Have you ever wondered if therapy can work when a therapist and patient are different from each other? Many have fears of differences and fascinations with strangeness; this is universal, yet individually determined for each of us. These may include the patient’s perception of differences in gender, external appearances, ways of thinking, skin color, racial background, cultural background, and religion.

One of the tasks of good therapy is to understand the individual meanings these differences have for the patient, starting from the most superficial and accessible and going toward the deepest underpinnings. Can such a task be accomplished in the presence of gross and obvious differences between the patient and therapist that preclude a shared understanding of a common racial/cultural/religious/ethnic background?

Perspectives on this issue have varied over time.

Oberndorf (1954) did not think it was possible:

“The fear of the stranger, originating in a young child’s feeling of security in the accustomed, and need for protection in the face of the unfamiliar person or place, are [sic] almost instinctive . . . the integration of the mentally disturbed individual can best be achieved if he is treated by one of those who understands his motivations rather than by one considered expert in a particular illness.” (pp. 757-758 )

The thinking here seems to have been that a patient’s motivations could only be understood by someone from a similar cultural background.

Between Oberndorf’s 1954 paper and the late 1990s, other papers were published on the impact of cultural, ethnic, racial, or religious differences between analyst and patient.  Schachter and Butts (1968) presented a point of view quite different from Oberndorf’s:

“Racial differences between analyst and patient involve issues of unconscious meaning at various levels, analogous to differences in sex between analyst and patient. They must be recognized and utilized, but only rarely do they create an either unanalyzable hurdle or a serious obstacle to treatment.” (p. 802)

It is essential that close attention be paid to the issue of the therapist’s comfort or discomfort in dealing with factors related to differences of ethnicity, culture, and religion. The ability to handle this material with patients increases as the therapist better understands his or her own prejudices and conflicts about ethnicity, religion, and culture; this constitutes important work in one’s own personal therapy / psychoanalysis.

Acknowledging and Understanding Differences

In India and Pakistan, henna (an herbal paste) is mixed with water and applied to the hands of women for certain festive occasions, including weddings. The henna, which is green in the powder and paste form, is left on the skin for several hours and is then removed; the dye seeps into the skin and colors it. The color on the skin of one woman can be quite different from the color on another. For example, the henna is pale orange on certain skins, and on others it shows up as bright, flame-colored orange. It is said that on certain hands, the henna “takes” better than on others. It is postulated that the color depends on some quality intrinsic to the skin.

So I believe, in psychotherapy and psychoanalysis, all patients and all therapists are “different” from each other.  In each therapy, the use to which the patient and the therapist put these differences is determined by the patient’s needs and conflicts. In some treatments, the differences may not emerge in bright colors; in others, they might present in almost dizzying hues because, for the patient, they serve a critical defensive function.

The point is simply for the therapist to acknowledge with the patient the real and external differences between the two of them, and to work with the patient to understand the inner-psychological meanings of the external differences between them.

REFERENCES:
-Oberndorf, C.P. (1953-1954). Selectivity and option for psychiatry. American Journal of Psychiatry, 110: 754-758.

-Schachter, J.S., & Butts, H.F. (1968). Transference and countertransference in interracial analyses. Journal of the American Psychoanalytic Association, 16: 792-808.

DR. AISHA ABBASI

Dr. Aisha Abbasi is a psychoanalyst, psychotherapist, and psychiatrist in private practice in West Bloomfield, Michigan and Tampa, Florida.

Dr. Abbasi has been voted (by other physicians) one of The Best Doctors in America for 19 consecutive years.

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