Interpreters in Counselling (Third person in the room)

Due to their inability to speak English fluently some clients might need the service of an interpreter during the therapy sessions. In the UK inclusion is a value in society and access to mental health services are provided equally regardless of the person’s mother tongue. I did some research and found that a whopping 100 languages are spoken in London and 7.7% of the population are non-native speakers of English in the UK so there is a real need to work with interpreters.        

Counsellors may need to work with interpreters and there might be some challenges by doing so. The BACP has published some guidelines for therapists on working with interpreters, which is available on their website free of charge. It is crucial that a qualified interpreter is used for mental health service interpreting and preferably the other language is their mother tongue. For certain clients such as refugees or asylum seekers the chance to use their mother tongue can make them feel understood. 

However, they might resist help or get anxious. There might be some challenges when using the service of an interpreter. It can create anxiety for the counsellor to have a 3rd person in the therapy room. They might feel uncomfortable or judged by being observed. Interpreters might not be available due to funding issues or other reasons. 

 

Interpreters should be familiar with the difference between the psychotherapeutic/constructionist mode when the interpreter is primarily concerned with interpreting the intended meaning and feeling-content being conveyed rather than word-for-word. On the other hand, in the cultural broker mode, the interpreter interprets not only the spoken words but also relevant cultural and contextual variables. Culture and language are in an interactive relationship with one another.

 

Non-verbal communication including facial expressions, gestures, eye contact and postures are also shaped by culture. The interpreter may be able to assist the counsellor to decode the intended message behind gestures or expressions and minimise misunderstandings. The presence of an interpreter in the session might influence the dynamics of the therapeutic encounter. Counsellors ideally should do some training course on working with interpreters before seeing a client who needs an interpreter. If this is not possible, relevant guidelines should be checked from the BACP website or these can be discussed with a more experienced colleague or supervisor. 

 

Doing a deaf awareness training course is also recommended before working with deaf clients who need a British Sign Language interpreter. 

 

Before the session min. 10 minutes should be allocated to meet the interpreter and brief them on any issues. The purpose of the meeting needs to be clarified and they need to be made aware of confidentiality and trust issues. The interpreter may experience vicarious trauma, it may be considered how to support them. They might feel helpless, angry or powerless. At the end min. 10 minutes should be allocated to debrief the interpreter after the session. 

 

All in all, establishing a good working alliance between the client, the interpreter and the counsellor is crucial. Children, family members and bilingual staff who are not professional interpreters should never be used as interpreters.

Gay Affirmative Therapy 2.

Since 2012 a statement of ethical practice regarding sexuality has been incorporated into the BACP Ethical Framework. Clients from diverse sexual orientations are to be included without discrimination. The BACP does not consider homosexuality as a kind of mental disorder and opposes conversion therapy.

 

The relationship between counsellors and clients is bounded by this framework. By showing respect to LGBTQ+ clients therapists can demonstrate professional standards of conduct. Instead of pathologizing clients for being non-binary, being free of gender bias is the favourable attitude in order to provide a safe place and relationship to clients. 

Davis and Neal wrote a book titled Pink Therapy in 1996. Chapter 2  details some information about gay affirmative therapy. It contains guidelines about how counsellors can create a positive therapeutic relationship with LGBTQ+ clients. Trust is central to this, clients will be able to accept help if trust is developed. Respecting the client’s integrity in an intersectional context is crucial.

 

Being aware of our own beliefs, values, fears and prejudices around sexuality is important. Supervision and personal therapy provides a good opportunity to explore our prejudices during our training. In some cases referral might be necessary if we can’t provide therapy for a client due to some of our beliefs. Lack of training or sufficient knowledge may also result in the need for referral.

Dual Heritage

 

*Please note, this article contains outdated vocabulary from old papers which may sound offensive.

 

Dual heritage means an upbringing in which one’s parents are of different ethnic or religious background. As early as 1928 a sociologist, Park, came up with the term “ the marginal man”, referring to a person of mixed race. According to his theory, the marginal man lives between two worlds but does not really belong to either of them. (in the USA context) This leads to isolation, alienation, feeling as an outsider, confusion and the self becomes divided. Park also noticed that the marginal man has a broader horizon. As I was reading chapter 3 from the book titled “ Black White or Mixed Race” by Tizard and Phonix I was surprised by the use of controversial phrases such as marginal man , half-caste and hybrid actually referring to human beings. I believe such terminology sounds discriminative and degrading too. 

The “marginal man” had to work through a lot of psychological maladjustment, feeling isolated and not belonging anywhere. As a coping mechanism he either assimilated into the white group by “passing as white” or into the black group of people. The latter meant dealing with any negative feelings towards them and also experiencing distrust and even hostility from members of the black community. This is a theory mainly based on observations. 

Later in the 1950s sociologists interviewed 2nd generation Jewish immigrants in the USA. They did not see their situation as conflicted, they did not feel marginalised. They had a positive dual orientation. In the 1960s due to the human rights movement and significant changes in the socio-political climate things started to improve but still a lot needs to be done.

“Othering” is a phenomenon, when some individuals or groups are defined and labelled as not fitting in within the norms of a social group. It influences how people perceive and treat those who are viewed as other. It also involves attributing negative characteristics to people or groups that differ from the perceived social norms.

Dual heritage can involve other aspects of cultural identity such as class, religion, language, sexuality, gender identity etc. The concept of intersectionality is worth noting, when working with clients, which means that a client’s identity is a complex matrix consisting of overlapping identities.   

Ethnic minority clients may experience difficulties in mental health provision if they wish to be matched with a counsellor from the same cultural background. Language can also be a barrier. The fear of being judged for being in therapy in certain communities, especially where collectivism is a value, can prevent clients from accessing mental health services. If this is not possible, intercultural therapy can still help.

Facilitating a non-judgemental safe place for the client where they can explore their identity issues is crucial. Getting into their frame of reference should be the aim, instead of assuming. How the client identifies can be different from apparent features. Identity confusion is more common with non-white ethnic minority clients.

In addition, ethnic minority clients including clients of mixed heritage suffer more from experiencing oppression and racism. Working interculturally can be a healing experience for them. By addressing the differences sensitively and acknowledging differences the counsellor can help to facilitate for clients to get over identity crisis and form a cultural/racial identity. By staying open, accepting, compassionate and curious the client will feel heard and seen.

The Proxy Self

 In the 1980s the Nafsiyat Intercultural Therapy Centre was established because it was noticed that some people from ethnic minority background did not really benefit from the work done with a white therapist as they were withdrawn or could not fully participate and displayed a kind a false self as a defence to make themselves more acceptable to the white therapist. Lennox wrote about this extensively, he noticed this pattern, which was employed in other parts of the clients’ lives as well to seem more “white” and hide their real self.

Being aware of this pattern can enable the therapists to provide a more authentic therapeutic experience for the clients. 

 

Interculturally trained therapists can provide a good enough therapeutic relationship and these sensitive issues can openly be addressed. However, there is also a need for more therapists from ethnic minority backgrounds because these therapists are underrepresented right now in the UK and in the USA as well. Clients might find it challenging if they want a therapist from the same ethnic or other minority group. There might be problems accessing therapy service or waiting lists, too.

Children of ethnic minorities don’t have a firm concept of racism so when they are rejected or not accepted by white people they might feel that they are bad. This splitting is really damaging for clients and if it is not addressed the therapy is just game playing. It is therefore very important for the therapist to recognize the splitting and provide a safe enough place and relationship to explore these feelings. This is usually a gradual process and the same situation can apply to issues around gender, gender identity, culture, social class, age, ethnicity etc. not just race. Creating a proxy self may have been happening for generations without being aware of it.

Interestingly enough, another type of splitting can occur. Ethnic minority people can put white people into two categories based on their experiences and encounters with them. Some can be perceived as safe, others can be seen as not to be trusted and people adjust their behaviour accordingly when interacting with them.

Representation of ethnic and other minorities in the media for example can be an affirming experience.

White Racial Identity (Intercultural Therapy)

 

Race is primarily about physical appearance, culture is of sociological origin. Ethnicity is psychological because of its connection to the identity of the person. Race is a group of humans that share physical or social qualities. It is a socially constructed system of classifying individuals according to characteristics that are genetically determined but these are not always consistent. 

Cultural identity means all the knowledge and values shared by a society, e.g. language, familiar roles and communication patterns. Culture means “way of life”, it is passed on by heredity knowledge, it includes beliefs, behaviour, attitudes, values, morals and customs. It is passed on but not genetically. Identity is who a person is, or the qualities of a person or group that make them different from others. It functions as the lens through which someone registers experiences, it influences how they see, understand and respond to events. Culture therefore shapes a person’s approach to all areas of life, from gender role expectations, to attitude towards authority or communication style. Ethnicity means belonging to a distinctive social group that shares a religion, nationality or language. Ethnicity is a group of individuals sharing a common and distinctive racial, religious or cultural heritage. Ethnicity is a name for a group of people that identify with each other. Ethnicity is usually an inherited status based on society.

The white racial identity model was developed by Janet Helms in the1990s. It was created to raise the awareness of white people, about their role in creating and maintaining racism. It aids white people into taking responsibility by dismantling systemic racism through a framework of power and privilege. According to this model there are six stages of the process.

The first stage is the contact stage. There is a lack of understanding of racism and minimal experiences with people of colour. White people are unaware of their own racial identity or the fact that whiteness has an identity. They might view racism as individual prejudiced acts, rather than something ingrained and systemic. They may believe racism is kept alive by continued discussion and acknowledgement of it as an issue. They move past this stage when they are confronted by real-world racist experiences and become aware of the effects of white privilege. 

The second stage is called disintegration. Previously held beliefs and mottos are challenged by personal experiences and increased awareness of being white and its privileges. Common emotional responses are shame, guilt, anxiety, denial, depression and withdrawal. They might explore racist thinking with others and they may attempt to persuade others to abandon racist thinking. They may experience conflict in acknowledgement of whiteness and identifying lack of language to explore and explain inner conflicts. It is characterised by a feeling of being caught between racial realities. Individuals either move on from this stage positively (pseudo-independence) or negatively (reintegration), depending on how overwhelmed and avoidant the person becomes by their uncomfortable feelings. 

The third stage is called reintegration. Guilt, shame and anxiety is transformed into anger towards people of colour. There’s an increase in victim-blaming and paying attention only to misinformation that confirms the stereotypes. They lean into the idea that maybe white people have been treated as superior because they are. They might feel the urge to avoid the topic of racism, rather than work through their discomfort and define a non-racist identity. They can move past this stage when they are prompted to find a way to challenge and channel their discomfort into positive action. 

The fourth stage is called pseudo-independent. People abandon beliefs in white superiority and they understand intellectually the unfairness of white privilege. Personal responsibility is recognized to dismantle systemic racism. They confront and uncover racism. They may still harbour internalised superiority and do not understand how they can be both white and non-racist. Individuals move past this stage when they move into a more self-possessed space, where white fragility is reduced, and understand the need for engaging in anti-racism work. 

The fifth stage is immersion. They actively seek to connect to their own white identity, redefine their whiteness and make a commitment to anti-racism. They ask important questions about racial identity and engage in critical thoughts about self and others. They focus on forming a positive white identity, which is not based on superiority. They take more responsibility for racism and privilege, seek out immersion in communities of colour. They often seek out other white people who are engaged in anti-racism work for support. Individuals move on from this stage when anti-racism work is actively and continually engaged in and critical thought is absorbed into everyday life.

 The sixth stage is autonomy. White people have clearly defined a positive connection to their white racial identity. Racial identity continues to be fluid, open to feedback and ongoing self-examination. They use their privilege consciously and are actively anti-racist within own sphere of influence and they are engaged with social justice efforts around racism. They are knowledgeable about racial, ethnic and cultural differences, they value diversity and understand intersectionality.

 

Cross-cultural therapy is called the ‘fourth force’, it emphasises the importance of awareness of one’s own cultural values and potential biases, recognising differences in worldview between oneself and clients, and the ability to implement culturally appropriate interventions. The starting point for working with diversity is self-reflection. This means cultivating awareness of one’s own cultural and ethnic identity and values, what they mean to you and to others around you. In the case of white therapists, being white, the privileges of whiteness need to be acknowledged in order to practise effectively as a white therapist in a multicultural society. Continued commitment to reflexive practice is vital, being on the lookout for one’s own biases, prejudices and beliefs, about one’s own and other cultures. Supervision from a supervisor who is experienced in working with cultural diversity is recommended to facilitate this. In some circumstances, being transparent and dialoguing with the client about issues such as biases and prejudices may prove helpful for both parties.

Curiosity, respect and openness are key to avoiding these resulting in ruptures in therapy, and to building a strong therapeutic alliance. Learning about a client’s culture, when different from one’s own, facilitates developing cultural awareness. Importantly, knowledge should be checked through discussion with the client. This serves to help avoid stereotyping, and any notion that cultural groups are homogeneous. It also helps situate understanding from the client’s perspective, facilitating a sense of self that is meaningful to the person concerned within their personal and cultural context. It is an ethical consideration to have the sensitivity and ability to enter a different world and not only understand it, but feel comfortable to challenge it.

Intercultural Therapy

 

Working interculturally with clients means that the difference between the client and the counsellor is recognized and explored. The counsellor should be aware of their own cultural values and beliefs and have a sense of cultural identity. This way she/he is more equipped to facilitate a similar exploration for the clients around their cultural awareness. Being aware, admitting and working through your own blind spots, biases and prejudices can be really important. This will enable the counsellor to keep the focus on the client’s agenda rather than being guided by own emerging countertransferential feelings. It can be useful to develop an awareness, pride even, in our own culture and yet accept the predominant culture. 

Continuous training and development around difference and diversity and the expansion of cultural knowledge is also necessary as the world and the society is changing around us so fast. Adaptation of interventions to meet the clients’ unique needs is also necessary. Identifying, acknowledging, appreciating and respecting clients’ diversity is a key to inclusion. We can be really culturally competent by displaying cultural responsiveness and sensitivity. (instead of just saying I treat everyone the same or I see no colour) It is also an ethical consideration.

The intercultural movement in counselling started in the 1960s as a result of significant political and social changes. In the 1980s in London, Jafar Kareem established Nafsiyat Intercultural Therapy Centre. His main motivation was that he noticed that there was a lack of provision of mental health services within ethnic minority groups. In addition, he noticed that there were several barriers which affected access to therapy services such as language barriers, racism or refugee status. The mental health of people from these marginalised ethnic minority groups was further affected by their external realities such as poverty, deprivation, social powerlessness etc.

Intercultural therapy is a form of psychotherapy aimed at benefiting culturally diverse groups. It recognises the importance of race, culture, beliefs, values, attitudes, religion and language in the life of the client. Kareem said: “taking into account the whole being of the client – not only the individual concepts and constructs as presented to the therapists – but also the clients’ communal life experience in the world, both past and present. The very fact of being from another culture employs both conscious and unconscious assumptions – both in the patient and in the therapist.”

The Transpersonal Relationship

There have always been spiritual healers such as shamans, witch doctors in all cultures around the globe. According to Clarkson the transpersonal relationship is the spiritual or inexplicable dimension of the relationship between the client and the counsellor. It’s a timeless element, it’s a kind of connection at an unconscious level.

Clarkson says “we still don’t know precisely what it is that we are doing as therapists and whether it makes any difference at all”. I find this statement brutally honest. It reinforces the idea for me that counselling is a kind of art, not a form of science . The kinship between the client and the therapist is that of a marital couple if we consider the  therapeutic relationship. There’s a sense of intimacy and also emptying of the ego. If the therapist can allow passivity and receptiveness and let go of skills, knowledge, preconceptions, assumptions this aspect of the relationship can be encouraged. Clarkson argues “the therapist dissolves the individual ego” thus allowing insight and transformation to emerge for the client.

There was a case study in the book when a client refused to form a working alliance by not stating the goal of therapy but he kept coming to the sessions. The therapist then, by letting go of expectations and the healer archetype, could be an empty vessel, a container, which was healing for the client. This reminds me of Rogers’ idea that the curious paradox: if you accept yourself change will come, but in this case the therapist strives to display this type of attitude towards the client.  Clarkson quoted Perls “we grow, we develop, we evolve, we connect, we strive for greater and greater perfection, we move towards the good”. She refers to this as Physis or life force, which again is a very optimistic way of looking at human nature. It reminds me of Roger's idea, that we all have the potential to grow. It all depends on the clients’ openness, capacity for wonder and awe. The therapist has to be aware of their own competencies, blind spots, prejudices and their willingness to engage in this type of relationship depending on their own cultural and spiritual background. I think it is also an ethical consideration, therapists are supposed to do no harm to clients so careful consideration is needed.

Bibliography:

Petruska Clarkson, The Therapeutic Relationship, Wiley, 2003

 

The Person to Person Relationship

The person to person relationship is based on mutual human equality as opposed to object relations. This stage of relationship can be reached/ it can occur when the transference is dissolved. The encounter happens when 2 genuine humans meet each other with mutual awareness. They are both present. Both the client and the counsellor are willing to see and be seen by the other as a congruent person with thoughts, emotions, feelings, likes and dislikes, prejudices and blind spots, too. This can be linked to Buber’s existential philosophy and Rogers’ personality theory, too.

Working relationally means that the counsellor is attuned to the client’s relational needs in the here and now. This can be healing for the client who may have not had this type of experience before. Humanistic and existential approaches believe providing this type of relationship can lead to growth and change. Creating realistic expectations is crucial as clients might have unrealistic expectations from the counsellor such as friendship, advisor etc. The counsellor’s self awareness is very important at this point to be able to focus on the client’s needs and not to fulfil his/her own unmet needs while working with clients. Own therapy and supervision are great opportunities to be self-aware.

According to Clarkson the person to person relationship can be just a few moments in therapy but it can also be a substantial phase. It is also hard to define and reach a sense of equality in the relationship. It can be compromised by the client's perception of the therapist as a person in power or having influence. However, if it is reached there’s a sense of genuineness, absolute honesty, mutuality and openness.

Clients sometimes can recall a special moment rather than an intervention. One of Petruska’s clients remembered a session when P. lent her a book and she felt valued by that act.

Bibliography:

Petruska Clarkson, The Therapeutic Relationship, Wiley, 2003

Reparative Relationship

The next form is the reparative/developmentally needed relationship in Clarkson’s Framework. When the client’s original parenting was not appropriate, e.g. overprotective or abusive, as a result the client can be in distress. The counsellor should be willing to demonstrate what the client’s fantasy needs, e.g. a parent. 

By the end of therapy the client will internalise this emotional regulation by overriding the old harmful or damaging ways of relating to self. The therapist can provide the nurturing, praise and affirmation the client may have never had.

 

 

 

 

 

According to Clarkson this type of relationship is “an intentional provision by the therapist of a corrective, reparative or replenishing relationship or action where the original parenting was deficient, abusive or overprotective.” To provide a reparative relationship it is beneficial to know what the injury, or trauma was or what the developmental deficiency was. The arrested development is the point where the client  has some stuckness. After establishing the working alliance and potentially working through transference the therapist is able to offer and show a different kind of relationship, that of a beneficent parental figure, showing support, encouragement and unconditional positive regard. The counsellor should be aware of their own upbringing and have worked through their own issues in order to provide an unbiased, corrective relationship and to be able to fully focus on the client’s agenda.

Through the reparative/developmentally needed relationship the counsellor can facilitate client’s exploration of their patterns of behaviour, working through that together, helping them form new patterns and then carrying on with those new healthier behaviour. Naturally, learning new patterns to embed them into the client’s life can be a lengthy process. By providing a safe therapeutic space for this work to happen, using the person centred approach and the psychodynamic model integratively, clients can make beneficial changes. This way they can internalise the counsellor and develop an inner therapist  can have a huge, long term impact on their lives.

Clients might regress to a previous developmental stage in therapy. Clarkson quoted Guntrip: “regression is a flight backwards in the search of security and a chance of a new start.” What the client needed back then but was missing from the parenting (developmental deficit) can be provided by the counsellor in the here and now. The counsellor should consider the nature, severity and duration of the deficit which has led to the deformation, deprivation or distortion.

This theory can be linked to Erikson’s psychosocial developmental stages. It is important  to have a thorough knowledge of those stages in order to enable counsellors to identify the stages and the deficit related to that specific stage. 

According to Clarkson this reparative relationship  can happen in a group therapy setting too, where clients can re-experience an alternative family dynamic.

Bibliography:

 

Petruska Clarkson, The Therapeutic Relationship, Wiley, 2003

Transference/Countertransference 2.

According to Clarkson the second form of relationship is the transference/ countertransference, which can be linked to psychodynamic theory. Transference may occur in every relationship, not just in the relationship between the counsellor and the client. 

 

 

 

Transference is the client’s emotional response to the counsellor, it’s a process of directing feelings, attitudes and conflicts to the person one has a relationship with in the present. Child-like patterns of relating to significant others are repeated by the client. This operates at unconscious levels. Clients have a tendency to create a repeated replay of situations from the past with significant others, they seem to fit all subsequent relationships into these early relationship patterns. This phenomenon is called repetition compulsion. This repetition provides an opportunity for the counsellor to study transference at close range. By highlighting transference reactions and bringing these outdated or unrealistic responses into consciousness the counsellor can help the client to recognize the “as if” quality of the transference by linking it to a past experience. (“You’re reacting to me as if I were…) The counsellor can help by not repeating the same reaction which the client experienced in the past. The strengths of those negative feelings can diminish by being able to express them in a safe relationship for as long as it is needed. Gaining insight by bringing these feelings into consciousness gives a sense of control over them. However, changing deeply internalised attitudes can be a lengthy process. Many factors can cause transference feelings such as the counsellor’s voice, accent, physical characteristics or behaviour.

Transference can be positive or negative. The client may perceive the counsellor as helpful and understanding, this way the client can relive the parent-child relationship he/she might have never had. (like a reparenting process) Other positive feelings transferred can be: loving, admiration or even idealising.

 On the other hand, the client can transfer negative feelings onto the counsellor, such as reluctance, distrust or suspicion. It can also be a valuable opportunity for the counsellor to work with this obstructive transference by not adapting the role the client casts on him/her but by exploring the underlying issues instead. Attending to transference appropriately is crucial because it’s like a mirror in which the client’s past is reflected, it provides information about the emotional problems the client is experiencing. It can help to gain a deeper understanding of the problem.

The Triangle of Insight can be a useful tool to explore the client’s transferential experiences. It’s a psychodynamic concept, which was developed by Karl Menninger. According to this concept, how the client perceives the relationship with the counsellor in the here and now (“In Here”) is affected by the client’s earlier relationships with significant others from the past. (“Back Then”) The client’s current or recent past relationships with others are also affected. (“Out There”) These three aspects are interrelated. The counsellor can help the client to make connections between the different aspects by working with transference and gain insight of repetitive patterns.

Counsellors can also have inappropriate strong feelings that are evoked by the clients. Some of these might be evoked by the actual relationship with the client, others might belong to the counsellor’s earlier experiences with others, unresolved issues or own difficulties; and can distort view. Petruska described it as “unfinished business from the past interfering with our here and now relationship”. In other words: The experience of distortion of the working alliance by the wishes, fears and experiences from the past transferred onto the therapeutic relationship. However, it can be very challenging to differentiate between the two. If the counsellor can identify counter-transferential feelings he/she should contain them and not act on them.    

Supervision has a crucial role in working through these unresolved issues or blind spots and also separating the client’s needs from the counsellor’s own needs. The counsellor’s self-awareness has great importance. Counter-transferential feelings or reactions include: inability to confront the client, being over-protective, envious, sexual attraction towards the client etc. 

A kind of counter-transference occurs when the counsellor overidentifies with the client’s problem, for example one can get angry with the perpetrator when counselling a victim of sexual abuse, this is called vicarious identification. Clients can also project unacceptable aspects of self or feelings that can’t be expressed. This way the counsellor feels these as a recipient, this concept is called projective identification. The counsellor might experience extreme tiredness or think about the client outside sessions. Attending to counter-transference appropriately is important because this way we can provide autonomy to the client, keep the focus on the client’s agenda and also put our own agenda aside.

By working through transference the next level can be reached: the I-thou relationship when the transference is dissolved and the client sees the therapist as a genuine, congruent person. (not distorted)

Bibliography:

Petruska Clarkson, The Therapeutic Relationship, Wiley, 2003