Counselling the ‘other’
This chapter explores the relevance of culture and the experience of being the ‘other’ in the world of counselling. It draws in theory and personal experience in its analysis of the counselling industry’s approach to race.
Background and context
Counselling has a problem with race, ethnicity and culture.1 Although there are no official figures, The Black African, Asian Therapy Network (BAATN, 2020) estimate that 5% of counsellors and psychotherapists in the UK are from Black and Ethnic Minority backgrounds, compared to BAME groups making up 12% of the population, indicating an inadequate level of representation.2 Mertins-Brown (2018) observes that there is a lack of Black and BAME counsellors, whilst a disproportionate number of BAME people are forcibly admitted to and held within mental health hospitals. This is broadly supported by Bailey et al. (2018) who write that, within the counselling professions, it is widely regarded that there is a failure in training and education to address race. In a similar vein, Russell (2020) states that therapy training providers have a lack of understanding about race which means Black and minority ethnic trainees are more likely to experience trauma and drop out of courses.
The Ethnic Inequalities in Mental Health Report (Fitzpatrick et al., 2014) highlights key areas in which BAME people face barriers to mental health support. The findings are disturbing and include poor access to services and a recognition that BAME people are often at the end of harsh treatments and services. The report states that the biomedical model does not work and a psychosocial model is more effective. The Eurocentricity of therapeutic models plus the expert nature of the therapeutic relationship were cited as flaws in the biomedical model.
Although the British Association for Counselling and Psychotherapy (BACP) claims a commitment to equality (BACP, 2019) the organization appears to fetishize the biomedical model. This has been apparent in their current collaborative attempt to define and standardise counselling and psychotherapy, in which they reduced the ability to work culturally to a box-ticking exercise and elevated the status of the diagnostic medical model (Egeli, 2019). Their recent manifesto pledge (BACP, 2019a) appears to ideologically and linguistically align with the government’s Improving Access to Psychological Therapies (IAPT) programme and colludes with the hegemony. IAPT, with its rigid and target-focused neoliberal framework does not have the flexibility to work with diverse communities (Boyles and McKinnon Fathi, 2019). It fosters a one size fits all approach which does not account for cultural differences. It also promotes individualism, manualised interventions and a managerialist culture (Loewenthal, 2018). The biomedical model puts an emphasis on evidencebased research, rooted in a positivist ontology which dehumanises people and reduces the complexity of human selves to statistics (Merrill and West, 2018). The medicalised model treats people as objects, involves social control of diverse groups and Western beliefs about mental health are seen to dominate other cultures globally (Watters, 2010; McNamara & Powell, 2020).
Despite the flaws of the neoliberal IAPT project, there is a view within the counselling professions that working within it could be a way of creating more therapeutic spaces for BAME people (Jackson, 2019). It seems that there is a failure to grasp that neoliberalism can be an oppressive form of neo-colonialism in itself. It enforces a stifling bureaucratic culture which isolates people within an interiorised understanding of self whilst promoting problematic binary categories of people (Thomas, 2019). These binaries are tied to colonial thinking which originally differentiated between colonisers and others (Lane, 2006).
According to Fernando (2012), the main difference between non-Western and Western approaches to mental health is the Western focus on individualism. This is rooted in colonial and enlightenment ideas and had racism at its core. Likewise Sue and Sue (2016) describe therapy as being individualistic and having an ethnocentric mono-culturalism which is dysfunctional and oppressive. They call for mental health workers to have a critical plurality7 to their work. The way ideas which underpin psychotherapeutic theories of personality have been (mis)used by colonialism cannot be ignored. The self-actualising tendency was originally reserved for what was seen as superior enlightened Western humans as opposed to inferior others, whilst Freudian theories were used to create a sense of othering non-Western peoples (Tuhiwai Smith, 2012) and influenced colonial anthropological thought, helping to create the trope of the primitive savage (Torgovnik, 1990). As Fernando (2012) suggests, we are left with a legacy of ‘race thinking’ (and the accompanying racism), which still impacts psychological therapies today.
Moodley and West (2005) state that, as they stand, counselling and psychotherapy are too individualistic and Eurocentric, rendering minorities as outsiders. Furedi (2004) argues that the individualistic nature of therapy distances us from each other, this is in opposition to non-Western concepts such as ‘I am because we are’ (More, 2004, 157) reflecting a more collectivist philosophy of solidarity. There can be a place of balance between the individual and the collective, as to separate the two entirely could be another binary division. Francis (2018) suggests, the two can work together, as individual voices can be expressed within a collective logic. The concept of self-actualisation, for instance, can be both individual and social (Tuhiwai Smith, 2012). Tudor (2018, 52) makes the case that Western thinkers articulate what he calls ‘“We” psychology’, arguing that psychotherapeutic theories are compatible with collectivist ideas. As Nolan and West (2019) suggest, we can have interconnectedness in our individual meaning making. In my research into cultural experiences there is a place for the individual; relational and social. Identity is continuously negotiated in our personal interactions with others and the wider society (Orbe and Harris, 2015). Individual stories are ‘redolent with the collective’ (Merrill & West, 2009, 68). However, to therapeutically enforce an individualistic perspective on a client would be to deny their social context, culture and experience.