First draft January 1st 2002
The Hidden Politics of Healing: Foreign Dimensions of Domestic Practice
Andrew Samuels, Centre for Psychoanalytic Studies, University of Essex
Abstract In a reversal of the usual flow of traffic, the author suggests that Western therapists (of all orientations including psychoanalytic) working with clients who do not display obvious differences from themselves should learn from what has been discovered in the practices of transcultural psychotherapy and also from the manner which psychotherapy has evolved in non-Western locales. A destabilization is sought of the distinction between and relations of ‘foreign’ and ‘domestic’. Issues focused on include power dynamics in the therapy process, the limitations of Western models of individual, parent, family and society, training issues and questions of pluralism and integration within the field of psychotherapy. Throughout, the background is the ubiquitous linkage of psychology/psychotherapy and politics, an inter-penetration of apparently internal and apparently external worlds.
Key words culture, domestic, foreign, intercultural psychotherapy, politics, power, training, transcultural psychotherapy
The practices of transcultural psychotherapy in Western countries, and the export of Western models of psychotherapy to foreign places, may be imaginatively taken as offering a mirror to what Western practitioners typically do domestically, especially when there appears to be homogeneity of therapist and client. In multi-ethnic cities like London, therapists work in a ‘domestic’ setting with ‘foreign’ clients (and ‘foreign’ or foreign-seeming therapists work - in scandalously low numbers, it has to be said - with ‘domestic’ clients). This has led to the growth of transcultural and intercultural therapy in which, as Renos Papadopoulos (1999) put it, foreigners are not regarded as ‘ill’ merely because they are foreign. But there is little mention in transcultural therapy texts of the applicability of the ideas they contain concerning transcultural therapy to ‘ordinary’ psychotherapy. For example, Zack Eleftheriadou makes the pertinent observation that the prime requirement for the successful practice of transcultural psychotherapy is that the therapist ‘examine their relationship to their own culture’ (1994, p. 31). She makes it clear that this is not the same as becoming generally self-aware or conscious and that the consequent knock-on effect is to produce greater sensitivity to cultural difference held by a potential client on the part of the therapist. Yet it is not hard to see that what is being proposed has relevance right across the board of clinical practice in psychotherapy.
Similarly, in his paper ‘Countertransference in cross-cultural therapy’, Michael Gorkin (1996, p. 170), offers ways of managing ‘countertransferential errors’ that occur when working with a client from a different cultural background. These include the therapist’s ‘familiarizing himself with [the other] culture’ and ‘examining candidly his motives for choosing [to work with someone from another culture]’. Gorkin goes on to suggest that an important technical problem is ‘whether and when the therapist needs to initiate with the patient an exploration of their cultural differences’. As with Eleftheriadou’s wise counsel, these are surely important matters for the conduct of any therapy, whether there are overt cultural differences between therapist and client or not; context and combination are crucial.
In countries whose culture is generally influenced by the West, like Japan, therapists whose training orientation and inspiration has been ‘foreign’ are constructing a ‘domestic’ psychotherapy scene. But, once again, a review of texts that touch the history of psychotherapy reveals almost nothing about the possible relevance of the changes and improvements that have been made in locales foreign to the West to standard practice back home (e.g. Borossa, 2000; Homans, 1989; Kirsch, 2000). This is in one sense perfectly understandable in that such a concern may have fallen outside the ambit of these books and papers, but there is also something suggestive about the omission. It is as if English literature were to have been denied the fertilizing and flourishing presence of Irish, Indian or African writers and their inspiring presence in and influence over the home-grown scene. Whereas, in fact, as Timothy Brennan pointed out, English is no longer an English language (1990, p. 54).
In this paper, I suggest that it is worth trying to find out what would happen if all psychotherapy were to adopt several of the key practices and focus on several of the key concerns of transcultural therapy, or to import some of the features of psychotherapy in non-Western settings. It is a deliberate reversal of the usual flow of traffic, an incitement to the displacement of the centre by the peripheries. We do not need to make the claim that all psychotherapy is transcultural in some sense to see that there are implications for theory and practice of unsettling the habitual distinction and relations between domestic and foreign practice in a given field. I will suggest that the main implication of making this move is to resituate the idea that there is an omnipresent political dimension to psychotherapy. It ceases to be an (important) apercu and what is discovered at the margins of therapy practice and in the frontier regions of therapy endeavour becomes of critical importance to the ancien regime at the centre which often seems to lack the energy to regenerate itself.
Transcultural therapy experience suggests that power, the experience and exploration of the negative and positive aspects of difference, struggle between therapist and client over resources and methods (including information), and conflict between competing visions of the future (all markedly political as well as psychological themes) are also the nodal ones for personal transformation (D’Ardenne and Mahtani, 1999; Sue, 1998). Diversity, and what Adams calls the ‘diversity of diversity’ (1996, p. 5) are pressing contemporary political images as well as being apt descriptions of the multiple selves or plural psyches that exist within the post-modern or late-modern citizen. (See Samuels, 2001, for a fuller treatment of the relationship between psychotherapy’s language and today’s political dilemmas.)
In this paper, I argue that the ideal goal of approaching each client with a fresh theory minted for that client and his or her needs can be more closely achieved when the domestic client is reframed as always already a foreigner. Instead of making the exotic familiar, we render the familiar exotic - thereby moving each and every therapy in an individuated direction (see Papadopoulos, 2002 for an account of how the exotic other can subjugate the familiar other and Plaut, 2001 for views on the dynamics of analysis with apparent similars who turn out to very other to the analyst). What we have learned from clinical encounter with real foreigners we can apply in our work with this other kind of foreigner; what we have learned from hearing what happens when we export therapy to non-Western countries we can apply in the wholly domestic setting. Multi-ethnic living underscores this understanding that ‘here’ and ‘there’ are not always clear-cut binary opposites. By fleshing this out psychologically, we may also do something interesting to the opposition between ‘us’ and ‘them’ in the social realm. (See Sreberny, 2002, p. 294, for her account of how globalization increases the number of ‘others’, thereby ‘challenging old identity structures’.)
I have written extensively (1993, 2001) about the ways in which therapy thinking can refresh the political vocabulary of Western societies that, seemingly, has lost the confidence of many citizens. But a concern with the political dimensions of the psychotherapy process itself, the ground covered in this paper, has also been present (see Samuels, 1997c, 1999). By ‘political dimensions of the psychotherapy process’, I do not mean to refer to the professional politics of psychotherapy (addressed in Samuels 1997a, 1997b) but to the increased understandings of the situation in depth of client and therapist that can be gained by attention paid to the micropolitics of psychotherapy process as they unfold within the session itself. In this connection, these issues of difference, power imbalances, and the conspectus of transcultural psychotherapy mentioned earlier can function as resources for and goads to further refinement of thinking about the clinical - and hence about ‘personality’ and ‘psyche’ itself.
As far as the personal raw material for what is developed herein is concerned, my participation in the export of ideas and practices of Jungian analysis to countries such as Japan, Brazil, South Africa, Australia, Ireland, Poland and Russia, as well as working clinically in London with persons who display some obvious differences from me, form the personal raw material for what is developed herein. When I was at school, I learned the following maxim from one of my teachers, who taught economic history. He made us aware that what look like intellectual discoveries are often descriptions of the most potent and progressive contemporary practices. Niccolo Machiavelli did not write a handbook for princes, containing smart new ideas; rather, he described what the most enterprising princes were already doing (see Samuels, 1993, pp. 78-102). Adam Smith do not invent the theories of capitalism - he described what the new joint stock company capitalists were doing. Herein, I try consciously to move from practice to theory on the basis that there is nothing so conceptually elegant and original as an effective practice.
But if the driving force for the paper is practice, it is still going to be an undeniably theoretical offering. The Greek world theoria means ‘looking about the world’, ‘contemplation’, ‘speculation’. In that senses the paper is a theoretical one. But the ideas are also a distillation of my experience as a sort of theor going about psychotherapy business in foreign parts. Although the root is the same, the meaning is tangential to theoria. Theors were emissaries sent by the Greek states to consult a distant oracle or to participate in important far-off religious rituals. They also disseminated and collected information, bringing ideas and news home. Putting together the lesson I learned from the economic historian and the function of a theor, the paper contains my attempt to describe practices and ways of thinking encountered abroad.
THE LOCATION OF PSYCHOTHERAPY
Merely to speak of transcultural psychotherapy is immediately to introduce ideas of location and movement into our thinking about what can seem like an exceedingly settled and static activity - though, as Henry Abramovitch (1997) has pointed out that, even when still technically intact, the therapeutic vessel or temenos is not always as containing or predictable as we assume it to be Psychotherapy as we know it today has very specific geographical starting points (Vienna, Zurich, Europe, the West) despite its affinity with other and older systems of healing the soul. It has also had particular client groups in its sights at various times (hysterics, neurotics, psychotics, borderline personalities, depressives). But in general terms the assumption has been that these client groups have come from the same or a broadly similar cultural location as the psychotherapists with whom they work. But, as readers of this journal will not need reminding, today’s circumstances are very different in that the cultural identity of therapist and client can no longer be assumed and the practice of therapy has spread over the globe. However, we should be careful before claiming therapy as a global activity; as Julia Borossa (2000, p. 80) has shown, the international spread of psychoanalysis, for example, has been extremely uneven and this raises interesting questions in and of itself about inherent limits on the movement of the movement.
Can Western psychotherapy just be moved to another place - like Japan, for example? Even with all the careful attention to rendering the foreign import suitable for home consumption (e.g. Kawai, 1996; Oda, 2001), there still has to be a question mark over the viability of the project. Is the spread of Western psychotherapy into countries like Japan (or, to give another example in only a slightly different vein, South Africa) a kind of Euro-American imperialism, a new colonial regime that will end in a bloody liberation struggle? We in the West should be aware that our colleagues in places like Japan are satisfied with the authenticity and efficacy of what they do, confident that, far from aping colonial masters, they are putting down local roots that make their work a genuine hybrid (to adapt Bhahba’s (1990) term to a new context - not the first time an import from cultural studies helps in a consideration of an aspect of a healing profession (cf. Samuels, 1993, p. 343)).
Those writers who have delineated the main obstacles to the trouble-free relocation of psychotherapy list Eurocentric assumptions about family patterns, the relations between individual and social group, the cultural relativity of affects in terms of what may be expressed and what is thereby understood. (For reviews of these problems, see Eletheriadou, 1994; Luepnitz, 1988; Totton, 2000.) Others, including myself, have noted that political as well as psychological assumptions have to be borne in mind - psychotherapy is not neutral as regards society’s values and mores and cannot ever really be so (see, for example, Pilgrim, 1997; Totton, 2000). Psychotherapy’s theories and even its languages are inherently cultural constructs determined by the landscape in which they arise. Western notions of child development are saturated with the ideology of that other kind of development - economic development. Capitalistic societies punish economic failure harshly and it is therefore not surprising that Western developmental psychology has stressed ‘milestones’ and ‘attachment’ in terms of failure and success rather than in more modulated and nuanced terms that would have a less judgemental flavor and refer less to some kind of ‘bottom line’ or hard-and-fast outcome.
As far as childhood generally is concerned, we can see the rise of what might be called ‘the global child’, one whose features are assumed to be invariant due to biology, neurology and so forth. This phenomenon, in which all children are taken to be the same and to have the same needs, is, quite rightly, resisted by many political activists and therapists in developing countries where it can be understood as a colonial import from the West (or North). This discourse of childhood rests on ignoring cultural difference and, in keeping with its Western roots, often contains a denial of cultural ambivalence towards children. For these reasons, the ‘global child’ can seem to observers worldwide to be morally and politically objectionable. After all, theorists like Melanie Klein and Jacques Lacan are decidedly unsentimental about childhood. Similarly, many Third World therapists agree that the global mother as depicted in Western psychotherapeutic approaches is not an adequate representation of ‘mother’ for the complexities of poverty-stricken Third World societies. I remember vividly the reactions of colleagues in London to my account of mingua, a maternal attitude to the high levels of infantile mortality found in the favelas of Brazil (see Scheper-Hughes, 1992). Mingua involves a kind of maternal indifference and even neglect - but, as many Brazilian commentators have noted (e.g. Ferreira de Macedo, 1996) it is in such circumstances an appropriate and certainly an understandable response. But such a response unsettles Western ideas of what constitutes a ‘good-enough mother’. The point, though, as it has been throughout the paper, is not to reprise transcultural criticisms of Western psychotherapy and developmental psychology but to import into Western settings such criticisms from the foreign and frontier lands where psychotherapy has migrated. The introduction of mingua into the discussion definitely affected the terms and content of debate, moving abstract discussion of maternal ambivalence (Parker 1995) in a more concrete direction leading to an understanding of its culturally derived features. But - and this is an example of my overall point - what if we run our domestic data through a foreign programme? Then the phenomenon of maternal ambivalence may be looked at in a more thorough-going manner.
So there exists a critique of Western psychology’s various claims to universality, moreover a critique that is of use to us in the West. Objections to the claim for universality cannot be rebutted simply by asserting that the affects (or the archetypes) are universal (because founded on biological or neurological bases) and so a system of therapy founded on them will be more portable than other systems (see Burman, 1994 for a refutation of the ‘universality’ thesis). In fact, the universalising assertion is literally utopian in that a psychological approach that exists everywhere will find itself existing nowhere. For, as Adams (1996, pp. 49-50) has pointed out, for every bit of archetypal universality, there is a bit of archetypal particularity - the particularities of person, time, place, culture and so on. Movement and context change everything. This is underscored by empirical evidence derived from studies of the movement of persons. Japanese people born in the United States perceive things more like Americans generally than do Japanese people born in Japan who subsequently relocate (Krause, 1998). Again, let us consider refreshing the psychotherapy we do at home by eschewing universal claims that have been shown not to work overseas.
A problem shared is a problem that, while not exactly halved, may be reduced. A high proportion of the problems that attach to therapy as an overseas export from the West exist here in the West as well. Many of us in the West are as alienated from a good deal of conventional psychotherapy today as those struggling to make sense of it in the non-Western countries. With the passage of time, it becomes clear that the cultural assumptions of Freud and Jung are as foreign, or even as uncanny (Unheimlich) to us now as our ideas about the psychology of family organisation are in India. Feminist psychotherapists (e.g. Eichenbaum and Orbach, 1982) , or those writing from the perspective of their own experience as lesbians or gay men (Magee and Miller, 1997; Neal and Davies, 2000) have long recognised that ‘establishment’ psychotherapy, mainly but not only psychoanalysis, is ‘other’ to their concerns and perspectives. But, up to now, there has been little recourse to what has been evolved in the transcultural sector. In terms of many of Western therapy’s ideas and practices, we are all ‘Japanese’, or at least in the position of a potential Japanese practitioner or consumer of psychotherapy - it has now become foreign to us, this strange process in which so little appears to happen and so much does happen. Maybe the widespread suspicion of therapists, even in countries that are supposed to have a psychotherapeutic or psychoanalytic culture like France (Turkle, 1979), suggests that therapists are irremediably foreign; the alienists are themselves alien. We might emulate ways in which Japanese therapists address the problems of relevance and sensitivity to locale that they have with Western therapy (e.g. Doi, 1985, 1989).
Let me review some examples of how Western practitioners and clients are cut off from psychotherapy as it has evolved in the West. Our idea of the ‘individual’ remains startlingly limited. The individual stands alone, with his soul deep inside him (and it is still very much a ‘him’ in that independence is more demanded of males than females, even today), full of passions - positive and negative - and struggling to ease the rupture he feels with others, the natural world and himself. Scholars (e.g. Whitbeck, 1989) have shown how this Romantic notion is quite a recent invention. Without it, there would be no ‘depth’ therapy as we know it. Other approaches to the individual that make use of a transpersonal or socialised psychology struggle to get off the ground, bedevilled respectively by accusations of excess spirituality or redundant political ideology. The question of how people are connected a priori is one that therapists who work with individuals have not handled well. Ideas of a pre-existing psychological connection between people who are not in intimate relationships with each other need to be expressed with great caution. The tradition begins in religious or mystical conceptions such as that of the mundus imaginalis (imaginal world) (Samuels, 1989) and, in depth psychology, is illustrated by one possible reading of C.G. Jung’s notion of a collective unconscious. But, in general, these ideas struggle to find widespread acceptance. This not only demonstrates that one distinguishing psychosocial characteristic of the West is loneliness but may make a contribution to the phenomenon. For, as I have argued elsewhere (Samuels, 1989, pp. 16-77), depth psychology is both a reflection and a motor of the cultures in which it resides. Those who have studied the issues involved in moving psychotherapy away from its Western roots have noted the centrality of the problematic of individualism. They point to a plethora of different ontologies - mostly with a far greater accent on connectedness and a privileging of the space between persons rather than the move between what has been inside and what will become outside the person.
These alternative ontologies of connectedness can offer assistance to Western psychotherapy as it struggles to find ways to recognise the synchrony of what appears to be ‘in here’ and what appears to be ‘out there’, and the ineluctable linkage of what appears to be ‘above’ and what appears to be ‘below’. Although lip service is paid to the need to honour external and internal perspectives equally, allowing for the two-way influence of these perspectives, this particular philosopher’s stone is as elusive as any other. We can see the problem, and the anxiety it causes, most strikingly when trying to hold the symbolic and concrete aspects of sexuality in the same frame. A tip to the literal and the metaphorical coagulates; a tip to the metaphorical and the literal slips through the fingers. This can have profound practical implications. For example, a failure to negotiate the line between literal and metaphoric understandings of sexuality complicates attempts to initiate national discussions in Britain about the line between appropriately physical aspects of parenting and child sexual abuse. Similarly, psychoanalysis and psychotherapy founder when it comes to reviewing and codifying the literal and metaphoric aspects of the erotics of the clinical encounter (see Samuels, 1996, 2000, pp. 101-121).
POWER AND THE THERAPY RELATIONSHIP
From a historical perspective, perhaps the most worrying and destructive way in which Western psychotherapy has become foreign to us here in the West is its overall reluctance to engage with power dynamics in its actual practices. Obviously, I am not saying that all therapists ignore the presence of power dynamics and power issues in therapy and I think that, in a halting way, moves are being made, mostly within integrative psychotherapy, to grapple with power relations in therapy. In transcultural psychotherapy, meaning therapy of any kind in which there is explicit recognition of and response to the psychological dynamics of the cultural backgrounds of the participants and the mixture of these, such a concern is necessarily widespread and fundamental due to the uneven spread of power between communities and the way in which ethnic and national strife become animated in the transference-countertransference relationship (see Kareem and Littlwood, 1992). But in therapy work done between similars, instead of a frank concentration on power, we often find the issue given an instant interpretative (and psychopathological) spin so that it is claimed to be a question of an ‘omnipotent breast’ or ‘the Law of the Father’ or the ‘Terrible Mother’, not to do with the process of psychotherapy itself. Sometimes, the power dynamics within the therapy session are overlooked in favour of a consideration of whether or not the client is or feels empowered - which is not really the same thing.
Many practitioners do not realise that therapy institutes a relationship that involves power as a primary and ubiquitous feature. Experiences in transcultural therapy suggest that we can make creative use of what often seems in the beginning to be an ugly and unjust scenario. Many people have been wounded precisely because of abuses of power, ranging from refugees to those brought up in standard issue middle-class British families. Recovery from such wounds will be impeded if the transference-countertransference power dynamic is insufficiently explored. Power issues in therapy often follow the lines of an inferior/superior dance in which the starting pose is that the therapist is up (‘idealised’) and the client is down. Perhaps this is the collective reason why so many clients either try to please the therapist or, conversely, spend their time fighting the therapist’s system. In my experience, it is essential to challenge the manner in which many power issues take on this inferior/superior tone so quickly. The vertical axis encourages a kind of spurious morality and denies that there is also a horizontal axis of interpersonal power which calls out for some kind of struggle on the part of the client (see Samuels, 1989, pp. 194-215).
The question of power is not only a matter for a particular therapy situation; it is central to the whole of psychotherapy practice. For, as an institution, psychotherapy has power. If I am a client and you are my therapist, the power you have over me is the crystallisation of institutional power and authority that has come into being as the result of years of professionalization. And there is more: psychotherapy does not go on in a power vacuum. As an institution, it is itself subject to the power of other institutions - the state, insurance companies, the husband who has made his wife ‘get therapy’, the professional body to which the practitioner belongs. Transcultural therapy experience suggests that merely asking for help is a highly charged social act that is very difficult to decode, whatever its individual psychological significances. Many apparently parental transferences are equally likely to be transferences to ‘the expert’ or ‘the professional’ and the dependency that ensues is, therefore, not regressively ‘infantile’ at all - it is structured into the social reality of the therapy situation.
The most dramatic example of the workings of power within psychotherapy is that of sexual misconduct. Although we know that this is not only a problem with male therapists and that there are abuses that take place within therapy conducted by females (Samuels, 1996; Schaverien, 1995), the stereotypical situation in which the therapist is male and the client female (‘she talks, he listens’) still requires special recognition. Female clients who find that they cannot say ‘no’ are victims of the abuse of power, and therapists who misuse their position are increasingly being understood as suffering from some kind of deficiency or shortfall in a feeling of authentic potency. But the necessary pathologisation of such therapists should not be allowed to disguise the political implications of what they have done.
In situations where sexual misconduct takes place, and in situations where therapists would do anything rather than run the risk of committing misconduct (and hence over-react, running the risk of depriving their clients of much-needed involvement), we see a good example of my point about the manner in which psychotherapy has become foreign to its domestic constituency. When the style of therapy adopted is distinctly anti-libidinal, the result can be a repression of sexuality within psychotherapy carried out by the very institutions of psychotherapy itself (Samuels, 1996). The client and the therapist are deprived of eros, a major source of life, creativity and transformation in their work together. Whilst the deleterious impact on the client may not be as severe as in cases of actual sexual misconduct, the spread of the practice of excessively safe analysis and psychotherapy is wider and it would be foolhardy to ignore this complementary problem. Here, terms developed by post-colonial discourse are useful. When considering psychotherapy and analysis that have repressed sexuality as a part of their discourse, one could say that it is now the domestic consumer of psychotherapy who is being flooded with an inferior product . Sexual misconduct, or its opposite, repression of the benevolently erotic are going on at home but the ‘methodology’ would be familiar to anyone living in a less developed country used to the receipt of out-of-date dumped goods or products too dangerous to sell at home. Anecdotal reports of a psychoanalytic conference in Cape Town in the 1990s, addressed by many British and American luminaries, at which the ‘imperialists’ were accused by African therapists of bringing ‘frozen turkeys’ into a refrigerator-less hot climate, make the same point rather well.
Transcultural psychotherapists have learned to respect difference and to make the exploration of difference a key theme in their work with clients who display obvious differences. The same ethical attitude is clearly needed in all psychotherapeutic work and I am sure that most therapists accept this. But we are only beginning to find literature that pays attention to difference when the difference is not so obvious - meaning when it is not a matter of ‘race’/ethnicity/religion, sexual orientation or working with the young or very old. For example, there have been very few texts that focus on the specific issues that arise when the client is working class or living in poverty and the therapist is much better off (but see Altman, 1995; Foster, Moskowitz, Javier, 1996). Even difference stemming from the sexual composition of the therapy dyad has not been looked at in a convincing way (but see Schaverien, 1995). I am suspicious of simplistic generalisations of a psychological kind about the dynamics of two males working together as opposed to two females, or any other combination. Certainly, a claim that the actual sex of the participants in therapy is irrelevant is as risible as the claim that differential ethnic combination has no effect on therapy work. But a claim to know in advance what happens in each particular instance - sexual or ethnic - is equally problematic.
My overall point in this section of the paper has been that the sensitivities and practices of the transculturally oriented practitioner have not yet spread as deeply into ordinary practice as they could - or should. I will now move on to look at what can be learned from a consideration of psychotherapy practices in non-Western locales where there has been an importation of Western therapies.
TRAINING AT THE FRONTIER
Over the past fifteen years, I have been involved in setting up courses in analytical psychology and Jungian analysis in countries where, for various reasons, such courses have not existed before. In Russia and Poland, this was due to the hostility of the communist regimes to analytical psychology. The absence of established training structures in these countries led to intense debate within the sponsoring body, the International Association for Analytical Psychology, as to the best way to proceed (see Crowther and Wiener, 2002, for an fascinating account of how they, as organisers of a course in Jungian psychology in St Petersburg struggled to come to terms with issues of cultural diversity, making use of what they term an ‘interactive field of strangeness’).
Returning to our debates in the West about how best to move East, at one extreme, the view was that we should do our best to bring talented individuals ‘out’ to the West, where they could undergo the usual type of analytical training. The worry was over how to select these individuals and whether or not they could be expected to return to their countries of origin where life was much harder than in Zurich or San Francisco. A second viewpoint was that the most comprehensive training possible should be mounted in the ‘frontier’ country, a training that would take nothing for granted even if its participants were already established mental health professionals. The worry here was that this would imply disrespect for local standards of basic training. At the other end of the spectrum, a third idea was simply to put on seminars and lectures of interest to psychotherapists in the former communist countries and allow them to incorporate the material into their practices according to their wishes and inclinations. The worry here was that this could lead to a huge increase in the practice of ‘wild’ Jungian analysis. That there are arguments for and against all of these positions is beyond doubt, but my purpose in summarising the debate is to show how it illumines some key questions about psychotherapy training in Western countries.
Specifically, what is highlighted is the degree to which the practice of psychotherapy does or does not need to conform to some kind of external standard and the degree to which it can be left to find its own level, trusting to people’s innate sense of responsibility. These are important questions when it comes to access to training opportunities for therapists. It has become a commonplace, in progressive therapy circles, to note that the absence in the psychotherapy world of persons of colour and those belonging to minority communities is holding back the responsible development of the profession, inhibiting in a severe way its capacity to be of use to the widest possible cross-section of the population (Fernando, 1995).
I mean no disrespect to the range of excellent established training in the various psychotherapy traditions in the West by saying that it has become clearto me from experiences in Russia and Poland, just to give two examples, that one simply does not need the degree and intensity of training to practice effectively as a psychotherapist that is usually assumed to be the case in the West. Nor is it necessary to ask for specific and high level academic and other qualifications as pre-requisites for the successful undertaking of therapy training.
I recall my work as a training therapist with a client who left school at fifteen. He had enormous trouble in writing the course paper and hence was at risk of not completing the training. Here was someone who was, through no fault of their own, for socio-economic reasons simply not able easily to manage what was involved in writing the paper. Yet the client was apparently getting pretty good reports from supervisors and seminar leaders. On the basis of accounts like this, I think there is a crucial question concerning openness in respect of psychotherapy training that can be illumined via the factoring in of lessons learned from experiences in foreign parts.
The socio-economic factor needs to be addressed when we consider this vexed question of educational qualifications for psychotherapy. Could we create a climate in which, in the run-up to application and entry for psychotherapy training, an individual can become what I would call an ‘imaginal core professional’? That is to say, if a talented person with non-relevant background and no educational qualifications wants to be a psychotherapist, we as a profession have the potential to make it possible for them to acquire what is felt to needed to become a core professional (which is one way in which pre-requisites for many psychotherapy training have been expressed in the UK and US). This strategy, followed with success in non-Western settings, would dramatically increase the possibilities for ethnic minorities and those of working class background to train to be therapists.
PLURALISM AND INTEGRATION
One of the most exciting developments in the psychotherapy field in the West is the growth of ‘integrative’ approaches. Such approaches arose in part from the realisation that no one method of psychotherapy appears to have massive overall advantages over the other methods. These days, practitioners can more easily understand that it is not an admission of failure to note that their particular approach has limitations. The needs of clients can sometimes be met by going outside the school of psychotherapy in which the therapist was primarily formed. Of course, integrative psychotherapy can become a school of its own, with the dangers (as well as advantages) of that, as Lapworth, Sills and Fish have pointed out (2001). Whilst integrative psychotherapy is arguably the cutting edge of psychotherapy theory and practice, it is clear that integration is a very difficult position to achieve - not least because, up to now, integrative psychotherapy has tended to move in but one direction, in which non-psychoanalytic people integrate psychoanalytic material but not vice versa. Psychoanalytic practice itself has probably suffered from this one-way street, which has come about largely through uncritical internalisation of professional politics with its spurious hierarchies. Apart from such problems, integration (whether psychotherapy integration or integration of the warring elements discerned in one’s own personality) is always emotionally stressful as well - it is far less wearing to be a believer.
In psychotherapy’s frontier areas, a form of integrative psychotherapy also exists and has come into being for very different reasons. It shows no sign of falling into the trap of scholastic desiccation, nor does it seem particularly stressful to plug into this kind of integration. One young Muscovite therapist told me that her two main loves were Winnicott and Neurolinguistic Programming. She presented cases in group supervision in which she moved between these two perspectives with an ease that startled me - one could just not imagine hearing that kind of thing in London. What was amazing to me was that she had not the slightest embarrassment in telling me this; she had no idea at all that it is still extremely unusual, to out it mildly, to find such a pot-pourri of loves in Western psychotherapy circles where, despite the growth of integrative approaches, the historically existing schools continue to exert considerable power and fascination.
It was when thinking about the Russian therapist that I began to see how, alongside the more formal, ambitious and far-reaching project of integrative psychotherapy, there may be the possibility to develop, here in the West, a simulacrum of the innocent atmosphere that had allowed this Russian therapist to pick and choose without inhibition. From a mythic standpoint, the Greek god Hermes, who begins life by stealing the cattle belonging to his brother Apollo, would be the presiding deity. The problem with integrative psychotherapy may be that it requires so much responsible commitment on the part of the practitioner, who has thoroughly to familiarise him or herself with the various approaches to be integrated. Inspired in part by the Russian therapist, I began to develop a rather different, yet thoroughly hermetic approach to the same issue, which involved what I called a ‘pluralistic’ approach to psychotherapy (Samuels, 1989). Pluralism, as I will explain it, is deliberately intended to work at a less elevated level than integrative psychotherapy, though be part of the same overall ethos. Hence I am happy with the suggestion of Lapworth, Sills and Fish (2001, p. viii) that integration be regarded as the umbrella term. I believe, though, that it is the pluralistic strand within the integrative project that will help us to realise the full benefits of psychotherapy integration, overcoming reistances that derive from the fact that integration is so demanding. Pluralism, as I understand it, is simply far less demanding than integration. It may not be beautiful but , in its promiscuity, it works in a rough and ready fashion.
The paradox is that, while the Russian was liberated by ignorance of psychotherapy’s rules, the pluralistic psychotherapist, like Hermes, has to be very worldlywise and attuned to what is going on in the field - but will choose to ignore those rules and make a bid for independence. The pluralistic therapist is usually extremely disillusioned by the field, yet daunted by the integrative desideratum that he or she learn so much about such a wide range of therapeutic modalities. It can sound shocking to see it in print, but pluralism does not require a particularly high level of adherence to ‘the real thing’ - the Russian therapist was neither a ‘genuine’ Winnicottian psychoanalyst nor a ‘genuine’ NLPer. It did not matter - and that is the point. We need to remove an unachievable ‘realness’ or ‘genuineness’ from the professional super-ego of therapists in the West and encourage (judiciously) imitative and performative clinical practices in which, in true post-modern style, it is understood that no-one has a settled professional identity any more. You do not have to be a genuine psychoanalyst to use psychoanalysis nor a genuine Gestalt therapist to use Gestalt. Actually, these days, I think that only those therapists who think and work integratively or pluralistically are working authentically. Deliberate ignoring or eschewing of ‘foreign’ ways of working is both inauthentic and irresponsible.
Pluralism recognises that each school of psychotherapy is relatively autonomous from the other schools and has its own strengths and weaknesses. But as the Russian therapist demonstrated in her case presentation, rather than integrating the different perspectives, pluralism means taking it in turns to be the dominant school and accepting that, in some ways and in some situations, another approach will be more useful. Pluralists speak in several tongues without smoothing out the many differences between languages. I think many therapists are suspicious of hegemonistic attempts to impose a false resolution of differences upon the field. If we do that, we will lose sight of the unique value of each position.
So the therapist learns to sing more than one song and the expansion in her repertoire compensates for the lack of a perfect rendition of any one of them. I hope it is clear that this is not the same as fully integrating other points of view. It has been visits to lawless Russia or unstable Poland that have underscored the importance of playful acknowledgement of the need to steal, just as Hermes needs to steal to establish himself in his full creative potency as the god of transformation and the messenger of the gods. Hermes is in fact a highly social god, interested in trade, commerce and exchange, befriending men on numerous occasions - for example he helps Odysseus find the magic plant that will help him resist Circe, accompanies Herakles on his descent into Hades and guides Perseus in his quest for the Gorgon. He is a joker and Trickster (Samuels, 1993, pp. 78-102), it is true, but most experienced therapists know that, at times, one simply cannot and must not take the theories too seriously (i.e. literally), converting them into dogmas.
The important goal of psychotherapy integration inevitably brings with it many of the weaknesses associated with eclecticism in that eclecticism and integration are rather violent in their selection of the ‘best bits’ out of context, tending to ignore the inconsistencies and contradictions between systems of thought. Pluralism accepts such irregularities and celebrates the competitiveness that is thereby constellated by using ideas and methods that at one level are incompatible. The Russian therapist knew perfectly well that Winnicott and NLP were not smoothly compatible - but she had a good time struggling with the wrinkles so as to make them both part of her own individual brand of practice. In fact, she had in all probability encountered these two highly different approaches when travelling teams of teachers espousing one or the other had visited Moscow. She knew she was in a market place (and she knew about the overt franchised aspect of NLP and the covert franchise aspect of psychoanalysis). She knew that she could never be the real thing in someone else’s eyes - but she was content to be the real thing in her own eyes. She had an individuated attitude (if I might be forgiven for using such a culturally specific compliment) to psychotherapy and she was 25 years old.
An intellectual point which is relevant here is that we tend to forget that those big and attractive theories with which we feel at home have got a history of their own. They arise from a pluralistic matrix in which things did not fit together neatly and where competitive struggle between theorists and schools was rife. For example, the Kleinian corpus was not a single, time-bound, unchallenged, piercing vision., This was something D.W. Winnicott noted in a letter to Klein in November 1952 - a quite agonized and remarkable letter. Amongst many other complaints, Winnicott wrote strongly against ‘giving the impression that there is a jigsaw of which all the pieces exist (1987, p. 35).
I do not believe I am idealising the blissful ignorance of that Russian therapist who had done what she ahd done without considering the matter at all. I want to use the fact that she could do good-enough work with her melange of approaches as an inspiring image to enable Western therapists to drop their rigid adherence to a single modality of psychotherapy and to make the achievement of integrative psychotherapy less demanding on all of us.
In The Political Psyche, I tried to make long overdue reparation for what I see as Jung’s anti-semitic statements and positions in the in the 1930s (Samuels, 1993, pp. 287-336) and move on to establish analytical psychology and Jungian analysis as contributors to a culturally sensitive and informed psychology. Jung was certainly trying to make a contribution in those areas, though the overall effect was highly destructive and injurious to the overall acceptance of his ideas about psychology and psychotherapy. I showed how Jung’s ideas about the existence of differing national psychologies chimed with anti-semitic Nazi ideology about the necessity to preserve such differences in the face of Jewish intentions, via the international agencies of capitalism and communism they allegedly dominated, to ‘bastardize’ the life of healthy nations. Controversially, perhaps, I also suggested that much can be done with the notion of ‘national psychology’ that need not excite the quite understandable fears of liberals who associate the term with fascism or nationalism in its pernicious and murderous forms (these ideas are expanded in Samuels, 2001, pp. 186-194). Jung can be read as making the first coherent protest against any claim for the existence of a universal psychology (for him, it was psychoanalysis that had the goal of world (psychological) domination). It was Jung’s clinical experiences with an extremely international selection of clients that led him to recognise what we would call today the transcultural factor at work in the psyche. My experience has been similar in that it has been clinical work with persons of a different background to my own and active participation in psychological discussions about ‘the nation’ and ‘nation building’ in South Africa, Brazil, Poland, Russia and Israel, that convinced me of the worthwhileness of moving accounts of national psychology off the anecdotal level. When working with clients from all backgrounds, we can see that nationality is one powerful factor at work in the formation of social and psychological identity. It seems suspect that something as powerful as ethnicity and religion should be so overlooked.
Having trailed the taboo-ed possibility that the question of national psychology should be revisited, I want to highlight a very different ethos that I also sketched out in The Political Psyche, again as my personal response to what I see as the huge problems with Jung’s excursions into political and cultural psychology. Jung wanted to sit at the top table, whether political or psychotherapeutic. Today’s Jungians, and other Western therapists as well, need to restrain their desires to influence politics and politicians at the highest levels. They have first to stand alongside the materially disadvantaged and the socially frightened, as well as sit down with their educated analysands. To do this, they must open their hearts and minds to that which is ‘foreign’.
Acknowledgements I am grateful to Henry Abramovitch, Louise Kaplan, Renos Papadopoulos, Fred Plaut, Peter Rudnytsky, Jocelyne Samuels and Tom Singer for their many helpful suggestions for changes to the first draft of this paper.
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