Dwairy, M. (2009). Culture analysis and metaphor psychotherapy
with Arab‐Muslim 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.