Chapter 1
Race, Culture and Psychotherapy
Race, culture and other multiple constructions: an absent presence in psychotherapy
Roy Moodley and Stephen Palmer
Race, Culture and Psychotherapy provides a thorough critical examination of contemporary multiculturalism and culturalism, including discussion of the full range of issues, debates and controversies that are emerging in the field of multicultural psychotherapy.
Beginning with a general critique of race, culture and ethnicity, the book explores issues such as the notion of mteriority and exteriority in psychotherapy, racism in the clinical room, race and countertransference conflicts, spirituality and traditional healing issues. Contributors from the United States, Britain and Canada draw on their professional experience to provide comprehensive and balanced coverage of the following subjects:
• Critical perspectives in race and culture in psychotherapy
• Governing race in the transference
• Racism, ethnicity and countertransference
• Intersecting gender, race, class and sexuality
• Spirituality, cultural healing and psychotherapy
• Future directions
Race, Culture and Psychotherapy will be of interest not only to practising psychotherapists, but also to students and researchers in the field of mental health and anyone interested in gaining a better understanding of psychotherapy in a multicultural society.
Roy Moodley, Ph.D, is Associate Professor of Counselling Psychology at the Ontario Institute for Studies in Education, University of Toronto, Canada.
Stephen Palmer, Ph.D, is Honorary Professor of Psychology at City University, London and Director of the Centre for Stress Management, London, UK.
Contributors: Neil Altman, Dinesh Bhugra, Kamaldeep Bhui, John Chambers Christopher, Farhad Dalai, Nathan Field, Jacquelyn Gardner, Beverly Greene, Dorothy Evans Holmes, Jerald Kay, Narendra Keval, Deborah Y. Liggan, Ruth M. Lijtmaer, Judith Mishne, Roy Moodley, Stephen Palmer, Shumona Ray, Adina J. Smith, Ursula Streit, Richard Tan, Nadine M. Tang, Rinaldo Walcott, Carmen Braun Williams, Kris Y. Yi.
The terms race, culture, ethnicity, multiculture, anti-racist and its related terms that act as labelling descriptors of ethnic minority clients, or as a reference to the 'Other', or as linguistic signifiers of cultural differences, and the lack of a comprehensive definition of these concepts have produced much confusion and difficulty in the practice of psychotherapy (Sue, 1997), and has resulted in the same set of multicultural competencies being used on clients regardless of their cultural or ethnic characteristics (Helms and Richardson, 1997). Carter (1995) suggests that since the influence of race and racial identity is unclear in psychotherapy, therapists experience difficulties when working with black clients. One way out of the difficulty and confusion, it seems, is to develop a more clear, meaningful and flexible understanding of race, culture, ethnicity, multiculture and the other related terms.
Developing a precise and finite definition of these terms may not be possible or desirable, given their complex history, their present reflexivity and their potential for change in the future. However, for both psychotherapists and their clients these social constructions are essential elements within which the identity of the client is negotiated and the inter-subjective relationship is constructed. Psychotherapy with a black or ethnic minority client then becomes a site within which fixed, essential and stereotyped ideas about race, ethnicity, multiculturalism, black and multiethnicity tend to get challenged and changed. Liberal ethics of seeing all clients as equally but differentially £i3P is interrogated by notions of social pluralism and cultural diversity.
In this chapter, we begin by considering the social construction of race, culture and ethnicity and the other multicultural terms. Throughout this discussion we attempt to intersect these terms with psychotherapy.
THE SOCIAL CONSTRUCTION OF RACE, CULTURE AND ETHNICITY
The social and cultural theories and critique on race, culture, ethnicity, racism, anti-racism and multiculturalism have been well articulated and
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Race, culture and other multiple constructions 13
documented (see, for example, Gates, 1992; Gilroy, 1990; Hall, 1992; Law, 1996; Mason, 1992, 1995, 1996; Solomos and Back, 1995). Although multi-culturalism and its related terms have also been discussed and critiqued by post-colonial commentators {see, for example, Bhabha, 1994; Fanon, 1952; Gilroy, 2000; Said, 1978; Spivak, 1988), there still appears to be much confusion about what is meant by these concepts (Buhner and Solomos, 1996). The notion that race and ethnicity are not 'natural5 categories (Appiah, 1989), having a biological or genetic base, is now generally accepted by most writers in this field. While in the past some researchers have favoured a (racist) genetic explanation, the overall position, however, in social and heaUh_sgiences, is one of acknowledging that race, racism, _ethnicity, culture and multiculturajism are socio-culturally and politically constructed and .contested,, allowingthem .toacquire, a variety of meanings that allow for a flexible, fluid and multiple understanding of ethnic minority^ clients. From a post-structuralist and post-modernist perspective this reflex-ivity should allow for a creative approach to health care practice, particularly in psychotherapy and psychiatry. However, this does not appear to be the case. Ethnic minority clients are still categorized and labeled in a singular 'strait-jacket' way, often exclusively in terms of a particular continent of origin, or religious affiliation, or racial skin tone where race is seen to be equated with skin color, particularly the color black which then becomes a privileged site for the interpretations of psychopathology of African and African-Caribbean clients.
This a priori definition, reduced to a conventional Cartesian dialectic, has led to diagnostic generalizations about specific ethnic minority clients' mental health problems with the offer of non-specific treatment procedures across a wide range of culturally diverse clients. As Williams notes, 'The categories race, culture, black, have been problematised as a base on which to construct analysis' (Williams, 1999, p. 213), and she argues that such a conceptualization 'leads to a reductionist's aggregation of ethnic differences . . , [to] confuse practice through oversimplification, generating stereotypes and fostering ethnocentrism' (p. 213). In other instances, these concepts have been the signature legitimizing not only a concrete pharmacological practice with ethnic minority clients but creating an invisible screen of a liberal, post-structuralist and modernist flexibility which hides coercion and state ideological intervention of the minority client. This view is shared by Sashidharan in his critique of transcultural psychiatry. He argues:
'culture' or 'ethnicity' take on a special, politically loaded meaning . . . [and] invested with a new meaning these mere words or concepts suddenly become powerful tools with which the transcultural psychiatrist [psychotherapist] sets out to particularise social structures which are products of historical and political struggles. As a result, culture or aspects of people's lives and experiences are reduced to mere
manageable problems falling within the clinical or professional competence of the culturally informed practitioner.
(Sashidharan, 1986, p. 159)
Sashidharan's comments may appear to be critical_of..„the culturally, informed psychotherapjsX„wkQ^Jmbues...thesejdefinitio critically cxami'ning~them "for their role in promoting a coercive and oppressive practice. It seems that when these terms are employed as a convenient epistemological tool for the identification of 'psychological distress' of ethnic minority clients they tend to universalize different world views I thereby maintaining the status quo of Western psychotherapeutic models.
Any question of difference is then presented as complex, ambiguous, contradictory and confusing, leading many professionals to avoid or dismiss cultural diversity in psychotherapy. \ However, before a discussion of the relationship between these multicul-
| tural concepts and psychotherapy can be undertaken it is necessary to look
j at the concepts of race, culture, ethnicity and multiculturalism individually.
i l
Race
The term race first appeared in the English language in 1508 to refer simply to a category or class of persons, without any reference to anything biological (Miles, 1982). It was only in the late eighteenth century that the word race was invested with a physical connotation, and only in the early nineteenth century that specific theories of racial types began to emerge, most notably about populations outside Europe (Alderman, 1985). Many of the ideas associated with genetics and racial differentiation during this period were founded on pseudoscientific theories that are now discredited. But at the end of the century, 'eugenicists and social Darwinists were offering "scientific" justifications for genocide as well as for imperialism . . . through which Europeans projected many of their darkest impulses onto Africans' (Brantlinger, 1985, pp. 205-217).
The person who is most noted for thinking about race has been the African-American social theorist W. E. B. Du Bois who discussed the concept of race in 'The Conversation of Races' (1897). This paper and the other writings of Du Bois have been the topic of discussion by Appiah who argues that for Du Bois, '"race" is not a scientific - that is, biological - concept. It is a socio-historical concept' (Appiah, 1986, p. 25). Appiah notes:
Race, we all assume, is, like all other concepts, constructed by metaphor and metonymy; it stands in, metonomically, for the 'Other'; it bears the weight, metaphorically, of other kinds of difference . . . Even if the concept of race is a structure of oppositions - white opposed to black (but also to yellow), Jew opposed to Gentile (but also to Arab) -
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Race, culture and other multiple constructions 15
it is a structure whose realisation is, at best, problematic and, worst, impossible.
(Appiah, 1985, p. 36). [italics in original quotation]
Yet it is within this impossibility that contemporary Western culture attempts to rind a 'truth' about difference, meaning, genetics and culture. It is also within this problematic that psychiatry, psychotherapy and psychoanalysis are attempting to make sense of a black and ethnic minority client. Sometimes a reductionist and fixed view of race and racial difference becomes the basis for understanding the relationship with the ethnic minority client. As Henwood and Phoenix point out, 'Racial difference is neither fixed in stone nor merely illusionary, because it is the outcome of practices of (de)racialisation which position groups and subjects in more or less advantageous and discriminatory ways' (Henwood and Phoenix, 1996, p. 853).
Race, racial difference and the many forms of racism/s that are experienced by black and ethnic minority groups are not fixed categories, nor are they transhistorical, pointing to a time of origin or a cultural or historical specificity where the roots of discrimination and domination had begun. These ideas and ideologies are dynamic and forever changing in relation to the discursive social, economic, cultural and political practices that are operating at the time. Ferber offers a timely reminder when he argues, 'In representing race as a given foundation, we obscure the relations of power which constitute race as a foundation. Rather than taking race for granted, we need to begin to explore the social construction of race, and the centrality of racism and misogyny to this construction' (Ferber, 1998, p. 60).
For those psychotherapists who are critical or anxious about working with the ideas and ideologies of race and racial difference, Ferber, like Sashidharan (quoted earlier), emphasizes the need to see race within the context of power relations. If not, psychotherapy becomes one of 'those powerful forces that underlie the formation and perpetuation of racial and ethnic injustice in a complex and changing world' (Stone, 1998, p. 15).
Culture
The term culture covers a wide spectrum of meanings, from physical elements in a society such as buildings and architecture to abstract and metaphorical elements such as myths, values, attitudes and ideas about spirituality. According to Halton (1992), the concept of culture is so indeterminate that it can easily be filled in with whatever preconceptions a theorist brings to it. For example, Taylor's (1871 [1920]) definition of culture includes knowledge, belief, art, morals, law, custom and any other capabilities and habits acquired by individuals as members of society. Related terms such as subculture, popular culture, counterculture, high culture,
ethnic culture, organizational culture, mass culture, political culture, feminist culture, deaf culture and others, have been indicative of the complexity, dynamism and the evolving nature of the concept of culture within the disciplines of social-scientific and humanistic study. This understanding of the term culture suggests that 'culture', like race, is neither fixed nor static.
For Raymond Williams the word culture is 'a noun of process: the tendering of something, basically crops and animals' (Williams, 1976, p. 77). It seems that from its earliest meanings, derived from the Latin colere - to till, cultivate, dwell or inhabit - culture and its close ally 'colonize' became a powerful organizing influence in producing and reproducing a dominant world view amongst Europeans. As Halton says, 'Even before the nineteenth century . . . already beset by the etherealising tendencies of ethnocentric universalism ... the Enlightenment dream of "universal reason'" was the underlying principle to the 'expression of European power' (Halton, 1992, p. 43). This ethnological origin appears clearly to describe the noun of a process, that is of expressing European power through colonization, domination, subjugation and Diaspora. This was also a time when the noun became a verb - a doing word - one in which Eurocentric ideologies were formulated to 'cultivate' not just crops and animals but other humans too. This was culture representing itself as civilization, which produced and reproduced the 'Other', as for example in Orientalism (Said, 1978). This kind of cultural formulation also constructed Africa as the Heart of Darkness (Conrad, 1902).
While there is very little agreement by the cultural commentators about the meaning of culture, there is, however, jyg^jjjLacj^lancAA is a process that.j.s^..nqrstatjc but_cpnstantly_cjtaiygngjn.time and space within a given society. An important feature of culture is that while individuals tend to express or display cultural traits, culture appears to be understood as either a coherent or incoherent society or group phenomena. The concept of culture should not be treated as a global entity but as far as possible be disaggregated into a number of discrete variables (values, ideologies, beliefs, preferences) to avoid any vagueness, multiple meanings and circular definitions. It is the global characterization of culture that offers methodological difficulties when an attempt is made to link it causally with phenomena in individual behaviour (Smelser, 1992). This latter point is particularly important in understanding psychotherapy with ethnic minority clients. A contemporary critique of psychiatry would contend that the psychiatric discourse tends to link culture with the now outdated pseudo-scientific theories on race (see Thomas and Sillen, 1972) and Western socio-biology of the culturally different client. These approaches have often resulted in particular treatments for black and ethnic minority clients, some of which would now be seen as racist (see Fernando, 1988).
In 'Trouble with Culture', Ahmad clearly defines his position on culture when he says, 'stripped of its dynamic social, economic, gender and
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Race, culture and other multiple constructions 17
historical context, culture becomes a rigid and constraining concept which is seen somehow to mechanistically determine peoples' behaviour and actions rather than provide a flexible resource for living, for according meaning to what one feels, experiences and acts to change' (Ahmad, 1996, p. 190). Furthermore, Ahmad argues that culture has often been used as a decoy to divert attention away from factors such as social inequalities and racism in the lives of ethnic minority communities. At the same time race, culture and ethnicity are clearly ideologically constituted and as such 'carry with them material consequences for those who are included within or excluded from, them' (Bulmer and Solomos, 1996, p. 781). So it seems that the "term culture is as problematic as the term race and just as troubling as the term ethnicity.
Ethnicity
There is a tenderiey, in the literature, to use the terms race and ethnicity interchangeably (Mason, 1996). Furthermore, there seems to be an 'increasing use of "ethnicity" as a euphemism for "culture"' (Tilley, 1997, p. 489), in much the same way that black is used to describe African or Caribbean ethnicity.' In the 1990s, socio-economic and geopolitical changes in the international arena, particularly in the West, summoned ethnicity out of European 'inner-city third world hamlets' to include many European white minority groups, bringing into consciousness that the colour white, which is often forgotten in this category, is also a part of ethnicity; to the extent that in the late 1990s, according to Tilley, '"ethnicity" has become the term of the hour in political science, as we grapple with its role in domestic conflict and international security' (Tilley, 1997, p. 497). Associated terms such as ethnic cleansing, Balkans' racism, Rwandan genocide and others have come to grip our consciousness as historic events had marked the last century. Indeed, these are not new phenomena. Since the dawn of history, hegemonic masculinities have privileged particular spaces as discursive forums for patriarchy, patriarchal projections, annihilations, dissolution of the 'Other', and other similar Kleinian terms to indicate the primitive instincts. The terms have changed over a period of time but the projections have not. For example, in the first part of the twentieth century Europe experienced the Holocaust, and at the end of the century ethnic cleansing was unleashed without any recourse to human rights that have since evolved. Ethnic cleansing it seems is a metaphor for our time (Ahmed, 1995).
The concept of ethnicity, according to Mason, found its way into political and academic discourse largely as a response to dissatisfaction with the idea of race and with the assimilationist assumptions of a focus on immigration. Since race as a conceptual and empirical idea to locate difference was proving to be problematic because of its articulation within a political discourse, the term ethnicity was more appealing and privileged because of
its flexibility and inclusiveness of all those minorities that appeared to be outside the fixed meanings of race, that is South Asian, Chinese and others.
The positioning and repositioning of subjects and groups in terms of race, racism, culture and ethnicity have been seen as a cyclic process throughout the pre- and post-war periods. For example, the idea of ethnicity referred to the Irish, Italians and Jews in the early part of the twentieth century, but took on a more sinister and racialised meaning for the Jewish community. In the latter half of the century, after the migration of West Indians, East Asians, Pakistanis and Bangladeshis, the term revised itself to exclude, except for Jews, those white Europeans defined earlier, and focused negatively on Africa, Asia and the Caribbean.
It seems that individuals can go 'beyond' the realms of the boundaries and limitations set by culture, race and ethnicity, moving from fixed meanings to more imaginative ones. This question of the 'beyond' is crucial to Homi Bhabha's quest in Location of Culture (1994), in which he argues:
the 'beyond' is neither a new horizon, nor a leaving behind of the past... What is theoretically innovative, and politically crucial, is the need to think beyond narratives of imagined origins and initial subjectivities and to focus on those moments or processes that are produced in the articulation of cultural differences. These 'in-between1 spaces provide the terrain for elaborating strategies of selfhood - singular or communal - that initiate new signs of identity, and innovative sites of collaboration, and contestation, in the act of defining the idea of society itself.
(Bhabha, 1994, pp. 1-2)
Bhabha's decisiveness about moving beyond the narrative of initial subjectivity may be too much of a Utopian project for a number of, if not most, individuals from black and ethnic minority clients. The formulation of a new cultural space, one in which difference can mean different and equal, is a prerogative for those who are able to manage the material construction of cultural difference in the face of racism and cultural domination. The majority of ethnic minority people are caught up in a less aesthetic struggle about culture, race and ethnicity than those in the dominant (middle-class) culture. Their analysis of a culture of difference appears to be compatible with their social and economic realities of an inner-city existence. Their hope of a new sign of cultural identity is more akin to the ideas offered by Stuart Hall in his discussion of new ethnicities where he argues for,
a positive conception of the ethnicity of the margins, of the periphery. That is to say, a recognition that we all speak from a particular space,
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out of a particular history, out of a particular experience ... we are all, in that sense, ethnically located and our ethnic identities are crucial to our subjective sense of who we are .. . [and] it is not an ethnicity that is doomed to survive, as Englishness was, only by marginalizing, dispossessing, displacing and forgetting other ethnicities. This precisely is the politics of ethnicity predicated on difference and diversity.
(Hall, 1992, p. 258)
Stuart Hall leaves us without any doubt that a new cultural politics of race and the experiences of racism articulate conceptions of ethnicity. This is far from the position taken by Modood et al. who suggest that, where 'black' and 'South Asian' have been used to describe ethnicity, 'such categories are heterogeneous, containing ethnic groups with different cultures, religions, migration histories and geographical and socio-economic locations. Combining them leads to differences between them being ignored' (Modood et al., 1997, p. 227j. This is precisely the kind of difference and diversity to which Hall refers. Furthermore, Modood et al. suggest that the way forward is to allow individuals to assign themselves into ethnic groups. Much more complex a process since, 'one of the most thorny problems in theorising about race and ethnicity is the question of how political identities are shaped and constructed through the meanings attributed to race, ethnicity and nation' (Solomos and Back, 1995, p. 16).
What seems clear as we consider the various theoretical formulations of race, culture and ethnicity is that the secondary qualifiers which come into play also need to be reconceptualized. Words like difference and diversity are themselves contested terms and need to be understood sometimes in quite specific contexts whether in health care or social policy. As Brah in her paper on 'Difference, Diversity, Differentiation: Processes of Racialisation and Gender' argues,
the usage of 'black', 'Indian', or 'Asian' is determined not so much by the nature of its semiotic function within different discourses. These various meanings signal differing political strategies and outcomes. They mobilise different sets of cultural or political identities, and set limits to where the boundaries of a 'community' are established.
(Brah, 1993, p. 200)
For psychotherapists, it seems that the key to understanding these concepts is an awareness that all these terras are constructed within changing sociopolitical and cultural ideologies that may have consequences for psychotherapy and clients' attitudes towards the process of change. Adhering to a rigid understanding of these terms may offer psychotherapists cognitive, emotional and professional security but may lead them to indulge in
stereotyping clients negatively with dire consequences for a vulnerable client. The client, on the other hand, may from time to time alter the meaning of the concept of ethnicity during the conversations with the therapist and many times through his/her various stages of psychotherapy. As Adam says,
Ethnic identity waxes and wanes not only in response to group members' own perceived needs, both instrumental and symbolic, but also in response to imposed identities by outsiders.
(Adam, 1995, p. 463)
Individuals are often torn between the need to experience themselves existentially in the 'here and now', and the desire to be historically or psychically connected to a specific, but not too distant, past. This may be constructed in ethnic, cultural and racial terms. In essence the subjective 'self manages both the inner psychological world and outer social, cultural and political environments. Having explored the terms race, culture and ethnicity, we now turn to the concept of multiculture.
Multiculturalism
In the 1970s and 1980s the idea of multiculturalism was the primary site within which the complex and confounding issues of race, culture and ethnicity could be theorised and practised. Much of it related to the acquisition of cross-cultural knowledge/s and competencies, and very little effort was made in the theory and the research to identify the social and political inequalities that established the relationships between the dominant culture and the ethnic minority groups. Consequently, in the 1990s, newer formulations under a new multicultural agenda began to emerge to redress the imbalances that were being seen as a result of multicultural policies in education, social care and health care. These took the form of an anti-racist project through specifically located and time-limited actions such as equal opportunities, political correctness, positive discrimination, affirmative actions and other such projects (Moodley, 1999a). Overall, however, the theory and practice of multiculturalism have always been problematic for expressing ethnic minority life experiences too simplistically or for not articulating a radical approach to cultural imperialism, racism, sexism and economic oppression (Moodley, 1999b). The problematic nature of multicultural thinking, according to Apitzsch, is that 'it seems to consist not only in its defining the main differences in society in cultural terms; but also through the fact that it is liable to underestimate those social forces that distinguish not only between cultures . . . [but create] distinctions
20   Roy Moodley and Stephen Palmer
and demarcations . . . domination, coercion and subordination, disguised behind the label of culture or "ethnicity"' (Apitzsch, 1993, p. 137). It is those social forces, underpinned by cultural imperialism, racism, sexism, hegemonic masculinities2 and other similar projections, which individually and collectively interact to produce an environment where the ethnic minority individual is denied, 'abjected5 and condemned.
So, any new formulation of multiculturalism must within its definition seek to articulate a more critical idea of difference that empowers cultural traditions, facilitates economic development, respects ethnic customs and supports non-racist values. Even with such a race, culture and ethnicity would still be ideologically constituted as they 'carry with them material consequences for those who are included within or excluded from them' (Bulmer and Solomos, 1996, p. 781). In this respect Stuart Hall (1992) attempts to construct (or deconstruct) a Derridean notion of différance, which in part would depend on the.construction of new ethnic identities where difference is positional, conditional and conjectural. Cornel West (1990) engages this notion, in New Cultural Politics of Difference, in which he argues that cultural differences are neither simply oppositional in contesting the mainstream for inclusion. He maintains that cultural differences are distinct articulations produced in order to empower and enable social action for the expression of freedom, democracy and individuality (see also Grillo, 1998 for a discussion on pluralism and the politics of difference). This idea sums up the 'critical multiculturalism' of Kuper, which 'is outward looking, organised to challenge the cultural prejudices of the dominant social class, intent on uncovering the vulnerable underbelly of the hegemonic discourse' (Kuper, 1999, p. 232).
Perhaps the greatest challenge to the notion of locating a specific definition of multiculturalism comes from multiculturalism itself. The lack of a complex theorization of multiculturalism (Willett, 1998) is perhaps a testament to the fact that multiculturalism, as the term suggests, is a multiple articulation of a number of varied, contradictory and contested ideas and explanations for complex human behaviours, functions, rituals and ceremonies. Therefore any attempt to homogenize it into a singularly defined concept can only create confusion and consequently reinforce the stereotypes that multiculturalism hopes to avoid in the first place. In accepting the multiplicity of multiculturalism as an aesthetically, empirically and philosophically based phenomenon, the experiences of multiple public and private social identities; gender and racial differentials; mono-, bi-, multi-linguistic articulations; polarised religious orientations and sexual pluralities of an individual (or group) can be contested, accommodated, tolerated and celebrated. Such a wide definition of multiculturalism inevitably creates a tension. The lack of permanency of identity raises fears about the fragmentation and disillusionment of the 'self and the 'Other'. Yet, it is this fragmentation that forms the basis for psychotherapy.
Race, culture and other multiple constructions 21
THE ABSENT PRESENCE OF RACE, CULTURE AND ETHNICITY IN PSYCHOTHERAPY
The socio-cultural and political ideas of race, culture and ethnicity have been constellations around counselling and psychotherapy in the last two decades mainly through the theoretical ideas of the psycho-social constructionists and the transcultural or multicultural psychotherapists. This latter group has been very vocal in arguing that race, culture and ethnicity have been either absent or marginalized in psychotherapy (see, for example, Carter, 1995; Draguns, 1997; Helms, 1990; Jewel, 1994; Kareem and Littlewood, 1992; Sue and Sundberg, 1996; Yee et al., 1993). Some of these commentators, especially the British, have followed the arguments posed in British transcultural psychiatry and cross-cultural counselling. In psychiatry, for example, Sashidharan (1990), Burke (1986), Fernando (1988), Littlewood and Lipsedge (1982[1997]) and others (see Cox, 1986) have been highly critical of the absence or marginaiization of issues of race, culture and ethnicity. Where there has been an introduction of these ideas, some, particularly Sashidharan (1986), have been highly critical of the way in which they are constructed in transcultural psychiatry. Likewise, in his contention for a New Transcultural Psychiatry, Littlewood (1990) is also critical about the cohesive way in which race, culture and ethnicity have been used in mental (ill) health care.
In psychodynamic counselling, psychological counselling and in counselling, particularly in Britain, there appears to be an emerging visibility of the issues of race, culture and ethnicity in the theory, practice and training (see d'Ardenne and Mahtani, 1989; Lago and Thompson, 1996; Palmer and Laungani, 1999; Palmer, 2002). This includes the possibility of taking an idiographic counselling approach with ethnic minority clients, such as multimodal therapy (see Palmer, 1999). On the other hand, in psychotherapy there appears to be an obvious absence and (to put it mildly) a culture of conscious disengagement with the multicultural notions of race, culture and ethnicity. The few black and ethnic minority psychotherapists, researchers and writers are constantly calling for the inclusion of race, culture and ethnicity as variables in psychotherapy. For example, Kareem emphasizes the need for the inclusion of racial and cultural dimensions in both psychotherapy and psychotherapy training, so that .'psychotherapy does not become divisive and disintegrated' (Kareem, 1992, p. 33). Much of this discussion has focused on the absence of race as a construct in psychotherapy, particularly in the North American context. For example, Draguns (1997), Jewel (1994) and Sue and Sundberg (1996) point out that the effects of race are unknown in psychotherapy. Yee et al. (1993) argue that racial and ethnic influences have not been well elaborated in psychotherapy literature and practice. Carter draws attention to this fact when he says, 'Race has become less salient because mental health clinicians,
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Race, culture and other multiple constructions 23
scholars and researchers are more comfortable examining presumed cultural and ethnic issues than addressing racial issues' {Carter, 1995, p. 4).
While race is a critical variable, the singular attention to race alone would appear to exclude the constructions of meanings that are attributed to the other experiences of ethnic minority identities, irrespective of the limited theorization of these identities. For example, there are some South Asians who construct their identities through the concepts of culture and ethnicity rather than the conceptualizations of the notions of race and racial identity. Furthermore, Carter's singular focus on race could unwittingly reify race and give it a legitimacy and potency, thus naturalizing it as a socio-biological idea. Mason (1996) offers a caution when he suggests that in recent years race, culture and ethnicity seem to be constructed into a theoretical principle by invoking the idea of racialization, thereby naturalizing ethnic and other differences. This racialization of the dynamic experiences of ethnic and cultural differences is shaped into stable, negative constructs which'are then attributed to the whole of the ethnic minority group (see also Mason, 1994, 1995).
The critical issue, however, is that although many writers argue for the inclusion of race, culture and ethnicity, very little research has been conducted to realise their potential psychologically. When multicultural practitioners argue that race, culture and ethnicity are key concepts in forming the fabric of the therapeutic discourse, within which the client is held and contained throughout therapy, social intervention strategies are considered more important than psychological ones; while conventional psychotherapists, on the other hand, effectively remove the socio-political, cultural and historical meanings of a client's life experience by relegating race, culture and ethnicity to the margins. They argue that these multicultural variables cannot explain the inner life of a client nor do they offer a modicum of psychotherapeutic explanation of a client's 'subjective distress'.
CONCLUSION
In this chapter, we attempted to examine the concepts of race, culture and ethnicity to reflect on their complexities, confusions and ambiguities in social, cultural and psychological discourses and particularly to highlight their absent presence in psychotherapy. As contested sites they constantly move their boundaries and borderlines to suit a variety of ideological positions and at the same time provide a space for a critique on their processes. The reflexivity of these concepts has further complicated an already confusing discourse on minority groups in which these constructions are often bounded together as a single, linear, Newtonian idea. The homogenizing of minority communities into a single ethnic, racial and/or cultural group, namely black and ethnic minority, has led to general
developments in mental (ill) health care for these groups. These notions generate from ideological positions that evolve within narrow confines of theory and practice, thus causing commentators such as Ahmad to conclude that ethnic minority health care has always been a politicized issue in which the 'racialization of black people's health' has been 'a major industry' with 'minimal improvements or benefits to ethnic minority groups' (Ahmad, 1993, p. 18).
We also questioned the clinical usefulness of the multicultural concepts. As a result of the diversity of nomenclatures and changing vocabularies of the multicultural and multiethnic terminologies, psychotherapists are finding it difficult to adopt and implement appropriate therapeutic approaches with ethnic minority clients. The challenge for psychotherapy is to engage psychoanalytic theory in an innovative and alternative way so that the notions of multiple-identities and multiple-selves begin to evolve new epi-stemologies in research as well as in the actual delivery of psychotherapy. At the same time the traditional ideas that encompass race, culture, ethnicity, racism, anti-racism and multiculturalism must be 'deconstructed' and more fully theorised to provide clear psychological schemas within which new clinical paradigms and research methods can be formulated.
Notes
1 On other occasions, the word 'black' is often used interchangeably with African. For example, Graham (1999) writes in an article, 'African and black are used interchangeably in this chapter to refer to people of African and African descent through the world' (p. 251). Akande, in writing from a South African perspective, uses the term 'black' in a different way, for example 'black female students (Coloured, Indians, Africans)' (Akande, 1997, p. 391).
2 Conneli defines hegemonic masculinities as, 'the configuration of gender practice which embodies the currently accepted answer to the problem of the legitimacy of patriarchy, which guarantees (or is taken to guarantee) the dominant position of men and the subordination of women' (Conneli, 1995, p. 77).
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