Understanding cultural differences as a psychotherapist

It is extremely important to try to understand cultural differences as a psychotherapist. In session, if you do not understand something, or a point of view or opinion is contrary to your own belief system, it is important to sit back and weigh up the possibilities. During this process, a good therapist should look at the causes of certain actions, and the reasons for the behaviour. I will give some examples. How would one act as a therapist in the following circumstances?

1. A Chinese lady who fears that her daughter is going out with somebody who has dark skin. She refuses to let her daughter go out with this man and has threatened to ostracise her from the family.

2. A Saudi Arabian man who fears that he has failed his father because he has only has six sons. His two wives have both had several miscarriages and do not want to have any more children, and the husband cannot afford to look after any more children, let alone take on another wife.

And the list goes on... 

These extreme examples would need careful handling, but it is important to stress that understanding their culture and their predicament is essential to helping them. It is for this reason that many clients will brief you about the nature of their work in context so that you can understand the trials and tribulations of the work place. One’s cultural identity is at the heart of this. One’s belief system is important to understanding one’s self. As an old Chinese theorist once said, ‘To know oneself is to know others, for heart can understand heart’ (Anon, Chinese proverb). 

Our social identity is important to us because it helps us to understand ourselves within the context of our community, and our nation: this is the whole premise behind Social Identity Theory (Tajfel et al, 1986). This understanding is also a basic need that we all have: a need to be part of the wider community (Maslow, 1943), and we express our identity through our behaviour, choice of clothes and collective narratives. We wear designer clothes, punk outfits, Indian headwear, baseball caps, England football team tops, Saris, leidenhausen and suits. We act like football hooligans, opera goers, therapists, patients, waiters and so forth.

Memory is also important to our social identity. Hewer and Roberts (2012) talk about social memory being a dynamic interplay between history, culture and cognition. History although reflexive and reflective, is prone to being selective and bias; and yet, we all try to preserve the nature of our community as being one which is intrinsically good - the ‘benevolence of the state’ (Roberts, 2012). However, how do the Nazis remember the Second World War and the genocide that occurred during that time? Do they remember it or selectively forget its existence? They certainly do not celebrate the Second World War and armistice day in the same way as we do. Social memory needs to be taken into consideration when treating clients too because, if there is a conflict between one’s understanding and interpretation of one’s social identity and another interpretation, the conflict can cause a splitting effect. This splitting results in unresolved trauma, anxiety, frustration, phobia and other psychological problems—a phenomenon described by RD Laing as the ‘divided self’ (Laing, 1960; Roberts & Itten, 2012).

When we embrace our cultures, it helps us to gain an understanding of our world and how we live (Moscovici, 1981). There seems to be an unwritten rulebook in each culture: we behave in a certain way in certain social situations (see Jung’s ‘collective unconscious’)), although other traditions, such as the Passover feast in Jewish households, need to be taught in order that they continue from generation to generation.

We should take this into consideration as therapists. We can show prejudice extrinsically by being blatantly unfavourable to a particular out-group; or we can do it implicitly by disregarding or down-grading a tradition without any attempt to understand the importance of a custom of belief. Almost any group can become the target of prejudice (Hogg & Vaughan, 2005), and prejudice can take on many forms: ethnicity, race, sex, age, sexual preference, physical and mental health differences, religion... and the media can perpetuate this prejudice (Archer, 1983).

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