in person-centred counselling. PCCS Books. Palmer, S. (Ed.). (2002). Multicultural counselling: A reader. Sage. Patel, N., Bennett, E., Dennis, M., Dosanjh, N., Mahtani, A., Miller, A. & Nadirshaw, Z. (Eds.). (2000). Clinical psychology, ‘race’ and culture: A training manual. British Psychological Society. Pitts, J. (2019). Afropean: Notes from Black Europe. Allen Lane. Ryde, J. (2019). White privilege unmasked: How to be part of the solution. Jessica Kingsley. Tuckwell, G. (2002). Racial identity, white counsellors and therapists. Open University Press. Wekker, G. (2016). White innocence: Paradoxes of colonialism and race. Duke University Press. Wilkinson, R. & Pickett, K. (2010). The spirit level: Why more equal societies almost always do better. Penguin Books. Wilkinson, R. & Pickett, K. (2019). The inner level: How more equal societies reduce stress, restore sanity and improve everyone’s well-being. Penguin Books.

Valerie Watson

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‘Look in the mirror... and just below the surface’: Critical reflection, personal stories and training implications Valerie Watson

Setting the scene – growth, anxiety, change and action I attended a management training event in which participants were encouraged to ‘look in the mirror’, not out of the window. This exercise generated personal growth, fulfilling its metaphorical purpose of encouraging self-assessment and reflexivity before criticism of others. I was, and am, inspired to return to this task as a counsellor: to go deeper, daily confessing that it is not a challenge that I always feel capable of or ready to tackle. For those with insight, this invitation, if taken seriously, holistically and pedantically, is one of my ‘radical’ propositions, encouraging what Halmos (1965) refers to as a state of alertness (p.47). I believe it is when we truly and daily ‘look in the mirror’ as counsellors, noting the familiar and unfamiliar, tracking the scars, changes and developments in ourselves, that we potentiate our abilities to understand, learn to love and appreciate difference in others. A second radical proposition I make is a call to return to the study of anxiety in relation to difference through the various theoretical lenses I will refer to in this chapter. Change and action are implicit in the definition of radical; without the interplay of these factors, theorising or literary effort lacks substance or validity. A robust study and critique of critical race theory (CRT) provides a foundation for radical thinking and possibility for change and action. A study that explores the potential for the use of traditional healing methods and critiques concepts of white privilege, microaggression, internalised oppression, social constructionism and allyship (The Anti-Oppression Network, n.d.) needs to be followed up with a list of accountable actions that can be evidenced in the practice and records of individual counselling practitioners and organisations. Only then will it go some way towards achieving visible change; towards saying a sustained and influential ‘no’ to the damage caused by everyday racism.

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In our life experiences and work as counsellors, we are often confronted with anxiety, threats and fears. Anxiety about facing the realities of racism is the one we seem to want to avoid most. We know and experience the consequences of this avoidance through the maintenance and perpetuation of anxiety leading to defensive and hostile behaviour, which includes ignoring, distraction, denial, dissociation and displacement. We need to examine daily how we can unlock the fears of difference. The thing about facing anxiety is that, once we are able to do it and feel safe enough to do so, we feel better – everybody wins. We are also open to discover the joy, creativity, synergy and beauty in savouring difference. Perhaps we should begin each counselling training by asking trainees to give us a list of all the things they fear on a personal, societal and global level, and then attempt to provide a safe enough environment for those issues to be addressed in their training. In this way we would model and they might learn how to safely and respectfully explore these anxieties with their clients.

Revisiting and updating the roots and purposes of counselling Central to counsellor training in the UK is the provision of a confidential, safe, non-judgemental space in which to listen, hear and respond to clients’ stories. At its best, counselling is an educative, reparative and political act, ideally engaged in to be of universal benefit. Regardless of level or duration, any counselling training that does not explicitly address identity issues, race, power, power relationships and what it means to be deemed ‘other’ is ineffective. Without this, there is the danger of counsellors perpetuating the pain of clients not being fully heard. Developing a working knowledge and understanding of the context of the client is crucial. So too is being prepared to learn, unlearn and re-learn what we think we know. To promote trust and the potential for healing, counsellors need to demonstrate a willingness to understand and openly acknowledge the sociopolitical context of Black clients’ stories. In my view, this is a counsellor’s obligation and a position to be held irrespective of the content or nature of the counselling and client material. Being empathic and open to continual learning does not necessarily mean learning only from clients in the counselling room, and sometimes it may not be enough. Such in-session learning can be experienced by the client as a form of cultural exploitation or appropriation. It is incumbent on counsellors to delve into the wealth of accessible learning and training opportunities that exist outside of the counselling room and training environment in their effort to understand what it means to be ‘Black’, to be seen as ‘other’, and use this knowledge to sensitively inform their practice. This chapter will reflect on my experience, insights and belief in the power of learning through stories, arguing for the inclusion of critical race theory in counselling training. I will use six stories from outside the counselling room to invite discussion and learning of their possible meanings inside the counselling room. I offer personal and biased views. The context of my analysis, responses and meaning-making is centred on my being a Black counsellor who was born, educated and has lived and worked solely in the UK, alongside other identities I claim. These include female, feminist,

Valerie Watson

political, heterosexual, adoptive parent, in my seventh decade, with experience of most of the losses and gains that come with living.

A way of working and thinking: Experience, environment and time My therapeutic approach is grounded in the principles of person-centred (UK) counselling as presented by Rogers (1951, 1967, 1978, 1980), and enhanced through study of the work of contemporary person-centred theorists, including Lago (2006), Lago and Charura (2016), Lietaer (2016), Warner (2016), Schmid (2002), Prouty and colleagues (2002), Tudor and Worrall (2006), Natiello (2001) and others. These works have helped to shape my understanding and development of person-centred practice in ways that are intended to be facilitative for all clients and especially those from Black or non-white heritage. Of particular relevance is Rogers’ holistic theory of personality and behaviour change, with its emphasis on social interdependence and acknowledgement of how the environment or context affects the behaviour and responses of the organism. An increasingly stronger influence in my practice is the foundational theory of African-centred psychology, as described by Nwoye (2015), and the work of Marimba Ani (1994), which critiques Eurocentrism. With its emphasis on holism, spiritual and physical wellbeing, respect for nature, interdependence, relationship and respect for all identities, African-centred psychology has parallels with the person-centred approach, extending into an emancipatory and political world view I embrace. Aside from studying theory, my greatest influences have been practice, observation and reflection. Clients have taught me that what they want from therapy is to have honest communication and a consistent relationship with someone who has their interests at the centre and is striving to enable them to be heard, understood and empathised with; to be reassured that their experience is ‘normal’; to be recognised and treasured as human; to be held or kept in mind; to be seen as more than their problem; to be helped to repair themselves and their relationships; in some cases, to be re-parented, nurtured, loved; to be free to say the unsayable without judgement; to ask and examine questions about their life and relationships; to have a safe space where fears are acknowledged and not compounded; to be journeyed with compassionately; to explore spiritual understanding and meanings; to be assured that they are not completely mad, bad, hopeless, ugly and wrong; to be offered hope; to be treated as trustworthy; to reflect on what has happened or is happening, and to explore options or find ways to manage the lack of existing options. My practitioner world view is affected and enriched by being raised in a staunchly proud, Jamaican, working-class, single-parent, Christianity-observing household, whose food, music, codes of behaviour, language, dress and decor choice were often in contrast or conflict with the content of the formal education I have received and the neighbourhoods I have lived in. Crenshaw (1989) defines intersectionality as the injurious effect of experiencing multiple oppressions simultaneously due to combined and

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overlapping social and political identities. The intersection of race, gender and class oppressions have affected my life chances, access to education and self-perception. It has also stimulated my actions, sense of mission in my work and relationships. Much of this experience was not easily translatable to my understanding of personcentred theory or safe for me to disclose in my training, which tended to focus on the potential to transcend difficulties through individual effort and self-actualisation, avoiding challenges faced by social, economic and political realities and obstacles. Other sources of learning and training have been instrumental in support of my practice, which has mostly been in the higher education sector. I agree with Moodley and West (2005), who advocate for the inclusion and integration of traditional healing methods into mainstream counselling and psychotherapy. Study and knowledge of these methods in counselling training would be of great value and further support to Black clients. Movement towards the integration of traditional healing methods is happening in small ways (for example, mindfulness and forest bathing). However, this seems to be subject to the approval of such adaptations by white therapists and scholars of counselling. Readings of Clemmont Vontress’ conceptualisation and recommended practice from an existential Black perspective is one of the exceptions to this (Moodley & Walcott, 2010). Knowledge and understanding of the US and UK paradigms and theoretical concepts relating to social constructionism (Gergen, 2015), critical race theory (Rollock & Gillborn, 2011), racism (The Equality Act, 2010), white privilege (McIntosh, 1988; Ryde, 2019), white fragility (DiAngelo, 2019), cultural appropriation, microaggression, internalised oppression and double-empathy theory as related to autism (Milton, 2012) feature in my analysis of everyday life incidents and, in varying degrees, have an impact on my relationships and counselling practice, particularly with Black clients. The contemporary definition of trauma includes the effects of separation, bullying and loss, affirming its impact on the body and the brain, with its potential for damage to the hippocampus, manifesting as a prolonged fear and anxiety response. Cozolino (2002, p.255) suggests that impairment of the hippocampus may negatively affect clients’ ability to make best use of counselling. This understanding of anxiety and the impact of slavery, coupled with knowledge of the described psychological effects of intergenerational and transgenerational trauma and post-slavery syndrome as outlined by DeGruy (2005), is an informative and, in most cases, essential part of training for working with all clients, including those who are Black and those who have, through choice, civil disturbance or disruption, sought refuge in the UK. Such encounters call for empathy and an understanding of power relations and internalised racism. While waiting for a friend on a typical busy Saturday morning in London, I witnessed an angry dispute between two motorists (one Black, one white) when their car bumpers accidentally touched. No apparent injury or damage was caused, but in the verbal clash the white driver ‘kissed their teeth’ at the other. This provoked an accusation of cultural appropriation from the Black driver who insisted: ‘Only Black people kiss their teeth.’ The white driver complained that

Valerie Watson

‘bringing colour’ into the situation was offensive and irrelevant. I noted my fear of the situation escalating into physical violence and worry for the Black driver if it did. This brief ‘accidental’ interchange confirmed my suspicion and recognition of the potential to bring ‘race’ into any dispute. ‘Race’ is just below the surface and is everywhere, as are our histories of unresolved hurt, anger and distress; it is all the stuff of counselling. Stories are brought to the counselling room by clients as symbols, expressions or metaphors of disorientation, discomfort or distress. Observation of the inequity of power in Black-white relations has alerted me to the variety of possible meanings that might be derived from incidents such as the one above, should the protagonists and observers choose to reflect on the story from their frames of reference in the counselling room. Will these recollections be ignored or overlooked by counsellor and client as just an everyday story, a distraction from finding solutions to their diagnosed or presenting problem? Or might there be a starting point for further deeper exploration? Will there be identification and acknowledgement of the effects of microaggression, white privilege and white fragility? I believe direct or indirect referencing to these are important signifiers of true empathy, but I know that others may strongly disagree. Black clients who are continuously on the receiving end of the cumulative effects of oppression can and do experience intense levels of distress and trauma, characterised or expressed as a combination of anger, fear, powerlessness, weariness and defensiveness that might be interpreted and experienced by a white person, a white therapist, as ‘coming from nowhere’, ‘coming from nothing’ and ‘undeserved’. Such a response typifies many of the defensive, offensive, incredulous ‘white privilege’, ‘white fragility’ responses defined and described by McIntosh (1988), Ryde (2019) and DiAngelo (2019). These authors articulate and identify some of the essential personal work and training to be done and insights to be gained by all, and especially white therapists, if they are to truly become informed about the impact of racism. In her prose poem, Rankine (2014, p.18) asks us to imagine the feelings of the Black client attending their first appointment with their white counsellor, a trauma specialist, who shouts and tries to shun them, mistaking them for an uninvited caller at their back door.

Know your place and stay in your lane The social constructionist stance advocated by Gergen (2015) and others respects the ways in which knowledge affects use and abuse of power, rejects acting on assumptions and encourages reflexivity and learning through relationship and community. These principles underpin the proponents of CRT, such as Rollock and Gillborn (2011), who assert that the concept of ‘race’ is socially constructed and that racism is normalised in all aspects of Western society and perpetuated by an ‘accepted’ notion of white privilege that exists to retain structural and political power. Although this approach to social analysis is not without its detractors, I

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have found the premise of CRT supportive: its emphasis on using ‘lived experience’ as evidence and the different perspectives it offers that are affirming and validating when confronted or blocked by apparent hegemonic ‘truths’ presented by white scholars and commentators. By its nature and history, counselling theory and beliefs about its practice are controlled by white scholars, mostly men, and white frameworks. Study and debate of counselling practice through the lens of CRT and exploration of Black narratives available to us are an important addition to counselling training. For example, what do we understand and how do we respond if presented with Sylvia Arthur’s (2017, p.56–57) story, which illustrates the effects of racism, transgenerational trauma and white privilege in her complaint that she is merely seen as a ‘Black body’, a slave, and that her race, class and gender are negatively linked in the minds of her supermarket co-workers who describe her as being ‘big and strong’, despite contradictory visible evidence of being smaller and lighter. The ubiquity of Black faces now in UK media, television, advertisements and hoardings, drama, news and magazine covers showing Black people doing ordinary things like eating a meal, walking the dog, buying furniture and so on, compared with less than 10 years ago, could be seen as evidence of the growing visibility and acceptance that Black people exist and are consumers. However, Black visibility is often based on a skewed and inaccurate portrayal of Blackness, in part manufactured to mimic white middle-class culture, and could be seen as a form of ethnic and socio-economic oppression. Like Hirsch (2018), I note the preference for ‘mixed-race’ images as the ‘most palatable and marketable version of Black’ (p.180). Published data and reports show a rise in overt and covert racism, racist attacks and discrimination, both recent and historic (Home Office, 2019; Institute of Race Relations, 2018). This evidence supports the reality of life in the UK today for Black people (House of Lords Library, 2018), of living in a ‘hostile environment’ in which the dominant white culture continues to be a reluctant ‘host’, attacking those whose are visibly different. Against this background, Black clients accessing counselling might express a sense of powerlessness and despair when invited to explore the potential for empowerment with their Black or white counsellor. Reference to the paradigm of CRT in the counselling room could help to re-balance and explain the contradictions, offering a more realistic picture of what the client may be experiencing in their everyday life. Contemporary UK-based, Black scholars, writers and political commentators, such as Akala (2018), Eddo-Lodge (2016), Hirsch (2018), Olusoga (2016) and Shukla (2016), tell us what is known: that an increase in visibility does not necessarily mean equal treatment and can lead to the reverse – an increase in hostility and vulnerability to attack. The authors show that little has changed. Black people are still being oppressed, punished and hurt in subtle and overt ways. This observation and analysis applies in the US and other Western continents. Using the symbols, language and metaphors associated with the slave trade, Christina Sharpe (2016) demonstrates how oppression and injustice affect Blacks in America.

Valerie Watson

Akala (2018) recalls how one of his teachers condoned the murderous acts of the Ku Klux Klan (p.237), arguing that it reduced Black crime, and resisted Akala’s challenge to the contrary. Similarly, in an exploration of the complexity of Black and British identities, Hirsch (2018) wonders how the right-wing English Defence League rationalises their attacks against British Muslim communities.

Getting to work – sense of mission ‘I get angry about things, and then go on and work.’ (Toni Morrison in an interview with Zia Jaffrey (1998))

I am aged 13; it is break time. A physical education teacher has asked to speak to me in the changing rooms. On arrival, I see six friends and sports teammates. Our normally self-assured teacher is looking uncomfortable. She explains that teaching staff have noticed that we are gathering together at break times. Our teachers, she says, are ‘worried’ about us. ‘You are all so talented and could do so well,’ she says. The message is clear. We are ruining our chances of success by coming together. Streamed according to academic ability, we are from a range of tutor groups. We have all represented the school in sports teams. These gatherings, and no others, are acceptable. We look at each other, speechless. It becomes clearer – the problem is, we are all Black. We have broken an implicit rule that does not apply to our white peers. Our break-time gathering is seen as a threat. Our teachers have exerted their power and privilege to control us. Later, we are angry. It was, I realise now, events like these that led to my wish to protest and educate myself to understand why and, where possible, to ‘get to work’, as Toni Morrison says – to resist. The repeated depiction of the ‘angry Black woman’ stereotype in literature and in the media offers a distorted image, presenting Black women as figures of threat. The portrayal does little to explain the reason(s) behind the anger or that these shows of anger are often justified, presumed and over in moments. I mostly agree with Morrison’s assertion in her work that anger is harmful, wastes energy and resources and indicates a lack of control (Morrison, 2020). In her case, energy saved was channelled into her work. Anecdotally, I have heard from Black clients, peers and family members who have chosen to rise above the provocations of racism and oppression in favour of active resistance and achievements that expose the illegitimacy of these accusations and defy racism. I was fortunate to discover this strategy at an early age, inspired by the work of Black writers, artists, musicians and mentors in my extended family. However, there are disadvantages. The following stories illustrate the risks of believing in or seeking white acceptance at the cost of authenticity. In anticipation of negative stereotyping, Shani, a successful and diligent academic with a reputation for excellence and rigour amongst her peers, worked hard to avoid accusations of being an angry Black woman. She learned that the behaviour of white colleagues who expressed anger and acted in a deliberately intimidating way was rationalised or condoned. Shani diluted her presence and natural ebullience and muted a tendency for directness and robust exchanges.

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She toned down her enthusiasm for work, to avoid upsetting colleagues. For years, she enacted codes of behaviour and tone of language and expression deemed acceptable to her white colleagues in the UK, including a capacity for hard work. This strategy was successful until a new, junior, white colleague accused Shani of intimidation, but offered no supporting evidence. Shani, who rarely received praise, was reprimanded by her boss and excluded from a major project she was leading, to protect her junior white colleague. Her sense of injustice, confusion and traumatic injury was acknowledged to her secretly and separately by a few colleagues. I am sitting with a colleague in a café frequented by employees at my place of work. All are chattering intently at tables in small groups. All except us are white. We are approached by a colleague who greets us, asking, ‘So, what are you two ladies plotting?’ There is a moment of recognition for all three of us. Nothing is said. The enquiring colleague, conscious of her mistake, apologises and corrects herself, saying: ‘Well I am sure that it will be something great,’ as she leaves, waving. I acknowledge my shock and allow the moment to pass without comment. We recognise this microaggression for what it is, knowing that racism hurts everyone. No further comment is necessary. We are battle weary and do not want to spend precious time together in outrage. These two stories are illustrative of expressions of white privilege, white frailty, fear of the other, fear of insurrection and fear of groups. I am reminded that being Black is bad, but excelling in what we do and being Black can be worse. Black visibility (and invisibility) is a complex issue: we are seen as an enigma, exotic and a threat. Success and leadership positions in institutions can accentuate this. The social constructionist position I adopt allows for challenging assumed truths, translating and co-creating ways of working that openly acknowledge the context, history and socio-political situations in which we (Black client and Black counsellor) might find ourselves. Some clients find sitting still and talking in the counselling room limits and prohibits expression of feeling and experience. My positive experience of receiving counselling supervision outdoors extends to enabling an outdoor therapeutic experience to clients where possible and practical. I believe that taking counselling out of the therapy room, where possible, helps clients to link their understanding to their everyday life and environment. The longer-term positive impact is that clients do not associate coming for counselling as a sign of ‘illness’ but as a sign of growth and development. For some Black clients, it can also be an affirmation and recognition of the inappropriateness of Western counselling hegemony as a universal language of cure. As a means of building connectedness and psychological contact in and beyond the counselling room, I encourage clients to make regular and deliberate use of their preferred ways of meaning-making and communicating. This might include creative media, singing and exploration of films, novels, drama, traditional stories, poetry, spiritual practices, traditional healing and topical, historical and popular cultural references relating to food, clothing, idioms, music and songs to maximise the opportunity for clients to find their voice.

Valerie Watson

I contend that finding ways to respect theories of our counselling orientations while prioritising contextual congruence is a major theme for counselling training and continuing development in this field. Looking through the lens of CRT study and exploration of African psychology theory, with its inclusive philosophy, promotes sensitivity and invites trust from Black and non-white clients, strengthening opportunities to contribute to knowledge and practice.

‘If you’re white you’re all right. If you’re Black, get to the back’ Ged, a Black lecturer, told me how he was confronted by his own internal oppressor through the action of three Black students. Rather than sitting where they usually sat, with the other Black students at the back of the lecture hall, these three students moved together to sit in the front row. Puzzled by their action, Ged wondered if their action was a prank, a personal attack or an act of defiance or aggression. Days of distress and inward searching led Ged to the shocking insight of internalised racism. He resolved to make changes. In subsequent lectures, Ged moved the focus of his attention to other Black students at the back of the hall, engaging them in discussions and questions. After a few weeks of hesitation and suspicion, the Black students began to participate in the discourse and lecture activity. No longer ignored, erased or shamed, they became active, moved around the lecture hall and participated in the additional curricular activity of the cohort. For the first time, one Black student stood for the position of subject representative.

Which way now? Juno described her attendance on a training course offered specifically for experienced practitioners, which took place on a counselling service premises. Halfway through the day, the course was interrupted by a Black person who walked into the classroom and announced to the group of 40 that they were depressed, felt neglected, ignored and misunderstood and needed help. No one responded, no one moved. The facilitator continued with their sentence; the Black person went away. The four Black training participants who attempted to discuss the incident and the training group’s lack of response were reminded that this was not the theme of the day’s training event. Counselling training and practice should include the study of contemporary politics, the use of the arts and our combined global knowledge of science, history, natural sciences and folklore, all of which carry metaphors and symbols that can facilitate reparative dialogue. What better way to understand the impact of class politics on clients in the counselling relationship than to become familiar with political and sociological debate through learning from lived experiences? For example, Laura Waddell (2017, p.27) provides a forceful description of the politics of food for those on a low income. Her essay outlines the ways in which the diet of the poor is a source of comedy, shame and bullying that starts in childhood, the effect of which lingers long into adulthood. It is understanding of this kind that counsellors need in their work and practice.

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Experiential learning in counselling training, especially within the person-centred approach, can highlight some weaknesses when addressing issues relating to oppression, power relations, ethnicity and their sensitivities are concerned. The concept and anti-oppressive principles of ‘allyship’ in the training and practice environment can be of benefit. Allyship acknowledges commonality and connectedness, placing the responsibility for learning and action on those in privileged and powerful positions. Allyship: … is not an identity – it is a lifelong process of building relationships based on trust, consistency, and accountability with marginalized individuals and/ or groups of people. (The Anti-Oppression Network, n.d.)

If such accountability is accepted in every training arena, the minimisation or avoidance of issues perceived as difficult, like working with Black clients, will be reduced.

References Akala D.K. (2018). Natives: Race and class in the ruins of empire. Two Roads. Ani, M. (1994). Yurugu: An African-centered critique of European cultural thought and behavior. Africa World Press. Anti-Oppression Network (undated). Allyship. https://theantioppressionnetwork.com/allyship/ Arthur, S. (2017). Britain’s invisible black middle class. In N.Connolly (Ed.), Know your place: Essays on the working class by the working class (pp.51–61). Dead Ink. Cozolino, L. (2002). The neuroscience of psychotherapy. W.W. Norton & Co. Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, 1(8). http://chicagounbound.uchicago.edu/uclf/vol1989/iss1/8 DeGruy, J.L. (2005). Post-traumatic slave syndrome: America’s legacy of enduring injury and healing. Uptone Press. DiAngelo, R. (2019). White fragility: Why it’s so hard for white people to talk about racism. Allen Lane. Eddo-Lodge, R. (2016). Forming blackness through a screen. In N. Shukla (Ed.), The good immigrant (pp.77–83). Unbound. Gergen, K.J. (2015). An invitation to social construction (3rd ed.). Sage. Halmos, P. (1965). The faith of the counsellors. Constable. Hirsch, A. (2018). Brit(ish). Jonathan Cape.

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Home Office (2019, October 15). Hate crime, England and Wales, 2018/2019. Home Office. www. gov.uk/government/statistics/hate-crime-england-and-wales-2018-to-2019 Institute of Race Relations (2018, November). Briefing Paper 11: The embedding of state hostility. Institute of Race Relations. Jaffrey Z. (1998, February 2). The Salon interview – Toni Morrison. Salon. www.salon.com/1998/ 02/02/cov_si_02int Lago, C. (2006). Race, culture and counselling: The ongoing challenge (2nd ed.). Open University Press/McGraw-Hill. Lago, C. & Charura, D. (2016). The person-centred counselling and psychotherapy handbook: Origins, developments and current applications. Open University Press/McGraw-Hill. Lietaer, G. (2016). The research tradition in person-centered/experiential psychotherapy and counseling: bibliographical survey 1940-2015. Person-Centered & Experiential Psychotherapies, 15(2), 95–125. House of Lords Library (2018). Impact of ‘hostile environment’ policy: Debate on 14 June 2018. House of Lords Library briefing. www.ein.org.uk/news/house-lords-library-publishes-comprehensivebriefing-hostile-environment-ahead-lords-debate McIntosh, P. (1988/2019). White privilege and male privilege: A personal account of coming to see correspondences through work in women’s studies. In P. McIntosh, On privilege, fraudulence and teaching as learning: Selected essays 1981–2019 (pp.17–28). Routledge. Milton D.E.M. (2012). On the ontological status of autism: The ‘double empathy problem’. Disability & Society, 27(6), 883–887. Moodley, R., Walcott, R. (2010). Counseling across and beyond cultures: Exploring the work of Clemmont E Vontress. University of Toronto Press. Moodley, R. & West, W. (2005). Integrating traditional healing practices into counseling and psychotherapy. Sage. Morrison, T. (2020). Mouth full of blood: Essays, speeches, meditations. Vintage. Natiello, P. (2001). The person-centred approach: A passionate presence. PCCS Books. Nwoye, A. (2015). What is African psychology the psychology of? Theory & Psychology, 25(1), 96–116. Olusoga, D. (2016). Black and British: A forgotten history. Macmillan. Prouty, G., Van Werde, D. & Pörtner, M. (2002). Pre-therapy: Reaching contact-impaired clients. PCCS Books. Rankine, C. (2014). Citizen: An American lyric. Graywolf. Rogers, C.R. (1951). Client-centered therapy. Constable. Rogers, C.R. (1967). On becoming a person. Constable. Rogers, C.R. (1978). Carl Rogers on personal power. Constable. Rogers, C.R. (1980). A way of being. Houghton Mifflin. Rollock, N. & Gillborn, D. (2011). Critical race theory (CRT). British Educational Research Association. www.bera.ac.uk/publication/critical-race-theory-crt Ryde, J. (2019). White privilege unmasked: How to be part of the solution. Jessica Kingsley. Schmid, P. (2002, July 27). The characteristics of a person-centered approach to therapy and counseling: Criteria for identity and coherence. Carl Rogers Symposium, University of California, San Diego. Sharpe, C. (2016). In the wake: On blackness and being. Duke University Press.

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Shukla, N. (2016). The good immigrant. Unbound. Tudor, K. & Worrall, M. (2006). Person-centred therapy: A clinical philosophy. Routledge. Waddell, L. (2017). The pleasure button. In N. Connolly (Ed.), Know your place: Essays on the working class by the working class (pp.22–32). Dead Ink. Warner, M. (2016). Difficult process: Working with fragile and dissociated client experience. In C. Lago & D. Charura (Eds.), The person‐centred counselling and psychotherapy handbook: Origins, developments and current applications (pp.102–110). Open University Press/McGraw-Hill.

Priscilla Dass-Brailsford

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‘Where are you from?’ The effects of racism and perceived discrimination on people of colour Priscilla Dass-Brailsford

Note from the editors: This chapter relates primarily to a US context, but the statistics can be regarded as broadly representative in many cases, and the content is all too relevant to UK readers. The first time I was asked, ‘Where are you from?’, it was unexpected. Yes, I had travelled more than 8,000 miles from South Africa to attend graduate school in Cambridge, Massachusetts, so I had indeed come from somewhere. Nevertheless, I looked myself up and down wondering what it was that gave me away. My clothing? Basic college student garb – jeans and a sweater. The garb I had seen most people around campus wearing. My hairstyle? I did not think so because I had seen many other young women with a similar Farah Fawcett hairstyle – flouncy curls that swung on my shoulders. It was the rage in the late 1980s. Did I sound different? Of course I did. I had a South African accent with an English lilt, since I was born and grew up in a predominantly English-speaking part of South Africa. My hometown was along the East Coast in the province of Natal (it has since been renamed Kwazulu-Natal). It is often viewed as the last outpost of British colonialism – a province in which cucumber sandwiches, scones and clotted cream were served at high tea in hotel lounges, which people like me longingly watched from a distance. But that is another story. In any case, I liked my accent, despite it making me ‘different’ in the US. People would later confirm that it was my accent that indicated I was from somewhere else. But I now know that the unnamed ‘elephant in the room’ was the fact that I was not white but a person of colour. It explains why so many of my second-generation friends of colour, friends who were born here, as were their parents, and who sound very American, are also asked the same question, ‘Where are you from?’ or ‘You know what I mean, where are you really from?’ The question often comes from a white person and the responsibility always falls on the person of colour to figure out what is really being asked and to respond in a way that satisfies the listener. This is modern racism! I soon realised that growing up in

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apartheid-ruled South Africa did not adequately prepare me for the subtlety of modern racism that I would experience in the US, or maybe it had more than adequately prepared me so that I was always alert to the possibility of racism in my new environment? I would later learn that statutory ways regarding racism in the US had changed, but folkways were still lagging far behind. The US Civil Rights Act (Public Law 88–352, 78 Stat. 241), which was enacted on 2 July 1964, legally outlawed discrimination based on race, colour, religion, sex or national origin. Although the legal act reduced racial discrimination, it did not end it. However, for the first time, ethnic minorities had a legal path towards resolving racial infractions. The election in 2008 of Barack Obama as the first Black president fuelled a perception that issues of racism were finally over in the US and that a colour-blind society would emerge. However, events of the past decade, frequent shootings of African Americans by law enforcement officials and the proliferation of racist attacks on college campuses have challenged this perception. Moreover, research studies suggest that racial discrimination continues to be a common experience for many people of colour in the US (Carter et al., 2017; Shams, 2015). Comments such as, ‘Where are you from?’ are deemed to fall into the category of microaggressions, but why are they always experienced by the victim as a macroaggression? Naming it certainly does not sweeten the pill.

Microaggression The term microaggression, coined by Pierce in 1970, was initially conceptualised as encompassing negative comments, non-verbal exchanges and automatic comments that are experienced by recipients as insults and put-downs (Pierce, 1970). Sue (2010) similarly defined microaggressions as beliefs and verbal, behavioural and environmental exchanges that are derogatory, negative and based on racial, gender, sexual orientation and religious differences. Sadly, individuals who commit microaggressions often do not realise they have done anything ‘wrong’. Microaggressions are often unconsciously delivered in subtle looks, gestures and statements. These exchanges are so pervasive in regular interactions that they are often not noticed by white people. But microaggressions are harmful to people of colour because they have negative and detrimental psychological consequences, such as increasing feelings of anger, frustration, emotional turmoil and decreasing self-confidence, self-esteem and trust. Microaggressions do not always involve negative verbal statements or overt interactions; they can be observed in the climate of the workplace. For example, company directors may be unaware that there is not a single manager of colour in the company until it is pointed out to them. In contrast, people of colour in the company are usually aware of this racial inequity and may experience the work climate as invalidating, since there is no one who looks like them ‘at the top’. Perceived discrimination occurs when individuals negatively view events, situations or experiences and attribute the cause of the event to their racial/ethnic background (Knight, 2013). Perceived racism is generated from the perspective of individuals who are the target of racist acts. Targeted individuals are more

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vulnerable when the perpetrator is in a position of power and has hierarchical superiority and the ‘victim’, or target of discrimination, is in a subordinate position. Because of their subordinate status, such individuals may have less power, fewer social resources and limited opportunities to seek protective sanctions. The lack of these resources and opportunities, in addition to the act of discrimination, increases their sense of marginalisation. Perceived racism can threaten the overall health and wellbeing of people of colour.

Racial discrimination Minority stress theory, developed in the US, reviews the many ways that discrimination operates at the structural, interpersonal and individual levels to increase the exposure of people of colour to race-based stress, paving the way for the development of negative physical and mental health issues (Paradies at al., 2015). Racism that occurs at these three levels can be conscious and deliberate, with the intention to harm, disadvantage or discriminate against individuals who are racially different. However, it can also operate unconsciously, occurring without much thought, but reflective of how a white or dominant-culture person may actually feel about people of colour. For example, white teachers may display preferential treatment for white students by providing them with more help and support than they do Black students. At the other end of the continuum are extreme acts of overt racism and hate crimes. An example is the violent killing in 1998 of James Byrd, Jr., an African American man, who was chained, beaten and dragged naked behind a pick-up truck before being beheaded by a group of white men. Institutional or systematic racism can be found in an examination of the policies, practices, procedures and structures of businesses or institutions that favour whites and disadvantage people of colour. These policies and practices are not always clearly apparent. On the surface, they may appear to apply equally to everyone, but a closer examination may reveal policies and practices that disadvantage certain groups. An example is recruiting practices that may have unfair consequences on people of colour such as lower starting salaries and challenges in attaining promotion. Unfortunately, this type of institutional racism has many long-term effects that shape the upward social and economic mobility of affected individuals. Cultural racism is perhaps the most pervasive and insidious type of racism because it serves as an overarching umbrella under which individual and institutional racism thrives. Cultural racism is defined as the individual and institutional expression of superiority of one group’s cultural heritage (history, traditions, language and values) over that of another. As an example, when Latinx1 people do not feel encouraged to speak to a Latinx peer in Spanish during a break, the inherent assumption is that English is a superior language. 1. Latinx is a term currently used in the US to refer to a person of Latin American origin or descent, as a gender-neutral or non-binary alternative to Latino or Latina.

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The concept of the US as a ‘melting pot’ for everyone, regardless of their race or country of origin, has been largely debunked because it only melts some groups – for example, Irish immigrants who are assumed to be white Americans despite only having arrived in the country recently. Disallowing people of colour from practising cultural rituals (e.g. taking a day’s holiday for a particular religious or cultural celebration) and assuming that all group members are Christian are other examples of cultural racism. Cultural racism is also apparent when certain music or manners of dress are favoured above others, or seen as less desirable because they are associated with a particular racial group (e.g. Kente cloth and dashikis worn by Africans). Although there has been a decline in acts of overt racial discrimination, such as banks turning down loan applications from people of colour, there has been a tremendous increase in acts of subtle racism. Many researchers in the field of race studies concede that racism has evolved from direct acts of discrimination to become invisible, subtle and indirect, often operating below conscious awareness (BonillaSilva, 2014; Nadal et al., 2014). Nevertheless, the effects of unconscious racism continue to threaten the wellbeing of many people of colour in the US (Shams, 2015). Dovidio and Gaertner (2004) posit that most whites experience themselves as good and moral people who do not intentionally discriminate against others on the basis of race. However, it is difficult for any white person born and raised in the US to be immune from holding racial biases and stereotypes. Many whites who are classified as well-educated and liberal believe they are not prejudiced, hold egalitarian values, and do not discriminate, but nevertheless harbour unconscious biased attitudes that result in discriminatory actions (Dovidio & Gaertner, 2004). This type of racism may result in more qualified Blacks or other people of colour being ‘passed over’ for higher level positions based on preconceived notions of fitting in or concern about how others may perceive them. Racial trauma describes the physical and psychological reactions that people of colour experience after exposure to experiences of racism (Bryant-Davis & Ocampo, 2006; Comas-Díaz, 2016). Similar to survivors of other traumas (e.g. sexual assault, domestic violence), people of colour may experience fear, hypervigilance, headaches, insomnia, body aches, memory difficulty, self-blame, confusion, shame, and guilt after being exposed to racism (Helms et al., 2012).

Reactions to perceived racism Whether experiences of racism are overt or subtle, they produce significant psychological and physiological consequences. For example, in studies with Black samples, perceived racism was found to negatively correlate with physical health and cardiovascular disease (Goosby et al., 2015), psychological wellbeing (Barnes & Lightsey, 2005) and self-esteem (Utsey et al., 2000), and positively correlate with hostility, somatic complaints (Steffen et al., 2003), anxiety and depression (O’Keefe et al., 2015; Paradies et al., 2015). In the short term, individuals affected by trauma often experience emotional, cognitive, behavioural, physical and spiritual reactions. While most people recover within a short period of time, some continue to have problems for much longer. It is

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also common for reactions to vary in intensity. Some people may not experience any significant reactions initially, but will have delayed reactions months or years after the trauma. Others may recover but relapse when again faced with a similar stressor. Frequent triggers that remind individuals of the event and/or their losses (e.g. constantly experiencing insults in the workplace), past trauma history and the number of prior experiences of racism can intensify current reactions. The areas of functioning impaired by trauma (Dass-Brailsford, 2007) are outlined below: Emotional response: frequently observed emotional responses to stress or trauma include shock, numbness, anxiety, panic, fear, feelings of aloneness, hopelessness, helplessness, uncertainty, horror, irritability, depression, grief and guilt. Cognitive response: impaired concentration, confusion, disorientation, difficulty in making a decision, and a shortened attention span are common cognitive reactions that trauma survivors often display. These can negatively impair work performance. Those affected by trauma also report an increased sense of vulnerability, more frequent blaming of self and others, lowered self-efficacy, sense of loss of control and a heightened state of hypervigilance. ‘Perseveration’, or internally recounting and replaying the event multiple times, is a symptom often experienced in the aftermath of a traumatic event. Behavioural responses: traumatic exposure may manifest behaviourally in withdrawal, non-communication, erratic or repetitive movements (i.e. pacing, impulsivity, an exaggerated startle response, irritability, a sense of aimlessness, and an increase in anti-social and high-risk behaviours). Physical responses: responses that may also be regarded as physiological reactions include elevated heart rate and blood pressure, difficulty breathing, hyperventilation, chest pains, muscle tension, fatigue, excessive perspiration, dizziness, headaches and stomach aches. People affected by trauma may experience some or several of these reactions. It is not unusual for such a person to feel as if they are on a rollercoaster, with their symptoms temporarily abating or suddenly increasing in intensity as they experience different reactions. Traumatic experiences cause damaging long-term effects that may have deleterious consequences for brain and body functioning. In a large meta-analytic study focusing on the association between perceived racism and mental health consequences specifically for African Americans, a population that has experienced more incidents of racism than any other racial minority group, Pieterse and colleagues (2012) found that perceived racism was negatively associated with psychological wellbeing and positively associated with psychological distress, anxiety and depression. These psychiatric symptoms had a significantly stronger association with quality-of-life indicators, suggesting that the mental health of African Americans is significantly affected by exposure to racism.

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Positive associations have been found between racial microaggressions and psychopathology (Donovan et al., 2013), and suicide ideation (O’Keefe et al., 2015). Men who experienced discrimination-related trauma reported more severe symptoms of trauma and were at greater risk of contracting HIV (Bowleg et al., 2014). Psychosocial stressors such as perceived racism contribute to the aetiology, progression and prognosis of heart disease and hypertension, both of which account for raised cardiovascular death rates among African Americans (Roger et al., 2012). Research shows that racial discrimination takes a serious biological toll on African Americans. Cumulative exposure to racial discrimination has been associated with many negative physiological outcomes that include elevated blood pressure, increased heart rate and raised risks for cardiovascular diseases (Wagner et al., 2015). Racial discrimination is also linked to the dysregulation of the hypothalamic pituitary-adrenal axis, which helps the body control reactions to stress and regulates key physiological functions such as the immune system, emotions and digestion (Pfefferbaum et al., 2015). Trauma affects both the body and the mind over the long term. In addition to the physiological effects described above, trauma survivors are also more susceptible to physical diseases. Ultimately, physiological and psychological responses to trauma can cause early death. Two major diseases that are the result of perceived racism are hypertension and cardiovascular disease. Repeated or chronic stress negatively affects the body’s allostatic load, which regulates the physiological consequences of chronic exposure to fluctuating or heightened neural or neuroendocrine response. Racial discrimination triggers the fight-or-flight response, which may linger long after the incident has ended. Prolonged fight-or-flight responses to stressful events in turn lead to the development of disease and premature death. Several researchers have posited that African-Americans’ elevated nocturnal blood pressure levels and poor sleep quality in comparison with other racial groups are linked to chronic and heightened vigilance towards threats of discrimination (Brondolo, 2015; Goosby et al., 2015; Hill et al., 2015; Pieterse et al., 2012; Wagner et al., 2015). Further, research has found that racism-related vigilance is associated with more sleep difficulty for Black than for white adults (Durrence & Lichstein, 2006).

Opposing perceived discrimination Speaking up about perceived discrimination can have both positive and negative effects. For some ethnic populations, it may help restore their dignity and sense of pride about their cultural identity. However, these positive effects depend on being in a supportive environment that is open to criticism, including the voice of white allies who are willing to face hidden racism in themselves and others. The individual may initially feel stigmatised and labelled a trouble-maker, especially by peers who may not have an understanding of subtle racism and its effects on people of colour. Individuals who speak up may be ostracised by others, who may avoid them out of fear of being accused of wrong-doing, shunned and excluded by the larger group and not invited to social events and other activities. In many

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ways, nothing would have changed except that speaking out would have attracted additional negative attention to themselves. The literature on the impacts of standing up to perceived racism is almost non-existent, but one study found that people who ‘stood up’ suffered emotional distress; severe depression or anxiety (84%); feelings of isolation or powerlessness (84%); distrust of others (78%); declining physical health (69%); severe financial decline (66%), and problems with family relations (53%) (Rothschild, 1999). These numbers are extremely high and indicate that challenging racism can have severe consequences across all domains.

Factors affecting recovery and coping There are several important factors, extending from individual characteristics to the person’s ecological environment and the appropriate social support and resources within it, that can help people cope with racial trauma. The social support environment often determines whether victims feel validated and understood, and get the help they need from friends, family and co-workers/colleagues. In order to promote resilience, individuals will need to take care of their physical, mental and emotional health. Engaging in positive and health-promoting activities alleviates many symptoms of stress. Regular exercise, eating healthy foods and avoiding junk food and getting a good night’s sleep are some basic coping skills that racial trauma will sometimes impede. How individuals cope with perceived racism depends on their coping styles. Two common coping styles are avoidance and problem-focused coping. Avoidance coping is often a negative adaptation that can result in later problems. It is an indirect and passive coping style. Avoiding dealing with issues by eating, smoking or drinking more than usual are examples of avoidance coping. These strategies may help in the short term but can have deleterious long-term effects. Avoidance coping can increase depression and erode an individual’s self-worth and sense of agency (Brooks et al., 2019). Problem-focused coping, in contrast, is an active coping style that increases stress in the short term but has long-term benefits of resolving issues. For example, attempting to resolve the problem in a strategic way by reporting incidents of perceived racism to appropriate authorities and seeking legal help is an active way of problem-solving. Besides being direct, problemfocused coping restores an individual’s pride, self-confidence and self-worth. Higher levels of problem-focused coping can buffer the effects of perceived racism on depressive symptoms while supporting resiliency; higher levels of avoidance coping can exacerbate negative symptoms (anxiety, depression) with implications for increasing susceptibility to mental health issues (West et al., 2010).

Addressing race in the classroom Teaching graduate courses to develop students’ skills in diversity and multicultural competency has always been one of my passions, especially since it allows me to use my own life as a canvas. I usually begin a class by asking students what they

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thought when I first entered the classroom. The hesitancy is sometimes tangible but, with a little probing, their responses generally emerge: ‘We were concerned about whether we would understand your accent’; ‘You look different, and we were not sure you would understand us.’ And so the course is launched with what I call cultural introductions. These require students to split into dyads, to increase intimacy, and pair up with someone they do not know well but would like to get to know better. I then have students engage in an exercise where they ask each other the following questions: 1. Name/preferred name? 2. How do I identify: racially/ethnically/nationally? 3. What is my cultural background? 4. What is my social background? 5. What is my historical background? 6. Any other important cultural variables? 7. How does my cultural identity help me in the counselling field? 8. How does my cultural identity hinder me in the counselling field? From many years of experience, I find it is usually helpful if I am the first to culturally introduce myself to the whole class. I find that this sets the tone and provides a model for students in identifying the limits to self-disclosure. Be warned, this exercise can take up a good part of the first class, but it is time well spent and is invaluable in generating challenging discussions around racism and discrimination.

Conclusion Ethnic populations made up about one third of the US population in 2015 – a proportion that is expected to rapidly rise in future years. We can expect that, by 2050, people of colour will be a majority group (US Census Bureau, 2015). Among children, the change in ratio of ethnic populations from minority to majority status is predicted to happen much sooner, in the next few years (Hemmings & Evans, 2018). Clearly, the US is rapidly growing into a diverse and multicultural/ multi-ethnic nation, yet it still remains a country that struggles with issues of racism, discrimination and prejudice that victimise citizens of colour. Acts of overt racial discrimination continue to occur and are capable of causing significant harm. However, the impact of racial threat from well-intentioned people who commit unconscious acts of discrimination against people of colour cannot be underestimated. Socialisation exposes all people to a process of conditioning that often results in prejudices, stereotypes and beliefs that lie outside the level of personal awareness (Sue, 2010). Although, on a conscious level, white people may endorse the belief that all people are equal, on an unconscious level, they may harbour the opposite feelings, which inevitably influence the way they behave towards people of colour. The

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indirect nature of modern racism makes it more difficult to hold perpetrators accountable, yet the effects are similar to direct acts of discrimination. These common experiences of discrimination, such as asking, ‘Where are you from?’, provoke anger and frustration and decrease self-esteem among people of colour, largely and precisely because, unlike overt forms of racism, they are not easy to identify, challenge and confront. Moreover, because of the subtle nature of modern racism, perpetrators are often unaware of the psychological stress they cause people of colour. The classroom is a place where we can begin to address this important social issue.

References Barnes, P.W. & Lightsey, O.R., Jr. (2005). Perceived racist discrimination, coping, stress, and life satisfaction. Journal of Multicultural Counseling and Development, 33, 48–61. Bonilla-Silva, E. (2014). Racism without racists: Color-blind racism and the persistence of racial inequality in the United States (4th ed.). Rowan & Littlefield. Bowleg, L., Fitz, C.C., Burkholder, G.J., Massie, J.S., Wahome, R., Teti, M., Malbranche, D.J. & Tschann, J.M. (2014). Racial discrimination and posttraumatic stress symptoms as pathways to sexual HIV risk behaviors among urban Black heterosexual men. AIDS Care, 26(8), 1050–1057. doi: 10.1080/09540121.2014.906548 Brondolo, E. (2015). Racial and ethnic disparities in health: Examining the contexts that shape resilience and risk. Psychosomatic Medicine, 77, 2–5. http://dx.doi.org/10.1097/PSY. 0000000000000149 Brooks, M., Graham-Kevan, N., Robinson, S. & Lowe, M. (2019). Trauma characteristics and posttraumatic growth: The mediating role of avoidance coping, intrusive thoughts, and social support. Psychological Trauma: Theory, research, practice, and policy, 11(2), 232–238. https://doi. org/10.1037/tra0000372 Bryant-Davis, T., & Ocampo, C. (2006). A therapeutic approach to the treatment of racist-incidentbased trauma. Journal of Emotional Abuse, 6(4), 1–22. Carter, R.T., Lau M.Y., Johnson, V. & Kirkinis, K. (2017). Racial discrimination and health outcomes among racial/ethnic minorities: A meta-analytic review. Journal of Multicultural Counseling and Development, 45, 232–259. doi:10.1002/jmcd.12076 Comas-Díaz, L. (2016). Racial trauma recovery: A race-informed therapeutic approach to racial wounds. In A.N. Alvarez, C.T.H. Liang & H.A. Neville (Eds.), The cost of racism for people of color: Contextualizing experiences of discrimination (pp.249–272). American Psychological Association. Dass-Brailsford, P. (2007). A practical approach to trauma: Empowering interventions. Sage Publications. Donovan, R.A., Galban, D.J., Grace, R.K., Bennett, J.K. & Felicié, S.Z. (2013). Impact of racial macroand microaggressions in black women’s lives: A preliminary analysis. Journal of Black Psychology, 39, 185–196. http://dx.doi.org/10.1177/0095798412443259

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Dovidio, J.F. & Gaertner, S.L. (2004). Aversive racism. Elsevier Academic Press. Durrence, H.H. & Lichstein, K.L. (2006). The sleep of African Americans: A comparative review. Behavioral Sleep Medicine, 4, 29–44. Goosby, B.J., Malone, S., Richardson, E.A., Cheadle, J.E. & Williams, D.T. (2015). Perceived discrimination and markers of cardiovascular risk among low-income African American youth. American Journal of Human Biology, 27, 546–552. http://dx.doi.org/10.1002/ajhb.22683 Helms, J.E., Nicolas, G. & Green, C.E. (2012). Racism and ethnoviolence as trauma: Enhancing professional and research training. Traumatology, 18, 65–67. Hemmings, C. & Evans, A.M. (2018). Identifying and treating race-based trauma in counseling. Journal of Multicultural Counseling and Development, 46, 20–39. Hill, L.K., Hu, D.D., Koenig, J., Sollers, J.J., III, Kapuku, G., Wang, X., Sneider, H. & Thayer, J.F. (2015). Ethnic differences in resting heart rate variability: A systematic review and meta-analysis. Psychosomatic Medicine, 77, 16–25. http://dx.doi.org/10.1097/PSY.0000000000000133 Knight, C. (2013). The injustice of discrimination. South African Journal of Philosophy, 32(1), 47–59. Nadal, K.L., Griffin, K.E., Wong, Y., Hamit, S. & Rasmus, M. (2014). The impact of racial microaggressions on mental health: Counseling implications for clients of color. Journal of Counseling & Development, 92, 57–66. doi:10.1002/j.1556-6676.2014.00130.x O’Keefe, V.M., Wingate, L.R., Cole, A.B., Hollingsworth, D.W., & Tucker, R.P. (2015). Seemingly harmless racial communications are not so harmless: Racial microaggressions lead to suicidal ideation by way of depression symptoms. Suicide & Life-Threatening Behavior, 45, 567–576. http:// dx.doi.org/10.1111/sltb.12150 Paradies, Y., Ben, J., Denson, N., Elias, A., Priest, N., Pieterse, A., Gupta, A., Kelaher, M. & Gee, G. (2015). Racism as a determinant of health: A systematic review and meta-analysis. PLoS One, 10, e0138511. doi:10.137/journal.pone.0138511 Pfefferbaum, B., Tucker, P. & Nitiéma P. (2015). Adolescent survivors of Hurricane Katrina: pilot study of hypothalamic-pituitary-adrenal axis functioning. Child Youth Care Forum, 44(4), 527–547. doi:10.1007/s10566-014-9297-3. Pierce, C. (1970). Offensive mechanisms. In F. Barbour (Ed.), The black seventies (pp. 265–282). Porter Sargent. Pieterse, A.L., Todd, N.R., Neville. H.A. Carter, R.T. (2012). Perceived racism and mental health among black American adults: A meta-analytic review. Journal of Counseling Psychology, 59(1), 1–9. Roger, V.L., Go, A.S., Lloyd-Jones, D.M., Benjamin, E.J., Berry, J.D., Borden, W.B., Bravata, D.M., Dai, S., Ford, E.S., Fox, C.S., Fullerton, H.J., Gillespie, C., Hailpern, S.M., Heit, J.A., Howard, V.J., Kissela, B.M., Kittner, S J., Lackland, D.T., Lichtman, J.H., … Turner, M.B. (2012). Heart disease and stroke statistics – 2012 update: A report from the American Heart Association. Circulation, 125(1), E2–E220. https://doi.org/10.1161/CIR.0b013e31823ac046 Rothschild, J. (1999). Whistle-blower disclosures and management retaliation: The battle to control information about organization corruption. Work and Occupations, 26(1), 107–128. Shams, T. (2015). The declining significance of race or the persistent racialization of Blacks? A conceptual, empirical, and methodological review of today’s race debate in America. Journal of Black Studies, 46, 282–296. Steffen, P.R., McNeilly, M., Anderson, N. & Sherwood, A. (2003). Effects of perceived racism and anger inhibition on ambulatory blood pressure in African Americans. Psychosomatic Medicine, 65, 746–750. Sue, D.W. (2010). Microaggressions in everyday life: Race, gender, and sexual orientation. John Wiley & Sons.

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U.S. Census Bureau (2015). Race and Hispanic origin. USA QuickFacts. https://www.census.gov/ quickfacts/fact/table/US/PST045219 Utsey, S.O., Ponterotto, J G., Reynolds, A.L., & Cancelli, A.A. (2000). Racial discrimination, coping, life satisfaction, and self-esteem among African Americans. Journal of Counseling and Development, 78, 72–80. Wagner, J., Lampert, R., Tennen, H. & Feinn, R. (2015). Exposure to discrimination and heart rate variability reactivity to acute stress among women with diabetes. Stress and Health, 31, 255–262. http://dx.doi.org/ 10.1002/smi.2542 West, L.M., Donovan, R.A., Roemer, L. (2010). Coping with racism: What works and doesn’t work for black women? Journal of Black Psychology, 36(3), 331–349. DOI: 10.1177/0095798409353755



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Re-imagining the space and context for a therapeutic curriculum – a sketch Robert Downes and Foluke Taylor

Introduction We ‘breathe’ with Claudia Rankine into the racial imaginary,1 the space that she invited artists into to respond to the ways lives are influenced by our understanding and misunderstanding of race. Rankine speaks of how, as we are born into race, racism and white supremacy, our imaginations are not entirely our own, so we join in the imagining as therapeutic practitioners and thinkers. In this chapter, we bring our haunted and compromised imaginations to the task of re-imagining a therapeutic training – one that disrupts the centrality of whiteness and works to decolonise a curriculum using learning and teaching practices that recognise multiple voices, learning styles, needs and therapeutic traditions. ‘Western’ psychology is among the characters in this re-imagined story, but is shaken loose from the position of lone protagonist or hero. This reimagining insists on the presence of many stories. Neither the re-visioning nor the replacement of the accepted ‘heroes’ of psychotherapeutic thought were sufficient and both possibilities felt suffocating to this project. In the company of speculative fiction as a radical practice (texts that engage the reader to imagine and speculate the possibilities of understandings and makings of the world beyond the white supremacist patriarchal neoliberal order), and with a mind to Ursula Le Guin’s carrier bag theory of fiction (1989) (Le Guin speaks of the first tool asbeing a container2), we were able to breathe and play – to gather rather than classify, stratify or order a narrative. We have not imposed temporal structures and limits. This is not a beginning or an ending, but rather a sample telling of a training that might disrupt the usual state of affairs; one that understands the power of what bell hooks calls ‘imperialist white supremacist capitalist patriarchy’ (1987) and remains open to whatever possibilities of Blackening and queering therapeutic practice 1. https://theracialimaginary.org 2. In this text, Le Guin suggests that the container rather than the arrow is our most significant ‘tool’.

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and thought are revealed. This is not a hero-shaped narrative – starting here and going straight to there – but a carrier bag filled with stories: stories of being, being undone and unravelling from structures that have harmed us all. Our method was simple; we wrote to each other over a period of seven days from the perspective of two students – a Black woman and a white man. For the purposes of this text, we know these students as Cece and Niall. How they came together was a long thing and the subject of another chapter. Hence, this is a glimpse into an incompleteness. As they write to one another about their experience of the training, the nature of the learning environment and its study practices are revealed. We encounter a curriculum that is informed by various branches of critical theory and related practices that embrace and recognise Black and brown subjectivities while decommissioning whiteness. Dear Cece, Today we were introduced to the curriculum, and to some of the approaches to learning and teaching employed on this course. There are videos to watch, books and chapters to read, talks and podcasts to listen to, art to consider, field trips, and playlists to listen to and make. According to the handbook, the curriculum is an ‘alive body’; you can choose your format for offering accounts of your learning and integration. Essays are one option. We saw examples of slide shows, videos, scrap books and drawings. It feels like therapy school meets art school – Winnicott might have liked it. I am moved to play here, although this is serious play. After curriculum introductions, we began with an experiential work and study group called ‘complicating the white therapist’. Drawing from philosopher George Yancy’s work on ‘complicating the white self ’ (2008), the group will meet to study the construction of whiteness as the un-raced norm and to explore anti-racist clinical thought, practice and activism – a political psychology. The tutor (Bobi – preferred pronoun, they) said that starting here was necessary as a practice of ‘doing less harm’ – how, in the past, the curriculum and therapeutic institutions hadn’t fully addressed the legacies of slavery, colonialism and racism. Diversity training sidestepped the study of racialised object relations and left trainees under-resourced when it came to addressing the trauma of racism and the lies of whiteness in the consulting room. Someone renamed the seminar ‘de-commissioning whiteness’. Dear Niall, ‘Doing less harm’ sounds good, but I’m not about to drop my guard. However radical they say this course is, in my experience, to maintain a healthy suspicion is to stay alive and on track. My aim is to make it through the course, learn what I can and collect the paper on the way out. Whiteness can feel pretty basic in how it blocks access and stops us getting through, so I guess complicating it might be a good idea. Still, I’m staying fugitive. Put another way, in a private space in my mind, there is a collection of strategies and practices of escape and survival bequeathed to me by my ancestors. I will use them as necessary. They are what Toni Morrison speaks of

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as ‘a knowing so deep it’s like a secret’ (1985). I’m used to living with secrets, so I was genuinely surprised when the tutor today spoke about these knowings and practices directly, using the terms ‘Afropessimism’ (Wilderson, 2008) and ‘fugitivity’ (Campt, 2014). It was interesting to feel how naming a thing helped me to be with them differently and to stay curious. The handbook says curiosity is encouraged, which sounds legit, but I stay on my fugitive toes just the same. The afternoon seminar was called ‘History in the Room’. A quote from poet Dionne Brand had been projected onto the ceiling: One enters a room and history follows; one enters a room and history precedes. History is already seated in the chair in the empty room when one arrives. (Brand, 2002)

We lay on the floor like stargazers and reflected – sometimes internally and sometimes out loud – on the personal, intergenerational and transgenerational histories that were in the room with us. Someone spoke of the beauty and cultural value of the building that we were in. It was built, apparently, in the early 19th century, and therefore ‘historical’. It seemed like this person was proud (happy?) about this, but all I could think of was the labour extracted from my enslaved African ancestors that most probably funded it. I felt no pride or pleasure. In fact, I might have told her to fuck right off, if I didn’t think it would jeopardise my place on the course. Also, I didn’t want to feel like I was being unkind. So I was relieved when one of the teachers quoted James Baldwin (1955). When Baldwin was living in Switzerland, he wrote about what he felt about the architecture there. They were similar feelings to mine, but expressed with language that was more poetic – and acceptable – than mine. So we all got to think about a thing without getting too street about it. I guess I’ll be back next week. Dear Cece, I like the sound of ‘teachings from the ceiling’ and ‘knowing so deep’. They speak to what we are being guided towards. We began the day reflecting on the psychological and material harm caused by what bell hooks calls the ‘imperialist white supremacist capitalist patriarchy’ (1987). The tutor said that we were not going to start with the Diagnostic and Statistical Manual of Mental Disorders, but rather go straight to the source of our chronic dis-ease and suffering. We also lay down to name and listen to the personal and collective histories that were in the room and would need tending to over the next while. This was introduced as a practice of ‘more than one teaching voice in class’. The voices include those of the tutors, those we watch and listen to on screen, those we read and our own. In our ‘bring a sentence in and share it’ practice today, what stayed with me were the words that one of the group read from Christina Sharpe’s book, In the Wake: On Blackness and being (2016). Sharpe states that ‘to be in the wake is to occupy and to be occupied by the continuous and changing present of slavery’s as yet unresolved unfolding’. We were asked to write/create/make personally reflective

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pieces on how we see or don’t see this ‘unresolved unfolding’, and then encouraged to develop our understanding of auto-ethnographic approaches to this task. I am glad of the freedom from grade chasing. The fact that this homework was set by a fellow student was even more interesting – we get to do this to deepen our knowing and recognition of one another. Dear Niall, The ‘lies of whiteness’ is also on our curriculum. I’m a bit interested to find out more about what this means and also a bit wary of finding out that it is exactly what I have already had to live with and know my whole life already. Whiteness takes up a whole heap of time and space. I don’t know if this is a radical idea or not, but what about what there is to learn from/about/with Blackness and the therapeutic project? Thanks for the heads up on Christina Sharpe’s wake work. I’ve started reading and I’ve got to tell you, the idea that we need to practise ‘undiscipline’ got me really excited. Dear Cece, The tutor spoke to your point today about whiteness being a tricky area of study. He quoted Richard Dyer (1997): ‘The point of looking at whiteness is to dislodge it from its centrality and authority, not to re-instate it.’ I think this is why we will sometimes separate into two groups so that we can work out some of this stuff without doing more harm to our Black and brown peers. My friend Wynter called it the white remedial class. I got her point when we watched a clip of James Baldwin asking white people ‘How much time do you want for your progress?’3 We have colonised time too in our taking of all the time. I thought of your reference to ‘undiscipline’ today when one of my peers said she wasn’t going to read one more book by a white man for the whole year. Another student was bothered by this, and she told him she was sure she could manage, why couldn’t he? The tutors thought this was a valid and interesting opportunity. Someone suggested an old white male psychoanalysts’ history month. We’ve got jokes among all of this. We then separated into two groups – one for white people and one for Black/ brown/people of colour – to look at the concept and practice of metalisation. In our group, the tutor extended the title of the class to ‘mentalisation while white’. We unpacked this together until we grasped that we were being asked to imagine thinking about whiteness while being in the world and in our therapeutic practice. Some didn’t understand why we needed to separate to explore this topic. The tutor said this was exactly why we needed this class, that we were unpractised in recognising the white psyche and how it operates to shore up whiteness, and particularly a good whiteness. The tutor was patient with all of our defensive manoeuvres to avoid hearing how problematic whiteness is – manoeuvres that he said Robin DiAngelo describes as white fragility (2018) that we need to get intimate with. To be honest, this fragility looked rather dense at times, unthinking at others 3. From the 1989 documentary James Baldwin: The price of the ticket (American Masters).

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– like one great big refusal to think. Apparently, we are riddled with it and do not want to take this reality in because it will make us bad, and we are so desperate to be good whites that we can’t think while white. The tutor suggested that we were going to practise critical thinking while white and explained that this might take a while to grasp. While waiting, he said, we could map out every which way that our minds find whiteness and defend against being seen as racist. We did this via a repeating question: ‘Tell me a way your psyche is white.’ We had to answer this for an agonising 20 minutes each, without discussion. I thought I was a good white – an anti-racist white – until the tutor welcomed what I said as an opportunity to explore Sara Ahmed’s work (2004) on non-performative declarations of antiracism.4 I have to prepare a seminar on it now, so I walked into that. Another practice here – what you walk into, you study and share. We were shown a video clip of Toni Morrison describing whiteness as a lie – a compelling one that has been handed over to each generation as a norm. This led to another exercise: a circle of revelation where, in turn, we spoke out a lie of whiteness and kept going until we began to run out. One of the group said that this was excruciating, and the tutor said she would be worried if it weren’t. Another asked when would it end, and we were told that it doesn’t. Welcome to the other side of whiteness – a waking up to how things are. Our homework was to reflect on how an unexamined whiteness is problematic for the therapist and the people we might work with. We have a lot of homework (a.k.a. catching up) to do. Dear Niall, I enjoyed our Black/brown/of colour group this week. We made a playlist to celebrate. Solange was on our playlist – seeing and imagining and declaring things ‘for us’.5 Some people did express doubts about the relevance of this to a therapeutic curriculum, but our teachers have encouraged us to engage with a range of media and not to be afraid to look outside of academic texts and literature for our learning opportunities. I find myself wanting to talk about what happened in our group – because it was rich, and I want to celebrate that – but also not wanting to talk about it because it was rich, and I want to protect that. Sometimes being too open with Black experience leaves it vulnerable to being trashed or stolen. Fortunately – like a lot of us – I am well practised at deciding what to say and what not to say in white spaces. We also thought about mentalisation (do you realise you wrote ‘metalisation’?) and the ‘refusal to think’ of whiteness. So often this is like an unexploded bomb. Most of us have experienced some surprising detonations in our lives – often at times when we dare to speak of experiences of racism. Sometimes the explosions happen underground (red faces, shifting in seats, momentary wobbliness), but often they go nuclear. One of my peers – who we call Aunty, because she’s taken more breaths on this earth than the rest of us – gave an example from a previous course. She said it was a tutor who went nuclear – 4. www.kent.ac.uk/clgs/documents/pdfs/Ahmed_sarah_clgscolloq25-09-04.pdf 5. Solange. (2016) F.U.B.U. From the album A Seat at the Table, where she sings ‘This one’s for us’.

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who got red-faced and started crying and carrying on about how she wasn’t racist. She accused the Black students of being difficult and divisive because they were complaining about racism but not also offering solutions. Aunty was sad that she hadn’t been able to complete this course, but reflected that prioritising her mental health had been the right decision. Teachers who haven’t done the work – who have to ‘metalise’ around Blackness, whiteness and racism because they don’t yet have the capacity to ‘mentalise’ – should perhaps carry a health warning for Black students. Until then, though, I guess we will continue to ‘watch and see’ – that is, to hold onto what we know until the metalisation/mentalisation landscape becomes clear enough for us to know what we might be called on to share/teach, and what level of risk we will have to manage if we choose to do so. Dear Cece, Solange showed up here too. When we got back together after our complicating whiteness group, I asked Wynter what they had done in her group. She said it was a Solange moment (the song, F.U.B.U.). I guess I’d stepped out of my lane. After that, we went for coffee. She said that, although they were taking a break from whiteness, it had followed them there too. Dear Niall, Wynter is right. Whiteness is hard to get a break from. Although the relief of not having to be so vigilant and not having to hold on to what we know did mean that our discussion was quite passionate and loud and full. It was also punctuated with Lauryn Hill and Burning Spear. Someone made a joke about what the other group might be making of all of this, and how we were playing into all the Black stereotypes. They were only a little way down the corridor, so probably heard us laughing about this. I did wonder though, if anyone else also felt frustrated and sad to be reminded of how this ‘double consciousness’ (I was thinking of W.E.B. Du Bois (1994) here) plays out, even when we are not in a white space. I hate that we end up talking about and reacting to whiteness even when it’s not visibly present. I shared some of these frustrations in our closing round. The facilitating tutor shared links to resources for further reflection – including the work of Du Bois and Frantz Fanon – and offered some of her own insights about Black interiority and the Black psyche’s absorption and adaptation to a world formed around and embedded in white supremacist ideas. She encouraged us to reflect on our ‘introjects’ and the psychic processes that contribute to internalised oppression. She must have seen that some of our faces were a bit screwed up here because she turned up the music and left us to it for a while. Then she offered the example of hierarchies within art – the way that we might think of certain art forms and genres as being above others. We considered the words ‘classic’ and ‘classical’ and how they are applied to denote value, for instance in architecture, literature and music. What ideas, she wondered, had we internalised about the place, purpose, and philosophical value of Black music? Had we ever considered citing Burning Spear in our written assignments and essays? If not, why not? It was deep and to be honest, quite hard to think about

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in the moment. An unspecified ache spread up from my throat and my jaw and throat. Grief took all my words. The tutor flagged up Paul Gilroy’s Black Atlantic (1993) as a place to think more about this, when we were ready. Dear Cece, The word ‘metalisation’ was a slip and interestingly enough points to the impenetrable dense metal of whiteness that isn’t really that fragile. We continued with our white fragility studies today, and were introduced to re-workings of psychological concepts: whiteness as attachment disorder, as disorganised embodiment, as psychosis, and as a really bad object trying to be a good object that can never be a good object or even subject. It was grim but I was relieved to have this thing more deeply explained. I am saddened that whole Black lifetimes have been spent describing a whiteness that refuses to see itself. We are doing the work that George Yancy (2014) describes as un-suturing the wound of whiteness – opening ourselves up to the irreality of whiteness and the inevitable collapse into a narcissistic emptiness as we let go of the delusion of white innocence and goodness. I think this is the depressive position of whiteness. I wonder how to make this an aspirational journey since it feels so bad. At the same time, there is relief because I get to see what is true – no matter how grim. I wonder if there will ever be enough white people invested in doing this work, given the currents that operate against waking up. I notice that hope comes and goes. I wondered if – faced with this un-suturing – we would have enough energy for the afternoon’s field trip. The handbook outlines an expectation that we students organise for ourselves certain field trips that will inform practice and understanding of human experience as well as considered interventions. Someone suggested we visit ‘Fons Americanus’ – a 13-metre-tall working fountain installed in Tate Modern by artist Kara Walker. The installation is inspired by the Victoria Memorial outside Buckingham Palace and represents Britain’s brutal history of empire and enslavement. We took the first chapter of Christina Sharpe’s In The Wake with us. We read it aloud while sitting in a circle around the fountain itself. We then shared the chapters with other visitors.6 Dear Niall, I want to wade in the water where we don’t have to talk about whiteness or not talk about whiteness or not talk about whiteness by talking about it but whiteness, whiteness everywhere and no water to drink no one drop no time to drop 6. The first chapter of In the Wake: On blackness and being is available free on the publisher’s website: www. dukeupress.edu/Assets/PubMaterials/978-0-8223-6294-4_601.pdf

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I thought I was writing this poem in my head, but it turns out (this keeps happening) that I was actually speaking out loud. So one of the tutors offered us the opportunity to wade in the water of Blackness, which in this case meant me and the other Black and brown folk who fancied it again transferring to a room down the corridor. We were told that we could make it our own and spend the day working on our own curriculum. Kwame-John (who told us that he wanted to ditch his ‘slave name’ altogether but compromised because he didn’t want to disrespect his parents) was first to arrive in the new room. He pointed to the whiteboards on each of the four walls and joked that our escape from whiteness had only been partial. The tutor said the boards could be used to map out what we imagined a ‘takinga-break-from-whiteness’ curriculum might look like. Before we could get to that, we found we needed to speak about the few brown folk who had decided to stay with the (now) predominantly white group. Kwame-John framed it with Malcolm X’s house- negro/field-negro dichotomy – as the split between who was going to step back and watch the master’s house burn down and who was going to stay and help fetch water. I think he was talking about Dolores in particular, who keeps referencing her white ancestors and saying that there is good and bad in everyone. I have found her a bit annoying, but I also started thinking about what it might be that she is saving herself from by holding on to these things? Perhaps her attempts to point to shared territory are something like my suspicion and fugitivity – ways of navigating risk and keeping safe? The discussion of our Black curriculum was harder than I anticipated. It didn’t really flow and in the absence of flow Kwame-John talked even more than usual. He thought our curriculum should focus on creating therapies and therapists who could build the Black family. The tutor suggested that we explore what the term ‘Black family’ meant to us individually. It turns out that it means lots of different, sometimes contradictory, things. It became clear that, even if we felt some affiliation with Malcolm’s field negroes who were ready to escape, we were a long way from reaching consensus on which direction we should run. The tutor flagged up the work of Jamaican scholar Sylvia Wynter – warning us that she wasn’t the easiest thinker to understand but that she had a lot to say that was relevant to the discussion. For example, should we strive to inherit the categories that we’d been barred from (man, woman, human, for example) and aim for respectability via patriarchal, heteronormative, nuclear family structures? Or might we aim for a different sociality? We explored these questions via imaginative free writing – a practice that was introduced to us at the beginning of this course. I found myself writing about Dolores, or, as I soon realised, about parts of Dolores that I recognised in me. We shared our writing and someone scribed emerging questions onto the whiteboards. There were questions about what physical, material, psychological and spiritual realities were being transmitted through us and in our therapeutic relationships. There were questions about the intergenerational, transgenerational, and ancestral nature of these transmissions. It was the start of our curriculum. Our curriculum is long. My peers liked that I brought in the wake. We got to think about memory and remembering, trauma and haunting, and the past-that-is-not-past. We got

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to think about violence on the Black body (Coates, 2015), child development and parenting. We got to think about projections, splitting and how identification with the aggressor can detach us from our own pain. I’m not sure that we actually got time off from whiteness, but we did get enough of a break to be able to think about some of the depths of Black experience.

Outroduction Our curiosity about Cece and Niall extends beyond this chapter, both backwards and forwards in time. We are curious about what has brought them here and also about where – and to what – they might now be heading. They – and the trainings in which they are engaged – are imagined, but also, through that act of imagination, made real. Consider, by way of example, ‘race’ itself – an idea with no biological basis in reality but imagined with such commitment and force that it has become a very real ‘technology’ (Phillips, 2015), with real, devastating, and deadly consequences. adrienne maree brown says this (2017): We are living in the ancestral imagination of others, with their longing for safety and abundance, a longing that didn’t include us, or included us as enemy, fright, other.

We invite you to play; to add your own imagination to the mix and consider the ways in which you do, or do not, recognise Niall and Cece’s journeys. What hopes, fears and offerings do you have for them? If you were to join them, what would you write? What would you add to the curriculum? What can you imagine into being for the therapists who are coming? What kind of ancestor7 are you going to be?

References Ahmed, S. (2004). Declarations of whiteness: The non-performativity of anti-racism. Borderlands, 3(2). Baldwin, J. (1955). Stranger in the village. In Baldwin, J., Notes of a native son. Beacon Press. Brand, D. (2002). A map to the door of no return: Notes to belonging. Vintage. brown a.m. (2017). Emergent strategy: Shaping change, changing worlds. AK Press. Campt, T. (2014, October 7). Black feminist futures and the practice of fugitivity. Helen Pond McIntyre ’48 Lecture, Barnard College. http://bcrw.barnard.edu/blog/black-feminist-futures-andthe-practice-of-fugitivity. 7. http://laylafsaad.com/good-ancestor-podcast

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Coates, T. (2015). Between the world and me. Text Publishing Company. DiAngelo, R. (2018). White fragility: Why it’s so hard for white people to talk about racism. Beacon Press. Du Bois, W.E.B. (1994). The souls of black folk. Gramercy Books. Dyer, R. (1997). White: essays on race and culture. Routledge. Gilroy, P. (1993). The black Atlantic: modernity and double consciousness. Verso Books. hooks, b. (1987). Ain’t I a woman. Pluto Press. Le Guin, U. (1989). The carrier bag theory of fiction. In Le Guin, U., Dancing at the edge of the world: Thoughts on words, women, places (pp.165–170). Grove Press. Morrison, T.A. (1985). A knowing so deep. Essence Magazine, 5, 230. Phillips R. (Ed.). (2015). Black quantum futurism: Theory & practice, volume 1. AfroFuturist Affair. Sharpe, C. (2016). In the wake: On blackness and being. Duke University Press. Wilderson, F. (2008). Incognegro: A memoir of exile and apartheid. South End Press. Yancy, G. ( 2008 ). Black bodies, white gazes: The continuing significance of race in America. Rowman & Littlefield. Yancy, G. (Ed.). (2014). White self-criticality beyond anti-racism: How does it feel to be a white problem? Lexington Books.

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Twin tribes: Exploring unconscious privilege and otherness in counselling and psychotherapy Dwight Turner

One of the most common comments I get from students of colour on training courses is they feel they will not be understood by white therapists. They feel uncomfortable talking about aspects of their cultural identity, they are fearful that they will be stereotyped accordingly, and they struggle with the power dynamics. A student counsellor of colour I once worked with, who I will call Nini, typifies this experience. During our time working together, Nini told me a story about an experience with her previous therapist. The therapist was a white, possibly middle-class, middle-aged woman. In one session, Nini was discussing the fact that she was struggling to find a partner who would stay with her as she wanted to start a family. The therapist questioned the cultural background of the men she liked, and Nini expressed a preference for men of colour, preferably from a Black British background. The therapist suggested that Nini would be better with a white, English man, as they were more likely to want to stay in the relationship, especially given there were so many single mothers of colour around. Nini, although shocked, found herself unable to say anything about this to the therapist, and took the comment home with her. It took some days for her to recognise how upset she was about this. Nini never went back to the counsellor. This experience is problematic from a number of angles. First, it is obvious that the psychotherapist’s training was insufficient, given her unconscious prejudice against her client’s culture. Second, the privileging by the psychotherapist of her culture meant her client was being encouraged to reject her own cultural background. Astonishingly, even today, these types of experiences are not uncommon. Despite numerous books and articles exploring the inadequacy of counselling and psychotherapy approaches when it comes to working with unconscious difference, the profession remains nested in a collective collusive safety created by the marginalisation of explorations of otherness in our trainings. There is, at best, a tokenistic approach to the topics; at worst, it is not considered at all.

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What this tokenistic approach to working with difference and diversity in counselling and psychotherapy trainings has done, though, is to mirror the same marginalisation and tokenism of minorities in wider society (Hall, 1996). This has led to some of the accusations of the institutionalised racism, homophobia, sexism and other isms and phobias that reside within our organisations (Holdaway & O’Neill, 2007). Yet, what is most important for this paper is the failure of counselling and psychotherapy trainings to properly explore the unconscious experience and meaning of aspects like otherness and privilege in order to equip our students and practitioners to work with the varying intersectional identities our clients will inevitably hold, be they of privilege or of otherness.

Background When Sigmund Freud fled to the UK towards the end of his life, he had already established psychotherapy as an important force in understanding the psychological, thereby placing it alongside the medical models of the day (Jacobs, 2003). Yet, personally, Freud also had to struggle with his ‘outsiderness’, both culturally in the Austrian Nazi Anschluss, heading towards war and genocide, and here in the UK as a cultural outsider. That he did so at all is testimony to the strength of his will. I have a personal sadness, though, that he was unable to do more research into the impact of his difference on the psychology of those seen to be the other, as his push to have psychotherapy included in mainstream medicine inevitably left him open to accusations of marginalisation and prejudice (Said, 2003). Although there is an often-cited argument that this separation of others was of its time, the impact of this reinforced privileging of Western patriarchal views about psychology has understandably had a detrimental influence on counselling and psychotherapy. There have, though, been attempts to redress this from time to time. For example, attempts to understand the experience and the role of the other is a seam well worked within counselling and psychotherapy by authors as diverse as Laing (1969), Frosh (2002), Dalal (2012), McKenzie-Mavinga (2009), and others. The importance of their work, while bringing into view the idea of otherness, often failed to recognise the fact that otherness does not exist without sameness, and that sameness often appears in the form of privilege and supremacy, an aspect of this dyadic relationship highlighted by Fanon (1959) through the lens of the colonised and their co-created relationship with the colonisers. Conversely, although there are numerous papers on otherness and issues of diversity, actual trainings around diversity have often struggled to find their grounding within the worlds of counselling and psychotherapy training. They are often tagged onto the end of trainings – a day, even just half a day here or there – meaning that those who identified as other often have felt their own unique experiences were not heard or acknowledged. While there are many reasons for this, one of the most important is the privileging of a white, heteronormative, patriarchal narrative in the majority of trainings. Definitions of privilege vary, but for the purpose of this chapter they are anything from patriarchal privilege to the privilege of living in the global North,

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the privilege of whiteness, ‘ableist’ privilege and the privilege of heteronormativity (Branscombe et al., 2007; DiAngelo, 2006; Goodley, 2014; Logie & Rwigema, 2014). Yet, these are only some of the ways privilege appears. In Western cultures, the privilege of youth is a driving factor in our urgency to resist the ageing process; living in a major city such as London can be seen as a privilege over those who live in the countryside, while some of the best examples are emerging from children who form groups not on any political categorisation of difference and similarity, but sometimes almost arbitrarily – just the fact that a child is smaller can mean they become marginalised, so the taller ones are privileged, or the girl who has darker skin and different hair is seen as dirty or unkempt by peers who privilege their own looks accordingly. The fact that there are so many forms of privilege suggests that privilege is more than just societally constructed. Privilege, when observed under a psychotherapeutic lens, is actually archetypal; it is an aspect of life; it is a quality, a skill, a task that has to be owned or overcome, dependent upon the individual or the group environment.

Intersectional theory Understanding both conscious and unconscious privilege within the world of counselling and psychotherapy is therefore essential to any exploration of difference and diversity. The most important means of understanding privilege is through the lens of intersectional theory. The background to intersectional theory is that identity is multi-faceted, and that we experience different types of oppression and privilege based on the different identities that we embody. For example, although I identify as Black, middle-aged, and the son of migrant parents, all of which mark me out as an outsider, I am also an academic, heterosexual, and live and work in Western Europe, which gives me a certain amount of privilege. Intersectional theory emerged out of feminism’s second wave, where the need for an intersectional method of exploring difference arose out of the privileging of the perspectives of white women in the fight for equality (Wright & Wright, 2017). This generalising of the experience of women through a purely white, and often heteronormative, lens led to an ‘othering’ of the experiences of women of difference, a point made by Lorde (1984), and it could be argued it is still seen in feminist discourse today in the debate about the trans community. This exploration of the varying layers of privilege and otherness was brought further into the academic and political mainstream by Professor Kimberle Crenshaw, who used it to explore the premise that women of colour would experience oppression based not only on their gender but also because of their race (Cho et al., 2013). Mohammed (2009), exploring how intersectional theory has been used in research in the Caribbean, considered privilege in the operation of caste, a system of difference that has been in situ for generations in many cultures. Its closest comparison here in the UK is the class system. Building on this narrative, Pieterse and colleagues (2013) discuss how identity is influenced by this delicate interplay of privilege and otherness, positing that it is

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important that counsellors are aware of how and where they position themselves in these respects, for their own development as practitioners as much as for their work with clients from the many disparate groups we all encounter. Although Crenshaw also recognised that we simultaneously hold varying aspects of privilege in our identity, if there is a criticism that I have of her work from a counselling and psychotherapy perspective, it is that she does not explore the importance of these varying intersectional privileges and how they might reempower those who have constantly felt marginalised. Another of the resistances against working with difference and diversity in a more nuanced way is that we are actually working with unconscious material, which when stirred has the potential to challenge the egoic structure of that which sees itself as privileged. From a psychological perspective, this is what DiAngelo (2018) considers with reference to the difficulties in discussing the issue of race. The term she uses is ‘white fragility’, where certain emotions, such as guilt and shame, are provoked in any discussion of racial difference, and are then immediately defended against by the subject. On the whole I agree with her assessment, but I would expand this in two ways: first, any discussion of difference, no matter the difference, and also the conjoined oppression of the other by the subject, brings with it this sense of guilt, so it is not just through the lens of racial difference, even if in varying forms; and second, the understanding and experience of difference should be handled delicately because its exploration immediately challenges the ego identity of the subject. It is a bit like showing the subject, or our client, their shadow; they are of course going to defend against it, or reject it, sometimes quite aggressively.

Training for and working with the dyad in counselling and psychotherapy Benjamin (1998) considered the role that narcissism plays in both the other and the subject, with this connection being symptomatic of the difficulty in working with otherness. This chapter expands this exploration in several ways. First, I argue that the link is actually between privilege and otherness. This is important, as seeing the lead position as being that of a subject denies the potential personal importance of said subject, or its privilege. Second, where Benjamin is right is that narcissism is present in both presentations; it presents in different ways, and it is important to notice this. For those of privilege, the clinging to power could be seen as an attempt to psychologically defend against the shame of their privilege. This is important when working with this dyad, in that any work, any training, needs to be aware of how touching on this privilege pushes against the narcissistic container of specialness that can encircle the ego identity formation in certain students, practitioners or clients. For the other, though, narcissism is connected to the denial of the pain of its otherness, its separation from the collective; its grandiose defence can be a protector against the intense feelings of isolation, loneliness and sadness that can arise. The lack of an intersectional approach fails to spot that the multifaceted means of identity formation leads to this complicated mixture of privilege and otherness.

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Where psychotherapy theory then becomes important is that, for each of us, or for every group or culture, there is always a splitting of these two positions: a split forced upon the individual or the group by self, family or culture and so forth (Mitchell, 1986). One of the difficulties training organisations have emerges from this intersectional, and therefore multifaceted, aspect of identity formation. When explored on most trainings, what happens is that we engage in a singular exploration of a particular identity, so participants have to repress any other identity aspects for that particular workshop or exercise.

Exploring the relativity of privilege and otherness in practice In my work with Nini, I asked her to undertake a privilege exercise (Thomas & Jha, 2018). The exercise involved answering approximately 50 wide-ranging questions, such as, ‘Have you ever had to come out?’ ; ‘Has a stranger ever asked to touch your hair?’, and ‘Do you work in a salaried job?’ Individuals take the test in order to explore the perceived level of privilege and outsiderness they hold at any one time. The importance of the questions is that they explore the intersectional nature of identity, recognising that, as individuals we hold many facets that make up who we are. It also highlights that, while we are all impacted by societal, cultural, familial and other scripts that tell us which aspects of identity are appropriate and which are not, we all have different ways of mitigating these influences, meaning that, while we are externally othered or other ourselves, how this occurs is specific to the individual. The exercise assists participants to recognise not only their own sense of otherness but also, with a closer analysis, which forms of privilege they hold. Another variation of this exercise is called the Privilege Walk. This involves students standing in a line and being asked the same set of questions, and either taking one step forward for a positive answer to a question or one step back for a negative answer. Again, students get to explore their own experiences of privilege and otherness, but here they do so in a group setting. The reasoning for this is that it challenges the capacity of certain students to confront their fragility when faced with the very privileges or experiences of otherness of their peers. So, while some students might wish to deny their privilege and hide within their own preconceived sense of otherness, or vice versa, the challenge of seeing a truer representation of their cultural positioning is important for the recognition of which twin has been unconsciously suppressed. Taking this further, the suppression of privilege therefore involves the narcissistic distancing oneself from one’s own sense of shame that can be triggered where there is a focus only on one of the political categorisations of difference within training settings or the therapy room. The shame of the privileged is also held within the container of the training session, as it is this that, if not held appropriately, triggers an unconscious reactivity with those who are consciously unaware of their privilege. Conversely, the doubling down into one’s own otherness can also be a defence against the power and privilege within one’s own identity. In order for the other to maintain this, though, there has to be a projection of the power and authenticity onto the other, and then a reaction of righteousness against that power.

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Bringing privilege into the room also allows students to connect with their own sense of humility in a held, contained way. The group holds the sense of shame or privilege; the group also holds the collective sense of shame at their otherness. These conjoined factors are therefore not unconsciously disconnected from where one aspect will rise to the surface suddenly, just as we are discussing the other. They emerge into the training space together, hand in hand, to be witnessed and felt, like the co-dependent couple they truly are. Although these exercises were designed by sociologists and psychologists, their importance to the world of counselling and psychotherapy should not be understated. Whereas previously working with otherness involved the splitting of the twin tribes of privilege and otherness, these exercises recognise and respect their conscious and unconscious mutual attraction. Therefore, any attempts to work with one arena and not the other risks splitting students, or clients, while either reinforcing their position as the other or forcing into the unconscious their underlying privilege and power. So, while this acting out of those students of privilege against the difference held in the room might be useful to undergo, in my experience this bubble of unconscious material is rarely held competently on trainings. Therefore, working at depth with privilege helps also to balance out the reactivity of students when issues of difference emerge into the training space.

Intersectional privilege for students, therapists and our clients The conjoined nature of privilege and otherness was a facet of relationality recognised in Fanon’s (1959) work, where he saw the colonised as being identified by the coloniser, and therefore vice versa. The main difference in the positions, though, was one of power and responsibility. While the dyadic nature as presented by Fanon was held purely within a postcolonial framework, when seen through an intersectional lens, this multiplies the coloniser and colonised narrative in a way perhaps only approached by de la Boetie (2015), who recognised the multi-layered nature of this experience in a less binary fashion, perhaps, than Fanon. Re-approaching this exploration from a more psychotherapeutic angle, Buber (2010) recognised the importance of the tension of the opposites, seeing the struggle between the subject and the other as being part of the road to reintegrating aspects of the self that have had to be excluded in order to comply with societal, familial and religious wishes. This is a point echoed by von Franz (1980), who stipulated that the other, be they an individual or a group, is actually the shadow for the majority. So, working with privilege in these fashions also helps students to consider their own unconscious narratives around power and otherness. As previously discussed, while many philosophers have explored the conjoined external relationship between the pair, here they are seen as an intra-psychic dyad. This means that the over-identification with one aspect leads to the suppression, or the forcing into the unconscious, of its twin. So, for student practitioners who may be Black, Asian or of another ethnic minority, or LGBTQIA, its recovery can lead to a growing re-empowerment of the self, encouraging a greater sense of authenticity and individuation.

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For example, on any training course, there is an importance placed on the personal development of the trainee practitioner. From having to be in one’s own personal therapy to experiential workshops often being an integral aspect of trainings, the recognition and therefore the reintegration of personal shadow material forms a cornerstone in the transition from being one of the collective to becoming a more individuated psychotherapist. Working with the twinship of privilege and otherness should therefore form an integral part of this process of transformation. This encounter with the projected privilege, or with one’s own repressed sense of otherness – aspects that may have been forced into the shadow – while not always easy, needs to happen in order for practitioners to become aware of which aspects they have attributed to their client. So, returning to the case example at the start of this chapter, had the therapist Nini was working with been at all aware of her own projected sense of cultural privilege, then it is more likely that she would have resisted the urge to culturally shame her client. In situations like these, for the client there is an enforced overidentification with their own sense of otherness. They are made to be the outsider, and the white therapist is the one they must conform to in order to maintain a sense of safety. Both people are sitting in a space of inauthenticity, a space of collusion where nothing can change, nothing can progress, and, in this case, where the therapy ruptured without any possibility of repair. This is an essential aspect of exploring privilege and otherness with our clients. As a therapist of colour, I regularly receive requests from clients of colour to work with me because of my perceived cultural similarity. One of the other experiences they often present with is a sense of their feeling uncomfortable while working with white therapists. When this happens, I have found it increasingly important to explore the cultural difference they encountered and what it was that they felt they either could not bring to the therapy room or were not allowed to. This exploration is not about criticising the other therapist. It is to understand the unconscious powerlessness that left my new client unable to bring something from their cultural background, from their own space of difference, and present it to their therapist. Simultaneously, I also have to explore the collusive nature of our shared otherness. While I might be of colour, and therefore appear to be a safer type of therapist for certain clients, the fact that I am a man, that I am heterosexual, or that I am an academic, all serve to change, or challenge, the dynamic of cultural similarity that brought the client of colour into my consulting room. So, when the unconscious privilege we all hold is not worked through, what happens is that we create a psychological barrier between our self and the client, thereby meaning we deny them the chance for personal growth. Understanding the projections, the times when we stereotype, and how we other the other are essential factors in recognising the clues of the unconscious on the road towards individuation. When difference is in the therapy room, it is essential to create a space for it in the therapy, lest we leave the client split and in a space of deference to our role as the therapist.

Dwight Turner

So, returning to the example of Nini, in our review of the work she had done with her previous therapist, the areas we explored included the following. First, I asked Nini if the cultural difference in the room had ever been explored by the therapist. This question surprised Nini, her reply being that, even though she thought it was an issue, it was never discussed. During our work, we also looked at the issue of power, as this had obviously crept into the therapy space around the need for the therapist to express her own opinion about the cultural choice of partner for her client. Last, what most upset Nini was the privileging by the white therapist of her own culture over that of her client, something she recognised was extremely prejudiced, and, given the aforementioned power dynamic, it was no surprise this led to the fracture in the therapeutic relationship. Nini, though, said that working with privilege in our therapy helped her to see the unconscious relationship between herself and clients from her own cultural background or gender, where the sense of sameness might obscure any or all types of privilege. It also helped her to recognise in her own countertransference how, when working with clients who were, say, white men or who had originated in the West, what was triggered within her was a symptom of the unconscious privileges being projected outwards by her into the room – privileges she then started to reintegrate and finally own.

References Benjamin, J. (1998). Shadow of the other. Routledge. Branscombe, N.R., Schmitt, M.T. & Schiffhauer, K. (2007). Racial attitudes in response to thoughts of white privilege. European Journal of Social Psychology, 37(2), 203–215. https://doi.org/10.1002/ ejsp.348 Buber, M. (2010). I and thou. Martino Publishing Limited. Cho, S., Crenshaw, K.W.,& Mccall, L. (2013). Toward a field of intersectionality studies: Theory, applications, and praxis. Signs: Journal of Women in Culture and Society, 38(4), 785–810. Dalal, F. (2012). Thought paralysis: The virtues of discrimination. Karnac Books. de la Boetie, E. (2015). The politics of obedience: The discourse of voluntary servitude. Mises Institute. DiAngelo, R. (2018). White fragility: Why it’s so hard for white people to talk about racism. Beacon Press. DiAngelo, R.J. (2006). My class didn’t trump my race: Using oppression to face privilege. Multciulrural Perspectives, 8(1), 51–56. Fanon, F. (1959). A dying colonialism. Penguin Books. Frosh, S. (2002). The Other. American Imago, 59(4), 389–407. https://doi.org/10.1353/aim.2002.0025 Goodley, D. (2014). Dis/ability studies: Theorising disablism and ableism. Routledge.

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Hall, S. (1996). Critical dialogues in cultural studies. Routledge. Holdaway, S. & O’Neill, M. (2007). Where has all the racism gone? Views of racism within constabularies after Macpherson. Ethnic and Racial Studies, 30(3), 397–415. https://doi. org/10.1080/01419870701217480 Jacobs, M. (2003). Sigmund Freud: Key figures in counselling and psychotherapy (2nd ed.). Sage Publications. Laing, R.D. (1969). Self and others. Penguin Books. Logie, C.H. & Rwigema, M.-J. (2014). ‘The normative idea of queer is a white person’: Understanding perceptions of white privilege among lesbian, bisexual, and queer women of color in Toronto, Canada. Journal of Lesbian Studies, 18, 174–191. https://doi.org/10.1080/10894160.2014.849165 Lorde, A. (1984). Age, race, class and sex: Women redefining difference. In A. Lorde, Sister, outsider. Crossing Press Limited. McKenzie-Mavinga, I. (2009). Black issues in the therapeutic process. Palgrave. Mitchell, J. (1986). The selected Melanie Klein. Penguin Books. Mohammed, P. (2009). The Asian other in the Caribbean. Small Axe: A Caribbean Journal of Criticism, 13(2), 57–71. Pieterse, A.L., Lee, M., Ritmeester, A. & Collins, N.M. (2013). Towards a model of self-awareness development for counselling and psychotherapy training. Counselling Psychology Quarterly, 26(2), 190–207. https://doi.org/10.1080/09515070.2013.793451 Said, E. (2003). Freud and the non-Europeans. Verso Books Thomas, S.M., & Jha, R. (2018). How privileged are you? Buzzfeed. www.buzzfeed.com/soniathomas/ how-privileged-are-you?utm_term=.uvnR9DNmn#.fs6xXKadj von Franz, M.-L. (1980). Projection and re-collection in Jungian psychology. Open Court Publications. Wright, T. & Wright, K. (2017). The arts in psychotherapy: Exploring the benefits of intersectional feminist social justice approaches in art psychotherapy. The Arts in Psychotherapy, 54, 7–14. https:// doi.org/10.1016/j.aip.2017.02.008

Neelam Zahid

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Lifting the white veil of therapy Neelam Zahid

When I was first asked to write this chapter, I experienced a visceral feeling of excitement and joy. However, as I thought about what I might write, the feelings of not being good enough crept in. I thought, ‘I’ve got nothing to write, I don’t work any differently to anyone else. If I expose how I work, then I will be found out to be a bad therapist.’ As I reflected on this, I realised that this process was familiar for me, living in a white world. I have often felt criticised for doing things differently and for making my personality, background and culture visible. I do not attribute all of this process to growing up as the ‘other’ in a racist society, but I am conscious of the huge impact of oppression, discrimination and unconscious bias on my internal and external world. Part of my journey as a therapist has been to reclaim my power as a British Pakistani Muslim woman, and as I write this chapter, I continue to break the chains of institutional racism and inequality.

On becoming a therapist My counselling and psychotherapy training was theoretically integrative and, initially, I predominantly worked psychodynamically, with a focus on exploring past and present relationships and re-emerging patterns. I focused on making the unconscious conscious and used transference to reflect on clients’ experience of being in the world and countertransference to enable the client to look at how they were experienced by others. However, clients often described feeling stuck and unable to change the re-emerging patterns in their life. I also noticed that many of my Black, brown and minority ethnic clients found it difficult to fully explore and speak critically about their families and primary caregivers. I soon became aware that clients needed something else to shift their way of thinking and behaviour. Through this learning, I started incorporating other approaches into my work, such as the empty chair technique (Gestalt), the Karpman Drama triangle (transactional analysis), and some CBT, which all seemed to work well. However, what I noticed with all my clients was that the person-centred and relational approach yielded the best results. As I started to work more relationally,

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I noticed feeling inadequate addressing the issues of race and culture within the room, and I became more aware of a gap in my initial training; I did not feel it had equipped me to sufficiently address these themes. Race, culture and ethnicity were only discussed during my training when they were raised by a student of colour, and they were generally explained by tutors through interpretation – the issues of inequality, unconscious bias and racism were not directly addressed. I did not have the opportunity to explore how my cultural difference impacted on my training, my relationship with my peers and the therapeutic relationship. Therefore, when I was confronted with difference in the therapy room, I felt silenced, just as I had been silenced in my training. Through personal therapy and by attending CPD on diversity, I started to break the silence of my discriminatory experience and work better with cultural difference. Over time, I incorporated creative ways to work cross-culturally, which have now become part of my core theoretical approach.

Transitioning to transcultural therapy Multicultural therapy embraces an understanding and reflection of diverse and intercultural experiences. In this approach, consideration is given to origins and belief systems that mirror and influence identity, personal experience, and the social impact of oppressions, within the therapeutic relationship. (McKenzie-Mavinga, 2011, p.30)

This definition is a good starting point from which to understand how to work transculturally. However, transcultural therapy is not about a ‘type’ of therapy for the Black and minority ethnic community. It is about bridging a connection between two or more cultures within the therapy room, and how we might choose to do this varies from one relationship to another. However, one consistent variable within transcultural therapy is the quality of the therapeutic relationship, which, as most research has shown, is the key to healing: The quality of the relationship we build becomes the heart of everything else that happens in the therapy… It is not the techniques that heal; techniques enhance the therapy, but they are not the essence of psychotherapy. It is the contactful therapeutic relationship that heals our clients’ relational wounds. (Erskine & Criswell, n.d.)

Another consistent variable in my clinical work is intuition or firasah, an Islamic concept that means intuition, insight or gut feeling in Arabic. Ibn ul-Qayyim alJawziyyah says:1 The firasah is a light which Allah, subhanahu wa ta`ala,2 deposits in the 1. Ibn ul-Qayyim al-Jawziyyah. The station of firasah. In Madarij-us-Salikeen. Dar Ibn Hazm Print. www. kalamullah.com/Books/Madarij-us-Salikeen.pdf 2. Translated from Arabic, this means ‘The most glorified, the most high’.

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heart of His servant. By this light, His servant distinguishes between truth and falsehood and between right and wrong.

He goes on to say: Firasah is linked to three human organs: the eye, ear, and heart. His eye examines the look and the signs, his ear examines the speech, the overt expressions, oblique inferences and hints, content, logic and tone of voice. And his heart analyzes both what is seen and heard to perceive hidden thoughts of others. His analysis and examination of the interior compared to the exterior is like one who examines currency to see if it is counterfeit after examining the outside.

This firasah (my intuition) is a way of feeling connected and attuned to the client. It guides me through the process of therapy so that I can meet the client where they are: this can be compared to early childhood developmental attunement. It helps me connect with the client and gives me insight into what the client needs from me in that moment; it is not a digression from sound clinical judgement. Information about my clients’ functioning and understanding what the client needs from therapy are essential throughout the whole process. Therefore, my intuitive process is grounded in a thorough knowledge of myself and the conscious/unconscious processes of my clients. This kind of intuition is documented well in Western theory of integrative psychotherapy, and therapists such as Jarreau, Bion and Jung have all stated the importance of intuition in the therapy room. Moursund and Erskine (2004) say: Probably the most important set of guidelines, though, comes from our own intuitive, emotional response to the client’s behavior… We are often able to pick up tiny cues, cues for which we are consciously unaware, from the nonverbal behavior of our clients; such cues can aggregate out of our awareness and make themselves known as a general hunch about how to respond most effectively. (p.105)

Rogers also recognised the role of intuition in the clinical process, saying: When I am at my best, as a group facilitator or as a therapist, I discover another characteristic. I find that when I am closest to my inner, intuitive self, when I am somehow in touch with the unknown in me, when perhaps I am in a slightly altered state of consciousness, then whatever I do seems to be full of healing… I may behave in strange and impulsive ways in the relationship, ways which I cannot justify rationally, which have nothing to do with my thought processes. But these strange behaviours turn out to be right, in some odd way. (1980, cited in Arnd-Caddigan & Stickle, 2017, p.85)

Rogers refers to being in touch with an ‘unknown’ part of himself, which sounds

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almost transcendental. This overlaps with Islamic psychology. In Sufi Islamic psychology, we are believed to have three different parts of the self: the Nafs (self, ego or psyche), the Qalb (heart) and the Ruh (spirit). The Nafs are seen as the lower part of the self and can refer to negative traits and tendencies that are controlled by emotions, desires and their gratification. The Qalb refers to the spiritual heart, which carries a deeper intelligence and wisdom. The Ruh is in direct connection with the Divine, even if we are unconscious of that connection. I have noticed that when I am more connected to my Qalb or Ruh in my daily life, I am more able to connect with the client and feel more attuned to them. When I feel disconnected or fragmented in life, I find it difficult to connect with the client and will often miss what the client needs. I have also found that when I am struggling with something in my personal life that has the potential to help me grow emotionally and spiritually, the client will inevitably present with something very similar: the therapeutic relationship strangely becomes a spiritual relationship in which we both mirror one another. It is as though we are connected by a source beyond and bigger than both of us. This connection, attunement and intuition is central throughout the counselling process and guides me on how and when to introduce the following cornerstone therapeutic principles into my clinical work. These principles are: •

broaching and the Black empathic approach

•

transference, countertransference, and pre-transference

•

self-disclosure.

But before I go on to discuss these principles in more detail, I need to start with the initial contact with the client – the assessment.

The assessment The assessment process starts when the client contacts me, or when a third party contacts me on behalf of a client. Many of the counselling enquiries I receive are from the Black, brown and ethnic minority communities, and many are made by clients’ families or friends. When this happens, I explain the process of counselling, confidentiality and boundaries and how it is important for the person wanting counselling to contact me themselves. Not everyone will understand the boundaries of counselling, and therefore it is important to provide some psychoeducation at the pre-assessment stage to family members and friends, and even clients themselves. Later, in therapy, it often becomes apparent whether this initial contact by a third party reflects internal family dynamics or legitimate practical reasons. For example, one of my older Asian clients made contact with me via her son because she could not speak English; once I spoke to her son and we established that I could communicate in Urdu/Punjabi with his mother, I was able to communicate directly with her without any further issues. During the assessment, I like to understand the client’s history, why the client has come to counselling, and what they would like to gain from therapy. I also

Neelam Zahid

like to understand what the client’s assumptions are of what therapy entails. Many clients from Black, brown and minority ethnic backgrounds who have not been in therapy before will ask me questions about how I work and what is expected from them in the sessions. Eleftheriadou (2010, p.134) observes, ‘Many of our clients will find it difficult to engage with a purely explorative therapeutic space’, and therefore, although I may explore these questions with the client in the psychodynamic sense, I also answer them as honestly as I can. When I conduct sessions with a client in Urdu/Punjabi, I sometimes use the ‘wheel of emotional words’ adapted by Geoffrey Roberts3 from Dr Gloria Willcox’s work. I have translated this wheel into Urdu to make it easier for clients to identify and explore their emotions. The inner circle contains seven core emotions: sad,  disgusted, angry, fearful, bad, surprised and happy, which branch out to a middle and then an outer circle of many different emotions. With each widening circle of emotions on the wheel, the feelings become more specific and distinct. Clients have reported that it has been helpful to have the feelings mapped out like this in Urdu. One client told me that she did not realise until we did the exercise that she was fearful because she was feeling exposed. I also like to keep in mind the following six cross-cultural components that Grieger and Ponterotto (1995) suggest when assessing a Black or brown client or one from another ethnic minority group. I am often guided by my intuition as to how many questions to ask in the assessment in relation to these components. It is important to get the right balance between listening to the client so that they feel heard and asking questions to gather information.

1. Client’s type of psychological mindedness (individual) Eleftheriadou (2010) rightly points out that referring to a ‘type’ of psychological mindedness, rather than a level, is more apt. Clients from a particular cultural background may have a distinct way of conceptualising emotions, and this is very different to having a ‘higher’ or ‘lower’ level of psychological mindedness. The type of psychological mindedness may refer to: •

how a client assesses their own emotional state

•

whether they have a choice and an understanding of the referral

•

if they think their issue is physical or psychological

•

whether they manifest their distress physically or verbally.

2. Family type of psychological mindedness The second point refers to the family’s type of psychological mindedness. When the client and family have different notions of distress, it can increase conflict.

3. https://imgur.com/gallery/tCWChf6

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3. Client and family attitude to counselling This factor will influence the therapy, especially if the family or community does not believe in verbally expressing unhappiness or sadness. One of my older Muslim clients told me that she believed that expressing her unhappiness about the death of her husband would imply that she was being ungrateful for the many happy years of marriage she had been given by God.

4. Client’s level of acculturation How much the client has incorporated the dominant culture into their lives can be assessed through their engagement with different/same cultures in their social/ romantic relationships. Therefore, the client’s relationship with her own culture can be an indication of how she will engage with a therapist of a similar or different culture to herself. One of my young Asian clients told me that she was comfortable seeing me, an Asian therapist, because she saw me as a ‘modern’ Muslim, just like herself. This gave us the opportunity to explore her struggles within her family, culture and religion and also with ‘English’ culture. Names are also a good indication of the client’s level of acculturation. Anglicised names (even through pronunciation) can give us some information about how connected the client is with their own culture, as well as the culture they are living in. One of my Indian clients pronounced her name in an anglicised way, and I pronounced it in the ‘traditional’ way. This opened up a discussion about what she felt about my pronunciation and her connection to her culture.

5. Family’s level of acculturation The family’s level of acculturation is a good indication for individual relationships. The language spoken at home can be a good indicator of how accultured a client’s family is. What language they speak with parents, siblings, aunts/uncles, cousins and extended family is all useful information, as clients may speak different languages with each of them. I once had a client whose mother did not want her to speak her native language at home. When exploring this issue, it became apparent that the client was very split from her own culture, just like her mother. Another indication of the level of acculturation within the family are the views about cross-cultural friendships or relationships. With some of my clients’ families, it is very clear that cross-cultural relationships are discouraged; in other families, they are positively encouraged.

6. Family’s attitude to acculturation Last, the family’s attitude to acculturation can have an impact on the client’s cultural identity. If the client and family have different attitudes to acculturation, this can often create issues that might be brought to counselling. For example, a client’s mother explained that she wanted her daughter to see me because I knew what was acceptable in our shared culture. On seeing the client it very quickly became evident that how she wanted to live her life was seen as unacceptable in her family’s culture.

Neelam Zahid

The therapeutic process Broaching and the Black empathic approach When I bring the issues of race and culture into the therapy room, I break the cycle of oppression and racism. Silence perpetuates the abusive cycle, as does handing the client sole responsibility for introducing the issues of race and culture into the therapy room. I use broaching to bring culture and ethnicity into the therapy room. DayVines and colleagues (2007) define broaching as: … the practice of directly addressing racial and cultural factors within the counselling relationship to explore how these factors might be related to the client’s concerns, as well as to acknowledge how they can affect the counsellor and client dynamic.

When I have broached the topic of culture and ethnicity with clients, they have told me that they have felt validated by this. Broaching has helped build rapport and trust with clients who can comfortably discuss their experience through their lens of cultural identity (Day-Vines et al., 2007). By not broaching the subject of culture and ethnicity, I collude with the idea that colour is not significant and support the colourblind approach. Not verbalising what I see in the room is a separating off of a part of the client that may have become ‘other’ and labelled ‘bad’ through their experiences of racism, oppression and abuse. This does not empower the client to reclaim their Blackness and fragments them even further. This illustrates the Kleinian concept of splitting, which can also be seen ‘operating in certain cultural prejudices about different others’ (Eleftheriadou, 2010, p.197). The Black empathic approach can be seen as an extension of broaching and is defined as paying ‘particular attention to the cultural influence of racism’ (McKenzie-Mavinga, 2009, p.57). This approach encourages the therapist to take responsibility for recognising their own defences related to the hurt of racism and to be aware of the client’s defences. I can provide a Black empathic approach for clients by having the capacity to hold a safe space for them to explore their hurt around racism because I have already explored my own and continue to do so. I can also make it explicit that the therapeutic space is a space where racism can be explored. The dynamic between me and the client will generate a unique unconscious racial charge, which I need to be open to exploring with the client and in supervision. So, as well as sensitively broaching the client’s ethnicity and racial experiences as they express them, I need to see them as a part of the client’s identity and personal psychology. This means specifically paying attention to the hurt of racism, even if it is not spoken about directly, and then actively working with these issues as a therapeutic tool to facilitate the client’s healing. Incorporating the following points into therapy work, as advocated by McKenzie-Mavinga (2009), also enables me to uphold the Black empathic approach:

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•

I acknowledge diversity, using appropriate disclosure. For example, I may say: ‘I am aware that I am from a similar/different cultural/racial background to you – what’s that like for you?’

•

I begin the therapy with a multicultural approach. For example, I ask if a client has made a conscious choice to work with me because I am an Asian therapist and explore why they made this choice.

•

If appropriate, I name racism and oppression. I tell clients about my awareness of how discrimination and abuse has affected people of colour.

•

I constantly monitor my responses and take these to supervision – for example, are they avoiding the hurt of racism? Am I taking on the role of the rescuer? What am I avoiding with the client?

Transference, countertransference and pre-transference I actively work with transference, countertransference and pre-transference in my clinical work. Although therapists are fairly familiar with the concepts of transference and countertransference, the pre-transference can get overlooked. Curry (1964) describes pre-transference as fantasies and values ascribed by white and Black therapists towards other races. This can also be applied to therapists and clients who hold certain stereotypes of people from different cultures. When a white English client came to me for counselling for a bereavement, she told me that her dog had also died, and that this had tipped her grief over the edge. She went on to say that she knew that ‘my people’ did not think too highly of animals and therefore would not understand what she was going through. In subsequent sessions with this client, I was able to carefully challenge her pretransference and the stereotypes she held, using my intuition to know when and how to introduce this into the therapy. For a Black or brown therapist, sitting with a white English client can be a powerful experience where different layers of process take place. It is important to pay attention to the transferential relationship as well as the ‘real’ relationship. Dhillon-Stevens (2011) distinguishes between them: The black therapist needs to hold two processes simultaneously: to be therapeutically available to the client and the client’s material, while being aware of her own process and the reality of her experiences as a black woman, which are reinforced and triggered by the client. This is a difficult tension to hold in the real relationship. (p.107)

An example of this is when a white English client came to see me after being released from prison. He explained that, when he started his sentence, he was regularly assaulted by gangs of Black prisoners. The only way he could stay safe was to join a gang of white British prisoners – after this, he was never attacked again. I was aware that I felt afraid of this client, and I broached our racial difference soon after

Neelam Zahid

the therapy started. After this, he did not return. It was difficult for me to hold my fear while being attuned to what the client needed but my broaching the difference between us at that point was too powerful for him. It probably made the client feel attacked in the therapeutic relationship, just as he did in prison. An illustration of my countertransference around race and difference was when I first started my own private practice. As new clients contacted me, I went through a process called recognition trauma. This is defined as ‘the awakening of hurtful experiences related to racism’ (McKenzie-Mavinga, 2009). I could not understand why clients from a white English background would come to see me for counselling. When I explored this further in my own therapy and supervision, I realised that I believed my ‘otherness’ made me inferior to white clients, and this belief was influencing my interventions with clients. For example, I challenged white English clients less than Black and brown clients. I had connected to my internal oppressor, which Alleyne (2010) describes thus: … the process of absorbing negative values and beliefs of the oppressor. This process invariably leads to self-hate, low self-esteem, the disowning of one’s group and other complex defensive behaviours and attitudes. (p.204)

This was a pivotal point in my journey as a transcultural therapist because I realised that my experience of being the oppressed frequently silenced me in the therapy room. It was only when I worked through this aspect of my countertransference that I could work more congruently with all my clients. When transference, countertransference and pre-transference are played out in the room, it can be highly charged, but can be very useful for healing when used therapeutically. Therefore, it is essential for therapists to have worked on themselves enough so that they do not become entangled with themselves and thus unable to practise effectively. Not only are these concepts a template for the client’s past relationships; they are also ‘highly charged with racial and cultural history dynamics’ (Akhtar, 2006).

Self-disclosure Self-disclosure in therapy can be a contentious issue. However, by the very nature of my skin colour, I self-disclose something about my ethnicity and cultural background that I do not have the privilege to hide. If I am counselling a client in their native Urdu or Punjabi, the dialect we use also discloses which part of Pakistan we are from, and therefore I disclose something about my family background and community. My ‘self ’ is no longer individual in the Western sense; I become part of a collective society when I enter the therapy room. By default, then, the boundaries of therapy become different, as does self-disclosure. In my experience, first generation migrants tend to have a different understanding of boundaries and the concept of self-disclosure than second and third generation migrants. Often older first-generation Pakistani clients ask me personal questions about where I live, where my parents live and what part of

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Pakistan my parents are from. How I reply is obviously of great import to them. I tend to answer these questions briefly and then explore with my clients why they have asked them. One client told me that my answers to these questions helped her to understand me. I regard these questions as the client’s way of gaining trust, strengthening the therapeutic alliance and understanding me in context of our wider community. Another aspect of self-disclosure that I have found helpful for Black, brown, and other ethnic minority clients is my own connection to my cultural identity. When exploring a Polish client’s cultural background and identity, she explained that she saw me as ‘English’, just as she saw herself. As we discussed this, I disclosed that I identified with being British Asian and not English. This opened up a discussion about how and why she had rejected her own culture and ethnicity. My client was dissociated from certain parts of herself, and my acceptance of my cultural and ethnicity helped her to integrate these different parts of herself and work through her many traumas. My intuition tells me whether I am using self-disclosure therapeutically or getting caught up in acting out my countertransference of being compliant. At my core, when I feel attuned to the client, self-disclosure becomes a tool to deepen the connection between the client and me so that healing can take place.

Moving forward with transcultural training Perry (2016) describes the default human as white, middle-class and heterosexual: ‘the reference point from which all other values and cultures are judged’. Bakkar (2019) says: ‘He [the default man] and what he represents is the backdrop against which all other identities exist.’ The default therapist is a white, middle-class, middle-aged woman and has similarly become the reference point for all therapy practices, resulting in the ‘othering’ of Black and brown therapists We should not underestimate how biased and racist our education system in the West is. Every child should be taught about slavery, colonialism, discrimination and unconscious bias in mainstream education. The education system needs to be reformed, as does counselling training. Bolted-on diversity trainings alone are not sufficient if we truly believe in a multicultural Britain; we need a much greater shift if we are truly committed to creating change. I believe it is the responsibility of all therapists, regardless of racial or cultural background, to adopt a Black empathic approach and use anti-oppressive practice. To this end, all qualified therapists should be knowledgeable and regularly assess and update that knowledge in the following areas: •

awareness of our own culture, assumptions, prejudices and stereotypes

•

the significance of the pre-transference

•

diverse cultures and their histories

•

how race and racism has impacted counselling and psychotherapy

•

the history of slavery, colonialism and oppression

Neelam Zahid

•

the impact of oppression and race on the unconscious process

•

the dynamics of cultural, racial and ethnic difference in the therapeutic relationship.

Every qualified counsellor and trainee should regularly review their own practice against a multicultural framework. Transcultural training and working with difference should be an integral part of training courses and ongoing CPD for all counselling and psychotherapy professionals and should be provided by internal and external specialists. It is naïve to assume that institutional racism will not penetrate training organisations and influence in-house provision. Asking staff members who are part of the institution to deliver diversity training is like putting a fox in charge of a hen house; the danger is that uncomfortable feelings such as powerlessness, cultural shame, internalised oppression, racism and identity formation will get missed, quashed or avoided. We must remember Alleyne’s warning (2010, p.188) against a ‘culture of compliancy’ within our institutions. If we are all committed to lifting the white veil of therapy, then white therapists must be open to challenge and to feeling uncomfortable and vulnerable. The shadow side of therapy and therapy training needs to be exposed so that white is seen as a colour too.

References Akhtar, S. (2006). Technical challenges faced by the immigrant psychoanalyst. Psychoanalytic Quarterly, 75, 21-43. Alleyne, A. (2010). Psychodynamic considerations for diversity consultancy in organisations. In Z. Eleftheriadou (Ed.), Psychotherapy and culture: weaving inner and outer worlds (pp.187–210). Karnac. Arnd-Caddigan, M. & Stickle, M. (2017). A psychotherapist’s exploration of clinical intuition: A review of the literature and discussion. International Journal of Integrative Psychotherapy, 8, 79–101. Bakkar, N. (2019). On the representations of Muslims: terms and conditions apply. In M. Khan. (Ed.), It’s not about the burqa: Muslim women on faith, feminism, sexuality and race (pp.45–63). Picador. Curry, A.E. (1964). Myth, transference and the black psychotherapist. Psychoanalytic Review, 51, 547-554. Day-Vines, N.L., Wood, S.M., Grothaus, T., Craigen, L., Holman, A., Dotson-Blake, K. & Douglass, M.J. (2007). Broaching the subjects of race, ethnicity, and culture during the counselling process. Journal of Counseling & Development, 85, 401–409.  Dhillon-Stevens, H. (2011) Issues for psychological therapists from black and minority ethnic groups. In C. Lago. (Ed.), The handbook of transcultural counselling and psychotherapy. McGrawHill/Open University Press.

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Eleftheriadou, Z. (Ed.). (2010). Psychotherapy and culture: Weaving inner and outer worlds. Karnac. Erskine, R.G. & Criswell, G.E. (n.d.). Psychotherapy of contact-in-relationship: Conversations with Richard. Institute for Integrative Psychotherapy. http://www.integrativetherapy.com/en/articles. php?id=100 Grieger, I. & Ponterotto, J.G. (1995). A framework for assessment in multicultural counselling. In J.G. Ponterotto, J.M. Casas, L.A. Suzuki, & C.M. Alexander (Eds.), Handbook of multicultural counselling (pp.357–374). Sage. McKenzie-Mavinga, I. (2009). Black Issues in the therapeutic process. Palgrave MacMillan. McKenzie-Mavinga, I. (2011). Training for multicultural therapy: the course curriculum. In C. Lago (Ed.), The handbook of transcultural counselling and psychotherapy. McGraw-Hill/ Open University Press. Moursund, J.P. & Erskine, R. (2004). Integrative psychotherapy: The art and science of relationship. Thomson Brooks/Cole. Perry, G. (2016). The descent of man. Penguin.

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The legacy of colonial history and the ongoing challenge to therapist training and practice Vedia Maharaj

The future, silent, behind them. (Merrie Joy Williams, 2019, cited in Linton & Walcott, 2018)

Today’s world map is shaped by the consequences of colonialism, in which borders were marked out with little or no regard for local contexts and realities. With their own aspirations, colonisers misconstrued the cultural, social, economic and political conditions under which the colonised led their lives. They imposed new identities that were neither appropriate for nor in line with existing communities. This debilitated self-esteem, self-agency and community and national development. The global borders of colonialism symbolise the markings of historical pain and oppression.

Indenture and colonial tales Bahadur (2013) records how the ending of slavery resulted in a different kind of slave: the ‘indentured’ worker, still widely found today. … after the enslaved were emancipated in the 1830s, Britain began to rustle up replacement workers for plantations worldwide… Ultimately, over the course of eight decades, they ferried more than a million ‘coolies’ to more than a dozen colonies across the globe, including British Guiana, Trinidad, Jamaica, Suriname, Mauritius and Fiji. These were the first group of Indians abroad in any significant numbers. (p.xx)

Indians were recruited under the system of indenture. This was a system of bonded labour for a fixed period of time, commonly five years, with the option to renew the bond or return to India with free passage. The ‘bonded’ aspect meant Indians were legally contracted to the ownership of their employer for the period of the bond.

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Some entered this system by choice, based on what they believed they were being offered, and some entered by enticement and force. The purpose of indenture was to maintain the production of Britain’s economic wealth across its colonies. A British official in Guyana summarized the status of indentured labourers as follows: ‘Practically an immigrant is in the hands of the employer to whom he is bound. He cannot leave him; he cannot live without work; he can only get such work and on such terms as the employer chooses to set him; and all these necessities were enforced, not only by the inevitable influence of his isolated and dependent position, but by the terrors of imprisonment. (Carter & Torabully, 2002, p.51)

Researching our paternal lineage in Trinidad, my cousin, Suresh, tells me what he knows of our forefathers’ experience: The journey was gruelling. They thought they were coming to a land of paradise, but were whipped and things. Really, we came as slaves toiling the fields, humiliated and tormented in all forms and fashions. Whether you want to call we slaves or labourers or under servitude, we was slaves.

My maternal aunt, Indira, talks of how her great grandfather’s indenture contract was cut short. They return him early. He was a rebel protesting pay and how they did treat we. The owners didn’t want rebel.

Indira spoke with pride that her great grandfather was a rebel. He had a son, whose name was Arjun Singh, whom he left in Trinidad. Arjun Singh married twice. Indira relates: He had nine children from both marriages. Them born after indenture finish. Arjun Singh purchase a plot of land. It eh fit for growth but this eh matter. It was a chance for the future.

It is an interesting colonial economic move of power that Indians could only purchase unfit land. The Indian in the colonies was quietly buying himself out of contract and establishing himself on marginal lands in his new guise of gardener and small planter… All of the abandoned lands, whether they are in arid districts or in regions generally believed unsuitable for cane cultivation, are, today in the hands of Indians. (Carter & Torabully, (2002, p.56)

Yet another maternal aunt denies that we were indentured: ‘Them things didn’t happen to we. We not indentured. We paid we passage.’ The force of her denial is a

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measure of the shame and pain it expresses. … I became interested in the notion of the mother wound, which is the generational trauma carried by women and passed down to their daughters and granddaughters in patriarchal society. (Djeli, 2018, p.8)

Under the brutality and trauma of imperial conditions and rule, Djeli’s words speak for my aunt. For her, it is unspeakable, but it is there. Both men and women were maltreated under the indenture system. Slavery did not end. It simply changed its political and policy format. Indenture supposedly ended in 1917. However, the change of law and culture did not change racialised concepts or the mind-set of white supremacy.

Movement of people The British economy, short of labour, needed these willing hands. The doors were open. (Fryer, 2018, p.378)

After the Second World War, the UK was short of labour and invited British subjects in its Caribbean colonies to come to these shores and work in its public services. These British subjects were the previously enslaved and indentured. The British Nationality Act 1948 gave the people in its colonies the same nationality rights of those born and living in the UK. This Act fitted the political and economic climate of Britain at that time. Britain needed workers. This was a contentious action for Britain’s white population. It was also a topic of political debate, with the Conservative party actively against it, on grounds that it would lead to mass migration into the UK. Commenting on how West Indians landing in the UK were perceived by Britain’s white population, Fryer writes: They saw them as uncivilized, backward people, inherently inferior to Europeans, living in primitive mud huts ‘in the bush’, wearing few clothes, eating strange foods, and suffering from unpleasant diseases. They saw them as ignorant and illiterate, speaking strange languages and lacking proper education. (Fryer, 2018, p.380)

Here we get a view of how the majority of the population viewed non-white British subjects. It is inaccurate to state that all white people held the same views. Some had been administrators and settlers in the colonies, conducting themselves within the parameters of imperial power and now returning at the same time as those who had been colonised. Some had not left the UK and held varying levels of interest in and information about the activities of the Empire overseas. In the British national context, whiteness was a relatively understated identification, not needing to be explicit when nearly everyone looked the same (Schwarz, 2011, p.11). Therefore, concepts of ‘the motherland’ and white supremacy are drawn from a number of

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differing positions, while being navigated through politics and structural systems grounded in whiteness and historical experience of vast colonial power. Fourteen years later came The Commonwealth Immigrants Act 1962, which restricted migration from colonised territories in Africa, the Caribbean and Asia – a political move favouring whiteness and a white Britain. The important point to note is that people of colour have historically been pawns in political and economic structures, without regard for their socio-economic or psychological welfare. They have throughout been considered when service has been needed, be that through slavery, indenture or as employees building modern Britain. The lens of the coloniser has simply shifted its angle and shifted it again and again, maintaining structural whiteness in the centre of its focus.

Common motherland encounters My father, an Indian Trinidadian, arrived in the UK in 1964. Born and raised in the Empire, he was legally a British subject of the United Kingdom and Colonies. In Trinidad, he had worked in a solicitor’s office as a legal clerk. He intended to complete a degree in law there. He instead decided to come to the UK as my mother, then his girlfriend, had applied for and got a position to train as a nurse in Preston, Lancashire. On arrival, with his three A-levels and legal clerk experience, he applied for clerical officer posts. These required just two A-levels. In interviews he would be asked, ‘Why don’t you go back and work in your own country?’ and told to ‘apply for the clerical assistant post’, even though he was over-qualified for that. This he spoke of with a tone of wounded anger. He talked of how hard it was to find accommodation as both an Indian and a Caribbean, and more so after I was born. Property owners placed signs in their windows: ‘No Blacks, no children’, ‘No Coloureds, keep our community white’. This, coupled with practices such as child minders not wanting to touch the nappies of ‘coloured’ children, resulted in me being returned to Trinidad, at the age of two, to live with my maternal grandmother. This type of experience is, unfortunately, common for children of Caribbean parents.

Colonial past present Moving our focus from the end of post-colonial rule to the present day, we see the systemic inequality resulting in race riots and protests, such as the Notting Hill riots in 1958, the Bristol bus boycott in 1963, the Grunwick workers’ protest in 1976/78, the birth of the Southall Youth Movement in 1976, the Brixton riots in 1981, and more. In today’s Britain, there is a call-out for the decolonising of structures that continue within the heart of British institutions and political systems. To have decolonised from the majority of its colonies does not mean white Britain has magically and automatically decolonised its institutional structures. This has not been the central focus. Attention has instead focused on multiculturalism, equality of opportunity, integration, assimilation, inclusion and the like. However, equal access and opportunity is not possible when our institutional structures obstruct equality.

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… the state tried to assimilate the ‘immigrants’. The policies in this phase were explicitly racist, involving ‘diluting’ the population of South Asian (and African-Caribbean) people and assimilating them into British ways by erasing their culture and language. (Wilson, 2006, p.74)

The policies Wilson refers to are of Thatcherite times, 1979 to 1990, tackling multiculturalism. Essentially they are concerned with social conditioning and control by assimilation to British ways. Again, a colonial way forward. This was a form of the past in the present with whiteness leading the way. It’s a different presentation with comparable ambition. In the present, as regards natural predisposition and racial bias, our current prime minister Boris Johnson has referred to Muslim women who wear burqas as resembling ‘letterboxes’ and ‘bank robbers’. He has famously referred to Black people as ‘piccaninnies’, and as having ‘watermelon smiles’. He has refused to comment on his views regarding the intelligence of Black people and eugenics following a string of comments made by his No. 10 adviser Andrew Sabisky (Buchan, 2020). It is a challenge to believe that his political decisions will work toward declaring and decolonising the country’s imperial structures. It is equally irrational to assert that equal access and opportunity justly exist and are structurally open and accessible. Today’s border controls, detention centres, rise in hate and race crime, profiling of Muslims as terrorists, police arrests, prison and mental health incarceration of Black and Asian men and women, blaming and shaming of immigrants and refugees, lack of equal pay and the need for ethnic-blind recruitment, the call-out across the media industry for minority TV and film roles and awards and so on are all caused by maintaining racist structural and political systems of oppression. The Mental Health Foundation (n.d.), reviewing findings related to Black, Asian and minority ethnic communities, reports: BAME communities… are more likely to experience poverty, have poorer educational outcomes, higher unemployment, and contact with the criminal justice system, and may face challenges accessing or receiving appropriate professional services.

Its website cites statistics from a range of sources: •

Among 16- to 24-year-olds, unemployment rates are highest for people from a Black background (26%) and from a Pakistani or Bangladeshi background (23%) in comparison with their White counterparts (11%)…

•

Even when employed, men and women from some ethnic groups are paid less on average than those from other groups with similar qualifications and experience…

•

Pakistani and Bangladeshi communities consistently have high rates of poverty, as do Black, Chinese and Other ethnic communities…

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•

Homelessness is a key issue among minority ethnic groups, with 37% of statutory homeless households from a BME background in 2013.

This snippet of statistics demonstrates structural racial inequality and oppression, evidencing post-colonial imperialist structures in present-day Britain. These types of statistics are often turned on their head and used against these groups to blame them rather than raising challenging questions about Britain’s political systems.

Internalising oppression Racial oppression is learned from structural inequality and neglect. Its messages are internalised, becoming a part of who we are. These experiences are not only found in large-scale statistical surveys and socio-political and economic policies. They occur in everyday experiences. For example, when a person with an Indian accent is told they should learn to speak English properly, we effectively invalidate them, implying they have failed and are less than. Contrast this with telling a French person their accent is attractive, with the effect being that they feel desirable and valued. For both the Indian and the French person, on grounds of their accent alone, power or oppression is imposed and internalised. For both there are bodily felt experiences, conditions of worth and a shift away from their organismic self. Acts of Parliament and behavioural acts that allow one person to be racist, so oppressing another, sit inside structural Britain. Such structures, for example, invite one child to believe they are more likeable than another child. The structures themselves bind people into roles they did not necessarily choose and then, before comprehension emerges, they’ve unconsciously internalised racial bias and used that as racial banter. Such processes create great anxiety among people of colour. Some experience a desire to not be like their peer and social group; they try to somehow hide their own colour while being it, or they victimise their own culture while breathing it, effectively internalising learned structural bias and oppression. This results in being one’s own oppressor; we are left with both the external and internalised battles of racism. I cannot be personally present without being Indo-Caribbean, Trinidadian, British Asian and ancestrally indentured from colonial India. These aspects of myself sit within me as comfortable but complex layers. Such origins lead people of colour to engage in ancestor enquiry that facilitates insights into both the internal and external journeys of immediate elders and beyond. These enquiries bring home past suffering and hardship that preceded any form of contextual and perceived benefit. They also bring to light present day connections of suffering through microaggressions and intergenerational trauma. I have observed the psychological strength, shame and pride held within the bodies of elder family members as I listened to tales of indenture, colonised Trinidad and early life in Britain. I have reflected on the collective unconscious of colonisers and the colonised. Notably from discussions, my core being and beliefs have been both nourished and haunted. I have looked inwardly to understand

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the ways in which my mother embodies the oppression of her mother and I the oppressions of my mother, both born under colonial rule. I have questioned the layers of my cultural inheritance within and outside family contexts. Like many, I have battled with the term ‘British Asian’, as it erases histories. It leaves people of Asia, the indentured and white people, with no sense of the magnitude of our collective and divided shared histories. No sense of inflicted wounds or shared wounds. No sense that the stories we are told hold an infinite number of hidden stories, across centuries. No capacity to be acquainted with the roots of current structural and collective racial oppressions that continue to cause trauma. No context to comprehend that wounds to sections of society are wounds to all society. For example, where people of colour internalise the impact of racism, white people internalise denial, shame and guilt – guilt in many guises, such as internalised racial bias, historical power and greed, existing post-colonial benefit and more.

The profession In teaching and learning of academic psychology, there is generally the assumption that this body of knowledge is culture-free and has universal applicability. It is also assumed in teaching and learning of clinical applications of psychological theory that these are sufficient to address people’s problems, irrespective of their culture. (Patel et al., 2000, p.36)

A thought for contemplation is that psychotherapy academics explored and defined their theoretical concepts during colonial rule – Freud, Jung, Rogers, Bowlby… It is tricky to believe that they were not prejudiced by global politics and constructs. This raises the question of how this is addressed in contemporary counselling and psychotherapy training. Our profession’s grand theorists inevitably reflected their whiteness and therefore speak to whiteness. It is not surprising that British and European theorists would exclude concepts from the traditions and science of Europe’s and the Empire’s natives, slaves and indentured people. This sits contentedly within structural racist contexts. Subsequently, this requires minority therapists to fit in or take a risk by raising difference. Such risks inevitably evoke a range of responses from white students characterised as manifestations of ‘white fragility, denial and guilt’ (DiAngelo, 2016.) Such training discussions, often poorly directed by tutors, frequently hinder open dialogue. To fit in means allowing oneself to be owned by the structural status quo. It requires not only white complicity but also Black complicity and silence. Why is ‘Black and minority ethnic’ seen as the problem when raised? What if the problem was seen as whiteness and its denial of racism? What if that is what is explored and not race as difference? What if the counselling profession viewed it that way? What if white people reflected on their racial difference? If, as a profession, we ignore racism and its psychological, physical and emotional impact throughout history, can we begin to see, feel and experience its place in modern psychological thought and conditions? Is there a way to

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seriously consider the blind spots of the profession, rather than turning a blind eye? Is there a way to examine training course structures, enhance tutor ability, and avoid systematically churning out counsellors who are ill-equipped to work in contemporary society? How would it be if training acknowledges both white fragility and white complicity, recognising that, due to fragility, complicity takes place not just out there but on training courses and in therapy rooms? Change can only be implemented when whiteness stops looking to Blackness for the answers or for diversity training but instead looks inwardly so that, when faced with students of colour who commonly want to explore their difference, they are not frozen and halted by ‘Are you calling me racist?’ and other white fragility and complicity reactions. There is a lot of shame and pride in disowning one’s racism. As therapists, our fear and shame around how to explore race and racist thought, language and behaviour without moral judgement stand in the way, unowned and unexplored. White people are able to repress, disavow or escape their racist thoughts, language and behaviours, but then it is internalised as guilt and shame, resulting in blame and wounding. Without looking inwardly and without addressing their own internalised colonial wounds and current fragility, white people will always blame people of colour for their responses and reactions, with no accountability. The larger question is how can we as therapists engage with free thinking and language when training curricula and larger political structures and historical systems are shutting us down? Can white people allow themselves to be racially oppressed, silenced or attacked so that this can be explored productively? How do we understand our institutional spaces both within and in the external? How are colonialism and capitalism enacted daily, and embodied and organised within us? Perhaps our collective psyche has invested so much in systems and structures that to question, change or challenge would be experienced as an immense loss. It is rather like losing the word ‘United’ from the United Kingdom, even though we are not united, or like saying ‘We want our country back’ as if we have lost it, when it is here, still, needing us to deal with the impact of the past in the present.

References Bahadur, G. (2013). Coolie woman: The odyssey of indenture. C. Hurst & Co. Buchan, L. (2020, February 17). Andrew Sabisky: Controversial Boris Johnson aide who suggested black people were mentally inferior resigns. The Independent. www.independent.co.uk/news/uk/ politics/andrew-sabisky-resigns-boris-johnson-tory-aide-government-a9341151.html Carter, M. & Torabully, K. (2002). Coolitude: An anthology of the Indian labour diaspora. Wimbledon Publishing Company.

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DiAngelo, R. (2016). What does it mean to be white? Developing white racial literacy. Peter Lang Publishing. Djeli G. (2018). Mother wounds. In D. Dabydeen, M. del Pilar Kaladeen & T.K. Ramnarine, We mark your memory: Writings from the descendants of indenture (pp.8–24). School of Advanced Study, University of London/Commonwealth Foundation. Fryer, P. (2018). Staying power: The history of black people in Britain. Pluto Press. Linton, S. & Walcott, R. (Eds.). (2018). The colour of madness: Exploring black, Asian and minority ethnic mental health in the UK. Skiddaw. Mental Health Foundation (n.d.). Black, Asian and minority ethnic communities (BAME). www. mentalhealth.org.uk/a-to-z/b/black-asian-and-minority-ethnic-bame-communities Patel, N., Bennett, E., Dennis, M., Dosanjh, N., Mahtani, A., Miller, A., Nadirshaw, Z. (Eds.). (2000). Clinical psychology, ‘race’ and culture: A training manual. BPS Books. Schwarz, B. (2011). Memories of empire, volume I: The white man’s world. Oxford Scholarship Online. Williams, M.J. (2019). Disorderly thoughts. In M.J. Williams, Open windows. Waterloo Press. Wilson, A. (2006). Dreams, questions, struggles: South Asian women in Britain. Pluto Press.

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12 Towards the re-emergence of meaning:

Existential contributions to working with refugee clients Benjamin Mark Butler

Culturally, the trauma tag affirms suffering. (Pupavac, 2008, p.272)

Long before I began working therapeutically with this demographic of clients – a time in which I could scarcely entertain the consequences of being unwittingly displaced from one’s birthland, family, culture and support structures – I always associated refugees with violence and trauma. Deeply entrenched into the very roots of my younger psyche there existed laden scenes of bombings and of bullets; of bones and of blood; of cruelty and of cadavers; of fighting and of fleeing; of dystopian cities, jungles or deserts in which helpless, feeble and frightened ‘others’ were subject to absolutism, suffering, exile, exodus or death. Overall, these anarchic mental images represented a space in which life for refugees could not be, or rather, would not be, survivable, least of all retain the potentiality for a meaningful existence. Although this may reflect some real dimensions of life for those besieged by persecution, conflict or war, qualitatively there is so much more to their stories. In retrospect, perhaps the in-roads to these associations were informed by the context in which I was (and remain) framed. Growing up in a ‘visual culture’ (Wright, 2002, p.53), for instance, may indeed have contributed to these constructions. To corroborate this assertion, a growing body of literature demonstrates that media portrayals of Western societal attitudes towards refugees has generally oscillated between dehumanisation and victimisation (Chouliaraki & Zaborowski, 2017; Esses, et al., 2013; Ghazal, 2019; Haslam et al., 2008; Lodge, 1996; Smets et al., 2017). As one such (in)famous example, Donald Trump Jr., son of the former US president, once compared people displaced from Syria to poisonous sweets, tweeting: ‘If I had a bowl of skittles and I told you just three would kill you, would you take a handful? That’s our Syrian refugee problem’ (Malkin, 2016).

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It is beyond the purpose and scope of this chapter to challenge such projected social-political attitudes and labels. Yet, their consequences frequently create a misrepresentation of the totality of a refugee’s inner resources and capabilities, neglecting how resilient, adaptable, tenacious, courageous and motivated they are to establish or re-establish meaning in their lives, despite the uncertainty and chaos they may have faced. What follows in this chapter, therefore, are several radical propositions to practitioners of counselling and psychotherapy when working with refugee clients. In no order of importance, these are: •

that therapists might, understandably, limit the focus of their therapeutic interventions to the treatment of post-traumatic stress disorder (PTSD) before exploring how refugees experience their existence or how they generate meaning in their lives.

•

that existential meaning is a fundamental motivational system, and all human beings have an innate proclivity to manifest this drive in the world. The unfavourable social-political challenges that refugees frequently face therefore present major obstacles to living in accordance with these inherent purposes.

•

that existential-phenomenological approaches may help therapists better understand how clients experience their world and what is of importance in their lives.

•

that psychological therapists must remain mindful to not add to the trauma narrative by reducing refugees to clustered sets of symptoms when they formulate their presenting problems.

•

that, in sum, existential meaning is considered a pivotal part in helping refugees establish a deeper sense of self, wellbeing and belonging following forced migration.

To contextualise these perspectives, they will be explored through two fictionalised case examples: Kristofer and Donkor. Although these are not real people, the themes, experiences and therapeutic vignettes are nevertheless based on actual counselling sessions.

Existential meaning in counselling and psychotherapy But I know that on that day, in that hour, my new life started. Step for step I progressed, until I again became a human being. (Frankl, 1959/2004, p.97)

In the closing remarks of his outstanding work Man’s Search for Meaning, Victor Frankl (1959/2004) set the stage on which meaning-orientated therapy (logotherapy) was to be born. For Frankl, human beings were meaning-seeking creatures, compasses tilted towards finding meaning in their existence and towards doing what was needed to attain a purposeful future, despite the inherent trials of life or

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tragedies of their situation. Frankl, who bravely survived the torturous conditions of the German Nazi concentration camps, arrived at the ultimate conclusion that ‘meaning is possible, even in spite of [human] suffering’ (1959/2004, p.117). Other existentially inclined philosophers and theorist-practitioners share this view, taking the stance that existence itself is the attempt to construct meaning; that meaning-making is woven into the very fabric of one’s being. From this ontological standpoint, meaning is not considered a by-product of behaviour, or a consequence of other biological determinants that influence decision-making processes. Rather, meaning is regarded as a fundamental motivational system that guides behaviour, facilitates choice and orientates human beings in the world (Cooper, 2015; Frankl, 1959/2004; Maslow, 1966; Spinelli, 2007; van Deurzen, 2002). If the drive to meaning therefore helps human beings navigate their way through daily life, when existence is shrouded in doubt or uncertainty and the individual is treated with indifference or apathy, some form of suffering is often generated. Seen through existential lenses, this has empirically been viewed as preoccupations with large and metaphysical questions with no predetermined answers (Yalom, 1980); anxiety and depression (van Deurzen, 2012); risk-seeking or self-destructive behaviours (Frankl, 2010), and, in extreme cases, thoughts about suicide (Camus, 1942/2018). If, as Griffin and Tyrrell (2003) write, ‘movement and meaning are inextricably linked’ (p.5), enabling clients to remove the obstacles that prevent them discovering more purposeful ways of living may indeed be a psychotherapeutic endeavour. Recent outcome reports on the existential therapies clearly demonstrate their effectiveness in helping clients substitute feelings of personal emptiness with fulfilment (Raynar & Vitali, 2014; Vos et al., 2015). Not only does this confirm that existential therapy’s often-perceived esoteric body of theoretical works can be translated into practice (Keshen, 2006); it may also suggest that meaningmaking is a ubiquitous human drive; a fundamental tenet of primary concern to the individual. However, as existentialism is deeply rooted in indigenous European philosophical thought, can it be said that these ontological assumptions cross over to a shared cross-cultural understanding? That is to say, is the drive to meaning hardwired into us all; is the direction of all human existence universally focused on carving out meaning? Or, as aptly asked by Hoffman and colleagues (2009), are we in danger of merely ascribing these Western existential ideas to a non-Western context? I share the views put forward by Vontress (1979) and Moodley and Walcott (2010), who explain that the above questions transcend all national, ethnic and cultural boundaries. These researchers argue that concerns of existential meaninglessness are inevitably encountered by all people, and Basma and Gibbons (2016) further suggest that questions of uncertainty, freedom and purpose are endemic to the refugee population, as they are ‘thrown into crisis and attempt to grapple with these anxieties on a daily basis’ (p.160). Based on my therapeutic experiences with clients forced to migrate from their homes, coupled with the complex losses, fears, terrors and social-cultural adjustments they encountered

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along the way (Cilia La Corte & Jalonen, 2018), it seems tenable to suggest that these disassembling, even tyrannical events throw refugees towards stark questions of meaning and existence itself.

Exploring existential meaning You have to leave the island in order to see the island. (Saramango, 1999, p.13)

Thus, as my cultural presupposition is that existential meaning is a human given and prerequisite for healthier wellbeing, I have found phenomenological-existential practices useful in establishing an interpersonally orientated context for the therapeutic relationship. This both allows for all of the client’s subjective feelings, fears, aspirations, values and deepest concerns to be accepted and explored, free from cultural expectations (Kinzie, 1978), and can help create an egalitarian, safe and trusting therapeutic relationship (Owen, 1994). Cooper (2003) proposes that phenomenological-existential dimensions of therapeutic practices exist on a spectrum. At one end, the attempt is to remain closely focused on a clients’ lived experiences; at the other, there is an understanding that clients are grappling with life’s meaning, paradoxes or other concerns inherent in existence (see Figure 12.1). Figure 12.1: The dimensions of phenomenological-existential therapeutic practice Understanding

←

→

Explaining

Phenomenological

Existential

Epoché (reduction) Description Verification

Paradoxes Ultimate concerns Givens of existence

Before unbracketing these existential assumptions and exploring a client’s relationship with meaning by inviting them into therapy, phenomenological methods may help therapists enter a client’s lived world more accurately. These include: the rules of epoché, working descriptively, and verification of what the therapist senses and seeks to understand the client to be expressing (Cooper, 2003; Spinelli, 2007). Epoché, as explained by Arnold-Baker and van Deurzen (2008), is the therapist’s attempt to move beyond the objective-scientific approach by bracketing or setting aside their own biases or presuppositions for how things are perceived or theorised. It is by taking this stance, they argue, that therapists may comprehend the primacy and depth of another’s phenomenologically lived world ‘as if it were new to you’ (p.58). During this period, the emphasis is therefore away from any scientific or philosophical explanations and instead towards helping clients express the thoughts, feelings, attitudes and beliefs that constitute their lived experiences, free from judgement or expectation.

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According to Spinelli (2007), this process can further be assisted by working descriptively – namely, helping clients describe their immediate experiences as they unfold within the therapeutic encounter, while verifying, or ‘checking back’ (Cooper, 2015, p.72) for the accuracy of their offered descriptions. Overall, these methods and principles are believed to help therapists understand more deeply the phenomenology of their client’s subjective lives, as well as how they generate their sense of meaning. Kristofer was born and raised in a minority faith-based religion within a majority faith-based culture. As a young boy, he was devoted to his God, cherishing each service that he attended where he could learn more about His teachings at the only church of its kind in the neighbourhood. But, throughout childhood and adulthood, Kristofer experienced great persecution by ethnic intolerance, as his rituals, routines, name and skin colour were different to those of the other members of his larger community. Consequently, he recalled often being treated like an ‘outsider’ and experienced teasing and bullying for his beliefs and ‘different way of life.’ One day, harassment escalated into violence, as Kristofer’s church was attacked, then set alight, while he prayed there. He recounted that the perpetrators, their heads and faces covered with cloth, told him to leave the country before the flames died out, unless he was prepared to stay and withstand ‘the wrath of the rightful, one true God’. Refugee clients frequently ask me what can be done to resolve their problems. According to van der Veer (1998), this is not uncommon, as non-Western refugees may be familiar with doctors or healers from their own culture suggesting ways that problems should be treated or resolved. After three years of attempting to claim asylum in the UK, Kristofer was now living in destitution, and asked me the following questions in our second counselling session: Kristofer: I don’t know what to do. What do you think is going to make me better? Can you tell me what do I need to do to feel better? I need something to happen to feel better. Benjamin: So, it seems like you’re really uncertain of knowing what to do to feel better, that you need something to take place to feel better. I’m really happy to offer anything that I feel could be useful to you and could answer your questions. But I think this asks another question of both of us that we may need to face: if I say to you what I think may be important in helping make things feel or be better for you, will this take away from what you feel or consider to be important to make things better? Kristofer: It’s very difficult to know, Benjamin. I’ve never asked myself what I need to have to make things better. Benjamin: Can you describe what your sense of not-knowing is, what it’s like to experience not-knowing what can make things better or help you feel better? Kristofer: Um… I look at other people, I come here to see you, I see people going to the shops; they have children, homes, money to buy things; they have jobs

Benjamin Mark Butler

and things to do. I have none of these things. I have no papers [leave to remain documentation], which means I do not have these things. Benjamin: So, you experience other people having things in their life: they have children, homes, jobs and things to get on with. And it seems that you experience yourself without these things, without the papers to have access to these things. Kristofer: Yes, I don’t have these things. Benjamin: And what’s that like for you? What’s that like to experience others doing things and having things? Kristofer: I just have no purpose in life. The doors have been closed to my purpose in life. This is not a meaningful life, this is what I think. Benjamin: So, you’re thinking that you are standing behind closed doors to a life of purpose, and behind these doors you are experiencing life as not meaningful. Kristofer: Life is not meaningful when you are shut behind closed doors that have been shut to you living a life with family and purpose. I have no legacy to pass down to anyone. I can’t even pray to God. Can you tell me what I think I need? Benjamin: Just to clarify how I think you are experiencing things: it’s more than just not having things in your life now; it’s that it is not a meaningful life for you when you feel shut behind closed doors, not able to pray to God or have a legacy to pass down to others. Kristofer: God and family are important to me, and I feel without them life is not meaningful. What do you think? Benjamin: Well, as I’m hearing you describe what’s important to you – that prayer, God, family and having purposeful things in your life now and to pass on are really important things without which life feels meaningless – this makes me think about something. I agree with you that we all have certain needs, such as needs for physical and practical safety, and the need to experience meaning in our lives to make life feel worthwhile and purposeful. Kristofer: I miss being able to pray. This condensed demonstration of existential-phenomenological principles illustrates how epoché (or bracketing), description and verification can help inform the existential givens that are of greatest concern to the client and help expand their worldview and meaning-making processes (Adams, 2013). In turn, these principles may help the therapist learn how the client experiences their world and what is of common or congruent existential importance in their lives. In the context of my work with refugee clients, the application of these processes has frequently led to deeper conversations around meaning and purpose, bringing the existential dimension to my understanding of their concerns.

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Arrested meaning and questions of self At one point midway on our path in life, I came around and found myself now searching through a dark wood, the right way blurred and lost. (Dante, 1472/2013, p.3)

In the case of those awaiting the outcome of their asylum or who have had their application rejected, the above quotation echoes a salient dimension of a refugee’s experiences. Like Kristofer, many other refugee clients I have met have expressed similar feelings: that their previous meaning structures have been destroyed by forced migration, and their relationship with life here and now is experienced as having been arrested. For instance, some clients have expressed experiencing existence-as-between-two-worlds: living detained between painful memories of the past and fears of an uncertain future, in a present that is devoid of both extrinsic purpose and consequently intrinsic meaning. Donkor was a politically active person who protested against his government for their violations of human rights. He reflected that, when he was a young man, God had ‘obligated me with intelligence, critical thinking and leadership skills’, instilling in Donkor a ‘mission’ to stand against the bureaucratic regime. When Donkor spearheaded an egalitarian campaign through magazines and social media outlets, he was quickly captured by local government officials and sent to prison, and there exposed to interrogation, beatings, neglect and torture for two months. On his release, Donkor discovered that his home had been ambushed and his wife and children subject to harassment, questioning and separation from each other. He feared that he could no longer protect himself and his family from government agents, so arranged for them all to be smuggled out of the country by a comrade to his cause, hoping to find safety. When he came to see me, three years after their flight, Donkor had been awaiting the verdict of his asylum case for 13 months. In our third counselling session, Donkor held out his hands as if he was binding something together, fingers tightly interlocked, and trembling. When I asked if he could articulate what meaning he attributed to this gesture, he described feeling trapped between his hands and that his life for three years had been caged, surrounded by memories of loss and dread of an unknown future. Standing between these two worlds, Donkor said that three years of being held in this space was a significant amount of unlived life. Cilia La Corte and Jalonen (2018) have eloquently described how this phenomenon may be experienced during the asylum phase of hope and fear: The asylum seeker remains in limbo… with the fear of being returned to their home country, potentially to face persecution, as well as the uncertainty of life in a new land. (p.29)

This vast reduction in experience, a holding space where the individual is deprived of the freedom to further their existence, often raises deeper questions of uncertainty about the self.

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Human beings require a range of external experiences for feedback in order to reform, adapt, modify and solidify their unique place among others and stand out in the world – a drive Becker describes as ‘the desire to stick out of nature with a towering majesty’ (1973, p.26). The self ’s orientation towards meaning therefore needs purposeful activities to create a comprehensible sense of who one is or wishes to be or identify as. For any refugee person whose life and meaning structures consequently are arrested, the only data that may be fed back to their sense of identity is the label of ‘refugee’ itself – a label symbolising the self as inhuman or victim. As van der Kolk (2014) argues, suffering people often suffer more and are alienated from their inner sense of self when defined by labels, as they are considered a ‘patient rather than a participant in [their] healing process’ (p.38). In our next counselling session, I asked Kristofer what he associated with the term ‘refugee’, to which he replied: ‘Weak and damaged, but everything that the media tells you I am, I am not. But I have nothing apart from my name now, and all I know is refugee. I am not sure what to believe anymore.’ What was happening to Kristofer seemed to me a descent into uncertainty, which can often be understood from the psychological perspective as a dissociative reaction to past traumas or current external stressors. In such circumstances, the medical-model approach to refugee therapeutic care can often assign to these clients the diagnosis of PTSD – a trauma identity signifying suffering beyond the victimhood label. Yet, from an existential perspective, it can be legitimately argued that confusion about one’s sense of self is a normal response to limitations around freedom of choice in fundamental areas (employment, education, housing and funding), as barriers between identifying meaningful activities and subsequently engaging with them are indeed apparent. The existential-phenomenologically orientated therapist is thus able to comprehend this dimension of a refugee’s experience beyond psychologists, whose motivation is to devise a more technical therapy based on psychological theories of the self (van Kaam, 1969). This is because they are interested in suspending psychological theory and aim instead to situate the therapeutic process within the personal life of the client. As the socialcultural environment evidently contributed towards how Kristofer organised his understanding of self, psychology must remain mindful not to add to the trauma narrative by only assigning Kristofer, and his fellow refugees, to clustered sets of symptoms in its formulations and treatment approaches.

Towards the re-emergence of meaning Leave death nothing but a burned-out castle. (Kazantzakis, 1952, p.87)

Some Western existentialists historically perceive that human beings need to assert their own meaning in life when thrown into an existence not of their own choosing or design (Sweep, 2016). However, using the aforementioned phenomenological principles, I have often found that non-Western refugees regard religion as

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fundamental to their belief systems and meaning structures, considering God to be the creator of the world and their religion as providing their ethics and guide to purpose in life and the activities worth pursuing. When life and its inherent meaning become arrested, and in turn self-identity is called into question, the task of the therapist may be to become more active in therapy, in order to consider the ways in which a more enlarged sense of self and meaning may re-emerge. Understanding Donkor’s circumstances of his forced displacement to find safety allowed me to further appreciate how he felt robbed of intrinsic meaning in his life. Specifically, he described that he could not participate in political events, demonstrations or activities on behalf of other people’s rights. These activities were so crucial to his existence that, in the fifth counselling session, he began expressing their existential significance. For Donkor, actualising God’s purpose for him, standing alongside his comrades, was meaningful and he wanted nothing more than to prepare physically and mentally to continue in these causes: Donkor: I wish I was strong enough to go back and fight for my people’s rights. God gave me these attributes to serve and protect them, so it’s very important for me to be ready again to do this, to stand by my brothers and go back to this mission. Benjamin: So, it sounds really important for you to use the skills and gifts God gave you to support your brothers and people back home. But home is now dangerous for you to return to under the current government structure? Donkor: Yes, it isn’t safe for me there, but I just cannot do anything. Benjamin: I’m actually thinking – well, wondering – what consequences you feel there have been for you doing these important things? Donkor: I have been shot at and sent to prison, and my mind is not strong like it used to be. I feel like I’m constantly on waves where I feel ready to go then suddenly come crashing down again. I’m always tired, as I can’t sleep, and my body often is in pain. Benjamin: I’m hearing how courageous you have been and how much resilience you have got to endure these painful consequences. And you have given so much of yourself to doing what is important and meaningful to you, even one hundred times of yourself doing what is really significant in your life. I just wonder if there are other ways that you can still apply your God-given attributes and contribute without such sacrifices to your mind and body? Arguably, a therapist’s place may not be to dismantle a client’s systems of meaning and beliefs, but instead to respect any differences in these areas and harness those of the client in order to help them re-emerge. Frankl (1959/2004), for example, asserted that a therapist has ‘no objections to making use of the therapeutic effect of his [client’s] religious convictions and thereby drawing upon his spiritual resources’

Benjamin Mark Butler

(p.122). In the next sessions, Donkor reported that he had again begun writing and having social discussions at his local church with peers, which he reported was a reprieve from his sense of boredom and meaninglessness. Furthermore, he also said that he was beginning to feel capable of doing something, as opposed to reducing himself to the narrative, ‘I cannot do anything’. This small attitudinal shift towards his circumstances suggested a radical shift in his sense of self; he was recommencing to see himself as someone who was able to withstand hardship and continue to contribute, despite his existence eclipsed by uncertainty. Similarly, when Kristopher spoke of the importance of God and prayers in his life, we looked together for a church community in his local area. He was thus once more about to find a worthwhile activity that added meaning to his life that met his needs for a sense of community and belonging too.

Conclusion This chapter has proposed that existential-phenomenological approaches to working with refugee clients can help the therapist develop a broader understanding of important issues beyond victim and trauma narratives, and that the re-emergence of meaning may be a contributing factor to safeguarding against uncertainty about self-identity. Although trauma cannot be dismissed, existential meaning is here considered to be a pivotal factor in helping refugees establish a deeper sense of self, wellbeing and belonging. In conclusion, I would argue that healthcare professionals should acknowledge the importance of the existential dimensions of meaning and purpose when working with refugee clients.

References Adams, M. (2013). A concise introduction to existential counselling. Sage Publications. Arnold-Baker, C. & van Deruzen, E. (2008). Existential psychotherapy: Philosophy and practice. In K. Jordan (Ed.), The quick theory reference guide: A resource for expert and novice mental health professionals (pp.47–62). Nova Science. Basma, D. & Gibbons, M.M. (2016). The anguish of freedom: Using an existential approach with Arab immigrants. Journal of Humanistic Counselling, 55(2), 151–162. Becker, E. (1973). The denial of death. Macmillan Publishers. Camus, A. (1942/2018). The myth of Sisyphus. Penguin Random House. Chouliaraki, L. & Zaborowski, R. (2017). Voice and community in the refugee crisis: A content analysis of news coverage in eight European countries. International Communication Gazette, 79(6– 7), 613–635. Cilia La Corte, P. & Jalonen, A. (2018). A practical guide to therapeutic work with asylum seekers and refugees. Jessica Kingsley Publishers.

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Cooper, M. (2003). Existential therapies. Sage Publications. Cooper, M. (2015). Existential psychotherapy and counselling: Contributions to a pluralistic practice. Sage Publications. Dante, C. (1472/2013). Inferno. Penguin Books. Esses, V.M., Medianu, S. & Lawson, A.S. (2013). Uncertainty, threat and the role of the media in promoting the dehumanization of immigrants and refugees. Journal of Social Issues, 69(3), 518–536. Frankl, V.E. (1959/2004). Man’s search for meaning. Rider Books. Frankl, V.E. (2010). The feeling of meaninglessness: A challenge to psychotherapy and philosophy. Marquette University Press. Ghazal, A.N. (2019). Biased neutrality: The symbolic construction of the Syrian refugee in the New York Times. Critical Studies in Media Communication, 36(4), 357–375. Griffin, J. & Tyrrell, I. (2003). Human givens: A new approach to emotional health and clear thinking. Human Givens Publishing. Haslam, N., Loughnan, S. & Kashima, Y. (2008). Attributing and denying humanness to others. European Review of Social Psychology, 19, 55–85. Hoffman, L., Yang, M. & Kakalauskas, F.J. (2009). Existential psychology East-West. University of the Rockies Press. Kazantzakis, N. (1952). Zorba the Greek. Bruno Cassirer Ltd. Keshen, A. (2006). A new look at existential psychotherapy. American Journal of Psychotherapy, 60(3), 285–298. Kinzie J.D. (1978). Lessons from cross-cultural psychotherapy. American Journal of Psychotherapy, 32(4), 510–520. Lodge, D. (1996). Therapy. Penguin Books. Malkin, B. (2016, September 20). Donald Trump Jr compares Syrian refugees to poisoned skittles. The Guardian. www.theguardian.com/us-news/2016/sep/20/donald-trump-jnr-compares-refugees -poisoned-skittles-twitter-reacted Maslow, A. (1966). Comments on Dr. Frankl’s paper. Journal of Humanistic Psychology, 6(2), 107– 112. Moodley, R. & Walcott, R. (2010). Counselling across and beyond cultures. University of Toronto Press. Owen, I.R. (1994). Introducing an existential phenomenological approach. Part 2 – theory and practice. Counselling Psychology Quarterly, 7(4), 347–359. Pupavac, V. (2008). Refugee advocacy: Traumatic representations and political disenchantment. Government and Opposition, 43(2), 270–292. Raynar, M. & Vitali, D. (2014). CORE Blimey! Existential therapy scores GOALS! Existential Analysis, 25(2), 296–312. Saramago, J. (1999). The tale of the unknown island. Harvill Press. Smets, K., Mazzocchetti, J., Gerstmans, L. & Mostmans, L. (2017). Beyond victimhood: Reflecting on migrant-victim representations with Afghan, Iraqi, and Syrian asylum seekers and refugees in Belgium. In L. d’Haenens, W. Joris & F. Heinderyckx (Eds.), Images of immigrants and refugees in Western Europe (pp.117–197). Leuven University Press. Spinelli, E. (2007). Practising existential psychotherapy: The relational world. Sage Publications. Sweep, T.G. (2016). Accommodating thrown-being in the world. Unpublished doctoral dissertation. University of Queensland.

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van der Kolk, B. (2014). The body keeps the score: Mind, brain and body in the transformation of trauma. Penguin Books. van der Veer, G. (1998). Counselling and therapy with refugees and victims of trauma (2nd ed.). John Wiley & Sons. van Deurzen, E. (2002). Existential counselling and psychotherapy in practice (2nd ed). Sage Publications. van Deurzen, E. (2012). Existential counselling and psychotherapy in practice (3rd ed.). Sage Publications. van Kaam, A. (1969). Existential foundations of psychology: A bold re-evaluation of contemporary psychology. Image Books. Vontress, C.E. (1979). Crosscultural counselling: An existential approach. The Personal and Guidance Journal, 58, 117–122. Vos, J., Craig, M. & Cooper, M. (2015). Existential therapies: A meta-analysis of their effects on psychological outcomes. Journal of Consulting and Clinical Psychology, 83(1), 115–128. Wright, T. (2002). Moving images: The media representation of refugees. Visual Studies, 17(1), 53–66. Yalom, I. (1980). Existential psychotherapy. Basic Books.

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Who is transforming what? Ideas and reflections on training, practice and supervision in radical mode Carmen Joanne Ablack

An increasingly obvious known is the depth and complexity that arises when exploring relational, power and authority dynamics in the therapy room, in therapy and allied professional trainings and in supervision. Continuous reflective study is necessary in order to be working towards recurrently developing good practice and better emotional and psychological health. A question is begged in this: who is responsible for transforming what, exactly? In this chapter, using experience and learning from more than 30 years of practice, supervising and teaching, I unearth my current ideas and reflections on training, practice and supervision, in a radical mode. Supporting this digging and examining with vignettes and with reference to some of the literature, I try to answer, at least in part, this question. Any answers, like our work, are open-ended and subject to development through experiencing, reflecting and renewing our practice, be it as therapists, trainers, supervisors, researchers in the field or those responsible for leadership of the professions. All non-autobiographical vignettes are based deliberately on snippets of conversations and related examples and are developed from my supervision and training experiences. None presented here arise from work with a specific individual’s story. We are all responsible for the ongoing transforming needed. Perhaps it is in the form of depth of acceptance and coming to terms with doing something about limitations in our thinking and practice; perhaps it is in creating sounder structures that invite, embrace and support the challenging of insular and unaware ‘sacred cows’. I suggest we are all responsible for ensuring both, demanding nothing less from ourselves, each other and, vitally, from our various institutions and practice settings. If not, the ‘serious (philosophic, practice, moral and ethical) negligence’ referred to by Lago and Charura (2019), in their letter of invitation to contributors to this book, not only remains but also becomes increasingly and dangerously further embedded.

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McKenzie-Mavinga (2016), citing a Sainsbury Centre for Mental Health review from 2002, reminds us of an absence when it comes to ‘accounting for the historical and sociocultural context of situations’ in relation to Black clients, service users and others. My experience is that this is equally true in training, CPD, supervision, conference and workshop situations for Black-identified professionals, trainees and clients, and also for others who are seen as ‘not the majority’. (This ‘majority/ minority’ question comes up later in the autobiographical vignette.) Equally, I think leaps of understanding are needed in order to appreciate the ‘multidimensional oppressions such as homophobia, sexism, ableism, and cultural taboos’ in the ‘development of intersecting identities’ (McKenzie-Mavinga, 2016, p.50). This integration of understanding allows a working through of the challenges and obstacles of racism and, by implication, a working through the challenges of all other oppressive dynamics and practices in relation to the multiplicity of identities that apply in specific situations and contexts. The first vignette, Claudine’s story, below is a start to the exploration offered in this chapter.

Claudine Claudine had been seeing a white, straight, woman counsellor for a couple of years after the break-up of her marriage. At age 40, Claudine felt that she needed to look again at who she was and how she would approach the rest of her life. Claudine had good established friendships in her community. A tall, dark-skinned, Black British woman, she had questioned her sexuality and come to realise she was not sure about it, or even about her gender identity. When she found the courage to disclose these thoughts for the first time, her counsellor responded, ‘I’ve never heard of a Black woman your age doing this.’ She paused and then added, ‘How do you think your community will react?’ Claudine more or less shut down at this point, said she didn’t really know and then said she needed to leave early and would see her counsellor next week. Claudine got up and left the session and did not go back. This example helps us to explore several things that are vital in good therapeutic work: •

to appreciate and acknowledge how complex one communication from a client can be

•

to recognise and develop the ability to not use generalisations in our work

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to recognise and practise the ability to not ask questions but rather encourage exploration, especially when faced with an area that we are uncomfortable and /or unfamiliar with

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to develop the capacity to simply state when we are in territory that is new for us and to be transparent about this, with and in the interest of the client.

In terms of good practice, Claudine’s disclosure required a sensitive and nuanced response from the counsellor; one that stayed with the client’s experience in the

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moment of telling her counsellor something new about herself. The first words in response to Claudine were what the counsellor had heard of, or not heard of – this is a common reactive mistake by practitioners, as well as trainee therapists, when faced with something out of their experience: to speak from their experience or from their lack of experience. In making the focus their own experience or their limitation of experience, they are not staying with the moment for the client, even when they ‘know’ to do otherwise. Practitioners can, through good reflective practice and supervision, come to realise how often what we ‘know’ and what we ‘do’ are not the same. I am aware of what is taught about staying with the client’s experience across different modality approaches. However, the vignette is an accurate reflection of what can often come into my practice room from the work of trainees and supervisees, where reactive responses, sometimes masked in the language of therapy or the therapist’s position, are substituted for actual being with what is happening in the room, in the moment. We can speculate that the counsellor had become comfortable with seeing Claudine, maybe thinking she already knew the client’s issues after a couple of years of working with her. The disclosure may have been a surprise or may have been something she had, somehow, out of awareness, not welcomed in the room. When the counsellor says ‘… a Black woman, your age, doing this…’, this is both a generalisation about Black women and also a change of focus from the client’s ‘personal experience’ of questioning herself to a blander comment to the client about ‘Black women her age’. The client becomes much less visible in this exchange. From a supervision viewpoint, some key words for me in starting to explore what happened and what can be learned would be ‘I’ve never heard of…’ By encouraging the supervisee to notice they started with what they have heard/not heard of, it can allow them to recognise, take ownership of and make meaning out of their ‘delegitimising’ of the client’s experiencing of herself. It also draws attention to where the therapist puts their focus. This can often become an unconscious and unexplored power and authority issue between the therapist and their client. In choosing ‘I’ve never heard of…’ as my invitation to the therapist to explore in supervision with me, I am attempting to model staying with the supervisee’s actions, thought processes and behaviours. I am not giving a reactive response that brings the attention to me. Some questions and thoughts I might offer as part of the reflecting on the processes at play are: •

What does the therapist get from doing this, in this way?

•

What is deflected or avoided in the response and the quickness of the response?

•

How does the therapist understand their reaction? Not in the context of their own story – although this may have relevance; rather, in the context of how this has impacted the therapeutic space between therapist and client.

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•

What is the nature of the power dynamics underlying how the counsellor ‘holds’ the therapy space?

Reflection on the therapist’s understanding in relation to their own story might also be called for. However the key point here is the client’s experience with the therapist as the exchange happens and the consequent impact on their relationship. What the above leads me to is a question I believe is vital for us all as practitioners: Are we willing to deconstruct ourselves and thus make the possibility of ongoing repeated reconstruction a way of working in future? In the vignette, ‘I’ve never heard of…’ becomes an out-of-awareness benchmark of ‘normality’ in the exchange, implying somehow that what the client says is less valid simply because the counsellor (psychotherapist, psychologist, psychiatrist, trainer, service manager, trustee) has ‘not heard of it’. There is an important reality to add here that is perhaps more difficult to face: the experience of people from ‘different’ groups of being made less visible also occurs for the ‘different’ therapist, supervisor, manager and trustee. It happens when the client, supervisee, trainee, staff member, other trustees and so forth seem unaware of acting and speaking from their place of privilege. Earlier, I stated, ‘This can often become an unconscious and unexplored power and authority issue between the therapist and their client.’ I have had British-born and/or Britishraised supervisees tell me of incidents where a client (usually white and educated) ‘corrected’ their pronunciation of a word or offered a ‘class’-based test, such as ‘Well, as you know…’ followed by some quote in Latin, or exclaimed, ‘You haven’t read/seen/…?!’ They take a normative that relates more readily to their background and apply it ‘as if ’ all should know or have experienced the same. This sub-textual ‘putting in place’ happens also between therapists and other professionals on email listings and in other forums.

Hogarth, who he? A couple of decades ago, at a meeting of psychotherapists, therapist A publicly humiliated therapist B by drawing attention to a perceived lack of knowledge about the arts. B had just admitted that they did not who Hogarth was; they did not get the analogy that A had made to Hogarth’s work, and said this, seeking an explanation and also learning. However, therapist A instead glanced around the room and, with a shake of the head, said ‘Unbelievable’. This was a deeply humiliating experience for therapist B. The other aspect relevant to our understanding here is that no one else named what had happened, in the moment or afterwards with B. There seemed to be no understanding that Hogarth was not a figure that all cultural groups would use as a reference point; no appreciation that not everyone is educated in such a way as to know a specific cultural art-history reference. The same observation can apply equally to words or quotations, or languages themselves (assumptions that everyone has learned/ speaks/reads a second language, for example). By culture here, I could be talking about class, education, heritage group and so forth. The humiliation experienced

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by B and the failure by the rest of the participants in the meeting to tune into the potential class and cultural humiliation is an example of microaggression through absence of awareness and action. This absence of reflective practice and reparative action is another way in which oppression becomes a sub-textual behaviour and effect. In essence, it silences through humiliation and emphasis on difference as wrong, making one way of being, knowing and experiencing as somehow more superior to another. By the way, I know who Hogarth is now!

Some lessons from sitting in my dad’s office I remember, I was about 16 years old, sitting in my dad’s office after school. My dad responded to a question from me after one of his junior staff members mispronounced the word ‘archipelago’ when speaking with him in front of me. Once the person had left the room, I checked what I thought was the correct pronunciation. I think I was worried I had it wrong! My Dad said, ‘You know what his using that word and saying it not quite correctly tells me? It tells me he is probably taking time to read and learn new ideas and words. Perhaps he has never had a chance to learn how to say it correctly because he has not heard it said out loud.’ Then he added, ‘I’ll tell him when it is just the two of us, and I can ask him about what he has been reading and we’ll have a discussion.’ I have never forgotten the lessons and thoughtfulness behind my dad’s words. It also taught me the importance of being interested in those you have some responsibility for, and not assuming you know. As I reminisce on this incident, recalling the walls of the room, the sheen and polish of the furniture, I also remember the smile of support my dad gave this member of staff and then my dad’s clarity as he made his points to me. What I take today from this is my dad’s attention to the specific situation and context of the individual in question (Wollants, 2012), and also how he handled my question, speaking in such a way as to help me understand, and so, in a sense, his attention to my context as a 16-year-old. This brings me to the importance of why we adjust what we do to meet the client. It also reminds me why I know taking the ‘same’ approach and frame to everyone is so unhelpful. My dad was giving thought to what would support the other person. This one small incident shows us how important support for meaning and understanding from the experience of the other, in their terms, matters. We cannot ‘formulate’ what this needs to be. As I think about my younger self and how this experience with my dad stays with me today, with a deepened, newer meaning for me, I am clear it was and remains an embodied-relational exchange (Totton, 2015). The past in the present always has new meaning; it is so much more than thinking and behaviour adaptation.

Some thoughts on intellectual shaming Thinking about all the different examples above, it is clear we as practitioners are not immune to ‘intellectual’ shaming. It happens far more often than is

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acknowledged. These kinds of exchanges are not confined to the therapy room alone; they are relevant for training, supervision and organisational contexts, where reactive mistakes are also commonly made. This ‘delegitimising’ of experience, this implied hierarchy, happens at all levels and in all sectors and contexts in our professions and is something we each have a responsibility to understand, explore and regularly look for in our work. I want to acknowledge how important this is when considering another aspect of difference and identity processes: namely, working with neurodiverse clients and those with intellectual disability. Corbett (2015), in his chapter on ‘The politics of intelligence: Working with intellectual disability’, helps us to understand something about ourselves as therapists and the tendency to ‘avoid engaging with patients with disabilities’ (p.23). His discourse helpfully focuses on the therapist and patient, on contexts and situations and the considerations, challenges and learning that are needed by us. Having thought about Corbett’s chapter for a few years, I am these days paying attention to trainees who wish to have their neurodiversity acknowledged and understood as an equally valid part of the learning community. Corbett brings to the fore our lack of training to bring an open, systemic and existential understanding to our work across client groups. For brevity of space, I simply reiterate that his observations and ideas are equally applicable to all contexts in our profession, not just the client-therapist context. The taking of our own world viewpoints/experiences and applying them to the context and situation of the client as if they apply is the mistake to be learned from Claudine’s experience, and this is also emphasised in Corbett’s (2015) chapter. This is, in my opinion, an abuse of power in the moment, albeit unintentional; the intentionality does not change the effect it has on the client and on the therapy process. With Claudine, we see the impact of this in her shutting down and leaving. We also see in her leaving that good-enough trust has not been established in the relationship. Trust is an active process and is not a ‘thing’ that gets established and then can be assumed to be in place. Trust processes in the relationship also must be available for deconstruction and reconstruction as an ongoing process in the work with the client. We must explore these difficult passages in our communications with clients, colleagues, students, supervisees and members of the public in great detail in our therapy, supervision, conferences and other discussion spaces. We have to become willing ‘deconstructors/reconstructors’ as a matter of course in our work, deconstructing what we ‘know’, what we ‘think we know’ and ‘what we do’ in order to self-support our personal professional development in the moment and beyond the moment. A leap of understanding comes in embracing and digesting the vital role that differences between the client and the therapist have on the very fabric of the relationship. Beyond digestion is a willingness to explore our own deconstruction and that of the relationship with the client in such a way that the client is able to see our vulnerability, without our guilt or self-pity thrown into the mix. This is hard

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and sometimes emotionally painful. I am calling for a more radical approach to understanding and actioning in the room and in the relationship overall. It is a willingness to embrace and understand the client’s experience of us and to not shy away from owning and exploring when we have diminished or made more invisible the other person(s). In doing this we do not use theory to ‘explain’ or to hide behind. If anything, it requires us to acknowledge that theoretical frames, as taught and practised, are often inadequate to hold the actuality of the client’s experience in the room and in life. While we can and must acknowledge the two-dimensional nature of theory as useful in exploring and understanding, we also need to acknowledge that theory is not more legitimate or effective than the actual unfolding of understanding that emerges from the person-to-person exchanges experienced in the room and reflected on together and afterwards.

Revisiting Claudine’s session This time, I imagine a different and longer exchange. I offer it as a possibility for differentiated experiencing and meaning-making. The words used below are not meant to tell the reader ‘This is how you say it’. The ideas and intentions behind the words, the attention to the moments, are what is important in the re-imagining. Here, I am looking to show reflectively informed interventions and concepts. In this re-imagining, I attempt to show how a more reflective response, and one that is not attached to the therapist’s own experience, could have a very different effect. What is offered below hopefully simply encourages you to think about what you would say in similar circumstance and how else you might respond to your client and your client’s disclosures.

Claudine’s story – version two When Claudine found the courage to disclose these thoughts for the first time to her (straight) counsellor, the counsellor (after breathing and taking in the client and herself in the moment as she spoke) responded: Therapist: You are not sure about your sexuality, and you are not sure about your sexual identity (breath)… Notice how it is for you to say this to me here, today… Claudine: Um… It’s strange… I have not told anybody else this… I mean, I haven’t been sure I could tell you… Therapist: You weren’t sure you could tell me? Say more… if you want… Claudine: I… look, we haven’t talked much about you… about how you are different to me… like I said, it’s strange… Therapist (after breathing and settling in own body): Well, what you have just said is my experience also (offers gap for client response, then continues)… We have

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not talked here about how I am different to you… (offers gap for client response, then goes on). I am realising I have never asked you directly what it is like for you to have me as your counsellor… It sounds like it has had an effect on you (pauses)… and has somehow stopped you telling more about what goes on for you… (Therapist maintains some eye contact for moments while saying the above, and again allows the client space to take in her words. She does not ask questions of the client.) Not asking questions of the client at this point is crucial; the therapist needs to stay with the client and allow her space to respond. This allows the client to know that this is a relational exchange and that the therapist welcomes her questioning and is giving it her full consideration. It potentially can rebalance some of the power dynamics always at play in the therapy room. Therapist: (after a moment of conscious breathing): I notice I want to say a bit more about our differences… Is that okay for you? Claudine: Well, it is the elephant, isn’t it (laughs a little). Therapist: Yes, it is the elephant in the room between us (smiles). Um… I am noticing my regret that I did not do this with you before now… (allows space for client to hear her words) … So now, I am naming my whiteness, your Blackness…. my straightness and your questioning of your sexuality… (waits for the client to choose what she wishes to respond to). Note the therapist is consciously trying to not set the agenda here. She is staying with the client’s interest. Claudine: Oh… well… You named you’re white and straight… and I feel… I feel like this is the beginning… Therapist: The beginning? The beginning for us (therapist clarifies her understanding)? Claudine: Yes… like we are beginning now… everything we did before was important… but this feels like now we start with each other for real. Therapist: Now we start for real with each other… and I am discovering something here with you that matters in our relationship… I want to do this here with you… Claudine: So, have you ever said you are straight to a client before? I mean, is that new for you? Therapist (deep steadying breath): I will answer your question… and I want to ask you how this matters right now for you… and I will answer in a moment. Claudine: Umm… I think it tells me if you are being real here with me…

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Therapist: I’m doing my best to be that… (pause). Yes, it is the first time I have told a client I am straight… or, as I think about the questions you brought, I’d like to say to you now that straight is how I identify… (silence for a while). The therapist tries to capture the essence of what the client has brought by correcting to ‘straight is how I identify’. In using these words, the therapist makes a clearer statement and also reflects her awareness of identity as a process. Therapist: Would you share what you are noticing… right now? Claudine (big breath): I’m realising how much not knowing about you has really stopped me from trusting you… not all the time, but how there are parts of me I thought you can’t get… umm. I think I am more wary here than I had realised… and I am thinking about this… (silence for a while). Therapist: Maybe what we do today allows something to emerge… that has some meaning around how we handle difference here… (silence for a while)… I have things to reflect on and you have things to reflect on… I suggest we can each see what emerges between now and next time we meet… How does that sound for you? Claudine: I can agree to that… I need time to digest… I’ll be here next week. Therapist: Okay, and I agree to do some digesting also… I’ll see you next week. In this version, the therapist is staying with the emergent present experiencing in the room, and not trying to ‘make sense’ in the moment. Trying to make sense can mean the client experiences us as not present enough or they pick up on a kind of scrutiny that can feel objectifying. The reflective scrutiny involving checking speculations and making links to possible aspects of theory for insight is often more suited to a post-session reflecting and to supervision. We may use specific terms, unpacking them to help clients and ourselves understand what is emerging; this use of therapy language is kept to the minimum, ideally. The presence of the person of the therapist is key to being with the emergent intercultural (whole being in context), and to the dialogic nature (here-and-now sensing and naming) that is needed when exploring identity and identity processes. I am highlighting here a looking beyond the original meaning of psychotherapy theories while honouring their origins and finding new, more inclusive meanings, both within and without the core theoretical models, that can become part of our ongoing reconstructive processes. Our therapist says to Claudine, ‘I am discovering something here with you that matters in our relationship… I want to do this here with you.’ Similar words naming the therapist’s commitment are important in establishing a human-tohuman connection. They say, ‘I am taking time to notice how I am, so I can be here with you more fully.’

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Something reparative is then reiterated in the comment, ‘I have things to reflect on and you have things to reflect on,’ which allows a re-contracting between client and therapist to happen. One major point to note is the client has space and time to reflect on what she wants to bring to the dialogue. When faced with something uncomfortable or brought into our awareness by a client, we may defensively fall into a habit of asking questions, as an unconscious act of ‘taking charge’ again. When clients point out our lack of awareness, inadequate training or lack of ability to be with them in a fullness of presence, we can act from a resentful, shamed and/or offended place. When this involves issues of identity, the action-reaction dynamic gets amplified. Finding ways of owning this amplification with the client is part of the work.

Supervision spaces Our supervision spaces need to offer opportunities where we can, together, critically reflect on and work through ‘the impact of racism and recognition trauma on the intersubjective space and relational process’ (McKenzie-Mavinga, 2016, p.182). This means supervisors must be trained and practised in understanding and working with these dynamics. It also means we need supervisors who have a depth of understanding of their own habits of reactive responding and what these mean in terms of their behaviours, actions and beliefs. The recognition of fears, anxieties and challenges as we become aware of what we are engaged in and the pain of the wounding these explorations bring to light need specific processing, enabling ‘progress from fear to transformation’ (McKenzie-Mavinga, 2009, p.2). This progress from our own fearfulness as we face our habitual and embedded reactivity in light of challenges can only happen across the professions when psychology, psychiatry, counselling and psychotherapy trainings and their professional organisations and the allied supervision trainings and organisations are attending to differentiated needs. They can only happen where the deconstructing of long-held paradigms and fostering of reconstruction into processes of understanding and actions happens as a matter of regular practice. Our task becomes the critical evaluation of our own position and our full engagement with being critically evaluated in our own position. This goes beyond taking responsibility for dialogue; it speaks to the very heart of what is being offered and why. It requires radical reconstructive processes and active and willing engagement across the professions, with those who are not currently represented placed at the very heart and soul of all our efforts.

Recognising the role of intersectional understanding Identity and identity processes are deeply complex. Intersectionality plays a vital role in understanding this complexity and is an important part of any deconstructivereconstructive dialogue. We need to explore and discover with our clients the ascriptions, formations, attachments and disavowals that they have experienced in their socio-cultural and other identifications and bring our fullness of attention to how we are part of such processes.

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Coming back to Claudine for the moment, her age, gender and community are named, as is her racial identity as a Black person, in the original response from the counsellor. We can ask the following paired questions to start to look at experienced intersectional processes of discrimination: •

What is ascribed to the client at this point?

•

What effect does this have on the client and what might happen with how she may ascribe to herself (what might she swallow whole from the experience)?

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How does the therapist ‘form’ or hold the client in their mind in this moment (what is the therapist revealing)?

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How does the client experience being ‘formed’ or held in mind by the therapist (what does the revelation do to the client)?

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What are the assumptions made by the therapist about how the relationship with their client is working in the moment, and also over the period of working thus far?

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What happens to any sense of attachment and safety the client may have developed, both in the therapy and in the reflected experience of the wider world?

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How is the therapist denying the relationship and who the client is at this point?

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How is the client experiencing this denial (how might the client make sense of this, in light of already experienced intersectional processes of discrimination)?

By intersectionality, I am referring to the experiences of what happens when our multiple identifying processes overlap and are not properly attended to. This overlap can then be operationalised into systemic discrimination and biases. The operation of systemic discrimination, bias (unconscious or otherwise) and marginalisation happens through (the acting from) privileges, prejudices, fears and other processes of enacted abuse of power and authority positions. This enacted abuse can be experienced by individuals, groups, communities and societies. These paired questions above and the other discussion points made in this article offer, I hope, some direction in terms of the kind of deconstructive analysis needed. I urge those reading this to come up with many more questions and ideas about what is needed in your own work, in your words. I believe we all can identify the support we need and make use of it in developing ongoing deconstructionreconstruction narratives for ourselves.

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References Corbett, A. (2015). The politics of intelligence: working with intellectual disability. In Warnecke, T. (Ed.), The psyche in the modern world (pp.23–41). Karnac. Lago, C. & Charura, D. (2019, March 2). Personal communication (Letter of invitation to the contributors to this book). McKenzie-Mavinga, I. (2009). Black issues in the therapeutic process. Palgrave. McKenzie-Mavinga, I. (2016). The challenge of racism in therapeutic practice: Engaging with oppression in practice and supervision. Palgrave. Totton, N. (2015). Embodied relating. Karnac. Wollants, G. (2012). Gestalt therapy: Therapy of the situation. Sage.

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Negotiating the Faustian pact: A psycho-social approach to working with mixed-race people Yvon Guest

There is very little literature on the experience of mixed-race people in the UK, although they are becoming the fastest-growing minority group in the UK, and the largest. Although both Black and white communities tend to assign mixedrace individuals with African or African-Caribbean ancestry – a Black identity – there is evidence that we see ourselves as a distinct intermediary group (Olyedemi, 2013). Sixty years on from Enoch Powell’s ‘Rivers of Blood’ speech, and now in the aftermath of Brexit, race relations are increasingly fraught. The furore from white nationalists and some sections of the media over Prince Harry’s marriage to Meghan Markle, a mixed-race woman, led to the imprisonment of one young man for calling for Harry’s death as a punishment for being a ‘race traitor’. When social scientists attempt to understand race, they end up privileging either the external world or the internal world. By bringing psychoanalytic and sociological thinking together, as advocated by Hollway and Jefferson (2000), I aim to capture what happens in terms of unconscious intersubjectivity (inner-outer world traffic): that is, what travels from the mind of an individual to the outside world, and vice versa, between mixed-race individuals and their external world, via their interactions with the Black and the white communities. My objective here is to illustrate how traumatising it can be for mixed-race people to have to navigate environments that can coerce them into choosing one racial group over another, while feeling they don’t belong truly to either.

A word about ‘mixed-race’ I will take a moment here to explain why I am using the term ‘mixed-race’. This is multi-layered. I concur with Ifekwunigwe (1999) that race is not a biological fact; we are all, regardless of colour, part of one large gene pool. Race is a social construct, devised by white colonialists, which creates artificial divisions. Heritage is preferred by many because heritage is about ancestry rather than race, and in

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theory less divisive. However, using the term dual-heritage is problematic. Some people have multiple strands of ancestry: for example, South Asian, African and European. To resolve this dilemma, Ifekwunigwe (1999) advocates the use of the word Métis,1 which originates from Canada, to describe people of mixed indigenous and European ancestry. I view the real problem here as the limitations of language. I could call myself Métis, or dual-heritage. However, if someone abuses me because of the colour of my skin, that person will be perceived as racist. If I am discriminated against in an employment scenario or while accessing public services, there will be an investigation into institutional racism. On a personal level, as a child, I was labelled half caste, or coloured. Around my teens, this changed to Black, then to mixedrace; much later in life, I became dual-heritage or biracial. I feel comfortable with mixed-race. In this, I follow Olyedemi (2013), who holds that, regardless of whether we use the concept of race, culture or heritage, it always comes down to white being seen as superior (Olyedemi, 2013).

The background to this chapter According to Davids (2011), psychoanalytic models are silent about racism because they omit the social, while social scientists construe racism in a way that leaves out the workings of the mind. For Davids, racism exists in the world and in the mind: The racist element runs outside of, and parallel to, ordinary conscious discourse – that is why our inquiry must be psychoanalytic rather than psychological. (Davids, 2011, p.7)

Before undertaking a PhD, I perceived the individual (internal world) and the environment (external world) as separate entities. For my doctoral thesis, I applied a psychosocial approach to integrate psychoanalytic and sociological thinking in seeking to understand trauma and resilience in adults who had experienced being in care as children. This enabled me to explore ways in which individuals interact with their environment and vice versa. I was able to capture some of the intersubjectivity or ‘inner-outer world traffic’ (Hollway & Jefferson, 2000), including the psychodynamic (unconscious) working of the mind. Since I resumed my clinical practice, an ever-increasing number of mixed-race people (predominantly of European and African or African-Caribbean heritage) have sought my help on issues around racial identity. I had only touched on trauma and resilience in mixed-race individuals in my thesis. I am mixed-race myself, and drawing on this new material from clients, my aim here is to contribute to our understanding of our lived experience. 1. The Métis are of mixed indigenous and European (primarily French) ancestry, living mostly in Canada, where they are one of the three recognised Aboriginal peoples, and in parts of the US. They have combined Native American and European cultural practices since at least the 17th century.

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Making use of conventional and new models of thinking I wanted to be able to understand how concepts such as ‘white is good’ and ‘Black is bad’ are applied to individuals and groups. I found a useful explanation to begin my exploration in Melanie Klein’s concept of splitting (1946). Splitting is something that we are all capable of; indeed, Klein sees the capacity to split as an essential part of development; a way of managing our powerful feelings of love and hate. We all have the tendency to think of some people as wholly good or wholly bad. Splitting becomes destructive when objects – other people or oneself – are seen as entirely good or entirely bad, not as whole people with the capacity to be both at various times and in varied circumstances. Having established an understanding of how ‘good’ and ‘bad’ are the result of splitting, I then needed to address the problem of why white and Black people believe that white is good and positive and Black is bad and inferior. I found a suitable, though partial, explanation within the concept of projective identification. This concept also originates in the work of Melanie Klein (1952/1975), who viewed projection as an unconscious defence mechanism used to expel uncomfortable thoughts and feelings: for instance, when someone is feeling inferior and projects those feelings of inferiority onto other individuals or other groups. Introjection occurs when someone takes inside them the views or attributions towards them of others, particularly those on whom that person depends or people who are significant to their sense of themselves. In the context of racism, a Black child may internalise characteristics of its parents or its community into its own persona: for example, a strong work ethic or being a good neighbour. Projective identification involves projection of something that is unacceptable to oneself onto another. That person then internalises those projected qualities, believes they are true and may even start to act in ways that fulfil them. So, for example, a Black or mixed-race child may internalise racist attitudes from the wider white community and come to see themself as bad, inferior or stupid. In other words, the other takes in and identifies with what is projected into them. So far, I had developed an understanding of the origins of splitting individuals and groups into ‘good’ and’ bad’ and the processes by which individuals and groups identify with the ‘good’ and ‘bad’. I didn’t want to leave it there because, in my exploration of inner-outer world traffic, I wanted to grasp how a traumatic experience like racism impacts on an individual. Franz Fanon was able to illustrate some of the inner-outer world traffic in the context of racism. He was the first to apply psychoanalytic thinking to explore the effect of colonialism on the psyche of the colonised. Fanon used the concept of projective identification developed by Klein (1952/1975) and then expanded it to illustrate what transpired when colonialists met darker-skinned ‘colonial subjects’. According to Fanon, before white people journeyed to the colonies, they were predisposed to a prejudice that anything black or dark, such as the night or dirt, was bad or negative. Therefore, they projected all that was savage and animal into the Black other and, by splitting this off , were able to maintain an idealised picture of the white colonist as ‘civilised’ and of superior intellect.

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Thus, behaviours such as unrestrained sexuality and indolence, which the white colonialists experienced as negative, immoral and shameful, were attributed to the Black populace. Fanon held that coming into contact with white colonialists left Black people with a ‘colonised mind’: the belief that to be white was to be good and to be Black was to be bad and inferior. Black people internalised racism from white people, via a process Fanon described as ‘epidermalisation’. Having identified with it, they then projected this inwards into their own dark skin and outwards onto other Black people (Fanon, 1967).

Colourism and shadism Two further linked concepts that I encounter in my work with individuals of mixed race (and also with Black clients) arising from the legacy of colonialism and the transatlantic slave trade are shadism and colourism. These describe discrimination based on the lightness or darkness of the shade of one’s skin. When white male plantation owners forced female slaves into sexual relations, they created a classification based on how light or dark the skin shade of the mixed-heritage offspring was. This established a type of caste system among slaves. The lighterskinned slaves were given roles working within the household, closer to the master (raised to a higher position by the whites). Darker-skinned slaves were allotted the more physically demanding field work, further from the master (cast into a lower position by the whites). In 2019, The Guardian newspaper ran a series of articles on colourism entitled ‘Shades of Black’. These described the discrimination that darker-skinned women encounter both from the Black and the white community, and how this either makes it difficult for them to establish lasting intimate relationships or makes them feel invisible. The film No Shade, written and directed by Clare Anyiam-Osigwe (2018), illustrates the impact of shadism on her and her friends growing up in the UK and how whiteness is seen as the global standard for beauty. Williams’ biography of Michael X (2008) explores the impact of the skin-based caste system on Michael and his Black Trinidadian mother. In order to capitalise on him having a white father, his mother discouraged Michael from playing with darker-skinned children and sent him to schools for white and lighter-skinned pupils. This book also offers a fascinating exploration of Michael’s struggle to find his place among the first-generation Windrush immigrants in the UK (Williams, 2008). So, although shadism and colourism originate from the language of the slave owner, these prejudices are still present in the white and Black community. Alice Walker, the novelist, is said to have coined the phrase ‘colourism’. She is convinced that, even if all the white people in the world disappeared, colourism would still exist in the Black community (Walker, 1983). This is an example of inner-outer world traffic between the white and Black communities and within the Black community. I contend that darker-skinned people in the Black community are just as deeply affected by the caste system based on skin shade or tone as mixedrace people, but for different reasons. My hope is that this will be explored further by my darker-skinned peers, as they have the direct lived experience.

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Miscegenation To be mixed-race is not just to be lighter in skin tone; it is also to be a product of miscegenation, or the production of offspring by people of different races. From studies of eugenics, geneticists have argued that inter-racial hatred is a natural mechanism of biology to ensure the races remain separate (Galton, 1883; Popenoe & Johnson, 1918). It has been argued that, if the races were to mix, then the ‘inferior’ Black races would gain but the (presumed superior) white races would lose (Provine, 1973). Ifekwunigwe, in her book Scattered Belongings (1999), explores the concepts of belonging and not belonging and being a stranger in two cultures. She holds that social inequality stemming from the artificial constructs of Blackness and whiteness, along with issues of gender and class, manifest in many forms of expression, from grief, rage and despair to resilience, resistance and innovation. In her autobiography Black, White and Jewish, Rebecca Walker (2001) writes about the impossibility of living in these three separate worlds in America. Hers is a searing, painful account of the lived experience of being born a product of miscegenation at a time when it was seen as making a political statement, and then navigating a childhood where the political ideology had changed.

Identity There is evidence that children who live in multicultural areas are more likely to identify as ‘intermediate’; by this they mean mixed-race, brown, coloured or ‘half and half ’ (Wilson, 1987; Tizard & Phoenix, 1993). Evidence from the UK 1991 national census shows that children of parents from differing races want to be recognised as a distinct group (Olyedemi, 2013). Racial identity in children is linked to the development of language. Social interaction leads to children feeling, consciously or unconsciously, a shared experience with some individuals but not with others. They are drawn to those they perceive as most like them (Hall, 1996; Woodward, 1997). The more that human beings feel accepted by those around them, the higher their self-esteem (Brewer & Brown, 1998; Erikson, 1968). Erikson (1968) posits that non-acceptance can lead to problems with identity, crisis and confusion, which initially come to the fore during adolescence. As individuals become conscious of their experience of the world and their interactions with others, psychological issues such as insecurity about who they are or what they want from life may emerge.

Making sense of it So far, I have outlined the problems between the races and some of the dilemmas faced by people of mixed race. How do I understand what happens as a result of those experiences? How do I and my clients make sense of them? Bion (1984) holds that, in the same way that we have the capacity to digest physical nourishment, we need to develop the capacity to digest (i.e. contain) our experience: to transform it

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into something that we can make sense of and grow from. Britton (1992) develops Bion’s thinking further in terms of what happens to experience that cannot be processed or digested. He suggests that it must go somewhere and proposes three possibilities: that it becomes embodied, enacted or projected. Embodied experience can produce psychosomatic symptoms and stress reactions. When we try to get rid of overwhelming experience through action, this can produce behaviours that may be construed as manic, antisocial or aggressive. But if we cannot digest the experience, we can project it on to others, reproducing cycles of oppression and victimisation. Cultural humility is a vital component of my work. According to Hook and colleagues, this is the ‘ability to maintain an interpersonal stance that is otheroriented (or open to the other) in relation to aspects of cultural identity that are most important to the client’ (Hook et al., 2016). If I find myself in the situation where the person sitting opposite me looks and sounds just like me, I am careful not to assume I know either their ethnicity or unique life experiences.

A psycho-social approach to race in the counselling room As outlined earlier, I view racism as traumatic because it is an experience that overwhelms the individual’s capacity to process, digest or contain it. The clients who come to see me are having difficulty processing traumatic experiences around their mixed-race identity. In terms of inner-outer world traffic, they are struggling to process both the racism that the white community projects onto them and the shadism and colourism projected from the Black community. All the mixed-race clients who I work with will, at some stage, have been coerced into a Faustian pact around their racial identity. This metaphor comes from European mythology. The core idea is that an individual enters into a bargain or pact in which they surrender something, knowingly or unknowingly, that is far more valuable than what they gain: for example, in the classic case of Dr Faust (Faustus), exchanging his soul for material gain. The mixed-race individuals I work with have been coerced into taking on the identity of whichever community they are raised in and forsaking the other, without understanding what is at stake. The majority are raised by white mothers, in a predominantly white world, with little input from their Black fathers. Clients endure the legacy of the situation that Benson (1981) initially described in the 1950s. This would have been when the early Windrush migrants were settling here. At that time there was great hostility towards interracial marriages between Black and white people. There was an assumption that the white women who typically entered into these relationships were already social outcasts, prostitutes, ex-prostitutes, women who had been rejected by their families for already having illegitimate offspring, poor women and those who were mentally abnormal or unstable (Benson, 1981). However, I have seen a few clients who were raised by a Black father or mother who has rejected their own Black heritage, often for complex reasons. These might include a wish to distance themselves from traumatic family dynamics or because, consciously or unconsciously, they believed that white is better than Black. They may also have begun an interracial relationship simply because they fell in love.

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Prejudice towards interracial relationships is still present. As pointed out earlier, the reaction to Prince Harry’s marriage to Meghan Markle is a case in point. Flash forward to my own counselling room and the Black woman and white man sitting before me, seeking couples counselling. She is now estranged from the majority of her Black family because they disapprove of her relationship with a white man. He doesn’t know what to say to his mother who says she loves her grandchild but feels so embarrassed when people look inside the pram and wonder whose grandchild it is. Clients talk about the difficulties they face being brought up in either community. Some have spent years struggling in both communities at different periods. They have heard their parents, whether Black or white, apologise for them having ‘too dark’ or ‘too light’ a skin tone, being unable to speak patois or lacking cultural awareness. The mother of one client voiced her regrets for having had mixed-race children because of the pain, suffering and poor mental health she has seen them endure.

Negotiating the Faustian pact Clients have shared with me how, in every social encounter, they are desperately trying to work out what the person standing in front of them, be they Black or white, wants them to be. They feel caught in a position of trying to hold onto a sense of self and simultaneously manage this level of responsive fluidity with others. Such situations can progress to the point where they find it easier to stay at home, in social isolation. As I stated earlier, in ideal circumstances, experience is processed, digested or made sense of. If not it becomes embodied, enacted or projected (Bion, 1984; Britton, 1992). The most common manifestation that I observe of what happens when experience becomes embodied is depression. Becoming a bully, criminal behaviour, self-destructive behaviours, including suicide attempts, and antisocial and compulsive behaviour are all symptoms of people enacting what can’t be made sense of. I have already discussed how racism, shadism and colourism are internalised and projected onto other mixed-race individuals or darker-skinned members of the Black community. It is projected because it is unbearable. As Davids puts it, ‘to be Black is to be bad and nobody wants to be bad’ (Davids, 2011). This is often attempted before therapy and the complexities that arise are what cause individuals to seek help. This complex process can generate tremendous feelings of guilt and betrayal. A painful realisation may dawn: their white families, friends and community are racist. This may lead to attachments being disrupted. For an individual who has rejected their upbringing, there is a profound sense of loss. They may begin to idealise the part of their identity that was denied. They perceive what has been lost as their ‘Blackness’ – their African Caribbean or African heritage. This can lead to a hatred of their white selves. All of the clients I work with have mixed European and African ancestry, so I cannot speak for people of other combinations of mixed heritage. However, what I can say is that there is evidence that individuals of mixed European and Asian heritage also struggle

Yvon Guest

with identity issues (Guest, 2015; Millar, 2015) and, as practitioners, we need more research about this. Social media exacerbates racial tensions. Some individuals become radicalised online. They tell me they want to overthrow white supremacy or even kill white people, such is the strength of the internal split. The burden of ancestral, colonial shame sits heavily on the one shoulder while the intergenerational wounds from slavery and racism sit on the other. If they have grown up in only the white community, all they have to connect them to the Black community is their DNA. They have effectively been stripped of their cultural heritage since birth. However hard they struggle to understand, it is too late to have a lived experience of Blackness in a Black community. Clients recall their attempts to become part of the Black community, battling through rejection for being too white or lacking knowledge of Black culture. Having felt alien in a white world, they now feel like an imposter in both worlds. Some overcompensate with accelerated learning about Black history and culture or the exaggerated manner in which they speak, what they wear or how they style their hair. These are examples of projective identification – they identify with an image of Blackness. If they are very light skinned, they feel they are not qualified to claim any Blackness at all; even though they experience racist trauma vicariously, this remains an invisible but deeply painful wound (Guest, 2019). Having idealised the Black community, there inevitably follows the realisation that there is no big happy Black family. Huge disappointment, even despondency sinks in as they encounter divisions, conflicts and prejudices that they cannot understand until they can frame it as internalised and projected racism.

Revisiting whiteness This is a very precarious stage to negotiate. As with the previous stage, this can occur in the therapeutic setting or outside of it. In my work, one manifestation could be a rejection of the client’s Black self. Another scenario is that all the pain and rejection projected onto them by both communities is projected onto the Black community. The level of confusion can be so great they might reach a point where they abandon the attempt to forge a racial identity. Some have said to me, ‘Any identity will do just as long as I have one’ – doctor, lawyer, teacher or mother. Some have identities imposed by others; like hermit crabs, they exchange shells. Then there is yet another possibility: with skilful facilitation, they can integrate both worlds. To make sense of what doesn’t make sense cannot be accomplished alone. Now they can choose not to make a binary choice.

‘No man’s land’ When mixed-race clients arrive at a place where they want to embrace their mixed heritage, another dilemma begins. If they don’t want to be allied to either Black or white, when the price of admission is to give up half of their identity, they find themselves in a whole other new dimension: ‘no man’s land’. This concept originates from them being asked, ‘Where do you come from?’ Their reply is usually, ‘My

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mother comes from X and my father from Y.’ This illustrates how they have no place of their own; they don’t come from or belong anywhere; they sit between two worlds. ‘No man’s land’ is a unique and individual experience: no two clients inhabit the same landscape. Some of my clients, before starting counselling, doubted whether they actually existed. This begins in childhood, when they believed that they had come from outer space; that they must be alien because they do not resemble everyone else in their predominantly white or Black environment. Doubting one’s existence can also be explained in terms of how the outer world views mixed-race marriage and mixed-race offspring (Guest, 2015). Miscegenation was never illegal in the UK, but it was socially taboo and both communities were hostile towards it (Benson, 1981). Ifekwunigwe holds that to conceive Black and white as races is a non-existent social construct (Ifekwunigwe, 1999). This notion graphically reveals the dilemma for mixed-race people, who occupy the space between. We live in an increasingly racially polarised world. For those in ‘no man’s land’, one of the perils is getting caught in the crossfire. Another is resisting the constant pressure to choose a side. ‘No man’s land’ lacks many aspects that others take for granted. It doesn’t have a language, faith, literature, artefacts or culture. Historical figures have been claimed by one side or the other (think of Mary Seacole or Barack Obama), or neglected. Clients need to work towards establishing environments and communities that enable them to explore their embryonic identities. Finding other mixed-race individuals who are of the same mindset can be helpful. Living in diverse communities where the polarisation between Black and white is not so great facilitates a more nuanced experience.

To sum up Using a psychosocial approach facilitates greater understanding of how racism exists in the mind of the individual and the external world. This approach allows us to observe the constant dynamic flow between the two worlds, and the impact on people with complex identities as they attempt to navigate multiple worlds. Language, as it currently exists, has been shown to lack the sophistication to fully express the complexities of a world still significantly impacted by the legacy of colonialism and slavery. The notions of the Faustian pact and ‘no man’s land’ offer a way of conceptualising these experiences. These concepts may have wider applications for working with people from other mixed-race backgrounds than European and African or African-Caribbean.

Yvon Guest

References Anyiam-Osigwe, C. (Dir.). (2018). No shade. BUFF Originals. Benson, S. (1981). Ambiguous ethnicity: Interracial families in London. Cambridge University Press. Bion, R.W. (1984). Learning from experience. London: Karnac. Brewer, M.B. & Brown, R.J. (1998). Intergroup relations. In D.T. Gilbert, S.T. Fiske & G. Lindzey (Eds.), Handbook of social psychology (4th ed) (pp.554–594). McGraw-Hill. Britton, R. (1992). Keeping things in mind. In: Anderson R. (Ed.), Clinical lectures on Klein and Bion (pp.102–103). Routledge. Davids, F. (2011). Internal racism: A psychoanalytic approach to race and difference. Palgrave Macmillan. Erikson, E.H. (1968). Identity, youth and crisis. W.W. Norton & Co. Fanon, F. (1967). Black skin, white masks. Grove Press. Galton, F. (1883). Inquiries into human faculty. Macmillan. The Guardian (2019, April 8–12). Shades of black. The Guardian. www.theguardian.com/us-news/ series/shades-of-black Guest, Y. (2015). A psycho-social exploration of the lifelong impact of being in care as a child and resilience over a life span. Unpublished PhD thesis. University of the West of England. http://eprints. uwe.ac.uk/24515/ Guest, Y. (2019). Between black and white. Therapy Today 29(3), 26–29. Hall, S. (1996). Gramsci’s relevance for the study of race and ethnicity. In: Morley, D. & Chen, K.-H. (Eds.), Stuart Hall: Critical dialogues in cultural studies (pp.411–440). Routledge. Hollway, W. & Jefferson, T. (2000). Doing qualitative research differently: Free association, narrative and the interview method. Sage. Hook, J., Farrell, J., Davis, D., Deblaere, C., Van Tongeren, D. & Utsey, S. (2016). Cultural humility and racial microaggressions in counseling. Journal of Counseling Psychology, 63, 269–277. Ifekwunigwe, J. (1999). Scattered belongings: Cultural paradoxes of ‘race’, nation and gender. Routledge. Klein, M. (1946). Notes on some schizoid mechanisms. International Journal of Psycho-Analysis, 27, 99–110. Klein, M. (1952/1975). Some theoretical conclusions regarding the emotional life of the infant. In M. Klein, Envy and gratitude and other works, 1946–1963 (pp.61–93). Hogarth Press. Millar, T. (2015). Race, identity and the countertransference: A mixed-race patient and a mixed-race psychotherapist – a single case study. Unpublished PhD thesis. University of East London/Tavistock and Portman NHS Foundation Trust. https://core.ac.uk/display/42549290 Olyedemi, M. (2013). Towards a psychology of mixed race identity development in the United Kingdom. Unpublished PhD thesis. Brunel University. http://bura.brunel.ac.uk/handle/2438/7728 Popenoe, P. & Johnson, R.H. (1918). Applied eugenics. Macmillan. Provine, W.B. (1973). Genetics and the biology of race crossing. Science, 182, 790–796. Tizard, B. & Phoenix, A. (1993). Black, white or mixed race? Routledge. Walker, A. (1983). In search of our mothers’ gardens: Womanist prose. Harcourt Brace Jovanovich. Walker, R. (2001). Black, white and Jewish: Autobiography of a shifting self. Riverhead. Williams, J. (2008). Michael X: A life in black and white. Century.

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Wilson, A. (1987). Mixed race children. Allen & Unwin. Woodward, K. (1997). Concepts of identity and difference. In K. Woodward (Ed.), Identity and difference (pp.7–61). Sage.

Lennox K. Thomas

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Developing a diversity-sensitive psychoanalytic and psychodynamic psychotherapy: Personal and professional reflections Lennox K. Thomas

I would like to start by setting in context the motivation to developing a diversitysensitive psychoanalytic and psychodynamic practice. Intercultural psychotherapy was born in around 1980 out of the frustrations of British mental health professionals seeking to find ways to work appropriately with people from varied cultural backgrounds. Working across cultures and ethnicities was always intended to help patients who were on the margins of the mental health system and not thought suitable for talking therapy (Kareem & Littlewood, 1992). Many people of colour were not referred for psychotherapy by GPs, whose bias was that it was the domain of white, middle-class people who had the intellectual ability to use it. As a result, minorities and working-class people were deprived of a service. Controversially, however, Commonwealth immigrants in the UK were over-represented in the mental health system and usually over-medicated (Littlewood & Lipsedge 1982). The development of intercultural therapy was a bid to make psychodynamic therapy more inclusive by exploring its concepts and cultural precepts. We were interested in how universal the theories were and what, if any, adjustments needed to be made for them to become more sensitive and appropriate to different cultural and linguistic groups. One of the other aims was to seriously explore the idea that talking therapy only worked with the educated classes. This idea around intellectual elitism was also being tested by Valerie Sinason, in a project at the Tavistock Clinic in London, working with young people with learning difficulties. It was found that relationship-based therapy was effective with most patient groups because giving voice to emotion was important to all people (MacDonald et al., 2003).

Recognition of the impact of the patients’ social context and their perception of the therapist An approach to therapeutic work might be informed by any number of factors:

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the prior experience of the patient, the social values of the therapist and the degree to which the external world and reality are part of the therapeutic discourse. It was recognised that both helping patients to understand their inner world and acknowledging their external world were important. Without a connection between their psychological state and their social circumstances, the patient would only develop awareness of their internal world, not a good, functioning knowledge of the impact of the outside world on their mental health. There are few psychoanalytic texts that address this well, but American psychoanalyst Neil Altman (1995) provides a good example of engagement with the material circumstances of the patient. In his book, he discusses his therapeutic work in a poor immigrant area of New York and makes observations contrasting this with his work in well-heeled Manhattan. We also believed that the therapist presenting as silent and anonymous (a practice derived from classical psychoanalysis) was not a valuable component of the therapy, recognising this could unwittingly push patients into psychosis.

My early professional influences My first training in clinical social work with children and families was a good preparation for understanding human development and life-cycle events. During my training, I visited social work agencies in Boston and New York and met an impressive group of African-American psychoanalysts. They were interesting because many had begun their careers as psychologists in local hospitals or as clinical social workers in local charities, and they believed that Black mental health was being neglected by the state. Many of these American colleagues had suspicions of the government that had barred Black people from property ownership, education and the right to vote and, moreover, had conducted unethical, life-threatening medical experiments on them without their knowledge. From the perspective of Frantz Fanon’s assertion that it was difficult for the colonised to live in the land of the coloniser, it was clear the colonised had learnt to see themselves as inferior to their former masters (1963). So, in a society that has taught African-descended people to mistrust and hate themselves and those who look like them, it was important to develop a therapy that was able to recognise and address this. Because of societally created negative introjects, it is important for patients to carefully select a therapist who will not cause further harm but could help to restore self-love and psychological growth. Working with young people as a probation officer in West London in the early 1970s, I became interested in family psychotherapy in order to engage parents with the lives of their disaffected teenagers. I had always been curious about the theoretical base for psychological change and began training to work psychoanalytically with patients on the couch. This classical training was not taught critically; it was as if Freud or Klein were listening in, so lecturers stuck to the script! The topics of gender, class and sexuality were not mentioned in the lectures but, if you were lucky, clinical supervisors filled in the gaps. Similarly, race or difference were not mentioned. I would do my own research, sometimes enlisting the help of a relative in the US to seek out references,

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such as Grier (1967) and Shannon (1970). Griffith (1977) wrote about transference issues across the ethnic divide, which opened up useful topics in clinical discussion groups. Without these, I would have found it difficult to exist as a young Black man in this environment; I would have been barely visible. I took much of value from the reading and training but had to go on my own quest to find something in psychoanalysis that made reference to a Black therapist or patient or that bore ‘difference and diversity’ in mind. I found some references in Solnit et al (1999) and discovered a few therapists of colour, including Dr Marie Battle-Singer and Jafar Kareem, who had recently founded Nafsiyat, the intercultural therapy centre in north London.

Creating new theoretical and clinical perspectives Working in north London was exciting because Nafsiyat was surrounded by other therapy organisations addressing diversity issues. We became aware, through meetings with these organisations, that it was critically important to challenge the sexist, heteronormative and racist assumptions underpinning traditional theories and practices and to provide a lead for the statutory services. These efforts were taking place at a time when some therapists in the private sector did not believe that free access, once-a-week psychotherapy could possibly be effective. Nafsiyat was a collective of mixed-ethnicity professionals trained in clinical social work, psychology, mental health nursing, teaching and medicine. We began to study papers by Curry (1964) on race and the pre-transference, Holmes (1992) on transference phenomena, and Clarke and Clarke (1947) and Logan (1981) on negative self-identity in African-American children. Sudhir Kakar (1985) wrote an interesting paper on the cultural influences on child development in India. Colleagues at Nafsiyat were doing psychotherapy training at various training institutes and they all reported that their trainings made no reference to difference. The ‘intercultural project’ served to get together groups of people of all ethnicities who wanted to study the effect of talking therapy with people from different cultures and to make some link to what they were learning. We realised that assessment guidelines needed to flag up difference: for example, had the person experienced discrimination? Later, we realised that we needed to include a question about abuse, indicating that it was something that patients might talk about in the therapy. As the assessor was not necessarily going to see those patients in therapy, it was possible for them to be more active in the assessment. At the beginning, we saw young Asian and Caribbean people who had problems settling into their birth families, having been raised by their grandparents abroad. They were experiencing bonding and attachment problems. Other West Africans were living with their parents for the first time, having been privately fostered with English families in the British countryside, and felt like imposters in their African families. Our attention was naturally drawn to attachment theory (Bowlby, 1951) and the research conducted by James and Joyce Robertson (1971), who studied the

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effect of separation on children during hospital stays or other brief separations from their mothers. Clare Winnicott (1964) also observed children who were separated from parents during the Second World War and how they became attached to a soft toy or blanket, in which they found comfort. Dr Elaine Arnold (1975, 1997, 2012) conducted research at Nafsiyat to look into the experiences of parents and their children who had been left in the care of family in the Caribbean. Joining their parents in the UK had been problematic and some of these children were placed in the care system, which served to exacerbate their problems (Thomas, 2014). This story is explored in the novel The Unbelonging, by Joan Riley, about a girl joining her family from the Caribbean, and feeling out of place and desperately missing her grandmother (Riley, 1985). These early patterns of attachment have far-reaching consequences and can be passed down the generations. Repeated separations during the slavery period have certainly affected post-slavery communities. Mary Ainsworth conducted studies in several countries (1967), and she was able to observe multiple attachment styles in an infant’s family network. She discovered that similar patterns of attachment can be observed in families three generations on. Some families experience traumatic events, often through an avoided subject, generations earlier, that shapes family behaviour. The incubation of this trauma affects the way that children are treated in the family, sowing seeds of self-doubt and fear of the outside world (see Lago & Charura (2015) on post-traumatic slavery syndrome, and Reid et al. (2005) and DeGruy Leary (2005) on holocaust repetition fear). Intergenerational transmission of trauma can be experienced as a family or as a ‘people’. Once it is recognised, it is possible to engage with it therapeutically. Like the avoidance of difficult issues in families, communal trauma events are equally difficult to talk about. The intergenerational trauma as a result of Nazi concentration camps and the enslavement of Africans has been too painful for survivors to engage with for many years, and it is only now beginning to be talked about. People from the Indian sub-continent, Africa and the Caribbean were coming to therapy and finding themselves talking about events that had happened to great-grandparents decades earlier, which had been passed on to them as stories in childhood.

From the couch and blank screen to a relational approach For many therapists, learning to work effectively with diverse groups begins with their own experiences of therapy and knowing the areas that were not explored. One colleague said that his analyst had little understanding of Britain’s role in the colonies and was in no position to help him with his internal decolonisation. His therapist had difficulty understanding his patient’s wariness of white people, not recognising that there was a shared communal history of white oppression that came with this. Having their roots in psychoanalysis, with its understanding of unconscious processes, intercultural approaches to therapy have much in common with relational psychotherapy. The patient is invited to bring real issues to the consulting room. Recognising the real relationship between the therapist and the patient and taking

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into account difference in gender, sexuality, race and culture are as important as the clinical reasons for help-seeking, and probably part of the reason. Patients living as a minority in a majority culture can pose issues of identity and invisibility, so being seen by the therapist is important. Change takes place intrapsychically as well as interpersonally, and the relationship with the therapist is at the heart of shaping psychological development. On first meeting Jafar Kareem at my training institute, the British Association of Psychotherapists, I realised that he had been doing the same as me, greedily reading material about diversity when he trained years earlier. The book that he co-edited with Roland Littlewood, Intercultural Therapy, was published in 1992. The research in the book revealed compelling findings that Black and Asian people could make use of talking therapy, contrary to popular belief at the time. Black and minority ethnic patients at Nafsiyat were more likely to be referred by a psychiatrist, and we saw higher proportions of men. Some had experienced psychotic episodes and hospitalisation or had been on medication in the community for many years.

Critical exploration of classical psychoanalytic/psychodynamic theories What is missing from standard classical psychoanalytically informed psychotherapy teaching is how to understand and negotiate the therapeutic relationship with the ‘other’. The teaching of ideas developed by Freud in the 19th century with clinical examples from that time is interesting but will not necessarily help with issues contemporary to the 21st century. I doubt there would have been many Black or brown faces in old Vienna and the only account that I have read about a Black person in analysis was written by Wulf Sachs. He analysed an African nobleman in Southern Africa in the 1930s (Sachs, 1937). Sexual minorities and Black and minority ethnic people should not be made invisible on training courses by the absence of reference to their connection to psychotherapy as therapists or patients. The teaching of transference needs to include how historical relations around race, class or sexuality are played out in the therapy. There is little written about the meeting of the white therapist and Black or Asian patient and how the transference might develop between them in the context of our colonial past. Attention to the relationship between the Asian or Black therapist and white patient is even more difficult to find. This gap in psychotherapy literature does not serve Black, Asian and minority ethnic or white therapists well, given that most of the former will be treated by white professionals. The Black patient who is not informed about therapy will simply accept what is offered, but Black, Asian and minority ethnic trainees in therapy might feel cheated if they are not able to see themselves modelled in the authoritative position. Race and difference can be avoided in therapy – superficially perhaps out of politeness but there are deeper reasons than this. By acknowledging difference, the patient’s attention might be drawn to historical oppression and slavery. African and Asian patients who experience racial prejudice outside the consulting room have found it difficult to talk about it in therapy. When they find their experience

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is reduced to a misunderstanding by the therapist, or when the therapist takes it the wrong way, they report that some white therapists do not cope well with it. Avoiding the issue of difference in therapy serves the therapist but robs the Black trainee or patient of the opportunity to explore their hurt and inner colonisation. If the training therapy does not deal with these issues, the trainee will have difficulty working at depth with their own patients, Black or white, and the cause of psychotherapy will not be advanced. This sort of polite therapy is false and has skated over the surface of the psychological structures in the patient, maladaptive or otherwise. There are many complicated reasons for Black and Asian patients not speaking freely in therapy. This, sadly, gets in the way of their development. Dr Ralph Greenson (1973) gives a case example that illustrates how well the white therapist is able to work with this issue. Having worked with a Black male patient for some time, Greenson is surprised that, one day, this patient comes to analysis not his usual, polite and pleasant self. When Greenson asks what is the matter, the patient tells him that he, the analyst, needs to have a word with the doorman of the plush apartment building where he works. He says that, although he has been coming here for months, parking his car in the car park, walking into the building, suited, with his briefcase, the hostile doorman asks him every time what he is doing there and what is his business. Greenson calms his patient and tells him that he will deal with the matter, which he does. Greenson says that this incident is a useful gateway because, in the many months of intensive therapy, race or difference has not been mentioned once. The patient’s family had lived in the southern states of America and had survived racial segregation, rape, shame, lynching and house burnings, and this was the first time he was able to talk to a white person about his feelings about these things done by white people. Dr Onel Brooks describes in the book Thinking Space (Brooks, 2013) how he tried to talk to his white analyst about incidents at work that he thought had unfairly singled him out as a Black employee. He said that his psychoanalyst was quick to tell him that he was talking about a deeper issue, the Oedipus complex, and that he also seemed concerned about her (the psychoanalyst’s) racism. This contrasts with the way that Greenson engaged with his patient and was able to hear him. Feeling out of their depth with this material leads therapists to shut the patient down, refusing to talk about matters outside the consulting room that concern the patient. It is critically important for the therapist to recognise their countertransference and how they are conducting themselves in the therapy room. The training analysis is important for this reason: unless difference is addressed, the trainee will not feel comfortable or learn about their capacity to receive and contain what is said to them by the patient. In the case above, the therapist edited the patient’s narrative in order to protect her own comfort.

Damage to patients Therapists who are unable to deal with the issue of race cause damage to their patients by not engaging with these aspects of their lives. If race and difference is not worked through, the patient (trainee) will be ill-equipped as a professional and

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will repeat their own experience of therapy with their patients. Through training in a profession that is ill-equipped to deal with these issues, Black, Asian and minority ethnic trainees particularly are left to rely on the coping skills drawn from their families and communities. For example: Gurpreet, a trainee Asian counsellor in her 30s, talks openly about race and diversity and chose a Black woman therapist for this reason. She describes to her therapist an incident at the weekend, on a visit back home, when she was introduced to a friend’s new boyfriend in a pub. After a while, she realises that he is the class bully who made her life hell with racist insults 15 years previously. He clearly does not recognise her, and she does not remind him. He is polite, insisting on getting her a drink when she arrives. She wonders what has changed him and also wonders whether, if she reminds him of what he did, he would deny it.

This case was a challenge to the Black therapist, who had to hide her fury that this man was giving the impression of being decent. She also did not want her patient’s story to be supplanted by her own feelings from the times this form of racism had happened to her. The countertransference feelings were strong, but the therapist was able to hold back, having seen the hurt in her patient and wanting to give her enough space to express her feelings. Gurpreet felt that her friend’s boyfriend had learned that white people have the capacity to start afresh as if nothing has happened. What if he had recognised her, and getting her a drink was a means of dealing with the immediate embarrassment and the drink was a token of atonement for his cruelty? A few sessions after telling the story, she asked her therapist if a white person would ever tell their therapist, Black, Asian or white, a story like this about race. Gurpreet said that white people seem reluctant to talk about these matters, so a veil is pulled over it and the profession goes along with this.

Personal and professional development The teaching of classical theory cannot be without social context, because without it the therapeutic work would not be helpful. People who once colonised an Empire are now living with the former colonised and the psychological wounds left by racism and colonisation still need to be dealt with. If it is not addressed in therapy, the patient might feel that this is an unmentionable subject. The Black person was the recipient of many projections during slavery, which has served to complicate the relationships post-slavery. There are sexual stereotypes of Black people that don’t get talked about in therapy: the ‘young, Black buck’, the ‘mammy’, and the ‘Black slut’. They are so much part of our thinking that they are almost archetypical. Self-esteem and self-worth can be seriously affected by what powerful groups in society tell the less powerful, explicitly or otherwise. This happens on a daily basis in fiction and the media. Reversing hundreds of years of internal colonisation is both a political and a psychological act and should be a function of good therapy if therapy is about restoring self-love and good mental health.

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Some years ago, Dr Isha McKenzie-Mavinga (2009) wrote about the need to bring Black issues into therapy because the traditional curriculum will always justify leaving it out. I am aware of only one pioneering psychodynamic training that runs seminars called ‘The Social Critique’, examining diversity and other issues alongside the classical theory seminars. Once considered to be a post-qualifying experience, intercultural psychotherapy is now taught as a qualifying psychotherapy course. This strategy thus avoided theoretical resistance that had emerged in post-qualifying courses. Intercultural therapy training suggests that trainees have one intensive patient who is close to their own ethnic background and another from an ethnic background very different to their own. This helps to bring topics to the clinical discussion groups, from which the students can learn about sameness and difference. White trainees have talked of a hesitance to discuss their work with Black patients if Black therapists are in the room, for fear of not ‘doing it right’ and being criticised. Modern psychodynamic therapies have developed some reflexivity, moving away from the traditional passive approach of psychoanalytic therapy. Much has been learnt from relational psychoanalysis. One of the impediments to change is the fear of inexperienced psychoanalytic therapists being told that what they are doing is not real therapy. There is something about the mythologising of the therapist within psychoanalytic circles that creates distance and coldness in their interactions with the patient, yet research consistently finds that what is valued and therapeutic by the patient is empathy and warmth in the therapist.

How wider therapy can learn from these ideas Psychotherapists tend to be loyal to their tribe and mistrust those who are critical of it in any way. This is particularly the case if the critique is by someone with a Black or brown face. After hundreds of years of indoctrination about the inferiority of those who were enslaved or colonised, it is not at all surprising that this is the case. In the UK, there have been Black, Asian and minority ethnic therapists talking and teaching diversity in counselling and psychotherapy for 40 years (Kareem, 1988; Lago & Thompson, 1996; Fletchman-Smith, 2011). Very qualified and senior in their professions, their core ideas have been slow to catch on and be used in training. The same could not be said of supervisors, who are the backbone of continued professional development in psychotherapy. There is no set of competences that the supervisor has to satisfy in relation to race and diversity. The question needs to be asked, would the white supervisor be any more skilled at untangling the therapist’s difficulties around race with Black patients? As guardians of good practice in the profession, should more be expected of them so that they are not implicated in this collusive silence? Lago (2005) poses these serious questions to white therapists and supervisors. Becoming a therapist is not a cure for racist feelings.

Systemic resistances and barriers Training psychoanalytic therapists in diversity has been problematic because

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criticism of training and therapy has been seen as an attack on the founding parents of psychoanalysis. Yet intercultural and diversity ideas have been around for many years, promoted by working groups of the United Kingdom Council for Psychotherapy and the British Association for Counselling and Psychotherapy. There are many barriers to learning; some consider it is not necessary if they do not treat Black patients, or do not consider it necessary to think about diversity. One group of students told me that they were generally tired of all this race stuff and had left the NHS to get away from it. The presentation of critical ideas, usually from class, gender and race perspectives, can be as unwelcome as a spectre at a feast. But therapists who claim not to need diversity training because they do not see Black clients harm their white patients who might want to talk about race issues or deep feelings of prejudice or guilt.

A challenging experience in training I was invited to give a paper to a trainee group of 10 or so, mainly social workers who were improving skills for direct work with children. With the exception of one Black woman, all were white. I gave them a published paper based on Winnicott’s true and false self and the proxy self of Black and Asian children (Thomas, 1995, 2000; Uwahemu, 2004). After reading the paper, the white people in the group said that they did not understand it, but the Black woman said that she did. There was little curiosity among the white participants about the paper and even less about why their Black colleague understood it and they did not. I took this experience to be the game that is played to show resistance to ideas of difference. The paper gave clear examples of the difficulties some Asian and African-Caribbean children have in living in a dual world and the behaviours they adopt to help them negotiate this. Often it is to their psychological detriment, and it was for this important reason I had presented it.

Concluding thoughts There are moral and ethical issues involved if therapists are unable to recognise the psychological or emotional effects of racism and are therefore not able to treat the patient. For therapists to make changes with regards to diversity, they need to start from where they are, often recognising the gaps in their knowledge. Understanding one’s own whiteness, Blackness, maleness, femaleness and so forth exercises thinking about the impact one might have on others. It is critical to appreciate how one might be viewed by the other, including awareness of the oppressive historical relationships that might have existed and how these can be explored. The patient’s internalised racism (Rose, 1998) or homophobia prevents them from feeling they have the right to be heard in therapy, so the hidden self remains hidden and does not participate in the therapy. When therapists collude with the patient’s false selves, the therapy is incomplete, as they have only engaged with the false self and there is no analysis of defences. A case could be made against the state of clinical practice and its unethical position of not teaching therapists to work with diverse populations while claiming

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the therapy to be universally available and applicable to all. While it might not be possible to know about all cultures or differences, we can start with ourselves, knowing who we are, learning our blind spots and endeavouring to be selfreflexive. Trainings provide feelings of security and stepping outside of this evokes fear. Many therapy trainings lack depth on race and class and how this affects transference issues. This fails many therapists, Black and white alike. Black patients having group therapy have complained about the lack of understanding of the dual world they live in and sometimes feel bombarded by the projections of a whole group, even by the white group analyst. This herd instinct makes it difficult for a different voice and another narrative to be heard.

References Ainsworth, M. (1967). Infancy in Uganda and the growth of love. Johns Hopkins University Press. Altman, N. (1995).The analyst in the inner city. Routledge. Arnold, E. (Robertson). (1975). Out of sight not out of mind. Unpublished MPhil thesis. University of Sussex. Arnold, E. (1997). Issues of reunification of migrant West Indian children in the United Kingdom. In J.L. Roopnarine & J. Brown (Eds.), Caribbean families: Diversity among ethnic groups (pp.243– 258). Ablex Publishing Arnold, E. (2012). Working with families of African Caribbean origin. Jessica Kingsley. Bowlby, J. (1951). Maternal care and mental health. World Health Organisation. Brooks, O. (2013). Race and our evasions of invitations to think: How identifications and idealizations may prevent us from thinking. In F. Lowe (Ed.), Thinking space: Promoting thinking about race, culture and diversity in psychotherapy and beyond (pp.35–55). Karnac. Clarke, K.B. & Clark, M.P. (1947). Racial identification and preference in Negro children. In T.M. Newcomb & E.L. Hartley (Eds.), Readings in social psychology (pp.169–178). Holt, Rinehart & Winston. Curry, A. (1964). Myth transference and the black psychotherapist. Psychoanalytic Review, 51, 7–14. DeGruy Leary, J. (2005). Post-traumatic slavery syndrome. Upton Press. Fanon, F. (1963). The wretched of the earth. Grove Press. Fletchman-Smith, B. (2011). Transcending the legacies of slavery. Karnac. Greenson, R. (1973). The technique and practice of psycho-analysis. Hogarth Press. Grier, W.H. (1967). When the therapist is negro and some effects on the treatment process. American Journal of Psychiatry, 123, 1587–1591. Griffith, M.S. (1977). The influence of race on the psychotherapeutic relationship. Psychiatry, 40, 37–40. Holmes, D.E. (1992). Race and transference in psychoanalysis and psychotherapy. International Journal of Psycho-Analysis, 73(1), 1–11.

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Kakar, S. (1985). Psychoanalysis and non-western culture. International Review of Psychoanalysis, 12, 441–445. Kareem, J. (1988). Outside in – inside out: Some considerations in intercultural therapy. Journal of Social Work Practice, 3(3), 57–77. Kareem, J. & Littlewood, R. (1992) Intercultural therapy: Themes, interpretation and practice. Blackwell. Lago, C. (2005). You’re a white therapist: Have you noticed? Counselling and Psychotherapy Journal, 16(2), 35–37. Lago, C. & Charura, D. (2015). Working with transgenerational/intergenerational trauma. The Psychotherapist, 59, 23–25. Lago, C. & Thompson, J. (1996). Race, culture and counselling. Open University Press. Littlewood, R. & Lipsedge, M. (1982). Aliens and alienists: Ethnic minorities and psychiatry. Penguin Books. Logan, S. (1981). Race identity and black children – A developmental perspective. Social Casework, 62(1), 4–19. MacDonald, J., Sinason, V. & Hollins, S. (2003). An interview study of people with learning disabilities’ experience of, and satisfaction with, group analytic therapy. Psychology and Psychotherapy: Theory, research and practice, 76, 433–453. McKenzie-Mavinga, I. (2009) Black issues in the therapeutic process. Palgrave Macmillan. Reid, O.G., Mims, S. & Higginbottom, L. (2005). Post-traumatic slavery disorder. Conquering Books LLC. Riley, J. (1985). The unbelonging. Women’s Press. Robertson, J. & Robertson, J. (1971). Young children in brief separation, a fresh look. Psychoanalytic Study of the Child, 26, 264–315. Rose, E. (1998). Daring to work with internalised racism. Counselling, 8(2), 92–94. Sachs, W. (1937). Black Hamlet. Little Brown. Shannon, B.E. (1970). Implications of white racism for social work practice. Social Casework, 51(5), 270–276. Solnit, A.J., Neubauer, P.B., Abrams, S. & Scott Dowling, A. (Eds.). (1999). The psychoanalytic study of the child. Yale University Press. Thomas, L.K. (1995). Psychotherapy in the context of race and culture: An intercultural therapeutic approach. In S. Fernando & F. Keating (Eds.). Mental health in a multi-ethnic society (pp.172–190). Routledge. Thomas, L.K. (2000). Racism and psychotherapy. Working with race in the consulting room: An analytic view. In J. Kareem & R. Littlewood (Eds.), Intercultural therapy (2d ed.) (pp.146–160). Blackwell Scientific. Thomas, L.K. (2014). Attachment in African Caribbean families. In A. Danquah & K. Berry (Eds.), Attachment theory in adult mental health (pp.170–182). Routledge. Uwahemu, A. (2004). The proxy self: A more acceptable version of me. Counselling and Psychotherapy Journal, 14(1), 44–45. Winnicott, C. (1964). Child care and social work. Codicote Press.

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Colour blindness as microaggression: Perspectives on race and ethnicity in counselling and psychotherapy training and practice Mark Williams

Historically, counselling and psychotherapy have been considered to be a white, middle-class profession (Spalding et al., 2019) and as failing to attend to the specific but diverse social constructs of the identities of Black and ethnic minority patients. The perpetual perception has been that ‘talking therapies’ are ill-suited to the intellectual capacities of non-white patients, which extended to individuals of working-class background (see, for example, Lennox Thomas’s chapter in this book), so that these groups were readily excluded from such services. Our evergrowing diverse and multicultural British society calls for the continual examination of contemporary counselling and psychotherapy training and practice, which must seek to consider more transformative ways of developing appropriately inclusive models of intervention in these fields. Many researchers, including Moodley and Dhingra (2002) and Lago (2006) (both cited in Spalding et al., 2019), acknowledge the lack of empirical research regarding the intersection between race, culture and ethnicity, and counselling and psychodynamic psychoanalytic therapies, despite this growth of diversity and multiculturalism in British society. Carter (1995) brings about a mindfulness of how the influence of race and racial identity impacts on counselling and psychotherapy of all orientations, which can cause confusion for practitioners. Consideration must be paid to how the traditions, conventions and structures of psychodynamic counselling and psychotherapy training and practice can exclude the experiences of race, ethnicity and culture as constructs of identity that are all too present in the consulting room. Moodley and Palmer (2014) engage us in thinking that concerns the need for practitioners to have a better and more flexible understanding of meaning and relevance of race and its related terms to the individual’s identity and experience. It is important for the therapist not only to understand the patient’s self-identification in terms of these influences but also to understand the nature and impact of their

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social experience in relation to their race, ethnicity and culture. The definition of these terms does little to voice the experiences of racism, however direct or indirect, and its impact on the Black patient’s sense of self or how the internalisation of such experiences shapes their psychological construction. The question arises as to whether therapies that aim to inclusively engage Black, Asian and minority ethnic patients do so with the assumption that the focus on the individual, by its very nature, brings the whole person into the therapy and therefore presents the opportunities to address race and culture-specific factors affecting their daily life. Or do there continue to be gaps in practice with Black, Asian and minority ethnic patients where the generalised approaches to therapy fundamentally ignore the unique experience of race and racism in the human psyche? In other words, are counselling and psychotherapy training and practices colour blind? This chapter explores what continues to be the ‘rhetoric’ of racial bias in the psychiatric treatment of Black, Asian and minority ethnic patients in the psychotherapy process, and considers whether there is an absence of engagement with race and culturally related presentations of the Black identity in therapy. The ensuing discussions seek to move our exploration on from the experiences of Black, Asian and minority ethnic patients in psychiatric care, where psychopathology is overestimated, prognoses are underestimated, shorter periods of treatment are prevalent and there are higher rates of termination from treatment and more frequent referral to more restrictive forms of treatment (Burkard & Knox, 2004). This chapter considers how, and perhaps why, these experiences continue to be a concern in counselling and psychotherapy. The fundamental question held in mind throughout the analysis of the literature drawn upon for this discussion is how psychic resonance of racialised experiences is represented in the transference and countertransference of the patient-therapist relationship. The exploration of the concept of microaggressions in the form of negative expressions and actions aimed towards Black, Asian and minority ethnic people leads us to understand how the effects of such experiences come to manifest in the individual’s own beliefs, thinking, attitudes and behaviours. The development of these ideas in this chapter requires us to discuss available definitions or descriptions of microaggressions and consider examples of these. Furthermore, by establishing racialised experiences and the effects of racism as forms of microaggressions, we are enabled to consider the idea of the emergence of racial psychic pain in the transference and countertransference dynamic. This will afford possible explanations of why therapists continue to have difficulty in engaging with racial content in therapy (Burkard & Knox, 2004).

Microaggressions It is this very avoidance of addressing racialised content material in therapy that is taken as a conceptualisation of ‘colour blindness’ in counselling and psychotherapy training and practice. Owen and colleagues (2018) acknowledge that longterm, ongoing or recurring experiences of racism can affect the psychological wellbeing of Black, Asian and minority ethnic people, as well as their resilience

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to other life stressors. They point to the impact of subtle or indirect forms of racist behaviours and attitudes, more typically described as microaggressions, in the material that Black, Asian and minority ethnic patients bring to therapy. They look to Sue and colleagues (2007), whose research identifies three forms of microaggressions: microassault, microinsult and microinvalidation. The term ‘microassault’ represents what we typically understand to be racist acts, attitudes and behaviours; ‘microinsults’ are described as racial biases in verbal and nonverbal communications; ‘microinvalidation’ is defined as ‘communications that exclude, negate, or nullify the psychological thoughts, feelings or experiential reality of a person of colour’ (p.274). Sue and colleagues (2007) suggest ‘colour blindness’ to be one of nine categorisations of microaggressions. Owen and colleagues (2018) conducted a study that found significantly large reports of microaggressions occurring in therapy with Black, Asian and minority ethnic patients. The study highlighted ‘counsellor comfort’ in relation to the avoidance of addressing racial issues, failure to demonstrate cultural humility, and missed cultural opportunities in the therapy as examples of microaggressions in therapy. Some of the outcomes reported in their study link to the microaggressions they describe (Sue et al., 2007).

Racial trauma To avoid the reader being left with more questions than answers about this focus on colour blindness, it is important to offer some absolute tenets that are being applied in what follows. First is the assumption that racial trauma exists as an authentic phenomenon that presents as an effect of direct and indirect racial experiences generated through violence and perpetual reinforcement of oppression against people of colour. Second, racism is experienced in many forms by people from Black, Asian and minority ethnic communities from very early childhood, although early infant and childhood experiences of racialisation may be buried within the person’s psychic make-up and, even in adulthood, they therefore do not possess the verbal capacity to articulate them. The presentation of the effects of racist experiences can be masked by other social concerns, such as financial, familial and social relationships, wider social and political factors, and so on, thus making it difficult to identify its relevance in therapy. Finally, racial trauma defies the conventional definitions that presuppose a specific event of violence or attack, physical or verbal. In these discussions, it must be understood that the experience of race, racism and racialisation are everyday occurrences, and their triggers may be both internal and external, but, importantly, they have equal impact in how they are experienced and equal significance how they manifest in therapy (BryantDavis, 2007; Sue et al., 2007; Owen et al., 2018). Early accounts of the development of a Black identity (Cross, 1978; Cross et al., 1991) suggests a period when a person of colour redefines their identity to now include an ‘almost exaggerated idealisation of all things Black and a rejection of negromancy’. This is a former identification of the self, understood through the internalised view of a white racist society, which is seen to instigate feelings of

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low self-worth and is equated to mental illness (Cross, 1978). For Cross (1978), this is immersion-emersion, the third of five stages in the construction of a Black identity. Cross’s initial stage, pre-encounter, suggests that the Black individual favours everything white while avoiding the stigma of being Black. The next stage, encounter, ‘involves cataclysmic experiences of racist encounters’. The final two stages are internalisation, which is seen as the acceptance of a Black identity, and internalisation-commitment, which recognises internalised beliefs and values that are enacted as expressions of the Black identity. The successful completion of the five stages leads to the formation of healthy Black identities. Carter suggests we fail to appreciate the pervasive traumatic impact of those very experiences on the psychopathology and mental health of the individual (Carter, 2007). Although much critiqued, Cross’s (1978; Cross, et al., 1991) model of the developing Black identity has been the catalyst for many similar models, as well as revisions of his theories. What appears to be persistent in the research is the tendency to apply conventional Western methodologies in the psychoanalytical research of the Black identity, which limits the understanding of race and racial identity. This is not to negate the significance or the effectiveness of psychodynamic approaches to the treatment of mental distress and illness. However, there continues to be debate and concern about the dichotomy whereby the traditional approaches of psychotherapy and psychodynamic counselling are maintained alongside a recognition of the need for these approaches to develop stronger foundations in empirical research that both reaffirms traditional counselling and psychotherapy practices while simultaneously facilitating their evolution towards the needs of contemporary societies (Lemma, 2016) – in this case, transcultural therapy. As long as understandings of racial identity and the effects of racial trauma continue to be unclear in psychotherapy theory, the likelihood remains that therapists will continue to ignore its relevance in what the Black patient brings to therapy (Moodley & Palmer, 2014). Recent research (Bryant-Davis, 2007; Carter, 2007; Sue et al., 2007) has examined the effects of racial microaggressions and presented findings that parallel symptoms and presentations of post-traumatic stress disorder (PTSD). These include presentations such as a fear of physical harm or attack, difficulty in coping with everyday stresses, interpersonal and relationship problems, feelings of helplessness, and horror or terror of persecution related to institutional racism. These are everyday microaggressions that can become generalised as psychological presentations if divorced from any racial context. Sue offers a real-life example of his own experience of microaggressions while travelling on a plane with a colleague, when they were asked to move seats to balance the weight, yet three white male passengers, who had boarded the plane after him and his colleague, and were left undisturbed: Both of us (passengers of colour) had similar negative reactions. First, balancing the weight on the plane seemed reasonable, but why were we being singled out? … Were we being singled out because of our race?

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Was this just a random event with no racial overtones? Were we being oversensitive and petty? Although we complied by moving to the back of the plane, both of us felt resentment, irritation, and anger. In light of our everyday racial experiences, we both came to the same conclusion: the flight attendant had treated us like second-class citizens because of our race. But this incident did not end there… When the attendant walked back to make sure our seat belts were fastened, I could not contain my anger any longer. Struggling to control myself, I said to her in a forced calm voice: ‘Did you know that you asked two passengers of colour to step to the rear of the “bus”?’ For a few seconds she said nothing but looked at me with a horrified expression. Then she said in a righteously indignant tone, ‘Well, I have never been accused of that! How dare you? I don’t see colour! I only asked you to move to balance the plane. Anyway, I was only trying to give you more space and greater privacy.’ Attempts to explain my perceptions and feelings only generated greater defensiveness from her. For every allegation I made, she seemed to have a rational reason for her actions. Finally, she broke off the conversation and refused to talk about the incident any longer. Were it not for my colleague, who validated my experiential reality, I would have left that encounter wondering whether I was correct or incorrect in my perceptions. Nevertheless, for the rest of the flight, I stewed over the incident and it left a sour taste in my mouth. (Sue et al., 2007, p.275)

It is the deeper meaning in these interactions that continues to cause racial psychological wounds. These are psychological injuries that hold within them previous experience of racism and racialisation and the immediate expression of oppression and injustice. Other microaggressions are also communicated to the Black patient through their relationships with other Black people and Black, Asian and minority ethnic groups who they identify with and who have also had experiences of racism. Such microaggressions can generate levels of anger and frustration in the individual as well as affecting the internalised communication of low self-worth. Most development models of Black identity, as in that of Cross (1978), propose a stage in development when the Black individual encounters their Blackness or otherwise ‘otherness’ through a specific event or a series of racist events that prompts the realisation of racialised experiences – the encounter stage. However, as mentioned above, racialised experiences are encountered much earlier in childhood than Cross discusses and, dependent on age and stage of cognitive development, are perhaps not conceptualised by the Black child as experiences of racism. Yet, the psychological effects of such occurrences may be experienced and internalised as early formations of the Black identity. These may well be the hidden wounds that Hardy (2013) refers to when he talks about how children of colour fail in school and are channelled towards mental health services, social services involvement and the criminal justice system. Hardy recognises how the psychological pains of racial trauma can be masked by other ‘distracting symptoms ranging from hopelessness

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to acting out behaviour’, where all too often children’s symptoms of emotional injuries are problematised rather than analysed and understood. Therefore, it may be a logical conclusion to make from a psychodynamic standpoint that the absence of the language for children and young people to name their racial experiences and trauma implies there is more likelihood of Black children internalising their experiences of pain, hence causing internal psychological distress. There is an oversimplification in the conceptualisation of Black identities that fails to recognise the intersectionality of the multiple identities of the Black individual. These are understood not as separate identities but in relation to the diversity of individual experience and how variations in race, culture, ethnicity, gender, socioeconomic status, religion and other variants come together to make a unique self-concept that includes the individual’s internalisation of experiences of marginalisation and oppression. There are strong correlations between low income and unemployment, poor/lower education outcomes, poorer socio-economic conditions such as housing and community environment, poorer physical health and mental health outcomes (including higher rates of morbidity and mortality) and belonging to particular racial minority groups (Nazroo, 2003; Gay, 2004; Williams et al., 2010). These associations demonstrate the further dynamic complexities of intersectionality. Moreover, when the available models of racial identity seek only to discern structured stages and processes of nigrescence identity formation, they omit important links with early infant and childhood development. Rowe and colleagues (1994) cast critical light on the various models of racial identity development, including white racial identity development models, which are considered to be useful frameworks for counsellors to understand cross-cultural dyadic interactions and the idea that ‘a verified model of White racial identity attitudes would allow the personalising of cross-cultural learning experiences for White counsellor trainees’ (Sabnani et al., 1991). There continue to be gaps in the understanding of counsellors, therapists and trainees alike due to the lack of knowledge, approaches to teaching and the lack of useful models that adequately address issues of race.

Personal learning from therapy When exploring facets of my own cultural experiences as a Black professional academic working in a conceptually white institution, I discovered that I experienced uncertainty about my right to be in this profession, let alone to be successful. I found myself challenged when faced with the idea that I hated aspects of my Blackness, and my Black culture – presumably those parts that on the whole are not represented in academia and are less likely to be seen walking the corridors of a higher education institution, or those parts that feel academically inferior, or any number of other negative stereotypes that associated with being Black British. As a trainee therapist in therapy myself, I was immediately able to identify with the interpretation of my reluctance to explore the crystallised catacombs of my internalised identification of the Black me steeped in four decades of life experiences, which must simply be seen through the lens of a racial experience

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as much as any other experience that may relate to other forms of my identity. Interestingly, I think I too, as well as my therapist at the time, was willing to ignore the simple fact that, in my transference in therapy, I resented the idea of being defined by an external authority – by a predominant ruling presence that would subjugate me to identify with and behave in a way that was recognisable as belonging to a racial group with which I myself did, in fact, identify. But, at the same time, I could also recognise the qualities and ambitions that I possessed and that brought me to academia as characteristic of my own ethnic group. That my resentment towards my therapist may be related to my earlier experiences in childhood of being Black and not recognised for my intelligence or, conversely, being recognised as an exception to the rule of the academic failures of Black people, among a host of verbalised and non-verbalised minor racial aggressions, is unquestionably a part of my internal psychic workings and therefore has resonance in the externalisation of my internal psychic world. I felt that this dyadic complexity of my presentations in therapy was barely acknowledged or explored. On reflection, I felt that the interpretation of transference in therapy was apportioned to my feelings of abandonment by my deceased mother and a desire to demonstrate the damage she caused, not unlike the resentment I should feel towards my therapist for the damage she threatened in persistently drawing me into this way of thinking. Perversely, my anxieties about being an imposter in my profession and my fears of being found out and ostracised were not explored in their racial and cultural context. If we keep to Freud’s early descriptions of transference as a mechanism in the therapy relating to the patient’s early experiences with their parents (Freud, 1939, cited in Winer, 2014), we may rightly reduce interpretations of the transference to frustrations and traumas related to ‘normal’ development in children. However, the significant impact of racism on the human psyche as it relates to the emerging identities of Black, Asian and minority ethnic children must also be understood in therapy through the interpretation of the transference.

Transference and countertransference in the context of race and racism In the world of psychoanalytically informed therapy, transference is widely accepted as playing an important role as a tool, and the work of treatment is seen to be to help the patient understand the communication ‘so that current relating becomes more relevant and less encumbered, more “objective” and less “neurotic” in the language of the times’ (Thompson, 1945, cited in Winer, 2014). Thompson’s interest in the impact of culture on psychological development recognises the relevance of early experiences of women that are internalised and become a part of their identities and internal mental representations (Winer, 2014). The concept of intersectionality in relation to race, culture and identity speaks to the unique experiences of the individual relating to socio-economic status, gender, age, ethnicity, religion and other such influencing factors that impact on human development and therefore significantly influence our identities. They affect how

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we view the world in relation to ourselves, which in turn informs our understanding of how we are viewed in the world (Bryant-Davis, 2019). Bryant-Davis’s focus on post-traumatic stress disorder offers a further facet to this discussion in its call for the recognition of early experiences of racism and cultural biases as traumatic experiences that can be characterised as long-lasting psychological wounds. It follows that the manifestation of such traumas in Black, Asian and minority ethnic patients, being a part of the mental state of the patient, must surely be present in the transference communicated in therapy. Consequently, the patient’s ability to come to understand the meaning in the transference moves them towards what Thompson describes as being more objective, more understanding and less neurotic. Therefore, the therapeutic focus must be on effective interpretation of transference communication. According to Segal (1973, p.9), Klein’s (1930) earlier work ‘gained access to the understanding of the child’s inner structure through following the transference and the symbolism of the child’s play’. If it can be accepted that not only the child’s play but all of the child’s activities can offer opportunities for interpretation through the symbolisation of their phantasies and is represented in the child’s psychic life, then we are able to reinforce the importance of social context in development and identity. The therapist’s attunement to the extent and severity of specific racial trauma and microaggressions is of great importance. Burkard and Knox (2004) consider the effects of therapist colour-blindness on empathy and offer some interesting contributions to this thinking. One interesting aspect is the therapist’s ability to empathise with the effects of racial trauma on the patient. This presents many challenges to the therapist’s capacity to genuinely communicate understanding to the patient of his or her experiences. This is as much a complex dynamic for crosscultural psychotherapy and counselling as it may be for situations where both client and therapist may be from the same or similar cultural backgrounds. A further interesting point offered by Burkard and Knox (2004) is the attribution of patients’ responsibility for their problems and for finding solutions. In the first place, Burkard and Knox make links to the level of empathy the therapist is able to express and the effectiveness of cross-cultural counselling, where lower levels of empathy produce poorer outcomes. However, the entire context of the therapeutic relationship must be considered here as the frame and approach of therapy will have relevance to the patient’s experience of any empathic communication. The very nature of talking therapies being seen historically and still, today, as a middleclass resource may be a barrier to the expression and acceptance of empathic communication. There are several reasons for the avoidance and neglect of addressing the effects of racial trauma in therapy. One of the main factors that underpin this avoidance is the idea of colour-blindness in racial attitudes; the idea that race does not matter (Neville et al., 2000, cited in Burkard et al., 2014). To some extent, this is further perpetuated by the concept of post-racism: that we have overcome or moved beyond racism. Yet, we are still in an environment where Black, Asian and

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minority ethnic therapists are under-represented in the profession and where race and cultural-related issues that impact on mental and physical health and wider socio-economic experiences continue to go unrecognised or unacknowledged (Jackson et al., 2018). There is also the issue of ‘race avoidance’ (Mendez, 2019) in therapy. Therapists may bring a resistance or fear of addressing cultural difference and race in therapy that may well be related to the need for them to address their own prejudice and racial ignorance that are operational in the therapeutic relationship and become part of the countertransference. This may be one of the realities that affects the capacity for empathic attunement in the patient-therapist relationship and the perpetuation in therapy of the microaggressions the patient experiences in their everyday life.

Implications for practice and training Mendez (2019) offers a reflexive account of her encounter with a Black patient that I think encapsulates the nature of the problem that leads to the exclusion of helpful race perspectives in the education and training of psychodynamic therapists. She recounts her efforts to draw her patient to the more prescribed and familiar conversations regarding his everyday traumas, while possibly failing to acknowledge the significance of concerns the patient was bringing to the therapy about the traumas and injustices to which Black, Asian and minority ethnic people have been generally subjected, collectively and individually. Mendez acknowledges this potential oversight in the transference across all the patient’s phantasies and activities that related to his own feelings of abject annihilation and fear of complete destruction. Klein’s observation that the transference communication can be interpreted across the child’s phantasies and their interrelatedness demonstrates one way that therapists can be inclusive of the intersectional representations of the patient’s whole identity, and as such acknowledge all his or her experiences that make up the patient’s mental state.

Conclusion There is a need for the development of more reflective practice that seeks to engage psychotherapy students and therapists in identifying and addressing their own positions of prejudice in both their thinking and their language. There must be some acknowledgement of the position of privilege and/or power that the therapist/trainee holds, and how this may be reflected within the institutions and organisations that deliver education and treatment in these fields. There is a need for therapists to be willing to evaluate the appropriateness of their approaches in practice generally, but more specifically when working with people of colour. This will require the acknowledgement of microaggressions that occur in therapy. Therapists and students must be able to develop practices that help them to detect their own perpetuations of microaggressions and to seek to redress the incidences of these occurrences. It also requires the ability to conduct transparent dialogues about race and culture as a dimension of psychotherapy and counselling education and practice.

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This, of course, calls for the evolution of psychodynamic/psychoanalytic research and theory and a decolonisation of what are largely white European curricula that favour traditional psychoanalytic ideas about mental development and human behaviour and exclude transcultural perspectives on both mental health and treatment. We also need much more research into the exclusion of Black perspectives in psychodynamic therapies, and more action on the part of practitioners to continue to challenge such exclusions.

References Bryant-Davis, T. (2007). Healing requires recognition: The case for race-based trauma stress. The Counseling Psychologist, 35(1), 35–143. Bryant-Davis, T. (2019). The cultural context of trauma recovery: Considering the posttraumatic stress disorder practice guideline and intersectionality. American Psychological Association, 56(3), 400­–408. Burkard, A.W. & Knox, S. (2004). Effect of therapist color-blindness on empathy and attributions in cross-cultural counseling. Journal of Counseling Psychology, 51(4), 387–397. Burkard, A.W., Knox, S. & Clarke, R.D. (2014). Supervisors’ experiences of providing difficult feedback in cross-ethnic/racial supervision. The Counselling Psychologist, 42(3), 314–344. Carter, R.T. (1995). The influence of race and racial identity in psychotherapy: Toward a racially inclusive model. Wiley & Sons. Carter, R.T. (2007). Racism and psychological and emotional injury: Recognizing and assessing race-based traumatic stress. The Counseling Psychologist, 35(1), 13–105. Cross, W.E. (1978). The Thomas and Cross models of psychological nigrescence: A review. Journal of Black Psychology, 5(1), 13–31. Cross, W.E., Jr., Parham, T.A. & Helms, J.E. (1991).  The stages of Black identity development: Nigrescence models. In R.L. Jones (Ed.), Black psychology (p.319–338). Cobb & Henry Publishers. Gay, C. (2004). Putting race in context: Identifying the environmental determinants of black racial attitudes. American Political Science Review, 98(4), 547–562. Hardy, K.V. (2013). Healing the hidden wounds of racial trauma. Reclaiming Children & Youth, 22(1), 24–28. Jackson F., Jackson L. & Jackson, Z.E. (2018). Developmental stage epigenetic modifications and clinical symptoms associated with the trauma and stress of enslavement and institutionalized racism. Journal of Clinical Epigenetics, 4(11). doi: 10.21767/2472-1158.100096 Lemma, A. (2016). Introduction: Is Freud dead? In A. Lemma, The practice of psychoanalytic psychotherapy (2nd Ed.) (pp.1–11). Wiley & Sons. Mendez, T. (2019). In conversation with race and psychoanalysis: An introduction. Psychoanalytic Social Work, 26(1), 1–4.

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Moodley, R. & Palmer, S. (Eds.). (2014). Race, culture and psychotherapy: Critical perspectives in multicultural practice. Routledge. Nazroo, J.Y. (2003). The structuring of ethnic inequalities in health: Economic position, racial discrimination and racism. American Journal of Public Health, 93(2), 277–284. Owen, J.D., Drinane, J.M., Tao, K.W., DasGupta, D.R., Zhang, Y.S.D. & Adelson, J. (2018). An experimental test of microaggression detection in psychotherapy: Therapist multicultural orientation. Professional Psychology: Research and practice, 49(1), 9–21. Rowe, W., Bennett, S.K. & Atkinson, D.R. (1994). White racial identity models: A critique and alternative proposal. The Counseling Psychologist, 22(1), 129–146. Sabnani H.B., Ponterotto, J.G. & Borodovsky, L.G. (1991). White racial identity development and cross-cultural counselor training: A stage model. The Counseling Psychologist, 19(1), 76–102. Segal, H. (1973). Introduction to the work of Melanie Klein. Hogarth Press. Spalding, B., Grove, J. & Rolf, A. (2019). An exploration of Black, Asian and minority ethnic counsellors’ experiences of working with white clients. Counselling & Psychotherapy Research, 19, 75–82. Sue, D.W., Capodilupo, C.M., Torino, G.C., Bucceri, J.M., Holder, A.M.B., Nadal,K.L. & Esquilin, M. (2007). Racial microaggressions in everyday life: Implications for clinical practice. American Psychologist, 62(4), 271–286. Williams, D.R., Mohammed, S.A, Leavell, J. & Collins, C. (2010). Race, socioeconomic status and health: Complexities, ongoing challenges and research opportunities. Annals of the New York Academy of Sciences, 1186(1), 69-101. Winer, R. (2014). Commentary on ‘Transference as a therapeutic instrument’ – Thinking about transference. Psychiatry, 77(1), 8–13.

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Towards a decolonised psychotherapy research and practice Divine Charura and Colin Lago

I hope… we’re always on the move, to a new theory… to new areas of dealing with situations, new ways of being with persons. I hope that we’re always part of a growing edge. (Carl Rogers, quoted in Cornelius-White & Cornelius-White, 2005, p.396)

Sigmund Freud, Melanie Klein, Aaron Beck, Carl Rogers, Abraham Maslow et al did not live in Europe in 2021. The opening sentence to this chapter was informed by discussions we, as authors of this chapter, have had over the past decade when we have been discussing the applicability and challenges of classical psychotherapy theory to contemporary practice in the multicultural cities where we live. Undoubtedly these founding parents’ contributions have been invaluable in developing psychotherapy and counselling modalities, and for that we are indebted to them. Nonetheless, it is important that we review whether and how their theories still apply today, in 2021, given the very different societies we inhabit and the different challenges we face from those of their time. Our task in this chapter is to critically explore what it means to decolonise psychotherapy, counselling and practitioner psychology training, research and practice. It is a huge task to attempt in one chapter and it is important to note that what we offer here will critique but also complement literature from other writers on the subject (Liamputtong, 2008; Mendoza et al., 2012; Nyoni, 2019; Keating, 2020). In our experience, the whole subject of decolonising psychotherapy, counselling and practitioner psychology training, research and practice is often misinterpreted. In dialogue with colleagues, we have witnessed ‘decolonising the curriculum’ being interpreted to mean including a few Black/non-white authors on reading lists or including a group of Black and ethnic minority participants in research studies. Some have gone so far as state to us, ‘We have a diversity

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weekend on our programme’, or ‘We have the following reading list, which includes many writers of colour’. However, decolonising knowledge is much more than this. It is about breaking down the structures that support the status quo. These are structures that often support power inequalities, discrimination and racism within our profession. Keating (2020) argues that this can be done by analysing how oppression and power are used to exploit, oppress and discriminate against racialised groups. Furthermore, he argues that it is also about challenging and critically examining the beliefs one holds about other groups and the process of ‘othering’ and, through this, valuing the views of other groups. Decolonising research and practice is about challenging how Eurocentric ideas are used to inform what we do in these arenas. It is also about challenging the pre-eminence given to Western models for viewing mental health/ill health, even when these don’t apply to or fit other groups (Keating, 2020). It is essentially about critiquing psychotherapy/counselling theories, Western psychology perspectives and the way their research evidence base is seen as the gold standard, even when they are incongruent or culturally inappropriate to certain populations. Thus, it has been argued that decolonising research is about disrupting the alignment between ethnicity and mental ill health (Liamputtong, 2008; Mendoza et al., 2012; Nyoni, 2019; Keating, 2020). Keating (2020) asserts that ‘believing the myth that ethnicity is a risk factor for mental health is blatantly wrong’. He argues that ‘the factors that cause mental ill health are the adversities that are associated with discrimination, racialised trauma, oppression, exclusion, the invisibility of particular groups in the research and literature, but not ethnicity in itself ’ (Keating, 2020).

What are the radical propositions in this chapter? The propositions we are making in this chapter go way beyond tokenistic diversity seminars in psychology, psychotherapy and counselling training. It is important for all researchers and practitioners in our field to critically engage with how white privilege operates and impacts the system within which they work, including its trainings, research and practice. There must be a disruption of the status quo. For example, in research there must be active involvement of Black, Asian and ethnic minority groups through the process, which will ultimately be for the benefit of a diverse society (Liamputtong, 2008; Mendoza et al., 2012; Nyoni, 2019; Keating, 2020). As this chapter develops, we will highlight some critical positions that we draw from our experience as educators and practitioners and from research literature. Listed below are the propositions that we will expand on: 1. It is important to engage critically with one’s ontological and epistemological position in counselling, psychotherapy and psychology research design. By this we mean questioning ‘the nature of reality’ and one’s own experience of ‘being in the world’ (Pring, 2004). In relation to epistemology, we mean critically exploring how the theory of knowledge and the methods used to gain understanding of social reality are generated (Grix, 2001). We argue that this can enable an engagement with challenging how Eurocentric perspectives and

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power inform a system that maintains mechanisms that perpetuate oppression and discrimination – thus challenging how knowledge is generated and having an openness to embody a non-defensive approach and capacity for reflection. 2. It is important that educators and researchers have an awareness of the historical impact of traumatic experiences faced by the populations they will be working with or researching in. 3. It is important that practitioners and researchers have an awareness about the knowledge generation of the issues of difference and diversity of experiences of their clients/participants (individuals/group). In line with this, it is important to question whether there were/are culturally sensitive recruitment methodologies employed in the research and also, if relating to therapy practice, to question whether the practitioner engages with culturally sensitive approaches. 4. It is important that researchers critically analyse the research literature (including historical research that evidences discrimination) or engage in research planning from the position of analysing whether there have been cultural considerations made in the research design (Finlay, 2008). 5. It is important to question and reflect on one’s power in relation to questioning what theories dominate research and clinical practice, which, after all, draw and benefit from research. We ask you, the reader, to question yourself on whether you are critically engaging with perspectives that evidence challenging unequal power relations. This may mean you are consciously/unconsciously excluding the multiple realities and knowledge bases of the clients/patients or participants you work with (see, Tillman, 2002). If so, how? For those in educator or research roles in our field, we highlight the importance of co-creating a positive environment for learning and training with students/ trainees. This enables reflection on the impact of negative feelings that may be evoked from the process of destabilising and disrupting the status quo: that of seeing Eurocentric perspectives as the dominant discourse and gold standard of evidence that is then applied to all groups, while dismissing other ontologies and lived experiences. In line with this, we name and address what we see as some of the systemic failures of paying attention to diversity in psychotherapy and practitioner psychology research. We have noted as a start to this chapter a quote from Carl Rogers, (CorneliusWhite & Cornelius-White, 2005, p.396), which highlights what we hope for our professions in relation to research. That is, to be ‘always moving, open to change and to being part of a growing edge in our research practice, or in facilitation of research learning as well as in therapeutic practice’. We critique research and teaching pedagogy as well as the mainstream Eurocentric psychotherapy and counselling research curriculum development. By its very nature, the Eurocentric curriculum, which primarily informs current

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research and teaching in the UK, has an academic heritage determined mostly by white Western male theorists. So, in order to try to re-contextualise and offer the stimulus for new research developments, so striving to ensure that our practice is embedded in the current geo-socio-political-cultural position, this chapter importantly offers a counter-narrative – one, we contend, that better fits the multicultural and contemporary context within which we live, as well as in which we facilitate psychotherapy training and research.

Illuminating the dominance of Eurocentric perspectives in the counselling, psychotherapy and psychology curriculum To illuminate and unpack the nature of this challenge, we have an exercise in which we engage trainees who are on counselling and psychotherapy courses. In this exercise, we ask them to shout out randomly the names of all the theorists and major contributors who have influenced their theoretical and research orientation. In preparation for writing this chapter, one of us conducted this exercise with three different counselling and psychotherapy trainee cohorts. These ranged from those in the first year of their degree to those actively engaged in working with patients/ clients and two months from qualifying as therapists. The smallest group had 30 participants and the largest more than 40 participants. The groups with whom we have worked over the years, and in particular the groups we invited to take part in this exercise, are taught a curriculum that clusters models according to the four major forces in psychology: psychoanalytic (psychodynamic); behavioural and cognitive-behavioural (behavioural, cognitivebehavioural, reality); humanistic (existential, person-centred, Gestalt), and contextual/systemic (feminist, family systems, transpersonal trans/multicultural) (Corey, 2011). All the groups independently responded with the following names: Martin Buber, Sigmund Freud, Carl Jung, Melanie Klein, Carl Rogers, Aaron Beck, Fritz Perls, John Bowlby, Eric Berne, Salvador Minuchin, Murray Bowen, Heinz Kohut, Robert Stolorow, Abraham Maslow, Stanislav Grof. Unsurprisingly for us, having facilitated this exercise many times, what emerged from the groups was a list of names, philosophical perspectives and therapies built on a long history of Eurocentric thinking and ideologies rooted in white male privilege and colonial history. We have often felt deeply saddened, from our perspective as male practitioners who embrace and value feminist critique, that female contributors of significant research and theory are rarely acknowledged. For example, Anna Freud, Melanie Klein, Claire Winnicott, Mary Ainsworth (who worked alongside Bowlby), Laura Perls (who worked alongside Fritz Perls and co-established the Gestalt school of psychotherapy), Natalie Rogers and many others are not named or acknowledged when we use this exercise. Further, as we both deeply value and embrace classic and contemporary practice that values diversity of thought, positioning and perspective, we also notice that historical and contemporary non-white contributors are not named here, and rarely whenever we do the exercise. When we ask trainees, there

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is usually a limited awareness of the range of critical psychological perspectives that offer a counter-narrative to the dominant Eurocentric theoretical perspective. We will not list here the full list of contributors who offer such counternarratives, but we will point out that many non-Western cultures have a rich history of authors and researchers who offer an insider understanding of the psychology and culture of those of non-Eurocentric heritage. For example, Francis Cecil Sumner (1895–1954) was the first African American to receive his PhD in psychology and was instrumental in establishing the psychology department at Howard University to train African American psychologists. His work and that of those that followed offers a counter-narrative to the psychology of African American communities and includes a vast amount of research that counteracts racism and bias in psychological studies of African Americans. Then there are some of the most eminent figures in the history of psychology in Japan, such as Yūjirō Motora and Matatarō Matsumoto, whose work, and that of other psychologists who came after them, offers insight into Japanese cultural perspectives. Over the past few decades, there has been a continual and essential increase in psychologists who have offered a much-needed critical perspective and counter-narrative to the dominant Eurocentric theoretical perspective in both cross-cultural research and methodological/practice perspectives. We will list here only a few: Alessandrini, 1999; D’Ardenne & Mahtani, 1999; Denzin et al., 2008; Kareem & Littlewood, 1992; Lago, 2011; Lago & Thompson, 2006; Lee, 2013; Liamputtong, 2008; McKenzieMavinga, 2009; McMurray, 2004; Miller-Loessi & Parker, 2003, and Marriott, 2018. In our experience, despite examples of such important theory and research contributions, there remains a limitation in mainstream research and literature regarding the inclusion or acknowledgement of counter-narratives to the dominating Eurocentric research evidence base. The identification of the importance of different cultural voices and research practices being regarded as worthy of being viewed as equal knowledge-generation partners has formed our rationale for this chapter, with our focus on a radical call for decolonised, psychotherapy and counselling research, teaching, learning and practice.

A brief critique of decolonising the curriculum perspectives In relation to the lived experience of training and practice of practitioners, there has been a range of ‘decolonise my curriculum’ movements internationally, and here we give an example of those in the UK that have been championed by the National Union of Students. They have included, for example, the 2015 ‘Why is my curriculum white?’ campaign. This originated at University College London (UCL) and was quickly adopted by other student unions nationally. It was a response to the lack of diversity found on reading lists and course content and in recognition that universities in the UK continue to perpetuate the idea of certain sources holding academic privilege. From this movement was born a range of other ‘decolonise my curriculum’ initiatives by other academic psychology training institutions and professional bodies nationally, joining those taking place internationally.

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These movements have not been without strong criticism. For example, Stokes (2019) argues that decolonising the curriculum is a ‘big mistake’ because the last thing universities need is to have white male voices or Eurocentric theoretical perspectives side-lined. However, a counter-argument points out that decolonising institutions or the curriculum is not about the complete elimination of Eurocentric perspectives but about challenging longstanding oppressions, biases and omissions that limit how we understand not only psychology, psychotherapy and counselling theory, research and practice but, according to Muldoon (2019), politics and contemporary society as well. The Learning and Teaching Toolkit for Programme and Module Convenors (2018), produced by the University of London as part of its Decolonising SOAS programme, is a helpful briefing for programme and module convenors on what ‘decolonising’ learning and teaching might entail. Ultimately, the aims of such campaigns are to challenge and highlight the lack of diversity in educational and research systems. In the section that follows we outline further what decolonising the research curriculum entails. We make the case here for culturally relevant research pedagogy and for research educators to engage with decolonised and cultural considerations in the pre-testing and planning of research, selection/translation of instruments, recruitment, data collection, analysis and interpretation, and reflexivity.

What is decolonised, culturally informed, research teaching, learning, design and practice? Decolonising the education curriculum is an expression of the shift in the geopolitics of knowledge in which modern epistemological frameworks for knowing and understanding the world are challenged. It is about no longer accepting Eurocentric research approaches, evidence and curricula perspectives as the universal and best ways of understanding the world (Mignolo, 2011). It is a call for a radical shift to challenge racial undertones and all forms of ‘isms’ that breed discrimination (Mignolo, 2011; Nyoni, 2019). There is a commitment to promoting gender equality and to challenging and reforming research and curriculum perspectives that rank evidence and knowledge hierarchically by Eurocentric concepts, standards and assumptions (Tillman, 2002; Mignolo, 2011; Nyoni, 2019). A commitment to a decolonised approach acknowledges the diversity of cultures and contexts in which there is epistemology generation; it sees these contexts as having their own developmental intricacies, and thus regards them as equal knowledge-generation partners.

Awareness of discriminatory historical research and its impact When teaching research methods or conducting research within counselling/ psychotherapy or practitioner psychology, educators should reflect on the impact their work may have on those learning/engaging with it (Bishop, 2005; Chavez, 2008). In this chapter, we would like to use studies on trauma and Covid-19 as

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examples of what educators and participants could do to demonstrate decolonised, culturally informed research teaching, learning, design and practice. In qualitative research on trauma, for example, it is important for educators to have an awareness of the kinds of feelings the research methods may evoke. For instance, in our work on the lived experience of refugees and asylum seekers, it has been invaluable having knowledge of the Black psychology and Africancentred research pedagogy. In brief, these perspectives encourage researchers to acknowledge awareness of oppressive conditions that serve as barriers to minorities in society and how these have historically, and continue to impact on their lived experience. Furthermore, research course instructors and therapists engaging in research need to take into consideration narratives of how scientific research has historically been used as a mechanism of oppression for people of African descent (Henderson et al., 2016). To demonstrate the point, Henderson and colleagues (2016) argue that the historical impact cannot be ignored, particularly on those who belong to the groups on which such research was conducted. This could be in relation to their ethnicity, gender and so on. So, if research educators and counsellors and therapists are to engage with a decolonised research pedagogy, they need to have awareness of such studies. Examples of such historical studies include eugenics and forced sterilisation, which stemmed from research conducted with upper-class British families in the 1880s. Researchers hypothesised that the most elite populations were elite because of their genetic make-up (Selden, 2005). Such research was centred on the goal of ‘race betterment’ (Monroe & Alexander, 2005, p.19) and thus included initiatives to increase the number of births for privileged upper-class whites while decreasing the reproductive rates of those of lower classes, those with a disability and those with mental ill health. This was often through procedures such as forced and involuntary sterilisation. Another example was the Tuskegee syphilis experiment, in which African American men were informed they were engaged in a study of ‘bad blood’, when in fact it was a study of the natural progression of untreated syphilis. The study was supposed to last six months but went on for 40 years (Centers for Disease Control and Prevention, 2013). The men, and some of their partners, died from the disease, and children were born with congenital syphilis. The study was additionally unethical because penicillin became a viable treatment option during the life of the study and could have cured them (Centers for Disease Control and Prevention, 2013; Tuskegee University, 2014; Henderson et al., 2016). While it could be argued that these examples of such unethical experiments were of their era, there is a more recent example of overt actions that serves as a reminder of the importance of decolonising research perspectives. This example relates to one of the world’s most respected scientists, James Watson, a Nobel Prize winner for his part in discovering the structure of DNA, who claimed that Black people are genetically less intelligent than white people (Shapiro, 2008). We are, however, aware that these comments, made ahead of his arrival in Britain in 2007,

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rightly provoked outrage. It is important to challenge such perspectives, and this is an example of where having a rich curriculum that draws from the voice of nonEurocentric writers can offer a counter- narrative.

Decolonisation through engaging with culturally sensitive practice There is another dimension to ensuring that research is culturally sensitive, and this can be achieved by recruiting under-represented groups for research and services: for example, greater inclusion of non-white populations. There is in the UK an underrepresentation of minority groups in major research projects. For a comparison, the National Institutes of Health (NIH) in the US issued a policy more than two decades ago requiring the inclusion of women and minorities as subjects in clinical research studies (NIH, 1994). This policy also stated that research applications and proposals should include strategies by which they would achieve diversity in their samples. This perspective is supported more recently by some who have proposed a similar argument to the one we are making here for counselling and psychotherapy: that is, to ensure culturally informed research should be extended beyond large cohort studies or NIH randomised clinical trials and apply to all research (Awad et al., 2016; Bishop, 2005; Liamputtong, 2008; McMurray, 2004; Mendoza et al., 2012). While these examples relate widely to the importance of decolonising research, within the field of counselling psychology and psychotherapy there is literature that has outlined how oppressive and culturally insensitive ideologies continue to be at the centre of debates around issues of culture and difference. They include, for example, the uncritical acceptance of colonialist anthropological conclusions that are drawn into psychoanalytic theory (Morgan, 2008), and the Eurocentric focus in both psychoanalytic and humanist-existential theories. In these cases, preeminence in these modalities is often given to individualistic formulations of the self, while systematically marginalising other psychologies that draw on collectivist cultures and interrelatedness. Tillman (2002) argued that the use of culturally sensitive research approaches can apply to the cultural knowledge and experiences of researchers and their participants in the design of the research as well as in the collection, analysis and interpretation of data. She argued for culturally congruent and sensitive research methodologies that use a range of qualitative methods. These include interviews (individual, group, life history), observation and participant observation. She further argued that, as part of their commitment to cultural sensitivity and a decolonised approach, researchers should carefully consider the extent of their own cultural knowledge and insider and outsider issues related to the research process. It is important that researchers challenge their own cultural power, commitment to theoretical dominance and unequal power relations that may minimise, marginalise, subjugate or exclude the multiple realities and knowledge bases of their participants (Tillman, 2002). Another perspective is that it is important to question research privilege and power. This relates to questioning claims of neutrality and objectivity in

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psychological research. The researcher, or educator, should consider the power of ‘research on’ participants, as well as be aware of their own assumed knowledge of and standpoints on their participants’ social, political, economic and cultural lived experience (Tillman, 2002; Bishop, 2005; Denzin et al., 2008).

A case example of Covid-19 research: challenges and opportunities Recently we have seen the psychological impacts of Covid-19 and consequent selfisolation policies, and we identify here a few examples of areas of consideration in which a decolonised and reflexive approach towards power and difference can be demonstrated. It has been documented that disease outbreaks create a fear of the different other, and fear is a known key ingredient for racism and xenophobia to thrive. Devakumar and colleagues (2020), in a recent article on racism and discrimination resulting from Covid-19 published in the Lancet, argued that the pandemic had uncovered social and political fractures within communities, manifested in racialised and discriminatory responses to fear disproportionately affecting marginalised groups. Further, they noted how, following the spread of Covid-19, discrimination had increased towards people of Chinese heritage, including individual acts of microaggression or violence, as well as collective forms of discrimination, such as Chinese people being barred from some establishments. Very sadly, rather than humanity joining together and recognising Covid-19 as an equaliser, as it could affect anyone and everyone, Covid-19 responses were discriminatory in many societies. In addition, the disproportionate impact on people in the lower socio-economic groups, including people of colour and migrants, was not addressed as it should have been (Devakumar et al., 2020). Devakumar and colleagues (2020) went on to further argue that self-isolation was often not possible for these communities and individuals, leading to higher risk of viral spread. In some cases migrants, and particularly those without documentation, avoided hospitals for fear of identification and deportation, meaning they presented late, potentially with more advanced disease. Thus, in another example of our radical call for decolonised, psychotherapy research and practice, we have a momentous example of research into the psychological impacts of Covid-19 responses. It is important to demonstrate in research design this awareness of the socio-economic-political complexities, including further discrimination that marginalised populations and people of colour can face (Chavez, 2008). Including individuals from these communities as participants in research would offer a voice to their lived experience. Such a task of undertaking cross-cultural research offers researchers unique opportunities, as well as dilemmas, that can enrich research teaching, learning, design and practice (Liamputtong, 2008). We draw on Liamputtong (2008) further, with his argument that there is a range of questions that we can agree can facilitate decolonisation and cultural sensitivity in research. We have summarised these questions in the context of trustworthiness of research and decolonising research processes, as follows:

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Who are the participants I am working with?

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What ethical and moral considerations do I as a researcher, supervisor/ educator need to observe?

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How could a position of culturally appropriate methodology and method be adopted in line with the needs of people being researched?

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How do I deal with language and cultural norm issues in the context?

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How will I negotiate access? And what research methods should I apply to ensure a successful research process?

We would also add that educators of research methods and researchers engage critically with the literature. This can be done by challenging, in their review of the literature and their research design, any hierarchically ranked evidence and knowledge that gives pre-eminence to Eurocentric concepts, evidence and assumptions as the gold standard without thorough critique. The section that now follows focuses briefly on the importance of challenging one’s philosophical influences and values (ontological and epistemological perspectives) in research design. We offer examples from our own engagement with facilitating teaching, research, and research methods.

Clarifying one’s ontological and epistemological position in research design We have both learned through academic practice in the UK, the US and, more recently, on a joint educational trip we took to Cambodia, the importance of first clarifying one’s own positioning in relation to the research. We have shared values in our ontological position (the nature of being, or what exists in the world and the nature of reality). For example, we examine our ontological and epistemological positions in every reflection about research or therapeutic practice. An example is how we see ontology as rooted in constructionism, which argues that knowledge, reality or truth can never be truly known (Punch, 1998, p.170; Pring, 2004). In relation to epistemology, we see it as concerned with the theory of knowledge and the methods used to gain understanding of social reality. We concur that, when considering decolonising any curriculum, it is important to start from the position of seeing reality as highly subjective (Pring, 2004; Serning, 2011). In relation to our different positions and experiences, over the years we have worked together, we have found agreement in Blackburn’s (2006) philosophical stance of perspectivism. This stance argues that different perspectives are a result of being positioned at different viewpoints and that there is no absolute standpoint from which one can see the universe, but rather a multiplicity of perspectives. Additionally, our alignment with the central theme of a post-modernist philosophical assumption and stance, which embraces and involves complexity, an ethos of ‘both/and’ rather than ‘either/or’, enables us to accept seemingly different

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or opposing perspectives, paradoxically, side by side (Giovazolias, 2005; Wachtel, 2014). Within our epistemological position, nothing therefore is fixed but rather there is fluidity across different positions. Thus, our interest and commitment to difference and diversity is clearly demonstrative of us not privileging Eurocentric perspectives but, as Nyoni (2019) argued, seeing the worthiness of non-Eurocentric perspectives as equal knowledge generation partners.

Conclusion Thus, simply put, a decolonised research curriculum is not just about inclusion of a diverse range of research sources/references in the reading list but is an active way of engaging with research and reflexivity. It is about challenging how Eurocentric ideas are used to inform research and pre-eminence is given to Western models of viewing mental health/ill health in psychotherapy/counselling theories and Western psychology perspectives when they don’t always apply to other groups (Keating, 2020). Doing this enables the non-defensive approach to acknowledge the power and limitations of the theoretical perspectives and methodologies employed in the research. Furthermore, this stance rightly disrupts the presumed association between ethnicity and mental ill health, and the myth that ethnicity in itself is a risk factor in mental health. Engaging with decolonising the research curriculum also fosters learning and advancement in research that is contemporary, non-colonial and challenges longstanding oppressions, biases and omissions that limit how we understand therapeutic research, practice, politics and contemporary society. To conclude, we summarise this chapter by proposing the following 10 points: 1. It is important to embody a non-defensive approach and capacity for reflection. This can be achieved through acknowledging and encouraging engagement with one’s own ontological and epistemological stance in a way that embraces an openness to learn from the literature of past research, from the participants/ data, awareness of intersectionality, diversity and culturally informed research teaching, learning and design. 2. It is important for educators and researchers to have the awareness of the historical impact of traumatic experiences faced by the populations they will be working with or researching in. For example, in our area of interest, namely trauma, we explore the impact of intergenerational trauma linked to slavery in those of African heritage (Moodley & Walcott, 2010)  and the resulting epigenetic implications and transcultural perspectives (Lago & Charura, 2015). 3. Researchers and practitioners should have a clear awareness about the difference and diversity of experiences of their client/participants (individuals/group). For example, in our chapter, cited above, this related to trauma, but it could also relate to political and colonial oppression, genocide, disempowerment,

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discrimination and so forth. In our teaching, we have encouraged students on the research methods modules and when we have supervised/marked PhDs to critique literature through a culturally sensitive and decolonised lens. 4. It is important to question the nature of research that has been done in your area of interest and to check that the research participants in research into your field reflect a diverse population globally. This enables engagement with ethics and facilitates questioning whether there were/are culturally sensitive recruitment methodologies employed in the research. 5. Engage in reflexivity that demonstrates cultural considerations in the pretesting and planning of research, selection/translation of instruments, recruitment and the collection analysis and interpretation of data (Finlay, 2008). 6. It is important to conduct in-depth literature reviews that cite good examples of theory and research that demonstrate a decolonised, culturally sensitive/ informed approach, thus enabling learners/researchers to have a solid underpinning in their own approach. 7. Demonstrate trustworthiness and awareness of the depth of research within your area of interest, including engagement with toolkits for ethical and culturally sensitive research. 8. Question and reflect on your power as a researcher. This can be in relation to critiquing the dominance of Eurocentric perspectives that exclude the multiple realities and knowledge bases of your participants. It can also be in relation to challenging unequal power relations with disadvantaged, marginalised groups and communities (see Tillman, 2002). 9. We advocate facilitating reflection through co-creating with students/trainees on counselling and psychotherapy research modules a positive environment that enables reflection on the impact of negative feelings. The containment of emotions and creation of space for feelings evoked in research learning, as a result of reviewing literature and identifying discriminatory or disempowering research practice that has historically resulted in serious harm to participants, is important. (e.g. the Tuskegee syphilis experiment). 10. It is also important to identify studies that fail to demonstrate researchers’ challenge of their own cultural power or that assert a theoretical dominance or perspective that results in unequal power over the population of participants.

Divine Charura and Colin Lago

References Alessandrini, A.C. (1999). Frantz Fanon: Critical perspectives. Routledge. Awad, G.H., Patall, E.A., Rackley, K.R., & Reilly, E.D. (2016). Recommendations for culturally sensitive research methods. Journal of Educational & Psychological Consultation, 26(3), 283–303. Bishop, R. (2005). Freeing ourselves from neo-colonial domination in research: A Kaupapa Māori approach to creating knowledge. In N.K. Denzin & Y.S. Lincoln (Eds.), The Sage handbook of qualitative research (3rd ed.) (pp.109–138). Sage. Blackburn, S. (2006). Truth. Penguin. Centers for Disease Control and Prevention. (2013). The US Public Health Service syphilis study at Tuskegee: The Tuskegee timeline. www.cdc.gov/tuskegee/timeline.htm  Chavez, C. (2008). Conceptualizing from the inside: Advantages, complications, and demands on insider positionality. The Qualitative Report, 13(3), 474–494. Corey, G. (2011). Theory and practice of counseling and psychotherapy (7th ed.). Brooks/Cole. Cornelius-White, J.H.D. & Cornelius-White, C.F. (2005). Reminiscing and predicting: Rogers’ Beyond Words speech and commentary. Journal of Humanistic Psychology, 45, 383–396. D’Ardenne, P. & Mahtani, A. (1999). Transcultural counselling in action (2nd ed.). Sage. Denzin, N.K., Lincoln, Y.S. & Smith, L.T. (2008). Handbook of critical and indigenous methodologies. Sage. Devakumar, D., Shannon G., Bhopal S.S. & Abubakar, I. (2020). Racism and discrimination in COVID-19 responses. The Lancet, 395(10231), 1194. Finlay, L. (2008). A dance between the reduction and reflexivity: Explicating the phenomenological psychological attitude. Journal of Phenomenological Psychology, 39(1), 1–32. Giovazolias, T. (2005). Counselling psychology and the integration of theory, research and practice: A personal account. Counselling Psychology Quarterly, 18(2), 161–168. Grix, J. (2001). De-mystifying postgraduate research: From MA to PhD. University of Birmingham Press. Henderson, Z., Acquaye-Doyle, L.A., Waites, S. & Howard, T. (2016). Putting principles into practice: Addressing historical trauma, mistrust, and apprehension in research methods courses. Journal of Social Work Education, 52(1), 69–78. Kareem, J. & Littlewood, R. (1992). Intercultural therapy: Themes, interpretations and practices. Blackwell Scientific. Keating F. (2020, November 23). What does it mean to decolonize knowledge and why is it important in mental health research? Mental Health Question Time event organised by UCL Psychiatry, The Lancet Psychiatry, Black Thrive and The Mental Elf. www.youtube.com/watch?utm_campaign= Black+men+and+mental+health+recovery%3A+An+intersectionalities+approach&utm_source= emailCampaign&utm_content&utm_medium=email&v=jqUlVpvh5A8&feature=youtu.be Lago, C. (Ed.) (2011). The handbook of transcultural counselling & psychotherapy. Open University Press. Lago, C. & Charura, D. (2015). Working with transgenerational / intergenerational trauma: The implication of epigenetic considerations and transcultural perspectives in psychotherapy. The Psychotherapist, 59, 23–25. Lago, C. & Thompson, J. (2006). Race, culture and counselling (2nd ed.). Open University Press. Lee, C.C. (2013).  Multicultural issues in counseling: New approaches to diversity. American Counseling Association. Liamputtong, P. (2008). Doing cross-cultural research: Ethical and methodological perspectives. Springer.

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Marriott, D.S. (2018). Whither Fanon?  Studies in the blackness of being. Stanford University Press. McKenzie-Mavinga, I. (2009). Black issues in the therapeutic process. Palgrave Macmillan. McMurray A. (2004). Culturally sensitive evidence-based practice. Collegian, 11(4). Mendoza, D.B., Williams, M.T., Chapman, L.K. & Powers, M. (2012). Minority inclusion and ethnic differences in randomized clinical trials of panic disorder. Journal of Anxiety Disorders, 26, 574–582. Mignolo, W.D. (2011). I am where I think: Remapping the order of knowing. In F. Lionnet & S. Shih (Eds.), The creolization of theory (pp.159–192). Duke University Press. Miller-Loessi, K. & Parker, J.N. (2003). Cross-cultural social psychology. In  J. DeLamater (Ed.), Handbook of social psychology (pp.529–553). Springer Nature. Monroe, J. & Alexander, R. (2005). C.R.A.C.K.: A progeny of eugenics and a forlorn representation for African Americans. Journal of African American Studies, 9(1), 19–31. doi:10.1007/s12111-005-1013-9 Moodley, R. & Walcott, R. (Eds.). (2010). Counselling across and beyond cultures: Exploring the work of Clemmont E. Vontress in clinical practice.  University of Toronto Press. Morgan, H. (2008). Issues of ‘race’ in psychoanalytic psychotherapy: Whose problem is it anyway? British Journal of Psychotherapy, 24(1), 34–49. Muldoon J. (2019, March 20). Academics: It’s time to get behind decolonising the curriculum. The Guardian. www.theguardian.com/education/2019/mar/20/academics-its-time-to-get-behinddecolonising-the-curriculum National Institutes of Health. (1994). NIH guidelines on the inclusion of women and minorities as subjects in clinical research. NIH Guide 23(11). https://grants.nih.gov/grants/guide/notice-files/ not94-100.html. National Union of Students. (2015). Why is my curriculum white? www.dtmh.ucl.ac.uk/videos/ curriculum-white/ Nyoni, J. (2019). Decolonising the higher education curriculum: An analysis of African intellectual readiness to break the chains of a colonial caged mentality. Transformation in Higher Education, 4(1). DOI:10.4102/the.v4i0.69 Pring, R. (2004). Philosophy of educational research (2nd ed.). Continuum. Punch, K. (1998). Introduction to social research: Quantitative and qualitative approaches. Sage. Selden, S. (2005). Transforming Better Babies into Fitter Families: Archival Resources and the History of the American Eugenics Movement, 1908–1930. Proceedings of the American Philosophical Society, 149(2), 199–225. Serning, N. (2011). International aid workers’ experience of support : an interpretative phenomenological analysis. Unpublished thesis. Middlesex University. Shapiro, K. (2008, May). James Watson’s not so brilliant career. Commentary. Stokes, D. (2019, February 18). Universities should resist calls to ‘decolonise the curriculum’. The Spectator. www.spectator.co.uk/article/universities-should-resist-calls-to-decolonise-the-curriculumTillman, L.C. (2002). Culturally sensitive research approaches: An African-American perspective. Educational Researcher, 31(9), 3–12. Tuskegee University. (2014). About the USPHS syphilis study. www.tuskegee.edu/about-us/centersof-excellence/bioethics-center/about-the-usphs-syphilis-study University of London. (2018). Decolonising SOAS learning and teaching toolkit for programme and module convenors. https://blogs.soas.ac.uk/decolonisingsoas/files/2018/10/Decolonising-SOASLearning-and-Teaching-Toolkit-AB.pdf Wachtel, P.L. (2014). An integrative relational point of view. Psychotherapy, 51(3), 342–349.

Rachel-Rose Burrell

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Religion, therapy and mental health treatment in diverse communities: Some critical reflections and radical propositions Rachel-Rose Burrell

This chapter explores personal and professional experiences that have shaped my theoretical and research journey, pulling together elements central to my life and work – namely being Black, female and Christian, attending a Black majority church, and mental health and psychotherapy. It will describe how they have interwoven over time and led me to bring about meaningful change. It will also present an example of therapists working beyond the confines of the consulting room to influence social institutions to become more humanely responsive and better equipped to support their membership.

Early influences and experiences As a student nurse in the 1980s, I was assigned a 13-week placement on a psychiatric ward in a large hospital in central London. Walking onto the ward for the first time, I felt shocked, frightened and confused. Most of the patients were Black; 90% were Black men. It was overwhelming; I had never observed anything like this before. During conversations with the patients, I realised they were heavily medicated. My first counselling course introduced me to person-centred counselling, which resonated with me because the core conditions appeared so similar to biblical principles. Subsequent training courses in psychodynamic, CBT and transcultural therapy helped to widen my scope, thinking and approach when working with clients. However, I struggled with psychoanalytical theory: the symbolism and frequent reference to sexuality and violence felt at odds with my biblical teaching and Black culture. These experiences with psychiatric care and counselling theories remained imprinted on my mind and were significant markers in my professional and personal development. I began asking questions, researching and adding my voice to other like-minded professionals who were equally appalled with the numbers of Black

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people in the mental health system, with the design and delivery of counselling courses, and with racism and discrimination generally. I joined the Association of Black Psychologists and Operation Black Vote and rubbed shoulders with writers who contributed to the journal of the Race and Cultural Education in Counselling (RACE) division of the British Association for Counselling (as it was then called). I became interested in the writings of Dr Na’im Akbar, particularly Know Thyself (1998), and those of Martin Luther King and Malcolm X. These authors emphasised the importance of ‘we’, not ‘me’, and asserted that together people are richer, better and stronger, both within and between racial groups. After qualifying as a counsellor, I approached senior leaders in the Pentecostal church I attended to gain their endorsement for a counselling initiative I wanted to implement in the church, following years of hearing congregants talk about their emotional and psychological struggles. The response I received was: ‘There is no need for counselling when we have prayer.’ This perturbed me and raised many questions, not least of which was: Why does it have to be either/or; why not both? I felt stumped and decided not to pursue the project. Yet, over the years, I found myself revisiting the interface between faith and therapy and questioning whether the two could work together. My experiences as a student and qualified nurse, and later as a counsellor and psychotherapist, further stimulated my interest in Black mental health. These early encounters raised questions and stirred emotions, leading me on a quest to find solutions. In one of my early jobs as a residential psychotherapist, my first client, a young Black woman, refused to see me because I was Black. I couldn’t understand why; it was a very uncomfortable experience that left me feeling bewildered. It was later explained to me this was an example of ‘internalised oppression’, of ‘turning upon oneself, one’s family and one’s people the distress patterns that result from the racism and oppression of the majority society’ (Lipsky, 1978, p.5). The single two-hour lecture on diversity in counselling offered on my Master’s course at a leading London university also left me perplexed by the little time assigned to what was, and is, in my view, a huge and important community concern. The issue of diversity in therapy training still needs to increase, in my opinion.

The alarming statistics of mental distress I read several books by eminent psychiatrist and writer Suman Fernando (2002, 2012), and attended several of his seminars. He asserted little had changed since his earlier publications in 1995 and 2002 – Black people were over-represented in the mental health system, and this is still the case today. The mental health charity Mind (n.d.) reports that 23% of Black or Black British people will experience a common mental health problem in any given week. This compares with 17% of white British people. Fernando (2012) highlighted that Black people were between 10 and 20 times more likely to be diagnosed as ‘schizophrenic’; more likely to be sectioned under the Mental Health Act, or, since 2009, placed on community treatment orders. They were also more likely to be deemed both ‘mad’ and ‘bad’ and so kept in

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forensic institutes and not referred to or accepted for counselling or psychotherapy. Black people were therefore more likely to be subjected to medication rather than therapy. Fernando’s work supported my belief that church and community could work together in supporting the mental health of Black people, but that the field of psychiatry is slow to change, and also seems to hold a largely negative attitude towards faith/religion. The statistics are alarming (Mental Health Foundation, n.d.). People from African and African-Caribbean communities in the UK are more likely than others to be admitted to hospital for mental illness, as are people of mixed ethnicity. In addition to common everyday concerns such as money worries and work-related stress, African and African-Caribbean communities face further problems that can affect their mental health, such as sub-standard housing, unemployment and racism. Black people, and particularly Black men, are over-represented in psychiatric hospitals and secure units, and more likely to come into care via the police, rather than via their GP. This is attributed in part to not engaging with services early enough, due to distrust and understandable fears of the mental health system, stigma around mental health in their communities, and a belief that counselling and other preventive and community-based mental wellbeing support services are not relevant to them. The image of counselling often alienates Black people further, as it is mainly delivered by white, middle-class women, is rooted in white European theories, and the services delivering it are staffed by white people using ritualistic and rigid therapeutic processes (Jackson, 2019). Worldwide, people who move from one country to another have a higher risk of mental illness. This is especially true for Black people who move to majority white countries, and the risk is even higher for their children (Mental Health Foundation n.d.). In a report on Racial Disparities in Mental Health, Bignall and colleagues (2019) urge service providers to do more: to have a better understanding of cultural and faith beliefs of Black and minority ethnic communities and how these impact on beliefs and behaviours around mental health; to improve their recognition of symptoms and how these are expressed in different ethnic groups (for example, depression in people of the Caribbean community); to increase their understanding of how loss (particularly among refugee/migrant children) and trauma are contributing factors to mental illness, and to develop a more holistic approach that integrates mental health, physical health, culture and belief.

The historical development of Black majority churches Howard (1987), quoting Duffield (1981), writes that Black people have been living in Britain since at least Roman times. Britain’s Black population increased notably during the First and Second World Wars, when soldiers, seamen, munitions workers and others from the colonies rallied to fight for the Mother Country (Fryer, 1984). When the Second World War ended, there was a shortage of labour in Britain, especially in the textile and heavy engineering industries, transport and healthcare.

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This factor was largely responsible for the invitation of the most recent and largest African-Caribbean migration to the UK, beginning in June 1948 when the Empire Windrush docked at Tilbury from Jamaica (Howard, 1987). With religion being an integral part of many Caribbeans’ lives, on arrival to the UK they attended the Sunday services at established local churches (e.g. Anglican, Methodist) and responded to sermons and songs as they normally would, with loud, vocally expressive and vibrant worship. The host congregations felt this style of worship to be disruptive and inappropriate, compared with their more sedate and passive way of participating, and the frequent result was that the new Black congregants were told by the vicar, ‘Your people meet down the road’, or, ‘I’d prefer if you didn’t come again’ (Aldred, 2016). In response, Black Christians formed their own churches, often starting in homes and expanding to halls and hired rooms until enough capital was accumulated to buy church properties. What has been termed the ‘the Windrush era’ since 1948 has seen a surge of Black Christianity in Britain, which has had a profound effect on British society, including the church. According to Clarke (2015), a range of factors has contributed to the growth of Pentecostal Christianity in the UK, including the desire to maintain a sense of cultural identity in an unfamiliar and generally unwelcoming society. Church was a place of refuge and acceptance where spiritual, social, economic and emotional needs could be met (Charman, 1979; Cooper, 2013).

Faith, church membership and mental health A vast amount of research already exists with regard to the influence of religion on health, including mental health. Some studies have demonstrated that being religious results in: •

more hope, optimism and life satisfaction (Koenig, 2009)

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less depression and faster remission of depression (Koenig, 2007; Smith et al., 2003)

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lower rates of suicide (Van Praag, 2009)

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reduced drug and alcohol abuse (Cook et al., 1997)

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reduced delinquency (Johnson et al., 2000)

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some evidence of reduced anxiety rates (although other studies indicate that anxiety levels are heightened in the more religious) (Koenig et al., 2012; Shrieve-Neiger & Edelstein, 2004)

•

some evidence that prayers and Bible reading help people with psychosis cope with their voices, and that higher levels of religiosity increase compliance with medication (Mohr et al., 2006).

Anderson (2000) emphasises that healing is central to many world religions, including Pentecostal Christianity. He focuses on African Pentecostalism,

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highlighting that, for some, faith in God’s power to heal physical and mental illness directly through prayer has resulted in rejection of other forms of healing. There is the suggestion that the process of healing should involve modern medicine working together with traditionally or culturally informed practices (Thachil & Bhugra, 2009). With regard to the role of the church in helping individuals with mental distress, researchers at the University of Birmingham found that, historically, churches have provided a range of help and support to individuals in mental distress that is often undervalued and overlooked (Gilbert & Nicholls, 2003). Miller (1999) suggests that incorporating spiritual perspectives in secular treatment has been found to improve outcomes for religious clients. In terms of how church membership can impact health, Miller (1999) suggests that a spiritual community can provide spiritual fellowship as a source of social support and enhance a sense of belonging, security and community. This was also demonstrated by VanderWeele (2017), who found a strong association between church attendance and improved health, mood and wellbeing. Different communities understand and talk about mental health and psychological concerns in different ways. This subject remains taboo in many African and Caribbean communities, and consequently within their churches. In some communities, mental health problems are rarely spoken about and can be seen in a negative light. Such attitudes inevitably discourage people within the community from talking about their mental health and can prove to be a barrier to engagement with health services (Mermon et al., 2016). Black majority churches have long been cited as places of safety and sanctuary, providing spiritual and practical support and promoting selfprogression, strong identity, purpose and connectedness. All of these positively contribute to wellbeing, and the health benefits in terms of reduced anxiety and depression, for example, have been widely researched (Akhazemea, 2015). However, churches have also been associated with being hostile, punitive and unsupportive environments for individuals with mental health difficulties (and sometimes for those with none); as places where a person cannot be themselves but is expected to conform or risk being alienated. This abuse of power and control often has devastating and long-lasting effects. In addition, the Black Christian can find themself worshipping alongside their aggressor – those who are judgemental and disapproving. Thorne (2003) writes that organised religion has caused suffering to countless numbers of people, causing them to feel judged, wicked and unlovable. The significance of the leader/pastor of the church and how they might influence attitudes, interpretations and behaviours in relation to ill health and mental illness cannot be underestimated. Black majority churches have a significant place in the psychological care of their congregants, and it is clear that faith and belonging to, or regularly attending, a church are central to health and wellbeing. However, creating a church culture that cultivates awareness, understanding and compassion around mental health is key.

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Researching responses to mental health in Black majority churches Having attended Black majority churches since childhood, and with my background in mental health, I was drawn to research the provision of holistic care within the church, in terms both of prevention and treatment intervention. The study I undertook, ‘The Black majority church: Exploring the impact of faith and a faith community on mental health and wellbeing’ (Burrell, 2019), examined interpretations of problems, coping strategies and help-seeking behaviour of Black Christians attending a Black majority church. Black majority church communities are the fastest-growing group of Christians in the UK (Christian Research, 2006), and a growing body of research now exists on their role in supporting individuals in mental distress (Bhugra, 1997; Edge, 2010; Leavey, 2004). Fifty-six people participated in the study – 11 males and 45 females. Between them, they represented nine denominations of Black majority church, including New Testament, Apostolic, Independent and Catholic. Eleven focus groups and seven individual interviews were conducted, and the data were analysed using thematic analysis and narrative inquiry. My findings suggest that music, prayer, The Word (preaching, quoting/ reading the Holy Bible) and belonging to a church provide a positive sense of wellbeing. Lack of understanding of mental health issues within the church, distrust, ignorance and leaders lacking adequate training and qualifications were cited as areas impacting negatively on mental health and wellbeing. Faith in God emerged as central to mental stability and wellbeing, and was considered more effective and appropriate than therapy, in some cases. Mistrust and suspicion of psychiatrists and mental health services was expressed by the research participants, often based on both first- and second-hand experiences of the effects of medication, negative encounters, lack of understanding and little or no access to talking therapies. Research participants recovering from or living with mental health difficulties voiced a wish to be respected, to be treated with kindness, to receive a warm welcome when they attend church services and to be contacted regularly. A culture of acceptance, openness and de-stigmatising mental health problems, rather than spiritualising and demonising them, was emphasised. Participants stressed that leaders should be better equipped to deal with both the congregants’ and their own mental health concerns. In response to these identified needs, I have developed a range of products and services designed to address areas of concern raised by participants in the study. In the early stages of the study, I launched ‘Speak Your Mind’ on Ruach Radio, an award-winning, 24-hour Christian radio station. The talk show discussed mental health issues using biblical and psychological principles, and addressed what mental health is, the signs and symptoms of mental ill health, how to maintain good mental health and where to find help. Christian professionals were invited to share their expertise on a range of mental health topics, such as dementia, body dysmorphia, depression and anger.

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I also developed Sozo Therapeo, as a resource for churches to promote, improve and maintain good mental health through information, education and therapy. Sozo Therapeo provides bespoke training packages, information and access to counselling services to Black majority churches and faith- and nonfaith-based organisations. This initiative was developed in response to the lack of training among church leaders/leadership teams and their being generally insensitive and ill-equipped to manage mental health distress within Black majority churches. Leaders and church members can approach the service for signposting, information and training, and its website lists other Christian-based support services and helpline numbers for non-Christians. Research participants made specific reference to the lack of professional counselling that is sensitive to their racial and religious backgrounds, and emphasised the need for those providing such support to be trained in this. I have therefore developed a directory of qualified practitioners/therapists who are practising Christians of African, Caribbean or Black British background, thereby providing some degree of choice to individuals seeking a therapist who acknowledges religious, cultural and racial factors. I have also developed and piloted two training workshops, ‘Mental Health Awareness for Church Leaders’ and ‘Counselling Skills for Pastors and Leadership Teams’. They were designed in response to participants who had approached their church leaders for help and were left feeling worse, or in some instances damaged. The workshops aim to equip leaders to recognise signs of possible mental ill health, to develop good communication skills when engaging with distressed members and to build confidence in signposting and referral processes. A common issue raised by my research participants was the insufficient numbers of Black consultants, Black policymakers and books on mental health from a Black perspective to increase awareness and bring about change. In response, I created two training manuals, Mental Health Awareness for Churches and Counselling Skills for Pastors and Leadership Teams, knowing that some pastors would not attend training but might prefer to read printed material. Reading about how to manage mental health might help pastors and leaders avoid the damage caused to congregants through ignorance and inappropriate interventions. The manuals use biblical and psychological principles and can be used in conjunction with the training sessions or as a stand-alone reference guide. In addition, I provide consultancy to churches on setting up counselling services. I also developed a church-based therapy forum where members meet to discuss current issues and share resources, good practice and training. The aim is to facilitate joint events, provide a network of support, reduce the number of counsellors working in isolation and create a referral network.

Critiques of the current training for counsellors and psychotherapists My research findings implicitly pose the following question of traditional therapy services: ‘How equipped do therapists feel to deal with race and religious issues in the

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consulting room?’ Awareness of the different ways in which Black Christians approach their problems may have implications for how secular agencies promote services, use therapeutic models and formulate treatment programmes. Such re-visioning needs to enhance therapists’ capacities to deal with issues of race and religion and open their attitudes towards traditional healing and culturally informed practices. Marrington-Mir and Rimmer (2007), in their paper on ‘Black and minority ethnic people and mental health in Britain: An holistic approach’, challenge the medically dominated mental health orthodoxy in Britain and advocate for an integrated community development approach, underpinned by anti-racist and empowering practices. They offer successful practice examples of a holistic, selfgoverned mental health system for Black people in Britain. The authors take issue with the ‘championing’ of the singular medical model, traced to the birth of psychiatry in England and North America in the mid-19th century, with critics evidencing recurring themes of oppression, control and intolerance of difference (Fernando & Keating, 1995; Ndegwa & Olajide, 2003; Szasz, 1977). Zahid (2017), in her compelling paper about the Black experience in mental health services, states that mainstream mental health services are failing to understand and/or provide services that are acceptable and accessible to Black and ethnic minority communities and cannot meet their cultural needs. She highlights that mainstream approaches to counselling and psychotherapy might be so bound up by European assumptions about human nature that they become irrelevant to people from non-European cultures. She posits that the experience of slavery, colonialism, and oppression has been grossly underestimated within the therapy world, considering that psychotherapy research and practice evolved during the late 19th century when racism was the norm. In her paper, Zahid (2017) raises the question: ‘How do we address racism and cultural bias in the therapy world so that it isn’t re-enacted within the therapeutic relationship?’ Zahid emphasises that cultural awareness training is key and that it is important to explore one’s own prejudices, assumptions and issues regarding race and racism (Thomas, 1998), so that our cultural story does not unconsciously spill into the therapy room and cause clients to disengage from counselling services. Zahid warns that, if therapists ignore race or don’t deal with it adequately, there is a danger of the therapist and client re-enacting historical racist dynamics, and that the therapist may misjudge ‘political’ resistance as ‘therapeutic’ resistance.

Religion and psychology: An unholy alliance Interestingly, ‘psyche’, the root word of psychology, psychotherapy and psychoanalysis, translates to mind, emotions and feeling. But, according to Jacobs (1998, p.4), soul and spirit are more accurate descriptions. As therapy has evolved, there has been a deliberate attempt to move away from ‘healing the soul/spirit’ and to take the spirit out of psychology. Religion and psychology have for centuries occupied polar positions, often regarding each other with suspicion. Leading figures within the field of therapy have been less than complimentary of religion for many decades. Freud’s work

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was very much influenced by literature such as the work of Charles Darwin (1874/2004). Freud promoted his view in several works, such as The Future of an Illusion (1927/1989), in which he pathologises religion as ‘a system of wishful illusions together with a disavowal of reality, such as we find nowhere else… but in a state of blissful hallucinatory confusion’. In his short paper, ‘Obsessive Acts and Religious Practice’ (1907), regarded as the first major essay on the psychology of religion, Freud suggests ‘obsessional neurosis’ may be taken as a pathological counterpart to religion – a kind of individual religiosity, with religion functioning as a universal obsessional neurosis (see Lukoff et al., 2011 for a helpful review of Freud’s and his contemporaries’ writings on religion). Thorne (2003) describes how the post-Second World War generation became disenchanted with Christianity and were therefore primed and ready to fully embrace humanistic psychology, noting that for some this became the new secular religion. Thorne reflects on his clinical practice over several decades and identifies various demands clients have made of him, such as ‘love me’, ‘heal me’ or ‘give me meaning’. He suggests that recent changes to the major institutions of society – family, organised religion and medicine – have left those who need love, healing and meaning not knowing where to turn. In this social vacuum, he suggests, the therapist has offered hope and become the substitute family, doctor and priest. It is likely that many church leaders perceive themselves as lover, healer and provider of meaning to their congregants, but this can only become a true reality if they are also prepared to practise what they preach. Studies carried out to explore religion in the consulting room show increasing attention being paid to how therapists might respond respectfully and usefully to clients’ religious and spiritual beliefs and commitments (Coyle & Lochner, 2011). Therapists are encouraged to engage constructively with clients’ religious and spiritual material to enrich therapeutic experience and effectiveness. Coyle and Lochner (2011) mention that, within Western liberal social discourse, religion has often been associated with negative qualities such as conflict, control, judgementalism and anti-intellectualism. To ignore or attempt to deconstruct the religious and spiritual beliefs of clients could have major adverse implications. As Bergin and Payne (1991, p.201) point out: Ignorance of spiritual constructs and experience predispose a therapist to misjudge, misinterpret, misunderstand, mismanage, or neglect important segments of a client’s life, which may impact significantly on adjustment or growth.

There is evidence that clients with strong religious beliefs may be wary of seeking therapy in non-religious settings because of such fears (Mayers et al., 2007). Crossley and Salter (2005) carried out a study of clinical psychologists’ experience of addressing spiritual beliefs in therapy. They found that, while some practitioners reported a proactive approach, others waited for clients to raise spiritual issues on the assumption that, if these were significant, the client would

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mention them without prompting, but this assumption may not always be justified. Client feedback suggests that some therapists take a suspicious, even hostile attitude to the subject of religion (Burrell, 2019). Here is one client’s experience: When I was ill, I certainly learned VERY quickly to keep the spiritual side of myself separate from the rest of myself whenever I met with any of the ‘professionals’. (Jenkins, 2006, p.80)

Clients may be anxious that faith issues will be considered pathological if they bring them to therapy. This is echoed by Dein (2004), who suggests many psychiatrists see religion as primitive, guilt-inducing, a form of dependence, irrational and having no empirical basis. Thorne (2003), however, observes that therapists are showing a change in attitude towards spirituality and spiritual dimensions of personality. In his view, therapists who, in the past, rejected such notions now acknowledge their relevance and have even been forced to review their own understanding of human nature and destiny. He attests that this is partly driven by clients pursuing meaning and insisting that therapists explore this in the work, and partly due to a sea change in the fields of both psychology and theology, resulting in a developing dialogue. Thorne (2003) outlines three positions for the therapist in a profession where it is becoming increasingly difficult to avoid spiritual/religious issues. The therapist: 1. can deny the reality of spirituality and see such phenomena as explicable in psychological terms and therefore not requiring any further exploration 2. can acknowledge the validity of spiritual experience but dismiss it as something therapists are not equipped to respond to, or 3. can accept spiritual experiences as a natural and normal part of being human. Thorne asserts it is commonplace for spiritual experiences to occur in the consulting room in the form of extraordinary coincidences, sudden premonition or overwhelming feelings of love or of oneness, if one is willing to embrace the idea. He shares his belief that we are all spiritual beings.

Implications for training counsellors and psychotherapists It is pleasing to see BACP moving from simply suggesting spirituality, faith and religion might be included in therapy and supervision training (Harborne, 2008) to a stronger position, as now stated by its Spirituality division (n.d.): We are committed to understanding and working at the interface between spirituality, belief, faith and religion in relation to counselling and psychotherapy practice, training and research. We seek to advance standards of good practice, develop and promote a climate in which the subject of spirituality can be acknowledged and discussed freely, openly and inclusively.

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Tribe (2014) argues that awareness of race, culture and diversity is a fundamental element of good professional practice for all psychologists and an imperative element of training: The need for all clinicians to be fully cognisant with issues relating to race, culture and diversity within mental health and to use these in their daily clinical practice is a core skill and requirement. (p.134)

This is reinforced in the British Psychological Society Division of Counselling Psychology publication, Race, Culture and Diversity (Ade-Serrano et al., 2017), which states clearly, to all counselling psychologists: ‘Lacking an awareness of race, culture and difference is unethical’ (p.2), and repeats the call to: … bring about a change in the thinking of and attitudes towards race, culture and difference, particularly within the areas of training, clinical practice and supervision… (p.1)

One issue frequently highlighted by counselling students is the lack of adequate content on race and diversity within most counselling training curricula (Jackson, 2018). It is also argued that the professionals delivering these courses ought to be representative of the communities, ethnicities and diversities they are trying to raise awareness about. These students (and other professionals) from ethnically diverse backgrounds have commented that the training offered does not complement their experiences or speak to their identities as individuals (Ellis & Cooper, 2013). Diversity within therapy training requires a radical review, an enhanced and better informed curriculum and substantially more time devoted to it.

Conclusion The research cited in this chapter contributes to a growing body of knowledge that suggests that churches have an important role in supporting individuals in mental distress. However, Black majority churches do not always provide the welcome, safety and healing their congregants seek when experiencing mental distress. More information, understanding and basic counselling/healing skills are needed among church leaders. That said, the traditional suspicion of religion within the psy-professions and counselling does not serve the Black community well. Therapists, too, need to be better informed about the role of Black majority churches in the lives of their Black and minority ethnic clients, as well as the importance of faith and how it impacts interpretation of problems and help-seeking behaviour. If we are to support the mental health of the Black, Christian client in a holistic and culturally sensitive way, a genuine person-centred approach and a joined-up, respectful partnership between church and community services is the only way forward.

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References Ade-Serrano, Y., Nkansa-Dwamena, O. & Marsh, M. (2017). Race, culture and diversity: a collection of articles. British Psychological Society. Akbar, N. (1998). Know thyself. Mind Productions and Associates. Akhazemea, D. (2015). The reshaping of religious and social landscape of Britain: The influence of the black majority churches. Transmission, Spring, 24-26. Aldred, J. (2016). Pentecostalism in Britain today: Making up for failures of the past. Churches Together in England. Anderson, A. (2000). The Pentecostal gospel: Religion and culture in African perspective. Graduate Institute for Theology and Religion, University of Birmingham. BACP Spirituality Division (n.d.). Our vision. www.bacp.co.uk/bacp-divisions/bacp-spirituality/ about/ Bergin, A.E. & Payne, I.R. (1991). Proposed agenda for a spiritual strategy in personality and psychotherapy. Journal of Psychology and Christianity, 10(3), 197–210. Bhugra, D. (1997). Psychiatry and religion: Context, consensus and controversies. Taylor & Francis. Bignall, T., Samir, J., Heksby, E. & Butt, J. (2019). Racial disparities in mental health: Literature and evidence review. Race Equality Foundation. Burrell, R.R. (2019). The Black majority church: Exploring the impact of faith and a faith community on mental health and well-being. Unpublished thesis. Middlesex University. Charman, P. (1979). Reflections: Black and white Christians in the city. Zebra Project. Christian Research. (2006). English church census. Economic and Social Research Council. Clarke, M. (2015). Pentecostal spirituality as lived experience: An empirical study of women in the British black Pentecostal church. School of Philosophy, Theology and Religion, College of Arts and Law, University of Birmingham. Cook, C.H., Goddard, D. & Westall, R. (1997). Knowledge and experience of drug use amongst church-affiliated young people. Drug and Alcohol Dependence, 46(1–​2), 9–17. Cooper, L. (2013, July 25). Black and ethnic minority Christians lead London church growth. Evangelical Alliance. www.eauk.org/church/one-people-commission/stories/black-and-ethnicchristians-lead-london-church-growth.cfm Coyle, A. & Lochner, J. (2011). Religion, spirituality and therapeutic practice. The Psychologist, 24, 264–266. Crossley, J.P. & Salter, D.P. (2005). A question of finding harmony: A grounded theory study of clinical psychologists’ experience of addressing spiritual beliefs in therapy. Psychology and Psychotherapy: Theory, research and practice, 78(Pt.3), 295–313. Darwin, C. (1874/2004). The descent of man. Penguin Classics. Dein, S. (2004). Working with patients with religious beliefs. Advances in Psychiatric Treatment, 10(4), 287–294. Duffield, I. (1981). Black people in Britain: History and the historians. History Today, 31(9). Edge, D. (2010, April 10). Conversations with God or psychopathology? Black Caribbeans, Pentecostalism and mental health practice. ‘Spirituality in a changing world.’ First International Conference of the British Association for the Study of Spirituality. Ellis, E. & Cooper, N. (2013). Silenced: The Black student experience. Therapy Today, 24(10), 14–19. Fernando, S.J.M. (2002). Mental health, race and culture (3rd ed.). Palgrave.

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Fernando, S.J.M. (2012). Race and culture issues in mental health and some thoughts on ethnic identity. Counselling Psychology Quarterly, 25, 113–123.  Fernando, S.J.M. & Keating, F. (Eds.). (1995). Mental health in a multi-ethnic society: A multidisciplinary handbook. Routledge. Freud, S. (1907). Obsessive acts and religious practices. In J. Strachey (Ed.), The standard edition of the complete works of Sigmund Freud. Hogarth Press. Freud, S. (1927/1989). The future of an illusion. W.W. Norton & Co. Fryer, P. (1984). Staying power. Pluto Press. Gilbert, P. & Nicholls, V. (2003). Inspiring hope: Recognising the importance of spirituality in a whole person approach to mental health. Mental Health Foundation. Harborne, L. (2008).  Working with issues of spirituality, faith or religion. BACP information sheet G13. BACP. Howard, V. (1987). A report on Afro-Caribbean Christianity in Britain. Department of Theology and Religious Studies, University of Leeds. Jackson, C. (2018). Why we need to talk about race. Therapy Today, 29(8), 8–13. Jackson, C. (2019). Black spaces, black faces. Therapy Today, 30(8), 20–24. Jacobs, M. (1998). Psychodynamic counselling in action. Sage. Jenkins, C. (2006). A voice denied: Clients’ experience of the exclusion of spirituality in counselling and psychotherapy. Unpublished PhD thesis. University of Manchester. Cited in W. West (Ed.), Exploring therapy spirituality and healing (pp.28-47). Palgrave. Johnson, B., Larson, D. & McCullough, M. (2000). A systematic review of the religiosity and delinquency literature: A research note. Journal of Contemporary Criminal Justice, 16(1), 32–52. Koenig, H.G. (2007). Religion and remission of depression in medical in-patients with heart failure/pulmonary disease. Journal of Nervous and Mental Disease, 195, 389–395. Koenig, H.G. (2009). Research on religion, spirituality and mental health: A review. Canadian Journal of Psychiatry, 54(5), 283–291. Koenig, H.G., King, D. & Carson, V. (2012). Handbook of religion and health (2nd ed.). Oxford University Press. Leavey,  G. (2004).  Identity  and  belief within Black Pentecostalism.  In: Kelleher, D. &  Leavey,  G. (Eds.), Identity and health (pp.37​–58). Routledge.  Lipsky, S. (1978). Internalised racism. Black Re-emergence, 2, 5–10. www.rc.org/publication/ journals/black_reemergence/br2/br2_5_sl Lukoff, D., Lu, F.G. & Yang, C.P. (2011). DSM-IV religious and spiritual problems. In J.R. Peteet, F.G. Lu & W.E Narrow (Eds.), Religious and spiritual issues in psychiatric diagnosis: A research agenda for DSM-V (p.171–198). American Psychiatric Association. Marrington-Mir, P. & Rimmer, A. (2007). Black and minority ethnic people and mental health in Britain. An holistic approach. Journal of Integrated Care, 15(6), 37–41. Mayers, C., Leavey, G., Vallianatou, C. & Barker, C. (2007). How clients with religious or spiritual beliefs experience psychological help-seeking and therapy: A qualitative study. Clinical Psychology and Psychotherapy, 14(4), 317–327. Mental Health Foundation. (n.d.). Your mental health: statistics. Black, Asian and minority ethnic (BAME) communities. www.mentalhealth.org.uk/a-to-z/b/black-asian-and-minority-ethnic-bamecommunities

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Mermon A., Taylor K., Mohebati L.M., Sundin, J., Cooper, M., Scanlon, T. & de Visser, R. (2016). Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: A qualitative study in Southeast England. BMJ Open, 6, e012337. doi:10.1136/ bmjopen-2016- 012337 Miller, W.R. (Ed.). (1999). Integrating spirituality into treatment: Resources for practitioners. American Psychological Association. Mind (n.d.). Mental health facts and statistics. www.mind.org.uk/information-support/types-ofmental-health-problems/statistics-and-facts-about-mental-health/how-common-are-mentalhealth-problems/ Mohr, S., Brandt, P.Y., Borras, L., Gillieron, C. & Huguelet, P. (2006). Toward an integration of spirituality and religiousness into the psychosocial dimension of schizophrenia. American Journal of Psychiatry, 163(11), 1952–1959. Ndegwa, D. & Olajide, D. (2003). Main issues in mental health and race. Ashgate. Shrieve-Neiger, A.K. & Edelstein, B.A. (2004). Religion and anxiety: A critical review of the literature. Clinical Psychology Review, 24, 379–397. Smith, T.B. McCullough, M.E. & Poll, J. (2003). Religiousness and depression: Evidence for a main effect and the moderating influence of stressful life events. Psychological Bulletin, 129(4), 614–636. Szasz, T. (1977). Psychiatric slavery. Free Press Thachil, A. & Bhugra, D. (2009). Globalization and mental health: Traditional medicine in pathways to care in the United Kingdom. In M. Incayawar, R. Wintrob, L. Bouchard & G. Bartocci. Psychiatrists and traditional healers: Unwitting partners in global mental health (pp.212–228). John Wiley & Sons. Thomas, A. (1998). The stresses of being a counsellor trainer. In H. Johns (Ed.), Balancing acts: Studies in counselling training (pp.17–28). Routledge. Thorne, B. (2003). Person-centred counselling and Christian spirituality. Whurr Publishers. Tribe, R. (2014) Race and cultural diversity: the training of psychologists and psychiatrists. In R. Moodley & M. Ocampo (Eds.), Critical psychiatry and mental health: Exploring the work of Suman Fernando in clinical practice (pp.134–144). Routledge. VanderWeele, T.J. (2017). Causal effects of religious service attendance? Social Psychiatry and Psychiatric Epidemiology, 52(11), 1331–1336. Van Praag, H.M. (2009). The role of religion in suicide prevention. In D. Wasserman & C. Wasserman (Eds.), Oxford textbook of suicidology and suicide prevention (pp.7–12). Oxford University Press. Zahid, N. (2017, September 27). Can transcultural therapy address the issues of racism within psychotherapy? www.counselling-directory.org.uk/memberarticles/can-transcultural-therapy-addressthe-issues-of-racism-within-psychotherapy

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Race and cognitive dissonance: Could supervision be a way of connecting tutors to students? Fiona A. Beckford

As a psychotherapist who, over the years, has attended many training sessions with tutors looking to navigate their way through the unpredictable topic of ‘equality and diversity’, it is clear to me that there are some who have little or no problem addressing issues surrounding racial difference and how these dynamics play out in psychotherapy training; there are some who attempt to manage the topic, but seem to crash and burn at the first sign of a challenge, and there are others who shut it down the moment it presents itself. In such instances, I was often left wondering of the tutor: ‘What on earth were you thinking?’ But before we go into white tutors and their cognitive dissonance, permit me to share what this looked like for one Black British family. My parents were part of the Windrush generation. They left Clarendon, Jamaica for England in 1962, and on arriving in the UK went straight to work and decided to start a family. They were conscientious, working-class people who understood the importance of hard work in order to achieve a better life for themselves and their family. With one skilled in a trade and the other battling low academic confidence, to be offered a job and then retain it was one of the biggest achievements and challenges they faced, or so they thought. Securing employment would mean the difference between being able to pay the mortgage or instantly becoming homeless in a hostile environment. With a young family, this was not an option. Although this might appear elementary, they had an additional, day-to-day battle to fight, one that they had never encountered before , that had nothing to do with mortgage payments, yet presented itself on a weekly if not daily basis to them, constantly threatening to jeopardise their objectives and ambitions: cognitive dissonance. Cognitive dissonance describes the feelings of discomfort that result when your beliefs run counter to your behaviours and/or new information that is presented to you (Perlovsky, 2013). As people of colour, my parents were subjected to regular

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racial abuse from strangers and neighbours; even small children in the street could hurl insults at brown or Black people, with no reprimand and little or no repercussions. And each time a derogatory or offensive comment, sound or gesture was made towards them, my parents, without fail, would conduct themselves with dignity, and in such a way that it appeared the intended communication had no effect. But this was not the case. Externally, their behaviour implied they were not perturbed or discomposed by the treatment they received, but internally they were maddened and enraged, oftentimes wanting to give as good as they got. However, had they expressed their anger the way they wanted to, the community that surrounded them would have frowned on their response. Newspaper headlines, television narratives and race-hate graffiti had taught them any display of anger or retaliation, however justified, could have damaging consequences, resulting in the potential for longer-lasting harassment and hate targeting. By all accounts, judging by today’s standards, my parents were not highly educated people. However, they possessed an ability to absorb, process and productively thrive from a place of strength and resilience, which resulted in them teaching their children to be resilient, persistent, intentional and to ‘dream big’, despite the messages and behaviour they received on arriving and settling in England throughout the 1960s and 1970s. If Black British citizens could manage this level of relentless cognitive dissonance, I couldn’t help but wonder, why did it appear to be so difficult for white psychotherapy tutors who face racial challenges in training settings to manage theirs? As a young girl growing up, I became curious as to what it was like for white children my age, whose parents, uncles, aunts and so on imposed their conscious or unconscious racial bias or fear of difference onto them. I wondered if the children shared the same perspective as the adults around them. For those children who grew up and entered the psychotherapy profession and became educators or tutors, what had their journey into teaching looked like and did it carry a racial or cultural component of inclusion? Had they considered that one day they might tutor students of colour and, if so, what ‘isms’ they might bring into the training room? Before teaching, how had they prepared themselves to manage the transgenerational traumas and microaggressions (DiAngelo, 2012) that many people of colour had experienced and that would undoubtedly emerge during group discussions? If the majority of the faculty were themselves white, where would the Black perspective come from and how could it be successfully integrated into their teaching approach?

Researching these questions This curiosity led me to conduct a piece of small-scale qualitative research using interpretative phenomenological analysis (IPA) to explore the lived experience of white tutors delivering training on matters of race to Black students. To recruit participants, I contacted 22 institutions offering psychotherapy training courses in areas with relatively high Black populations (London, Birmingham, Coventry and

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Wolverhampton). Each institution varied in size and theoretical approach, and all provided BACP accredited courses. Of the 22 contacted, 20 were unable to provide assistance (e.g. by circulating the research request for white tutors or providing an email address to send the information letter to). One institution told me it used an external company to provide ‘diversity training’, so had no in-house tutors who could participate, and one institution agreed to circulate the advert to its tutors, which yielded no response. As recruiting via more conventional methods was not working, I wondered if the topic created at best unease or at worse resistance or anger. I posted an advert on the BACP website, which also yielded no response. Finally, to recruit the four participants in this study, I resorted to ‘word of mouth’ and adopted the ‘snowball’ approach, where one participant recommends another and so on. I did this twice, and on both occasions was successful. I interviewed four white tutors – two male, two female – and asked them the same semi-structured questions related to their experiences in the training room. The findings gathered from this research showed white tutors experience cognitive dissonance in relation to addressing race-related themes in training and struggle with feelings of shame, anger and internalised racism. Other research from the literature shows that tutors believe more can be done on an institutional level to reform the racial status quo for psychotherapy tutors (Bezrukova et al., 2012; Hays & Chang, 2003; Pajak, 2003; Ryde, 2005). However, in order for this to materialise, training institutions and governing bodies would need to take greater responsibility, which in turn would require the decision-makers within the higher echelons of such institutions to include representatives from different ethnicities. These representatives would sit alongside them and share control and responsibilities to reflect and consider the needs of our ever-changing multicultural communities. In the rest of this chapter, I will present my findings relating to one main question from the research: ‘What has been your experience as a white tutor delivering training on matters of race to Black students in the psychotherapy training context?’ To protect their identity, participants have been given pseudonyms. Anna, Stuart and Neville identify as white English and Millie as a ‘white foreigner’. The following themes appeared throughout the research: privilege and power, personal reflection, awareness of their bias, avoidance, silence and ‘The Voice’. The Voice represents what Welsing (1991) names as ‘every area of society’ that endorses without exception that ‘being white equals being superior’ and Anna provides a great example with her own experience of cognitive dissonance, when she says: That Voice, I think I’m superior because I’m white. Now, I knew that wasn’t my fault because that’s not what I believe but it’s what my experience had taught me.

Tables 19.1 to 19.5 show the themes and relevant quotations produced from the research. Between each table are my interpretations.

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Race and cognitive dissonance Table 19.1: White tutors and history Superordinate themes

Subordinate themes

Selected illustrative quotations

Conditions associated with cognitive dissonance

How history impacts tutors

Millie: Uh, and torture and things that relate to the history of Black people. So, somehow, I think it’s different… me… my whiteness if you like, is different to if I was a… I don’t know, a Dutch or a Portuguese or a Spaniard, or, uh, you know with the colonial history. Anna: I think it’s guilt. That’s what I think it is, it’s guilt and it’s – um, wanting to make it all okay and I’m not like that, but I can’t go into that place, I can’t, alright. I mean it’s very, very painful, it’s very painful. Interviewer: In what way? Anna: Now you see, it’s unfair, but you want it to be fair. Stuart: I used to do some training with a colleague of Asian heritage, um, with colleges and local authorities. But because it was so radical, it was just really… It really named the issues of power, discrimination, you know, power, powerlessness, um, the complexity of history etcetera, etcetera.

When asked, ‘What has been your experience as a white tutor delivering training on matters of race to Black students in the psychotherapy training context?’, all participants agreed that race is everywhere and ever present. The same can be said of its historical legacy, which accompanies all students into the training room in one way or another. Of the three participants who shared their experience of delivering training on matters of race to Black students, each appears to hold a completely different view on how the explosive forces of Black and white history impacts them. Yet each makes reference to the historical component related to race, which plays a significant part in their ability to tutor students of colour. Millie previously shared that she came from a country that did not enslave or colonise people from the African diaspora, but her country of origin was itself invaded and exploited, which generated ‘racism’ and ‘trauma’. So to her, being white but not English means her ‘whiteness is different’, so she sees herself as ‘other’. To provide a comprehensive answer to my question, Millie expresses a cognitive dissonance that is far more complex, subtle and nuanced than simply the Black and white contention. Millie brings into focus ‘differences within whiteness’, which highlights and acknowledges that being ‘white’ is not a singular, monolithic experience. This is important to highlight, otherwise there could be a danger of getting into binary thinking, rather than something more elusive and implicit. While white privilege exists, not all whites experienced the same benefits, such as

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the Irish, Jews, some Eastern Europeans and those from the Mediterranean (Ford, 2011, p.1017). However, this privilege is still attributed to all white people, and not to those of colour. Anna shares that the cognitive dissonance she experiences comes from a painful place within herself. She acknowledges that, on hearing Black students share their truth of discrimination during training and witnessing their pain, which is oftentimes dismissed, she has felt this pain herself and believes that both hers and that of other white tutors she’s worked with have stemmed from a place of guilt. For Anna, this guilt is fuelled by a longing to rectify the historic wrongs Black people have been subjected to, as she sees their injustices as ‘unfair’, not only in society but also in psychotherapy training. Consequently, she chooses to tutor a multicultural group of psychotherapy students, in the hope that she can make a significant difference by openly addressing with students the ‘guilt’ elephant in the room. With more than 40 years of experience in discussing and exploring matters specifically related to racial discrimination and injustice, Stuart is clearly a seasoned educator and a reflective tutor. As he shares, I find it interesting that, even with a tutor of colour co-presenting, this does not appear to dilute or distract the participants from the inescapable reality of those with historic and current power and those without (the ‘powerful’ and the ‘powerless’). The recurring experience Stuart expresses in the ‘complexity of history’ (racial) is paralleled in the complexity of his racial discussions and brings to the forefront the cognitive dissonance he experiences as a white male delivering this type of training. The rest of the data will be explored through the considerations of how supervision could be used to address the subordinate themes and quotations from each participant. Table 19.2: Avoiding white anger Superordinate themes

Subordinate themes

Selected illustrative quotations

Conditions associated with cognitive dissonance

Accumulation of avoiding white anger

Neville: Um, whereas, you know, the experience on the other – on the other side, it’s different and they tend to avoid the issue. Interviewer: Hmm. When you say, ‘they‘, who are you referring to? Neville: The non-Blacks. Interviewer: In what way is it painful for you? Anna: That people have to suffer that at the hands, if you like, of the oppressor, no – not if you like, at the hands of the oppressive group that I belong to. Interviewer: Um… Anna: Right, and I do belong to an oppressive group.

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Race and cognitive dissonance Stuart: Um, I-I-I think there was something about, um, uh, a – a sense that they were feeling accused. They were feeling defensive, um, as if I was saying they were absolutely responsible for, yeah, etcetera. Uh, as if, in some way, by inference, wh-what I was trying to say, ‘Let’s just have a look at these things,’ you know. ‘These are the statistics, this is what’s going on, I wonder…’, you know. Um, and however inoffensive or diplomatic I feel myself to be, um, there was a sense that clearly, I-I was pulling a trigger. I was pulling the trigger of something of defensiveness. Uh, that was my interpretation, that somehow, suddenly, I’d put them into a position of discomfort. Interviewer: Right. Stuart: Uh, and from an earlier position of a greater comfort, i-it was more comfortable to discuss cultural origins. It was less comfortable to talk about patterns of prejudice. Interviewer: Okay, and can you recall which of the students felt uncomfortable, were you able to identify who they were? Stuart: Uh, I mean, um, yes, to a great extent. I’m – I’m talking about the white students in the group or the white participants.

Here we see Neville, Anna and Stuart describing scenarios where they have either tried to avoid the race discussion with students because past experience has taught them that the ‘non-Blacks’ in the group (meaning white students) don’t want to address it; or the weight of their historical, oppressive whiteness is present, which triggers their cognitive dissonance; or the sheer idea or mention of exploring racial or social justice matters moves white students (for the most part) from a place of comfort to a place of discomfort. This discomfort morphs into defensiveness, which triggers not only other students in the group but cognitive dissonance in the tutor.

Supervision There is an argument that says tutors could discuss these thoughts and feelings with other tutors, who may understand, which is true. However, these are extremely personal, exceptionally emotive, highly sensitive and tremendously controversial issues to discuss with anyone, so each tutor would need the protection of the therapeutic alliance, clear boundaries, the knowledge of a non-judgemental environment and the absolute certainty of confidentiality. For some white tutors, it would be difficult to assert that the message from The Voice (‘I think I’m superior because I’m white’) is wrong, especially as the evidence in psychotherapy race-related training doesn’t support it. So, tutors require a safe place to be able to move from a place of comfort to a place of manageable discomfort, which would mature and develop their multicultural skillset. Too much

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comfort means we’re not growing, so it is necessary to be able to challenge and explore different ways of thinking in order to be effective when teaching students. If tutors are unwilling to become uncomfortable as part of the learning process, how can we teach or expect students to do this? Table 19.3: Escaping the oppression Superordinate themes

Subordinate themes

Selected illustrative quotations

Conditions associated with cognitive dissonance

Attributing causing offence to lack of knowledge

Anna: So, what my experience is in general, is from what students tell me. Which is when they try to bring their experience of oppression into the training, the truth is tutors can’t hold it… But I can’t go into my own oppressions. Because that’s something I learnt from my Black tutors. You know, if the white person goes into all their oppressions, which of course we all have, we are all oppressors and oppressed. Right? Who’s there for the Black students and client? And my students tell me that that’s what happens. Neville: That I’m somehow going to put my foot in it because I don’t understand and cause offence or something, yeah.

In different ways, both Anna and Neville are talking about the need for tutors to stay ‘present’ for their students and not allow themselves to dissociate. As a practitioner or a tutor, when countertransference takes place, it’s very easy to stop listening as the focus of our attention switches from the other to ourselves. This is exactly what Anna and Neville are talking about: either the fear ‘of us’ getting it wrong, or tutors being drawn into and focusing on ‘their own’ oppression instead of staying with that of the students.

Supervision It’s vital that tutors whose thinking may match that of the other ‘non-Blacks’ in the training room are able to share, explore and discuss in a safe setting how Black oppression triggers them, so they can stay in the uncomfortable moment. If white tutors can stay on track and pilot a way through this stormy and difficult subject, they will be modelling to their students how they too can do the same (like my parents did for me). Table 19.4: Is the price right? Superordinate themes

Subordinate themes

Selected illustrative quotations

Conditions associated with cognitive dissonance

Emotional cost in staying connected

Millie: Uh, so, there’s some… so in my… I don’t know what students thought about me, but in my experience, I felt an affinity [to Black students].

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Race and cognitive dissonance Stuart: Then we’d have lunch and then I’d say, ‘I’m wondering if, you know, that we need – begin to need to also look at, kind of, the structural relations within society and what’s going on.’ And it often felt as if, and I’m dramatising this, but it often felt as if sometimes the whole group would be at my throat. Anna: It’s, you know, sometimes when we do this diversity stuff and we get onto the Black/ white issue, I feel like my heart is being torn out. Millie: Yeah, I did, I did feel that, and I felt, I think early in – earlier in my career, maybe I was a bit more careful and sensitive, like I was very – I was more aware of how to talk about these things, maybe because I was feeling over-protective, but I think that this over protectiveness… Interviewer: Of whom? Millie: Of the… yeah, of the pain I might touch upon when I talk about issues of race. Interviewer: Pain in whom? Millie: In – in the Black student.

Millie, Stuart and Anna shared with me the very personal and emotional cost that comes with delivering race-related training. It’s embodied! Millie feels ‘an affinity’ with the Black students in the group. I would go as far to say maybe this affinity could be extended to any student who could be classed as ‘other’, as this is how she views herself. Maybe from Millie’s sense of ‘other’ comes this protective, almost maternal ‘careful and sensitive’ side that carries with it an understanding of what it means to be othered and the pain associated with it. Anna also speaks of a heart-felt pain that comes as part and parcel of racerelated training. She expresses her own experience of this pain and, previously in this chapter, of the oppression she is aware she cannot go into, otherwise the Black students in the training will be sidelined. Stuart’s experience seemed to be full of dread of the ‘after lunch‘ sessions, as previous encounters have taught him that the afternoon sessions are where the whole group could project their fears, anger or rage onto him, which he would then have to hold psychologically and physically, indefinitely.

Supervision The personal toll and subsequent emotional exhaustion experienced by tutors who take on the race discussion is massive and overwhelming, and they need a place to debrief after training. Both the institutions that employ the services of tutors and the tutors themselves are in the business of confronting, addressing and working through the historic psychological and emotional pain of others. How effective are

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we being as a profession if tutors (and the institutions that employ them) appear too afraid to tackle the very real and difficult pain presented by racially diverse groups? Table 19.5: The voice and its messages Superordinate themes

Subordinate themes

Selected illustrative quotations

Conditions associated with cognitive dissonance

Attributing personal experience of superiority to messages from society

Anna: One of the hardest things that ever came out for me in my life, and it took me a year, to allow it to come from the back to full consciousness. That ‘Voice’, I think I’m superior because I’m white. Now, I knew that wasn’t my fault because that’s not what I believe but it’s what my experience had taught me. Neville: Yeah, I sometimes find it quite difficult because, um, although I have had to experience exclusion myself being bisexual and even identifying as gay for a while, I realised that my background has meant I don’t know what it’s like. I’ve been in the majority. Interviewer: Hmm. Neville: Or the group that is advantaged, maybe. And so I’m kind of always rather a bit edgy about it, that’s my experience.

Unfortunately, the deception perpetuated by society that ‘being white equals being superior’ and ‘being Black or of colour equals being inferior’ is believed by many on both sides. All of us are equal; however, as Anna suggests, we have certainly not all had equal experiences of life. Here are two different white tutors (Anna and Neville) who, in sharing their experiences of delivering race-related training to Black students, appear to hold polar opposite ways of approaching and addressing the task. In answering my question, the cognitive dissonance that seemed to be present meant that Neville felt the need to ‘go into’ his oppression in order to help him appropriately respond. However, Anna is able to ‘hold it’ and talks it through by sharing the challenge she underwent in recognising that the message ‘The Voice’ had been feeding her did not align with what she believed. Anna doesn’t see the need to speak from the perspective of her oppression or unprocessed cognitive dissonance, because for her, a high degree of personal exploration and reflection has already taken place.

Supervision Imagine for a moment what a supervision session might look like if both these tutors were in the same session as you and you were able to hear their views, then safely reflect on and share your own teaching methods, injunctions and projections without discrimination or prejudice. How might you respond if this practice became a regular occurrence, developing camaraderie with other tutors and building confidence in your ability to manage racial pain?

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Conclusion Tutors can only fully equip trainee therapists to work through the challenges of race-related material if they themselves have been through the process (Howard, 2016, p.6). While there are white tutors who are not afraid of the subject and will address it assertively and with confidence, the research demonstrates that ‘it’s difficult’ and the reasons for this can be multiple. These participants have been willing to explore that which is ‘difficult to address’, but this research shows that many psychotherapeutic institutions still will not. Thus, students are free to qualify and begin closed-door work with clients of colour or clients of a different ethnicity to their own, having never systematically considered these conscious or unconscious biases. If this failure to address these issues continues within training courses, further damage to clients seems inevitable. When looking at diversity, Zeichner and Gore (1990) make their idea of educational social change clear by suggesting thought-provoking reflective practice takes place. They write: The central purpose of critical approaches is to bring to consciousness the ability to criticise what is taken for granted about everyday life. Class, gender, and race relations become key foci, given the historical and contemporary alienation of particular groups. (Zeichner & Gore, 1990, p.5)

Pajak agrees with Zeichner and Gore by stating that the cultural and psychological impact of observable change within each class for educators should be supported with clinical supervision (Pajak, 2003, p.4). Pajak suggests that teachers, like practitioners, need to have their work ‘critically examined and possibly altered to improve their professional practice’ (p.5). Clinical supervision stops short of being used as a supportive tool for tutors in training. Pajak suggests this needs to be taken further and supervision for tutors should be mandatory. Watson (2004, p.20) agrees and believes that, particularly in relation to matters of race, the role of the psychotherapy educator (tutor) is ‘too important to be unexamined’. Question: If ‘tutor supervision’ became standard practice within psychotherapy training, a place where tutors could safely address racial transference and countertransference, could this positively impact the experience of the tutor, and ultimately the students? I believe it would.

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References Bezrukova, K., Jehn, A. & Spell, S. (2012). Reviewing diversity training: Where we have been and where we should go. Academy of Management, 11(2), 207–227. DiAngelo, R,J. (2012). What does it mean to be white? Developing white racial literacy. Peter Lang Publishing. Ford, R. (2011). Acceptable and unacceptable immigrants: How opposition to immigration in Britain is affected by migrants’ region of origin. Journal of Ethnic and Migration Studies, 37(7), 1017–1037. Hays, D.G. & Chang, C.Y. (2003). White privilege, oppression, and racial identity development: Implications for supervision. Therapist Education & Supervision, 43(2), 134–145. doi: 10.1002/ j.1556-6978.2003.tb01837.x Howard, G.R. (2016). We can’t teach what we don’t know: White teachers, multicultural school (3rd ed.). Columbia University. Pajak, E. (2003). Honouring diverse teaching styles: A guide for supervisors. ASDC. Perlovsky L. (2013, April 10). A challenge to human evolution – cognitive dissonance. Frontiers in Psychology, 4, 179. doi: 10.3389/fpsyg.2013.00179 Ryde, J. (2005). Exploring white racial identity and its impact on psychotherapy and psychotherapy organisations. Doctoral thesis. University of Bath. Watson, V. (2004). The training experiences of black counsellors. Unpublished PhD thesis. University of Nottingham. Welsing, F.C. (1991). The Isis papers: The key to the colours. C.W. Publishing. Zeichner, K. & Gore, J. (1990). Teacher socialization. In W.R. Houston (Ed.), Handbook of research on teacher education (pp.329–348). Macmillan.

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Postscript Divine Charura and Colin Lago

Rather than writing a chapter that attempts to sum up the many perspectives and ideas offered within these pages – a daunting task, not least with all the potential omissions and errors of interpretation we might make – we have chosen to leave you with key lines from the chapters and favourite quotations chosen by our authors. Our wish is to offer a final stimulus for reflection on the myriad issues raised.

Preface ‘It is a contradiction in terms to claim that the helping professions aspire to be helpful to all clients when we are, as a profession, apparently systematically ignoring the needs of those from diverse communities. With such a situation, the combined psychological helping professions could be accused of serious philosophic, practice, moral and ethical negligence.’

Chapter 1 ‘Anyone and everyone who has been involved, whether as a student, training course participant or trainer, in training sessions dedicated to the exploration of diversity is likely to have experienced varying levels of discomfort, defensiveness, shame, guilt, denial and distress. This phenomenon is widely referred to in many of the chapters that follow. What is very clear from these training experiences is that a) the issue of personal identity, when raised for exploration and reflection, is of deep importance and significance to each person; b) one’s attitudes towards others of differing identities, once recognised and articulated, can become most distressing and disturbing; c) this is most likely to happen through open dialogue. The capacity to listen to others’ perspectives and personal histories can become severely inhibited by one’s own reactions of anxiety, guilt and shame.’

Chapter 2 ‘The basic challenge of the original project was to create the right circumstances

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for a meaningful and effective encounter between a variety of individual cultures where it was possible for everybody to feel included, recognised and welcome to participate and contribute. It was, first of all, important to establish a climate of inclusiveness and creativity where “problem solving” and group work could occur… The humanistic, phenomenological-existential theoretical framework was considered the most appropriate to establish that climate where a student-centred ethos was a priority and bracketing personal assumptions and engaging with the “unknown” were a necessity.’

Chapter 3 ‘Understanding human beings as Imago Dei, created in the image of God, helps me in my work, whether clients subscribe to a faith or not. What matters is that I accept them and how the therapeutic alliance is developed… I do not see humans as a bundle of cells living life as an awful experiment. We are far too complex a species to be described in such reductionist terms. I see all clients as human beings on a spiritual path, known or unknown, struggling to live, or at least trying to find out how to live.’

Chapter 4 ‘As I see it, the primary challenge for those devising counselling and psychotherapy training courses is how to get white trainees to engage as equals in the racial conversation as equals by considering themselves as racial beings and sharing their own racial experiencing. What thoughts and feeling emerge, how is this shared or processed, what is acknowledged or suppressed and how is supervision used to address any discrepancies in their racial understanding?’

Chapter 5 ‘… anti-racist thought can be seen as the basis of true Black social and cultural empowerment (Kendi, 2016). An anti-racist perspective is crucial for counselling intervention because it provides a modality for addressing the notions of white superiority that are often implicit in the theory and practice of counselling. These inherent racist traditions within the field have often had a negative impact on both people of colour and whites (Sue et al., 2019). An anti-racist perspective, therefore, offers direction for healing the psychosocial wounds often inflicted by racism on both victims and perpetrators. Further, an anti-racist perspective is underscored by cross-cultural counselling competency, which has become a hallmark of contemporary professional counselling.’

Chapter 6 ‘Developing a working knowledge and understanding of the context of the client is crucial. So too is being prepared to learn, unlearn and re-learn what we think we know. To promote trust and the potential for healing, counsellors need to demonstrate a willingness to understand and openly acknowledge the

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socio-political context of Black clients’ stories. In my view, this is a counsellor’s obligation and a position to be held irrespective of the content or nature of the counselling and client material. Being empathic and open to continual learning does not necessarily mean learning only from clients in the counselling room and sometimes it may not be enough.’

Chapter 7 ‘“You know what I mean, where are you really from?” The question often comes from a white person and the responsibility always falls on the person of colour to figure out what is really being asked and to respond in a way that satisfies the listener. This is modern racism! I soon realised that growing up in apartheid-ruled South Africa did not adequately prepare me for the subtlety of modern racism that I would experience in the US, or maybe it had more than adequately prepared me so that I was always alert to the possibility of racism in my new environment?’ ‘Cultural racism is perhaps the most pervasive and insidious type of racism because it serves as an overarching umbrella under which individual and institutional racism thrives.’

Chapter 8 ‘However radical they say this course is, in my experience, to maintain a healthy suspicion is to stay alive and on track. My aim is to make it through the course, learn what I can and collect the paper on the way out. Whiteness can feel pretty basic in how it blocks access and stops us getting through, so I guess complicating it might be a good idea. Still, I’m staying fugitive. Put another way, in a private space in my mind, there is a collection of strategies and practices of escape and survival bequeathed to me by my ancestors. I will use them as necessary.’ ‘We are doing the work that George Yancy (2014) describes as un-suturing the wound of whiteness – opening ourselves up to the irreality of whiteness and the inevitable collapse into a narcissistic emptiness as we let go of the delusion of white innocence and goodness. I think this is the depressive position of whiteness. I wonder how to make this an aspirational journey since it feels so bad. At the same time, there is relief because I get to see what is true – no matter how grim. I wonder if there will ever be enough white people invested in doing this work, given the currents that operate against waking up. I notice that hope comes and goes.’

Chapter 9 ‘The group holds the sense of shame or privilege; the group also holds the collective sense of shame at their otherness. These conjoined factors are therefore not unconsciously disconnected from where one aspect will rise to the surface suddenly,, just as we are discussing the other. They emerge into the training space together, hand in hand, to be witnessed and felt, like the co-dependent couple they truly are.’

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Chapter 10 ‘This firasah (my intuition) is a way of feeling connected and attuned to the client. It guides me through the process of therapy so that I can meet the client where they are: this can be compared to early childhood developmental attunement. It helps me connect with the client and gives me insight into what the client needs from me in that moment; it is not a digression from sound clinical judgement. Information about my clients’ functioning and understanding what the client needs from therapy are essential throughout the whole process. Therefore, my intuitive process is grounded in a thorough knowledge of myself and the conscious/unconscious processes of my clients.’ ‘When I bring the issues of race and culture into the therapy room, I break the cycle of oppression and racism. Silence perpetuates the abusive cycle, as does handing the client sole responsibility for introducing the issues of race and culture into the therapy room.’

Chapter 11 ‘Today’s world map is shaped by the consequences of colonialism, in which borders were marked out with little or no regard for local contexts and realities. With their own aspirations, colonisers… imposed new identities that were neither appropriate for nor in line with existing communities. This debilitated self-esteem, self-agency and community and national development. The global borders of colonialism symbolise the markings of historical pain and oppression.’ ‘The structures themselves bind people into roles they did not necessarily choose and then, before comprehension emerges, they’ve unconsciously internalised racial bias and used that as racial banter. Such processes create great anxiety among people of colour. Some experience a desire to not be like their peer and social group; they try to somehow hide their own colour while being it, or they victimise their own culture while breathing it, effectively internalising learned structural bias and oppression. This results in being one’s own oppressor; we are left with both the external and internalised battles of racism.’

Chapter 12 ‘Yet, [the] consequences [of these projected social-political attitudes and labels] frequently create a misrepresentation of the totality of a refugee’s inner resources and capabilities, neglecting how resilient, adaptable, tenacious, courageous and motivated they are to establish or re-establish meaning in their lives, despite the uncertainty and chaos they may have faced.’ ‘I have often found that non-Western refugees regard religion as fundamental to their belief systems and meaning structures, considering God to be the creator of the world and their religion as providing their ethics and guide to purpose in life and the

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activities worth pursuing. When life and its inherent meaning become arrested, and in turn self-identity is called into question, the task of the therapist may be to become more active in therapy, in order to consider the ways in which a more enlarged sense of self and meaning may re-emerge.’

Chapter 13 ‘Identity and identity processes are deeply complex. Intersectionality plays a vital role in understanding this complexity and is an important part of any deconstructive–reconstructive dialogue. We need to explore and discover with our clients the ascriptions, formations, attachments and disavowals that they have experienced in their socio-cultural and other identifications and bring our fullness of attention to how we are part of such processes.’

Chapter 14 ‘I view racism as traumatic because it is an experience that overwhelms the individual’s capacity to process, digest or contain it. The clients who come to see me are having difficulty processing traumatic experiences around their mixed-race identity. In terms of inner-outer world traffic they are struggling to process both the racism that the white community projects onto them and the shadism and colourism projected from the Black community.’ ‘All the mixed-race clients who I work with will, at some stage, have been coerced into a Faustian pact around their racial identity. This metaphor comes from European mythology. The core idea is that an individual enters into a bargain or pact in which they surrender something, knowingly or unknowingly, that is far more valuable than what they gain: for example, in the classic case of Dr Faust (Faustus), exchanging his soul for material gain. The mixed-race individuals I work with have been coerced into taking on the identity of whichever community they are raised in and forsaking the other, without understanding what is at stake.’

Chapter 15 ‘Therapists who are unable to deal with the issue of race cause damage to their patients by not engaging with these aspects of their lives. If race and difference is not worked through, the patient (trainee) will be ill-equipped as a professional and will repeat their own experience of therapy with their patients.’ ‘Self-esteem and self-worth can be seriously affected by what powerful groups in society tell the less powerful, explicitly or otherwise. This happens on a daily basis in fiction and the media. Reversing hundreds of years of internal colonisation is both a political and a psychological act and should be a function of good therapy if therapy is about restoring self-love and good mental health.’

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Chapter 16 ‘There are several reasons for the avoidance and neglect of addressing the effects of racial trauma in therapy. One of the main factors that underpin this avoidance is the idea of colour-blindness in racial attitudes; the idea that race does not matter… To some extent, this is further perpetuated by the concept of post-racism: that we have overcome or moved beyond racism. Yet, we are still in an environment where Black, Asian and minority ethnic therapists are under-represented in the profession and where race and cultural related issues… continue to go unrecognised or unacknowledged.’ ‘There is an oversimplification in the conceptualisation of black identities that fails to recognise the intersectionality of the multiple identities of the black individual. These are not to be understood not as separate identities but in relation to the diversity of individual experience and how variations in race, culture, ethnicity, gender, socio-economic status, religion and other variants come together to make a unique self-concept that includes the individual’s internalisation of experiences of marginalisation and oppression.’

Chapter 17 ‘Simply put, a decolonised research curriculum is not just about inclusion of a diverse range of research sources/references in the reading list but is an active way of engaging with research and reflexivity. It is about challenging how Eurocentric ideas are used to inform research and pre-eminence is given to Western models of viewing mental health/ill health in psychotherapy/counselling theories and Western psychology perspectives when they don’t always apply to other groups.’ ‘Decolonising the education curriculum is an expression of the shift in the geopolitics of knowledge in which modern epistemological frameworks for knowing and understanding the world are challenged. It is about no longer accepting Eurocentric research approaches, evidence and curricula perspectives as the universal and best ways of understanding the world.’

Chapter 18 ‘Black majority churches have long been cited as places of safety and sanctuary, providing spiritual and practical support and promoting self-progression, strong identity, purpose and connectedness. All of these positively contribute to wellbeing… However, churches have also been associated with being hostile, punitive and unsupportive environments for individuals with mental health difficulties (and sometimes for those with none); as places where a person cannot be themselves but is expected to conform or risk being alienated. This abuse of power and control often has devasting and long-lasting effects.’ ‘The traditional suspicion of religion within the psy-professions and counselling

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does not serve the Black community well. Therapists, too, need to be better informed about the role of Black majority churches in the lives of their Black and minority ethnic clients, as well as the importance of faith and how it impacts interpretation of problems and help-seeking behaviour. If we are to support the mental health of the Black Christian client in a holistic and culturally sensitive way, a genuine person-centred approach and a joined-up, respectful partnership between church and community services is the only way forward.’

Chapter 19 ‘… tutors require a safe place to be able to move from a place of comfort to a place of manageable discomfort, which would mature and develop their multicultural skillset. Too much comfort means we’re not growing, so it is necessary to be able to challenge and explore different ways of thinking in order to be effective when teaching students. If tutors are unwilling to become uncomfortable as part of the learning process, how can we teach or expect students to do this?’ ‘The personal toll and subsequent emotional exhaustion experienced by tutors who take on the race discussion is massive and overwhelming, and they need a place to debrief after training. Both the institutions that employ the services of tutors and the tutors themselves are in the business of confronting, addressing and working through the historic psychological and emotional pain of others. How effective are we being as a profession if tutors (and the institutions that employ them) appear too afraid to tackle the very real and difficult pain presented by ethnically diverse groups?’

Favourite quotations Our chapter authors also sent us many inspiring quotations, some of which we have included here. ‘Love is all we have, the only way that each can help the other.’ Euripedes, Orestes. ‘People are just as wonderful as sunsets if you let them be. When I see a sunset, I don’t find myself saying, “Soften the orange a bit on the right-hand corner.” I don’t try to control a sunset. I watch with awe as it unfolds.’ Carl Rogers, A Way of Being (Houghton Mifflin, 1980) ‘Be kind whenever possible. It is always possible.’ The Dalai Lama, on his visit to Capitol Hill, Washington D.C., March 7, 2014. ‘Humans can no more survive psychologically in a psychological milieu that

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does not respond empathically to them than they can survive physically in an atmosphere that contains no oxygen.’ Heinz Kohut, The Restoration of the Self (University of Chicago Press, 2012) ‘Peace is not just about the absence of conflict; it’s also about the presence of justice… Peacemaking doesn’t mean passivity. It is the act of interrupting injustice without mirroring injustice, the act of disarming evil without destroying the evildoer, the act of finding a third way that is neither fight nor flight but the careful, arduous pursuit of reconciliation and justice. It is about a revolution of love that is big enough to set both the oppressed and the oppressors free.’ Shane Claiborne, Common Prayer: A liturgy for ordinary radicals (Zondervan, 2010) ‘If I love you, I have to make you conscious of the things you do not see.’ James Baldwin, Conversations with James Baldwin, edited by Fred L. Standley and Louis H. Pratt (University Press of Mississippi, 1989) ‘A life is not important except in the impact it has on other lives.’ Jackie Robinson, speaking to teammates on the Brooklyn Dodgers in 1947 ‘Without a black past, without a black future, it was impossible for me to live my blackness.’ Franz Fanon, Black Skin, White Masks (Grove Press, 1967) ‘The purpose of life is to discover your gift, the work of life is to develop it, the meaning of life is to give it away.’ David Viscott, Finding Your Strength in Difficult Times: A book of meditations   (McGraw-Hill Education, 2003) ‘I get angry about things and then go on and work.’ Toni Morrison, The Salon Interview, Salon, February 27, 1998. ‘Teaching is not an imposition of the teacher’s will over that of the pupil, not at all. Teaching starts with FREEDOM and ends with FREEDOM.’ Vanda Scaravelli, Awakening the Spine (Harper Collins, 1993) ‘Things outside you are projections of what’s inside you, and what’s inside you is a projection of what’s outside. So when you step into the labyrinth outside you, at the same time you’re stepping into the labyrinth inside. Most definitely a risky business.’ Haruki Murakami, Kafka on the Shore (Vintage, 2005) ‘If we are thoughtfully trying to understand our tasks as administrators, teachers, educational counsellors, therapists, then we are working on the problem which will determine the future of this planet. For it is not upon the physical sciences that the future will depend. It is upon us who are trying to understand and deal

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with the interactions between human beings – who are trying to create helping relationships.’ Howard Kirschenbaum and Valerie L. Henderson, The Carl Rogers Reader (Houghton Mifflin, 1989) ‘Being a patient, rather than a participant in one’s healing process, separates suffering people from their community and alienates them from an inner sense of self.’ Bessel van der Kolk, The Body Keeps the Score (Viking, 2014) ‘One standard differentiation between Asia and the West is of collective versus individualist societies. That distinction helps our understanding of the two regions, but these terms should not be seen as mutually exclusive… people behave in both collective and individualistic ways, and operate within both frameworks to greater or lesser degrees. There is no dichotomy of the two, we are independent and part of a group at the same time. It is therefore valuable to see collective Asian values as complementary rather than counter to Western-style individualism.’ Caroline Esame, ‘Collective versus individualistic societies and the impact of Asian values on art therapy in Singapore’. In Art Therapy in Asia, edited by Debra L. Kalmanowitz, Sue Mei Chan and Jordan S. Potash (Jessica Kingsley Publishers, 2012) ‘“Blackness”[:] a symbolic program of philosophical “disobedience” (a systematic scepticism and refusal) that would make the former available to anyone, or more pointedly, any posture, that was willing to take on the formidable task of thinking as a wilful act of imagination and invention.’ Hortense J. Spillers, ‘Peter’s pans: Eating in the diaspora’.  In Black, White, and in Color: Essays on American literature and culture (University of Chicago Press, 2003) ‘Not everything that is faced can be changed. But nothing can be changed until it is faced.’ James Baldwin. ‘As much truth as one can bear.’ (New York Times, 1962, January 14) ‘Your conflicts, all the difficult things, the problematic situations in your life are not chance or haphazard. They are actually yours. They are specifically yours, designed specifically for you by a part of you that loves you more than anything else. The part of you that loves you more than anything else has created roadblocks to lead you to yourself. You are not going in the right direction unless there is something pricking you in the side, telling you, “Look here! This way!” That part of you loves you so much that it doesn’t want you to lose the chance. It will go to extreme measures to wake you up; it will make you suffer greatly if you don’t listen. What else can it do? That is its purpose.’ A.H. Almaas, Diamond Heart, Book One: Elements of the real in man (Shambhala Publications, 1987)

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‘Yesterday I was clever, so I wanted to change the world. Today I am wise, so I am changing myself.’ Widely attributed to Jalāl ad-Dīn Mohammad Rūmī ‘Those who we label as mad have their moments of normalness, and those who we think are normal have their moments of madness.’ Lennox Thomas (anecdotal) ‘If you stand for nothing, then you fall for everything.’ From The Dictionary of Modern Proverbs, by C. Clay Doyle, W. Mieder and F.R. Shapiro (Yale University Press, 2012) ‘And here is what I have to say, finally: Let’s invite one another in. Maybe then we can begin to fear less, to make fewer wrong assumptions, to let go of the biases and stereotypes that unnecessarily divide us. Maybe we can better embrace the ways we are the same. It’s not about being perfect. It’s not about being where you get yourself in the end. There’s power in allowing yourself to be known and heard, in owning your unique story, in using your authentic voice. And there’s grace in being willing to know and hear others. This, for me, is how we become.’ Michelle Obama, Becoming (Viking, 2018)

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About the contributors

About the contributors

Carmen Joanne Ablack Carmen is an integrative and body psychotherapist, Gestalt psychotherapist, group psychotherapist and supervisor. She teaches in the UK and Europe on diversity and intersectionality, relational body psychotherapy and Gestalt therapy, including somatic trauma, group work, couples and relationship therapy. She also offers clinical and non-managerial supervision, training, coaching and mentoring in diversity, embodied relational practice and mental health. Her publications include a chapter in Contemporary Body Psychotherapy: The Chiron approach; articles including ‘Introduction to body psychotherapy’; ‘Body psychotherapy, trauma and the Black woman client’, and more recently, ‘Finding our intercultural ground’ (International Journal of Body Psychotherapy 2019/20; 18(2)) and a chapter in Intercultural Therapy (2019) (edited by B. Ababio & R. Littlewood). Carmen is current President of the European Association for Body Psychotherapy and a member of the Black, African & Asian Therapy Network leadership group. Fiona Beckford Fiona is an integrative psychotherapist and clinical supervisor who works in an NHS CAMHS team as a community mental health practitioner. Before this, Fiona worked for 12 years in education, providing therapeutic support to both staff and students at Luton Sixth Form College. She also compiled and delivered reflective practice sessions to staff at senior, middle and junior management levels, and to committees and teaching staff, and delivered life-skills training to students, which included a module entitled ‘The importance of understanding cultural differences’. Fiona is an accredited member of BACP and team co-ordinator for the mentoring programme with the Black, African and Asian Therapist Network (BAATN). Having first been published in the Journal of Critical Psychology Counselling and Psychotherapy (2019) on the subject of ‘Do we address cultural differences in psychotherapy training?’, Fiona continues to enjoy studying and writing on topics close to her heart. Fiona takes great pleasure in gardening and loves exploring different cultures. Lucia Berdondini Lucia is a senior lecturer and programme leader of the distance learning MSc in Humanitarian Intervention at the University of East London, UK. She is also a

About the contributors

BACP-registered Gestalt psychotherapist and has been practising for the past 15 years with individuals and groups in a small private practice. She is particularly interested in the psychology of disasters and humanitarian projects and has focused her professional activity on developing counselling training courses in countries in war and post-conflict, such as Afghanistan, India and Angola. She has been collaborating with a number of international NGOs (such as Save the Children and the Red Cross), and she is still very active in the field of humanitarian psychosocial intervention. Rachel-Rose Burrell Rachel-Rose is a BACP-accredited counsellor/psychotherapist with many years’ experience of developing counselling services in the public and voluntary sectors and within churches. She is a member of the leadership team at Ruach City Church and heads a holistic wellbeing service, which she initiated. She provides bespoke training on a range of topics, including mental health awareness, conflict management and counselling skills. As a conference speaker, she is known for combining Biblical and psychological principles to bring about greater understanding and self-care. She is the founder of Sozo Therapeuo, a resource for churches promoting mental health awareness and support through education, training and therapy. Benjamin Mark Butler Benjamin is a qualified therapist (MSc Psychology, BSc Counselling) with both national (London) and international (South Africa) experiences of working with refugee clients. This interest grew during his time spent in Cape Town, coupled with his education in and enthusiasm for existentialism, which drew him towards applying its philosophies and therapeutic framework of practices in the humanitarian sector. Benjamin is currently using qualitative research methods to further understand clients’ phenomenological experiences of participating in existential psychotherapy, as well as continuing to support persons displaced from their homeland and living in the UK. Divine Charura Divine is a full professor of counselling psychology and programme director for the doctorate in counselling psychology at York St John University. He is a chartered psychologist and counselling psychologist. He is registered as a chartered member with the British Psychological Society and as a practitioner psychologist with the Health and Care Professions Council. Divine is also registered with the United Kingdom Council for Psychotherapy as an adult psychotherapist. He has co-authored and edited numerous books in counselling and psychotherapy. His two latest co-edited books are Love and Therapy: In relationship (co-edited with Stephen Paul) and The Person-Centred Counselling and Psychotherapy Handbook: Origins, developments and current applications (co-edited with Colin Lago). Divine is a lover of photography, art, music and outdoor pursuits.

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About the contributors

Priscilla Dass-Brailsford Priscilla is a graduate of Harvard University and Chair of the Clinical Psychology PsyD program at the Chicago School of Professional Psychology, Washington DC campus. She studies the effects of trauma, specifically community violence and other stressful events, and is particularly interested in whether individuals from historically oppressed or stigmatised groups experience unique stressors or exhibit culturally specific coping processes. Priscilla has several ongoing research projects on  trauma, ethnocultural violence, community violence and disasters. Prior to moving to DC, she taught for several years in Boston, MA and coordinated a community crisis response team for the victims of violence programme that responded to affected communities in the aftermath of violence and trauma. Besides numerous other publications, she is the published author of two books: A Practical Approach to Trauma: Empowering interventions (2007) and Disaster and Crisis Response: Lessons learned from Hurricane Katrina (2009). Priscilla has presented both nationally and internationally. She is a Fellow of the American Psychological Association, in Divisions 17, 35, 45 and 56. Robert Downes Robert is a psychotherapist, supervisor, visual artist, educator and student engaged in a critical psychological study and practice drawing from a range of traditions: queer theory, Black studies, intersectional feminisms, relational psychoanalysis, contemporary Marxism, alongside the spiritual teachings and practices of the Diamond Approach, the music of Björk and a 20-year dialogue with his friend and co-author Foluke Taylor. Sandra Grieve Sandra is an experienced person-centred counsellor and psychotherapist. She has been in private practice for more than 25 years and in that time has worked with a wide range of people in a variety of settings. She works creatively with both adults and children, individually and in groups. She offers a safe environment and works with warmth and humour to support clients to explore whatever is troubling for them. Sandra has a diploma in person-centred groupwork, a diploma in personcentred counselling, an advanced diploma in psychodrama psychotherapy and a postgraduate certificate in supervision. She is a UKCP-accredited senior trainer and she has taught previously at the University of Strathclyde and the Sherwood Institute. Yvon Guest Yvon is a psychodynamic counsellor living and working in Bristol. She enjoys working with a diverse client base, mainly Black and minority ethnic and LGBTQ. Yvon also worked for many years in the independent sector, where she developed a passion for facilitating the empowerment of society’s most oppressed and marginalised individuals. This, along with her own experiences as a care leaver, led to her undertaking a PhD on the themes of resilience and trauma, which she now

About the contributors

incorporates into her counselling work. In her spare time, Yvon loves going for long walks, family time, and playing with her grandchildren. Delroy Hall Delroy has been in active pastoral ministry for more than 30 years and is an ordained bishop within the Church of God of Prophecy. He is also a trained psychodynamic psychotherapist and a lifelong learner. Delroy has a firm commitment and deep respect for the humanities and the insights they offer in understanding how the world and its varied relationships impinge on humanity. With that understanding, he then seeks to further understand, through a theological lens, the role of faith in the complexities of everyday life. Outside of academic work, Delroy is known for having a keen sense of humour, keeps fit and loves his role as the chaplain for Sheffield United Football Club. Ali Ahmad Kaveh Ali is assistant professor in the faculty of social science at Herat University, Northwestern Afghanistan. He got his BA in Persian literature at Herat University and his MA in sociology from Pune University in India in 2008. He is president of the Afghanistan Social Research and Development Studies Organization. His research interest and areas include gender and masculinity, extremism, violence (especial gender-based violence), mental health and development studies. Ali has been involved in some national and international research projects focusing on social and mental health issues in Afghanistan. Colin Lago Colin was Director of the counselling service at the University of Sheffield, UK from 1987 to 2003. He now works as an independent counsellor/psychotherapist, trainer, supervisor and consultant. Trained initially as an engineer, Colin went on to become a full-time youth worker in London and a teacher in Jamaica, before becoming a counselling practitioner. He is a Fellow of BACP. Deeply committed to transcultural concerns within psychotherapy, he has published articles, videos and books on the subject. His books include Race, Culture and Counselling: The ongoing challenge (2006), Anti-Discriminatory Practice in Counselling and Psychotherapy (2010) (co-edited with Barbara Smith), The Handbook of Transcultural Counselling and Psychotherapy (2011) and The Person-Centred Counselling and Psychotherapy Handbook: Origins, developments and current applications (2016) (co-edited with Divine Charura.) His passions include mountain travel, biking and swing dancing, and he aspires to be an artist. Courtland Lee Courtland is a professor in the counselor education program at the Washington DC campus of the Chicago School of Professional Psychology. He is the author, editor or co-editor of seven books on multicultural counselling and three books on counselling and social justice. In addition, he has published numerous book

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About the contributors

chapters and articles on counselling across cultures. Courtland is a past-president of the International Association for Counseling. He is also a fellow of BACP, the only American to receive this honour, and a fellow and past-president of the American Counseling Association. Vedia Maharaj Vedia is a person-centred practitioner with 22 years in the field. Her specialist areas of interest are post-colonial racism and working with refugees and those who have been trafficked, and violence against women and young people. Currently she is the counselling co-ordinator in a school, overseeing and supervising a team of trainee and newly qualified volunteer counsellors. She is a clinical group supervisor at Refugee Action Kingston and group work facilitator at Women and Girls Network for women recovering from gender-based violence. Vedia is a mentor at the Black African and Asian Therapy Network, supporting trainee counsellors through psychotherapy and counselling courses. Vedia has also facilitated PPD groups at Thames Valley University and has provided training to Place2be trainees on working with refugee and asylum seekers who are children. Foluke Taylor Foluke Taylor is a counsellor/psychotherapist and writer. She works with – and teaches – creative writing as a relational, psycho-political, therapeutic practice. Through an always-evolving engagement with Black feminist thought and transdisciplinary scholarship, she continues to explore the blended ‘methodologies of fixing’ of therapy, art and activism. These practices offer significant moments of delight, which are themselves strategies for survival in a world on fire. Foluke has an MSc in creative writing for therapeutic purposes (Metanoia Institute). Her writing – various entanglements of fiction-not-fiction – has been shared via professional journals, anthologies, conferences and live art performances. Her memoir/biomythography, How the Hiding Seek, was published in October 2018. Lennox Thomas Lennox was formerly a clinical social worker and the first senior probation officer of African Caribbean origin in the UK. He worked with children and families, before training in psychoanalytic psychotherapy and later specialising in child, family and couples therapy. His continuing passion and commitment were for intercultural psychotherapy and work with refugees and trauma. He was a training therapist and clinical supervisor with additional interests in attachment, relational therapy and organisational consultancy. He was Clinical Director of Nafsiyat Intercultural Therapy Centre, and Co- Director of the University College (London) MSc in Intercultural Psychotherapy. He was also a co-founder and consultant psychotherapist at the Refugee Therapy Centre. Known for his warmth, good humour and intellectual capacity, he was recognised for his contribution to mental health by the National African and Caribbean Mental Health Network and granted an Honorary Fellowship of the United Kingdom Council for Psychotherapy. During his long career, Lennox

About the contributors

wrote three books and more than 20 articles and chapters. His interests were in gardening and Caribbean literature, having spent the first seven years of his life in Grenada. He died in April 2020, following a long illness. Dwight Turner Dwight is senior lecturer within the School of Applied Social Sciences at the University of Brighton, lecturing on the PG Dip and MSc courses in counselling and psychotherapy, and is a PhD supervisor at its doctoral college. He completed his PhD through the University of Northampton and the Centre for Counselling and Psychotherapy Education (CCPE) in 2017. His phenomenological and heuristic study used transpersonal and creative techniques such as visualisations, drawing and sand-play work to explore the intersectional nature of privilege and otherness. He is also a psychotherapist and supervisor in private practice and a part-time lecturer at the CCPE. Valerie Watson Val has worked in education for more than 30 years, as a schoolteacher, adult education lecturer and head of the University of Nottingham counselling service. She has occupied a range of voluntary roles in the community, including with Victim Support, Rape Crisis and adoption consultancy, and in the university as Chair of the BME staff network. Val maintains an abiding interest in issues of race, ethnicity, the impact of difference on relationships, community action, and the maintenance of health through the use of and access to the arts for all. Latterly, her work has focused on the potential of therapeutic work in groups and organisational reflective practice. Mark Williams Mark is a senior lecturer in social work at Leeds Beckett University, with specialist knowledge in mental health social work practice. Prior to taking up the post with the university, Mark worked in statutory mental health services in both health and social care provisions. He was key in developing a multicultural centre for Black, Asian and minority ethnic people with mental health issues in the late 1990s. At this time, he worked with Lennox Thomas and colleagues from Nafsiyat to develop culturally sensitive ways of engaging these communities. He maintains an interest in the lived experiences of people from those communities in the UK and the impact on individual mental health and wellbeing, and has gone on to organise a series of conferences for health and social care practitioners in mental health services working with Black, Asian and minority ethnic communities. His specific areas of experience in staff development and training focus on developing skills in stress management and resilience in the workplace and the use of supervision. Mark has trained in the foundations of transcultural psychodynamic psychotherapy with Tavistock and Portman, and previously studied Freudian psychoanalytic studies at master’s level. He is keen to use this and his broader knowledge of health and social care to further his approach to teaching and facilitate learning.

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About the contributors

Billie-Claire Wright Billie-Claire completed a research study on ‘Internalised racism in Blackness’ for her MA counselling and psychotherapy studies at the University of East London, on which her chapter is based. She has worked extensively with primary-aged children in schools, graduating from Place2Be in 2016 with a PG Diploma in counselling children in schools. Post-graduation, she worked with secondary school pupils as assistant school project manager. She currently works full-time with children, young people and families at Harrow Horizons, a collaboration involving Barnardos, the NHS and the local authority, which offers client-centred short-term therapy. She is piloting a new training course that she has developed for a small, independent counselling organisation, exploring racial identity application in therapeutic practice, using ideas drawn from areas of her research. Neelam Zahid Neelam is an integrative counsellor and psychotherapist accredited with BACP, a trainee supervisor, transcultural trainer, mindfulness coach, and an associate at The Minster Centre. Neelam completed her MA in counselling and psychotherapy at Regents College, London and has been working as a therapist since 2003. Currently, Neelam has  her own private practice, and  worked previously within higher education as a student counsellor for 13 years. Neelam has delivered a number of transcultural workshops at conferences for the Association of University and College Counsellors and BACP, as well as for psychotherapists and trainees in various educational institutes and voluntary organisations.  Neelam has also contributed to The Handbook of Transcultural Counselling and Psychotherapy on ‘The effects of a Pakistani heritage’.

Name index

Name index

A

Abu el Magd, N. 4 Adames, H.Y. 13 Adams, M. 133 Ade-Serrano, Y. 209 Adonis, I. 11 Afrasibi, S. 22 Ahmed, S. 92 Ainsworth, M. 166, 188 Akala, D.K. 12, 70, 71 Akbar, N. 200 Akesson, B. 23 Akhazemea, D. 203 Akhtar, S. 115 Aldred, J. 202 Alessandrini, A.C. 189 Alexander, R. 191 Al-Krenawi, A. 22 Alleyne, A. 10, 13, 115, 117 Almaas, A.H. 232 Altman, N. 163 American Counseling Association (ACA) 5, 8 American Psychological Association (APA) 23 Anderson, A. 202 Anderson, D.D. 46 Andrew, K. 63 Ani, M. 67 Anti-Oppression Network 74 Anyiam-Osigwe, C. 155 Apprey, M. 13 Arnd-Caddigan, M. 109 Arnold, E. 166 Arnold-Baker, C. 131 Arrendondo, P. 5 Arthur, S. 70 Association for Black Counsellors (ABC) 11 Awad, G.H. 192

B

Babury, M.O. 18, 25 Bahadur, G. 119 Bains, S. 6, 10, 11 Bakkar, N. 116 Baldwin, J. 90, 91, 231, 232 Barnes, C. 34, Barnes, P.W. 80 Barty, A. 63 Basma, D. 130 Battle-Singer, M. 165 Beck, A. 185, 188 Becker, E. 135 Behar, R. 12 Bell, C. 27 Benjamin, J. 101 Benson, S. 157, 160 Berdondini, L. 19, 20, 21, 23, 24, 25 Bergin, A.E. 207 Berne, E. 188 Bezrukova, J. 215 Bhopal, K. 12 Bhugra, D. 203, 204 Bias in Britain 12 Biden, J. 1 Bignall, T. 201 Bion, R.W. 156, 158 Bishop, R. 190, 192, 193 Black, African & Asian Therapy Network (BAATN) 11, 30 Black & Asian Counselling Psychology Group (BACPG) 11 Blackburn, S. 194 Boakye, J. 12 Bogues, A. 63 Bolt, M. 46 Bonilla-Silva, E. 57, 80

241

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Name index

Bowen, M. 188 Bowlby, J. 165, 188 Bowleg, L. 82 Bowser, B. 52 Boyatzis, C.J. 46 Boyd-Franklin, N. 5 Bragin, M. 23 Brand, D. 90 Branscombe, N.R. 100 Brewer, M.B. 156 British Association for Counselling & Psychotherapy (BACP) x, 3, 4, 9, 11, 171, 200 Spirituality Division 208 British Psychological Society (BPS) x, 3, 4 Britton, R. 157, 158 Brondolo, E. 82 Brooks, M. 83 Brooks, O. 168 brown, a.m. 96 Brown, R.J. 156 Bryant-Davis, T. 80, 176, 177, 181 Buber, M. 103, 188 Buchan, L. 123 Burkard, A.W. 175, 181 Burns, K. 57 Burrell, R.R. 11, 204, 208 Byrd, Jr., J. 79

C

Cameron, R, 9 Campt, T, 90 Camus, A, 130 Carter, M, 120 Carter, R.T. 5, 13, 53, 63, 78, 174, 177 Casse, P, 63 Centers for Disease Control and Prevention 191 Chang, C.Y. 215 Charman, P, 202 Charura, D, 67, 140, 166, 195 Chavez, C, 190, 193 Cho, S, 100 Chouliaraki, L, 128 Christian Research 204 Ciftci, A, 18, 22, 23 Cilia La Corte, P, 131, 134 Claiborne, S, 231 Clark, J, 3 Clarke, K.B. 165

Clarke, M, 202 Clarke, M.P. 165 Clay Doyle, C. 233 Coates, T.-N. 32, 96 Colston, E 1 Comas-Díaz, L. 56, 80 Cook, C.H. 202 Cooper, L. 202 Cooper, M. 130, 131, 132 Cooper, N. 209 Corbett, A. 145 Corey, G. 188 Cornelius-White, C.F. 185, 187 Cornelius-White, J.H.D. 185, 187 Costa, B. 10, 11 Cousins, S. 63 Coyle, A. 207 Cozolino, L. 68 Crenshaw, K. 67, 100-101 Criswell, G.E. 108 Crocker, J. 56 Cross, W.E. 45, 46, 176, 177, 178 Crossley, J.P. 207 Curry, A.E. 114, 165

D

Dabiri, E. 63 Dalai Lama 230 Dalal, F. 99 Dante, C. 134 D’Ardenne, P. 6, 189 Darwin, C. 207 Dass-Brailsford, P. 81 Davids, F. 49, 153, 158 Davis, A.Y. ix Day-Vines, N.L. 13, 113 DeGruy Leary, J. 68, 166 Dein, S. 208 de la Boetie, E. 103 Denzin, N.K. 189, 193 Devakumar, D. 193 Dhillon-Stevens, H. 3, 11, 114 Dhingra, S. 174 DiAngelo, R. 4, 12, 32, 52, 57, 59, 63, 68, 69, 91, 100, 101, 125, 214 Dillsworth, D. 12 Djeli, G. 121 Dodd, V. 12 Donovan, R.A. 82 Dovidio, J.F. 80

Name index

Drakuliç, S. 32 Du Bois, W.E.B. 93 Duffield, I. 201 Durrence, H.H. 82 DuVernay, A. 57 Dyer, R. 63, 91

E

Eagle, G. 42 Eddo-Lodge, R. 12, 63, 70 Edge, D. 204 Eleftheriadou, Z. 6-7, 111, 113 Elliott, J. 34 Ellis, E. 33, 63, 209 Ellison II, G. 30 Epp, L. 57 Equality Act 68 Erikson, E.H. 156 Erskine, R.G. 108, 109 Esame, C. 232 Essed, P. 52 Esses, V.M. 128 Euripedes 230 Evans, A.M. 84

F

Fanon, F. 93, 99, 102, 154-155, 164, 231 Farooqi, Y.N. 22 Fattahi, Z. 22 Faust 157, 231 Feagin, J. 52 Fernando, S. 200, 206 Finlay, L. 187, 196 Fletchman-Smith, B. 170 Floyd, G. ix, 7 Ford, R. 217 Frankl, V.E. 129–130, 136 Franklin, A.J. 53 Franklin, J. 59 Freud, A. 188 Freud, S. 99, 167, 180, 185, 188, 206-207 Frosh, S. 99 Fryer, P. 12, 121, 201

G

Gaertner, S.L. 80 Galbraith, J.K. 63 Galton, F. 156 Gay, C. 179 Geller, A. 60

Gentleman, A. 12 Gergen, K.J. 68, 69 Ghazal, A.N. 128 Gibbons, M.M. 130 Gilbert, J. 18 Gilbert, P. 203 Gillborn, D. 68, 69 Gilroy, P. 94 Ginger, S. 23 Giovazolias, T. 195 Goldberg, D.T. 52 Goodley, D. 100 Goosby, B.J. 80, 82 Gore, J. 222 Gorman, A. 1, 2 Grant, G. 12 Green, B.L. 53 Greenson, R. 168 Grieger, I. 111 Grier, W.H. 165 Griffin, J. 130 Griffith, M.S. 165 Grix, J. 186 Grof, S. 188 Guest, Y. 159, 160

H

Halaj, A. 18 Hall, D. 13 Hall, S. 99, 156 Halmos, P. 65 Harborne, L. 208 Hardy, K.V. 58-59, 178 Hartman, S. 34 Haslam, N. 128 Haugh, S. 63 Hays, D.G. 215 Hayward, F. 18, 25 Helms, J.E. 5, 45, 46-48, 53, 58, 63, 80 Hemmings, C. 60, 84 Henderson, V.L. 231 Henderson, Z. 191 Hill, L. 93 Hill, L.K. 82 Hirai, T. 9 Hirsch, A. 12, 63, 70, 71 Hoffman, L. 130 Holdaway, S. 99 Holdstock, L. ix Hollway, W. 153

243

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Name index

Holmes, D.E. 165 Home Office 70 Hondius, D. 12 Hook, J. 157 hooks, b. 88, 90 House of Lords Library 70 Howard, G.R. 222 Howard, V. 201-202 Hunt, R.G. 52 Huppert, J.D. 18

I

Ifekwunigwe, J. 152–153, 156, 160 Ingham, H. 35 Institute of Race Relations 70 Iqbal, S. 22 Itkowitz, C. 34 Ivey, A.E. xi, 6

J

Jackson, C. 201, 209 Jackson, F. 182 Jacobs, M. 99, 206 Jaffrey, Z. 71 Jalonen, A. 131, 134 Jefferson, T. 153 Jenal, S.T. 13 Jenkin, C. 7 Jenkins, C. 208 Jha, R. 102 Johnson, B. 123, 202 Johnson, R.H. 156 Jung, C. 4, 34, 188

K

Kagan (Klein), H. 20 Kagan, N.I. 20 Kakar, S. 165 Kareem, J. 3, 6-7, 28, 63, 163, 165, 167, 170, 189 Katz, J.H. xi, 63 Kazantzakis, N. 135 Keating, F. 185, 186, 195, 206 Kendi, I.X. 54, 56, 60, 225 Keshen, A. 130 King, D. 204 King, M.L. 200 Kinzie, J.D. 131 Kirkinis, K. 53 Kirschenbaum, H. 231

Klein, M. 154, 181, 182, 185, 188 Knight, C. 78 Knox, S. 175, 181 Koenig, H.G. 202 Kohut, H. 14, 188, 230 Krause, I.B. 6-7

L

Lago, C. 3, 6, 8, 9, 40, 63, 64, 67, 140, 166, 170, 174, 189, 195 Laing, R.D. 99 Larty, E. 28 Leavey, G. 204 Lee, C.C. 6, 54, 189 Lee, R.E. 55 Le Guin, U. 88 Lemma, A. 177 Lennon, A.E. 12 Liamputtong, P. 185, 186, 189, 192, 193 Lichstein, K.L. 82 Lietaer, G. 67 Lightsey Jr, O.R. 80 Linton, S. 119 Lipsedge, M. 163 Lipsky, S. 200 Littlewood, R. 3, 6–7, 28, 63, 163, 167, 189 Lochner, J. 207 Lodge, D. 128 Logan, S. 165 Logie, C.H. 100 Lorde, A. 100 Lowe, F. 44 Lubin, D. 8 Luft, J. 35 Lukoff, D. 207

M

MacDonald, J. 163 Mahtani, A. 6, 189 Malcolm X 7, 95, 200 Malkin, B. 128 Malott, K.M. 58-59, 60 Maman, Y. 11 Markle, M. 152, 158 Marrington-Mir, P. 206 Marriott, D.S. 189 Marsella, A.J. 5, 6, 22 Maslow, A. 130, 185, 188 Matsumoto, M. 189 Mayers, C. 207

Name index

McIntosh, P. 5, 55, 60, 68, 69 McKenzie-Mavinga, I. 10, 13, 40-41, 99, 108, 113, 115, 141, 149, 170, 189 McLean, J.S. 60 McMurray, A. 189, 192 Mendez, T. 182 Mendoza, D.B. 185, 186, 192 Mental Health Foundation 123, 201 Mermon, A. 203 Mieder, W. 233 Mignolo, W.D. 190 Millar, T. 159 Miller, K.E. 18 Miller, W.R. 203 Miller-Loessi, K. 189 Milton, D.E.M 68 Minuchin, S. 188 Mitchell, J. 102 Moghaddam, F.M. 22 Mohammed, P. 100 Mohdin, A. 1, 13 Mohr, S. 202 Monroe, J. 191 Moodley, R. 5, 8, 10, 64, 68, 130, 174, 177, 195 Moreno, J.L. 19 Morgan, H. 192 Morrison, T. 71, 89-90, 92, 231 Motora, Y. 189 Moursund, J.P. 109 Mouzon, D.M. 60 Muldoon, J. 190 Murakami, H. 231

N

Nadal, K.L. 60, 80 Nafsiyat 3, 165–67, 238 Natiello, P. 24, 67 National Institutes of Health (NIH) 192 National Mental Health Strategy 18 National Union of Students 189 Nazroo, J.Y. 179 Ndegwa, D. 206 Nicholls, V. 203 Nwoye, A. 67 Nyoni, J. 185, 186, 190, 195

O

Obama, B. 78, 160 Obama, M. 233

Ocampo, C. 80 Oden, T. 28 O’Keefe, V.M. 80, 82 Olajide, D. 206 Oleydemi, M. 152, 153, 156 Oluo, I. 60 Olusoga, D. 12, 70 O’Neill, M. 99 Owen, I.R. 131 Owen, J.D. 175, 176

P

Pajak, E. 215, 222 Palmer, A. 64 Palmer, P. 29 Palmer, S. 174, 177 Panter-Brick, C. 18 Paradies, Y. 79, 80 Parker, J.N. 189 Patel, N. 64, 125 Patterson, C.H. 8 Payne, I.R. 207 Pederson, P.B. 4, 5–6, 42 Peele, J. 34 Perkinson, J. 33 Perlovsky, L. 213 Perls, F.S. 19, 188 Perls, L. 188 Perry, G. 116 Pfefferbaum, B. 82 Phillips, R. 96 Phoenix, A. 156 Pickett, K. 64 Pierce, C. 78 Pieterse, A.L. 81, 82, 100 Pinker, S. 8 Pitts, J. 12, 64 Ponterotto, J.G. 111 Popenoe, P. 156 Powell, E. 152 Powell, J.A. 57 Prince Harry 152, 158 Pring, R. 186, 194 Proctor, G. 10 Prouty, G. 67 Provine, W.B. 156 Punch, K. 194 Pupavac, V. 128

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Name index

Q

Quattrini, P. 25

R

Race Awareness in Counselling Education (RACE) 3, 11, 200 Raja-Helm, P. 13 Ramaswamy, C. 9 Rankine, C. 69, 88 Ratts, M.J. 8, 54, 58, 60 Raval, H. 10 Raynar, M. 130 Reid, O.G. 166 Richard, H.W. 45, 46, 48, 49 Richardson, J. 60 Ridley, C. 5 Riley, J. 166 Rimmer, A. 206 Rizvi, A.A. 22 Roberts, G. 111 Robertson, J. 165 Robertson, J. 165 Robinson, J. 231 Roger, V.L. 82 Rogers, C.R. 19, 22, 67, 109, 185, 187, 188, 230 Rogers, N. 188 Rollock, N. 68, 69 Rose, E. 171 Rosenberg, J. 32–33, 35 Rothschild, J. 83 Rousmaniere, T. 31 Rowe, W. 179 Rūmī, J.D.M. 232 Rwigema, M.-J. 100 Ryde, J. 10, 64, 68, 69, 215

S

Sabisky, A. 123 Sabnani, H.B. 179 Sachs, W. 167 Saghar, L.N. 20, 22 Said, E. 99 Saini, A. 12 Salter, D.P. 207 Saramango, J. 131 Sartre, J.P. 5 Sayed, D.G. 19 Scaravelli, V. 231

Schaefle, S. 58–59, 60 Schmid, P. 67 Schwarz, B. 121 Seacole, M. 160 Segal, H. 181 Selden, S. 191 Serning, N. 194 Shams, T. 78, 80 Shannon, B.E. 165 Shapiro, F.D. 233 Shapiro, K. 191 Sharpe, C. 70, 90-91, 94 Shrieve-Neiger, A.K. 202 Shukla, N. 70 Sinason, V. 163 Smets, K. 128 Smith, B. 9, 63 Smith, L. 56 Smith, T.B. 202 Sodowsky, G.R. 8 Solange, 92–93 Solnit, A.J. 165 Spalding, B. 174 Spanierman, L.B. 52 Spillers, H.J. 232 Spinelli, E. 130, 131, 132 Stack Sullivan, H.S. 8 Steffen, P.R. 80 Sterling, A. 34 Stickle, M. 109 Stokes, D. 190 Stolorow, R. 188 Storer, R. 1 Straker, J. 13 Strous, M. 42 Sue, D.W. 5, 6, 8, 13, 54, 57, 84, 176, 177-178, 225 Sumner, C. 189 Sweep, T.G. 135 Szasz, T. 206

T

Talhite, A. 64 Taylor, T. 48 Taylor-Smith, H 31 Tervalon, M. 13 Thachil, A. 203 Thomas, A. 30–31, 20 Thomas, L.K. 13, 166, 171, 233

Name index

Thomas, S.M. 102 Thompson, C.E. 13 Thompson, J. 3, 6, 170, 180, 181, 189 Thorne, B. 203, 207, 208 Tillman, L.C. 187, 190, 192, 193, 196 Tizard, B. 156 Torabully, K. 120 Totton, N. 144 Tribe, R. 10, 209 Trump, Jr., D. 128 Tuckwell, G. 10, 64 Tudor, K. 67 Turner, D. 2, 9-10, 13, 30, 32, 38 Turner, E.A. 60 Tuskegee University 191 Tyrrell, I. 130

U

Unigwe, C. 12 United Kingdom Council for Psychotherapy (UKCP) x, 3, 4, 171 University of Herat (Afghanistan) 19 University of London 190 University of Strathclyde 19 US Census Bureau 84 Utsey, S.O. 42, 43, 50, 80 Uwahemu, A. 171

V

van der Kolk, B. 135, 232 van der Veer, G. 132 VanderWeele, T.J. 203 van Deurzen, E. 130, 131 van Kaam, A 135 Van Praag, H.M. 202 ViceNews 55 Viscott, D. 231 Vitali, D. 130 von Franz, M.-L. 103 Vontress, C.E. 4, 5, 13, 57, 68, 130 Vos, J. 130

W

Wachtel, P. 195 Waddell, L. 73 Wagner, J. 82 Walcott, R. 68, 119, 130, 195 Walker, A. 155 Walker, K. 94

Walker, R. 156 Warner, M. 67 Watson, J. 191 Watson, V. 10, 32, 50, 222 Watts-Jones, D. 43-44 Wekker, G. 12, 64 Welsing, F.C. 215 West, C. 27 West, L.M. 83 West, W. 10, 68 Wilderson, F. 90 Wildt, H. 18 Wilkinson, R. 64 Willcox, G. 111 Williams, D. 3 Williams, D.R. 179 Williams, J. 155 Williams, M.J. 119 Wilson, A. 123, 156 Winbolt, B. 28 Winer, R. 180 Winnicott, C. 166, 171, 188 Wollants, G. 144 Woodward, K. 156 Worrall, M. 67 Wright, B.-C. 6, 13, 39 Wright, K. 100 Wright, T. 100, 128 Wynter, S. 95

Y

Yancy, G. 89, 94, 226 Yalom, I. 130

Z

Zaborowski, R. 128 Zahid, N. 206 Zeichner, K. 222

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Subject index

Subject index

A

acculturation 47, 112 African diaspora 216, 232 Afropessimism 90 ancestral imagination 96 anti-racism 1, 63, 92 anti-racist counselling 52–65, 89 school of thought 56, 225 apartheid 78, 226 arts (therapeutic use of) 20, 73, 143 assimilation/ist 46–47, 54–56, 122–23 asylum seeker(s) 132–135 attachment 10, 94, 165–66, 238 avoidance anxiety 66 coping 83 issues 13–14, 74

B

bias media, 12 racial, 123–125 structural, 124 unconscious, 13, 107–108, 116, 150 Black British 38–39, 199, 213–14 client 42–44, 66–74, 155, 226 counsellor 11, 31, 50, 72 empathic approach 11–13, 113–16 identity 45–46, 152, 175–78 inferiority 54 majority churches 201–05 psychology 191 visibility 70–72 Black Lives Matter 1, 7 British Nationality Act 1948 121–22

C

caste system 100,153–55 Christianity 28–29, 80, 199, 203–05, 229–30 civil rights 4, 78 classical theory 169–70 cognitive dissonance 214–22 collectivism 46–48 colour blindness 47, 174–82 Commonwealth Immigrants Act (1962) 122 community access to, 11, 137, 201 Black, 155–59 involvement of, 141 sense of, 203 working in, 22–24 continuous trauma 13 core conditions 24, 199 cross-cultural counselling 53, 181 cultural appropriation 66–68 beliefs 21 competency 54, 58–60 dysthymia 57, 59 empathy 24 exploitation 66 heritage 79, 159 humility 13, 157, 176 norms 22–23 oppression 6 power 192 racism 79–80, 226 rituals 80 values 21–22 culturally sensitive practice 187, 192–96, 210

Subject index

D

decision-making 81, 130 decolonised/decolonising curriculum 34, 88, 183, 189–91, 194–95 internal 166 psychotherapy 186–88, 192–93 structures 122–23 deconstruction/reconstruction 145, 150, 228 dehumanisation 128 delegitimising experience 142–45 diversity training 89, 117, 126, 171, 215 dominant culture 52, 70, 79, 112 double consciousness 93–94 dual heritage 153 world 171–72

E

embodied experience 157–58 embodied-relational exchange 144, 234 empathy 22–24, 68–69, 181 epidermalisation 155 epistemology 186, 190–95 eurocentric counselling 6, 187 curriculum 187 perspectives 186–96 existential crucifixion 13 meaning 129–37 philosophy 5, 22 therapy 130–32 external world 152–53, 163–64

F

false self (see also proxy self) 171 Faustian pact 152–60, 228 fourth force 8

G

Gestalt 20–22, 188

H

heteronormative 95, 99–101, 165 historical hostility 5, 57 oppression 167–71 research 190–91

trauma 187, 191–95 homophobia 99, 141, 171 humanistic psychology 188, 207 therapeutic approach 19–20 theories 21–22 humiliation 143–44 hypervigilance 80–81

I

immersion-emersion 47–48 indenture 119–22 inner-outer world traffic 153 integrative psychotherapy 58, 108–10 intercultural awareness 18 clashes 20 counselling training 23 therapy 28, 163–70 intergenerational trauma 166 internalisation-commitment 177 internalised colonisation 126, 155 devaluation 30, 56 oppression 13, 65–68, 124, 200 racism 38–39, 43, 125, 158–59 interracial relationships 157–58 intersectional privilege 103–05 understanding 149–50 introjects 93, 164

L

latinx 79 lies (of whiteness) 89–91

M

macroaggression 78–79 marginalisation 52, 79, 150, 179 mentalisation 91–93 metaphors (in therapy) 20, 24, 69, 70, 73 microaggression 65–69, 78–79 colour blindness 174–83 racial 59, 72, 144 miscegenation 156–60

N

narcissism 94, 101–02

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O

ontology 130, 186, 194–95 otherness anti-semitism 32 and privilege 99–103 racist, 178 repressed, 104 shame of, 226

P

patriarchy 88, 99–100 person-centred approach 21–24, 68–69, 74, 107, 199, 210 post-traumatic stress disorder (PTSD) 129, 135, 177 power and authority 140–43, 150 pre-encounter 46, 177 projection 154 proxy self 13, 171 psychosocial approach 8, 54–55, 153, 160 psychoanalytic practice 163–64 research 164, 174 theory 168–70, 183, 192 thinking 152–54 psychodynamic practice 107–111, 163, 182 theory 28, 167–68 psychopathology 82, 175–77 psychosis 164–67, 202

R

racial bias 80, 123–25, 175–76 discrimination 53–54, 78–84 identity 38–50, 156–59, 174–79 power and privilege 55 segregation 54, 168 superiority 52 tensions 44, 159 reflexivity 65, 70, 196 refugees 18, 128–37, 228, 238 relationship-based therapy 163–64 religion and health 135–36, 199–206 and psychology 206–09

S

schizophrenia 200

selfactualisation 23, 68 assessment 65 disclosure 115–16 esteem 80, 119, 156, 169 perception 68 sexism 99, 141 shadism 155, 228 shame 73, 80, 101–04, 126 slavery legacy of, 120–22, 160, 169 survival 68, 159, 166, 207 social constructs 156 identity 174 sociometry 24 splitting (Klein) 96, 113, 154 stigma Black, 177 mental health, 18, 22–23, 201–04 supervision (therapy) 140–52

T

taboos 20–21, 24, 32, 43, 141 therapeutic trust 10, 21, 66, 73, 113, 145 therapy training curriculum 88–98 traditional healing 5–6, 10, 65, 68–70, 206 transgenerational hatred 13 history 90, 95 trauma 13, 70, 214 transcultural therapy 7, 108–10, 177 transference counter-, 105–07, 114–16, 168–69, 182 pre-, 114–16, 175 trauma continuous, 13 historical,  187, 191–95 intergenerational, 166 transgenerational,  13, 70, 214 triads 21, 40

U

unconscious bias 107–08, 116 privilege 98–105 processes 109, 166, 227

Subject index

V

vertical power 24 visual culture 128

W

white anger 217–18 complicity 125–26 fragility 57, 69, 91–94, 101, 125–26 privilege 39–43, 55, 65–69, 186–87, 216–17 supremacy 88–93 Windrush 155–57, 202, 213–14

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Also by PCCS Books

Subject index

Drop the Disorder! Challenging the culture of psychiatric diagnosis Edited by Jo Watson

ISBNs Paperback 978 1 910919 46 0 ePub 978 1 910919 50 7 In October 2016, the very first ‘A Disorder for Everyone!’ event took place in Birmingham and launched an ongoing, national campaign dedicated to exploring and exploding the culture of psychiatric diagnosis. How and why does psychiatric diagnosis hold such power? What harms does it do? What are the alternatives to diagnosis, and how can it be challenged? This book brings together psychologists, counsellors, psychotherapists, and users and survivors of services to propose answers to these questions. The contributors represent a wide range of expertise built through experience, research, campaigning and activism. All seek to offer an alternative vision for how we respond to those in extreme emotional distress. It is an essential book for every one of us who looks beyond the labels.

‘Anyone who wants to deal with the epidemic of distress and despair in our society should engage deeply with Jo Watson’s work and this massively important book.’ Johann Hari, journalist and writer; author of Lost Connections: Why you’re depressed and how to find hope ‘Drop the Disorder! is a clarion call for change.’ Robert Whitaker, author of Mad in America and founder of madinamerica.com ‘Challenging, insightful and often controversial… a truly innovative and valuable book that functions both as a learning resource and an ardent call to arms.’ Dr Eleanor Longden, Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust

Free UK postage at www.pccs-books.co.uk

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