W4Ch11

Ch 11 Transcultural Psychotherapy Bridges to Asia, Africa, and the Middle East

This chapter with Chapters 10 and 12 forms a trilogy of chapters dealing with psychotherapy with culturally diverse clients. A vacuum exists in Western multicultural counseling models. Currently, multicultural psychotherapy consists of applying multicultural competencies—beliefs, attitudes, and skills that do not themselves form a theory of human behavior and human psycho- logical development—to theories that are clearly monocultural in outlook. I have maintained else- where in this book that the multicultural com- petencies cannot be substituted for a theory of multicultural psychology. According to Moodley and West (2005), mul- ticultural psychotherapy has failed to theorize early childhood development, conceptualizations of the multicultural self, or any analysis of cultural psychopathology. All we seem to have are the cultural competencies as therapeutic techniques, and much of this work has no “force” outside the theorizing and researching by a small constituency of dedicated scholars. (p. xvii) While these competencies are a start toward examining the impact of culture on psychotherapy, they do not substitute for rigorous theorizing about how individuals develop or construct group-level identities. Instead of focusing on the multicultural competencies, multicultural theorists might con- sider integrating psychological constructs from different cultures and nations. Does culture have a significant impact on individuals’ expression of mental health issues? Do certain cultures facilitate the development of psychosomatic illnesses while others lay the groundwork for more expressive and acting-out disorders? One problem with multicultural theorizing is that too many areas are included under the mul- ticultural umbrella to formulate a comprehensive theory of psychotherapy. For instance, multicul- tural counseling includes such diverse areas as ethnicity, culture, sexual orientations, disability, and aging. While I am not advocating eliminating these areas under the multicultural heading, I am proposing that the field of psychotherapy might benefit from focusing on developing a theory of psychotherapy that deals primarily with ethnicity and culture. The dominant position of this book is that the current Western paradigm in counseling and psychotherapy is inadequate to meet the needs of a culturally diverse population. Because all Western psychotherapy approaches are Eurocentric in their cultural outlook, the real challenge is to find com- monality between Western approaches to psycho- therapy and non-Western approaches (Santee, 2007). Lee (1993) asserts that when psychology texts examine the history of psychology, they invariably report only the early Greek thinkers and the think- ers from Europe. Typically, no consideration is given to the contributions of early Chinese thought— namely Confucianism and Daoism—on psycho- logical thinking. When Western psychology ignores the contributions of Eastern and other nations throughout the world, the focus is culturally biased. If psychotherapy is to truly become multicultural, we must take into account psychotherapy models from non-Western cultures. This chapter offers a theoretical bridge that could possibly unite psychotherapies around the world. It is called the psychological healing bridge across cultures from Western and Eastern cultures. As Santee (2007) has pointed out, all cultures deal with stress, stress management, and psychological healing. What could Western approaches to psy- chotherapy learn about stress management and psychological healing from Chinese, Japanese, African, and Arab approaches to stress and psycho- logical healing? A psychotherapy healing bridge would allow psychotherapists from different coun- tries and cultures to collaborate more effectively with each other. We might also learn something about the mind and about stress management from examining how others many miles away from our homelands have dealt with such issues within their culture. A dominant theme of this book deals with the integration of theories of psychotherapy. We can approach such integration from primarily two per- spectives. First, we can concentrate on integrating different Eurocentric theories of psychotherapy. Second, we can integrate Eurocentric approaches to psychotherapy with various cultural approaches to psychotherapy. One of my goals in this chapter is to nudge the reader to consider integrating non- Western approaches into his or her integrated theory of psychotherapy. I deal with a number of non-Western psy- chotherapies. It was difficult to find a format for describing each theoretical approach; therefore, I did not try to force the description of the non- Western approaches so that they could fit neatly in my outline of the role of the therapist, client, and so on. I adopted the Buddhist doctrine of “go with the flow”—that is, describe the theory according to how the theorist described it. Moreover, none of the sections of the chapter provides an in-depth discus- sion of the specific transcultural approach. My goal is simply to introduce the reader to these approaches and to refer them to resources that provide a detailed analysis of each psychotherapy model. The chapter begins first with Asian psycho- therapies: Buddhism and the Japanese approaches of Naikan and Morita therapy. Then, I examine the Chinese approach of mindfulness, the African Ma’at model, and Dwairy’s (2008) Arab Muslim approach to psychotherapy. As you read this chapter, imagine a fulcrum around which you might inte- grate any one of these approaches with Western models of psychotherapy. For instance, what is the role of meditation in developing your own inte- grative approach to therapy? Do you encourage your clients to meditate as a means of dealing with stress? I maintain that most mental health issues and disorders reflect individuals’ stress response syndromes. How do you perceive stress and the role of psychotherapy in dealing with stress?

COMMONALITIES AMONG ASIAN THEORIES OF PERSONALITY AND PSYCHOTHERAPY

Before describing the individual Asian psycho- therapies, I examine the commonalities among the various approaches. Reynolds (1982) has described the Asian psychotherapies as the “quiet therapies,” primarily because clients spend so much time in isolation with their thoughts. The Asian perspective uses principles from Buddhist and Chinese medita- tion in its practice. Asian psychotherapies focus on clients’ attention and awareness, use meditation, and stress the importance of enlightenment. In general, Asian approaches to therapy focus on clients’ engaging in the process of self- and other understanding. In this respect, Asian approaches are very similar to existential approaches to ther- apy. Moreover, Asian therapies tend to emphasize and respect social relationships. They deemphasize the individual and stress the value of the whole of humanity. Individuals are viewed within the con- text of the families and the communities in which they live. Western family therapists are most similar to the Asian therapists in their emphasis on family rather than on individuals (Reynolds, 1982). In addition, Asian therapies use meditation to achieve a number of levels of awareness (Wilber & Walsh, 2000). In most Western theories of psy- chotherapy, the focus is on two levels of awareness: the unconscious level and the conscious level. Clients can observe their own thoughts and feel- ings through the process of meditation (Walsh, 2000). As one meditates, one is able to reach a higher level of consciousness and therefore dis- tance oneself from the hold of one’s issues. Asian approaches to therapy stress the impor- tance of enlightenment and freedom from fears and anxieties (Reynolds, 1982). Buddhism main- tains that it is important not to be controlled by fears, dependencies, and anxieties and is frequently used to fight alcoholism and drug addiction.

Influence of Buddha and Buddhist Principles of Living

Asian philosophers (Buddha, Confucius, and oth- ers) have had a profound influence on the psycho- logical development of individuals across Asia. At the heart of most of Asian approaches to therapy is the practice of Buddhist meditation, an integral part of the Buddhist philosophy. It is used as a way to not only get in touch with one’s inner self but also to develop insight and wisdom. In Buddhism: The Illustrated Guide, Trainor (2004) points out that there are more than 350 such meditation centers in Britain, while Bauman (1999) estimated that in the mid-1990s there were 3–4 million Buddhists, 500–600 Buddhist centers in the United States and more than 1,000 meditation centers throughout North America.

Siddha ̄rtha Gautama was a spiritual teacher from ancient India who is considered to be the founder Buddhism. In most Buddhist traditions, he is regarded as the Supreme Buddha. Buddha means “awakened one” or “enlightened one.” The time of his birth and death are uncertain. Most 20th-century historians date his lifetime as circa 563 BCE to 483 BCE. The Four Noble Truths and the Eightfold Path Buddhist teachings focus on Four Noble Truths and the Eightfold Path. These truths and path were taught by the Buddha about 2,500 years ago. They are essentially the same through every sect and tradition of Buddhism. The Four Noble Truths are 1. Life means suffering. To live means to suffer, because both human nature and the world we live in are not perfect. Each of us will have to endure physical suffering such as pain, sickness, injury, tiredness, old age, and eventually death; and like- wise, we have to endure psychological suffering like sadness, fear, frustration, disappointment, and depression. 2. The origin of suffering is attachment. We suffer because we become attached to transient things. Transient things include the physical objects that surround us, ideas, and all objects of our per- ception. Our minds are attached to impermanent things. The reasons for suffering are desire, passion, pursuit of wealth and prestige, striving for fame and popularity, or, in short, craving and clinging. 3. The cessation of suffering is attainable. The ces- sation of suffering can be attained through nirodha, which means the unmaking of sensual craving and conceptual attachment. Suffering can be ended by attaining dispassion. Nirodha extinguishes all forms of clinging and attachment. Suffering can be over- come through human activity and by not wanting things and by perfecting dispassion. Attaining and perfecting dispassion is a process that ultimately results in the state of Nirvana, which means freedom from all worries, troubles, complexes, fabrications, and ideas. 4. The path to the cessation of suffering involves a gradual path of self-improvement. It is the middle point between the two extremes of excessive self-indulgence (hedonism) and exces- sive self-mortification (asceticism), and it leads to the end of the cycle of rebirth. The path to the end of suffering can extend over many lifetimes, throughout which every individual’s rebirth is subject to karmic conditioning. The principles of the Eightfold Path provide the way to end suffering (Walsh, 1999a): 1. Right Understanding: Learning the nature of reality and the truth about life 2. Right Aspiration: Making the commitment to living in such a way that our suffering can end 3. Right Effort: Just doing it; no excuses. 4. Right Speech: Speaking the truth in a helpful and compassionate way 5. Right Conduct: Living a life consistent with our values 6. Right Livelihood: Earning a living in a way that doesn’t hurt others 7. Right Mindfulness: Recognizing the value of the moment; living where we are 8. Right Concentration: Expanding our conscious- ness through meditation These Buddhist teachings have influenced thinking in India, China, and Japan for more than 2,000 years (Reynolds, 1989; Walsh, 2001). Although many people associate Buddha with China, Buddhism was brought from India to China. In China, Buddhist teachings were merged with Confucius’ values and teachings. During the sixth century, the writings of Buddha and Confucius were introduced in Japan.