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American Imago 59.4 (2002) 459-481

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The Hidden Politics of Healing:
Foreign Dimensions of Domestic Practice

Andrew Samuels


The practices of transcultural psychotherapy in Western countries, and the exporting 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 multiethnic cities such as 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 experience 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 texts on transcultural therapy of the applicability of their ideas to "ordinary" psychotherapy. For example, Zack Eleftheriadou (1994) makes the pertinent observation that the prime requirement for the successful practice of transcultural psychotherapy is that therapists "examine their relationship to their own culture" (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 on the therapist's part to cultural difference embodied by a potential client. Yet it is not hard to see that what is being proposed has relevance right across the board of clinical practice in psychotherapy. [End Page 459]

Similarly, in his paper "Countertransference in Cross-Cultural Therapy," Michael Gorkin (1996) offers ways of managing "countertransferential errors" that occur when working with a client from a different cultural background. These ways include the therapist's "familiarizing himself with [the other] culture" and "examining candidly his motives for choosing [to work with someone from another culture]" (170). 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 where the culture is generally influenced by the West, such as Japan, therapists whose training orientation and inspiration have been "foreign" are constructing a "domestic" psychotherapy scene. But, once again, a review of texts that touch on the history of psychotherapy (e.g., Borossa 2000; Homans 1989; Kirsch 2000) 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. 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 contribution of Irish, Indian, or African writers, and their inspiring presence in and influence over the home-grown scene. In fact, however, as Timothy Brennan has pointed out, English is no longer an English language (1990, 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. This would be a deliberate reversal of the usual flow of traffic, an incitement to the displacement of the center by the peripheries. We do not need to make the claim that all psychotherapy is transcultural in [End Page 460] 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. From being an (important) aperçu discovered...


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