Friday, October 9, 2015

Turning Jeans that are too tight into a nice looking bag – metaphors in psychotherapy in a cultural context


Dwairy, M. (2009). Culture analysis and metaphor psychotherapy with ArabMuslim clients. Journal of Clinical Psychology, 65(2), 199-209.http://www.researchgate.net/publication/23628317_Culture_Analysis_and_Metaphor_Psychotherapy_with_Arab-Muslim_Clients

This is an interesting paper written by Prof. Marwan Dwairy from Oranim college in Israel.  Here are some thoughts and comments before we turn to the paper itself:

Dwairy identifies Arab society as having a collectivist – traditional culture, and writes about psychotherapy with clients of such cultures.  I think there is no dichotomy between collectivist –traditional cultures and individualistic – secular ones.  Both cultures are on the same spectrum, and every individual is on a different point on the spectrum.  Probably it's possible to think with the client herself about her place on the spectrum and her family's place on it.

We can think about Jewish Ultra Orthodox society, and maybe also about Japanese society (I don't know enough about these two societies) as closer to the collectivist – traditional end of the spectrum.  However it's best in my opinion to be cautious about stereotypes and generalizations, and to consider our specific client and not only the culture he belongs to.  The client himself is an expert on the values of the culture he belongs to, and he can explain those values to us.

Dwairy's ideas are good for every client wherever he is on the collectivist – individualist spectrum.  I think it's always good to work with metaphors, since they are a kind of "play therapy" that can be done with adults.  They open a playful potential space.  They also work well in family therapy.

Now we turn to the paper.  I remained as close to Dwairy's wording as possible:

Psychoanalysis is based on a Western individualistic understanding of personality, according to which after adolescence, the person becomes an individual entity.  But in collectivist cultures people usually remain dependent on their family beyond adolescence.  Their needs and drives (the Id), their values, attitudes and judgments (the Ego and the Superego) are not separated from those of their family.  Their feelings, thoughts and behaviors are dependent to a large extent on the family.  The main source of happiness – and the main source of threat – is the family.  The family's acceptance and esteem cause happiness.  Devaluation and rejection by the family cause distress.

 The main conflicts that a person from a collectivist culture experiences take  place in the relationship between him and his family and not within him.  People from collectivist cultures usually deal with such conflicts through social norms.   Mosayara is a basic coping skill with Muslims and Arabs, and it means to get along with the attitudes, wishes and expectations of others by concealing one's real feelings, thoughts and  attitudes.  This is a lifestyle in which the person tends to accommodate  himself to other's expectations.  Istighaba is another coping skill, in which one performs socially unacceptable actions away from the public eye, or in privacy, to avoid isolation or punishment.

In such a cultural system it's possible to explain psychological symptoms by understanding the relations between the client and his family, and by understanding the norms and values of the person and his family, and not by intrapsychic processes. 

Making the unconscious conscious can be counterproductive  with clients with a collective identity.  Exposing unconscious conflicts can lead the client into a tough struggle with his family, a struggle which he can't win, and which will leave him with an open wound.  In the beginning of therapy Dwairy recommends having a thorough analysis of the relations between the client and his family in order to assess the client's level of individuation and the family's degree of strictness.  In order to avoid a tragic end to psychotherapy with a client who has a collective identity, Dwairy suggests metaphor therapy and social analysis. 

Metaphor therapy is an indirect way to deal with unconscious content without making it conscious.  For example, Dwairy asks the client to draw the problem and to draw a possible solution to it.  He encourages the client to bring an object from home to the therapy session and to talk about personal memories, feelings and meanings related to this object.  He asks the client what he would like to do with the object.  For example, a client suffering from low self image decided to take a trophy he won in his childhood in a boxing competition out of his drawer and put it on his desk.  This reflected his growing self pride.

It's possible to do metaphor therapy in three phases: identifying the metaphor representing the problem (for example, a dam which is about to overflow), describing the way the client wants to change the metaphor (make alternative outlets for the water in order to ease the tension on the dam's walls), and discussing with the client what can be learned from the solution in the metaphor that can be applied to the client's life.  An adolescent described conversation with his parents as "talking to the wall".  When Dwairy asked him what he would like to do with the wall, he came out with many ideas:  open a window in it, paint over it, lean against it, decorate it and climb it.  Then they thought about things that can be learned and applied from these solutions to the client's life.

 Along with metaphors Dwairy recommends cultural analysis.

Through cultural analysis the client finds and adopts alternative values – within his value system and within his culture – that accommodate his needs (instead of the present values he holds that do not fit his needs and cause him distress).  The cultural analysis assumes that in every culture there are many conflicting values.  Usually one is aware of only some of these values.     These values sometimes reject and repress a person's most vital needs.  Cultural analysis can enable the client to be aware of other values within his culture, that he can adopt and thus deal with his needs better.

Even within a traditional family, different family members can have different attitudes.  If the client recognizes these differences, he will be able to choose to identify with figures in the family whose values may support the change he is looking for.

Religion has conflicting values as well. Every religion has values that are more tolerant and less tolerant.  The therapist can help the client choose the religious values that can lead to change.  The therapist does not have to be an expert in the client's religion.  He has to be open to learn from the client about his religion and to encourage a new understanding within the client's religion. 

Dwairy writes about the values of Islam and describes a case study with metaphor psychotherapy.   Very interesting.


I think these ideas are good not only for psychotherapy but also for assessment and post assessment intervention, both with clients of the same cultural background and from a different cultural background.  The child, the teacher, each of the parents and the psychologist can think about a metaphor for the problem that led to the referral, and about a metaphor for the solution.  Then we can see what we learn from the metaphors about the problem and about the possible solutions.   In families from a different cultural background the metaphors may have cultural content and values that can lead to a better understanding of the problem and to more fitting solutions.

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