Don't Make Assumptions About Patients' Culture, Analysts Advised
Not long ago, Kerry Sulkowicz, M.D., a New York City psychoanalyst who consults to businesses, received a request for help from a business executive in another country. Sulkowicz told the executive that he was open to helping him, but admitted that he had never been to the country in question. “No problem,” the executive replied. “In fact, it's good that you've never been to my country because you can bring some fresh perspective with you.”
This interplay, which Sulkowicz cited at a recent meeting of the American Psychoanalytic Association in New York City, illustrates the fact that when a therapist and a patient do not share the same culture, it does not invariably lead to disappointing results.
In fact, other examples of cultural mismatches between therapist and patient leading to successful outcomes were cited at a session on culture and psychotherapy at the meeting. For example, S. Kalman Kolansky, M.D., an Alexandria, Va., psychiatrist, reported that over the years a number of non-Jewish patients have sought him out because of his“ Jewishness,” his “otherness.”
And along the same lines, when therapist and patient come from the same culture, it does not invariably lead to a positive outcome, session participants revealed. For instance, some Hassidic Jewish patients have made it clear to Kolansky that they consider their Jewish-ness superior to his. Carmela Perez, Ph.D., a New York City psychologist pointed out that although there is "a widely prevalent idea among clinicians that an apparent match between a patient's ethnicity and a therapist's ethnicity--say, both of them being Hispanic--gives the therapist an advantage in being able to understand the patient, . . . it is [nonetheless] important to pay attention to subtle cultural aspects and their manifestations in the transference-countertransference dynamics of the therapeutic encounter."
So, to optimize the therapist-patient relationship from a cultural vantage, session participants offered some suggestions. Among them:
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First, think about what culture means. It doesn't invariably mean country of origin, current nationality, race, religion, or other obvious demographic factors, Susan Bodnar, Ph.D., an adjunct professor of clinical psychology at Columbia University Teachers College, pointed out. It can also designate bmicro-cultures within larger cultural landscapes—say, business executives who go drinking together.
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“Each of us has to think carefully about what our cultural contexts are,” Boston psychiatrist Michael Caplan, M.D., advised, because therapists' cultural identifications can influence how they view and interact with patients. For example, Bodnar thinks of herself as a Pennsylvania coalminer's granddaughter who grew up in the Philippines and who then became an anthropologist and is now “a well-educated Jewish psychoanalyst living and working on Manhattan's Upper West Side.”
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Determining the cultures with which patients identify can help clinicians better understand their psychological difficulties. For instance, if there is a large gap between how they were raised and what was expected of them, and what they are doing with their present life, it might be a source of their problems, Bodnar said. And one clue to the culture that bilingual or multilingual patients identify with, Perez noted, is the language they prefer to use in therapy.
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When people emigrate from one country to another, it can lead to their becoming confused about who they are and which culture they are a part of. The same is true about patients who identify with two or more cultures because their parents are of different nationalities or because they have lived in different cultures, Bodnar added. In a sense, she said, a “mild dissociative process is what happens when multiple culture identities crash against each other....” Thus, the therapist may need to help them integrate their disparate selves.
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Becoming better informed about various cultures is one way to maximize the potential for successful therapy. ▪
S. Kalman Kolansky, M.D., is sometimes sought out by non-Jewish patients because of his “Jewishness.”
Photos: Joan Arehart-Treichel
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Published online: 3 March 2006
Published in print: March 3, 2006
Notes
When patients identify with two or more cultures, they may experience a mild dissociative process and thus need help integrating their different selves.
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