Culture, Psychotherapy, and Counseling: Critical and Integrative Perspectives


Edited by: Lisa Tsoi Hoshmand

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    Why another book on psychotherapy and counseling? How is culture treated differently here than in the growing literature on counseling the culturally different client? The impetus for this book comes from a desire to focus on what is lacking, and to address schisms in the field of psychotherapy and counseling. At a time when practitioners who are expected to work with time-efficient treatment modalities seem content with their chosen forms of practice so long as they are presumed to be helpful, many of us have continued to feel the need for thoughtful exploration of domains and issues that require attention from the profession.

    Due to the fact that much of our theoretical knowledge related to psychological practice is derived from the scientific discipline of psychology, psychotherapy and counseling is viewed as a science-based enterprise. There is a sense, however, that the emphasis on empirically validated treatment approaches and cost-efficiency, driven by reductionistic science and managed care, respectively, have taken away some of the holism and humaneness that we attribute to psychotherapeutic work and the counseling relationship. Furthermore, because of the prevailing scientific ideology, the discussion of moral and spiritual realms of human life has been especially lacking. This state of affairs has created tensions in the field, and posed problems for the practice of psychotherapy and counseling where human understanding, personal worldviews, and existential issues are especially relevant. Our integrity as psychotherapists and counseling professionals also depends on a congruity between our intellectual and moral commitments in the way we practice. Unfortunately, there has been limited allowance in academic discourse and professional education for discussing the integration of the personal and the professional. This has not been helpful to students and new professionals who have to define their orientation in a field with divergent philosophies, theories, and models of practice, and attempt some form of integration.

    In spite of increasing acknowledgment of the importance of culture in psychological theory and practice, the implications of culture have continued to be treated as an additional, sometimes only pragmatic, consideration rather than being central to human understanding. This tendency is troubling in view of the current social and political climate and the global escalation of cultural conflicts. When a significant part of the world is sensitive to cultural imperialism, the cultural underpinnings of Western psychology as well as the academic and therapeutic cultures of the profession should be subjected to reflexive, critical evaluation. This is more likely to happen if we would accept the dual nature of psychotherapy and counseling—as an enterprise that is both science-based and fundamentally cultural in nature. Questions of identity, what it means to be human, and how individuals and groups can find sustainable goods in cultural coexistence can then be considered in the broadest sense possible. When issues of psychological and social well-being are raised in contemporary life, with all its multiplicities and challenges, the sources of therapeutic understanding and the nature of this socially embedded enterprise require our in-depth examination. It seems evident that, in addition to the kinds of scientific research and criteria that have defined empirically supported treatments in recent times, a broader approach to accountability is indicated that considers the social and cultural validity of our practice while drawing on the experienced, local knowledge of practice.

    I have assembled for this book a group of authors who take the view that psychotherapeutic understanding involves more than theoretical knowledge or the research-tested knowledge associated with technologies of human change. This understanding of the other, while informed by our professional education and training, is conceived as a developmental understanding derived from practice experience and reflection on therapeutic encounters against the backdrop of cultural living. There is as much philosophical intention as there is psychological know-how involved in this process. The mutual expansion of horizons in a therapeutic encounter and counseling relationship also contributes reciprocally to the vision held by both practitioner and client of what constitutes healthy development and well-being. That is why I have asked the authors to share the understanding and vision of human possibilities that have evolved over time in their work. What we hope to offer are personal accounts of diverse pathways to psychotherapeutic understanding in the effort to integrate personal worldviews and existential stances with professional knowledge and practice experience. There is no set formula for the journey, other than achieving some degree of integrity through informed and reflective practice. Such integrity, in many instances, illuminates our existential striving for moral ways of being in our cultural living, and for holism in our work in a fundamentally cultural enterprise.

    This book is organized in three sections. In the first section, I introduce the framework for thinking broadly about culture in its multifaceted meanings and implications. I further discuss the centrality of culture to the field of psychotherapy and counseling, reviewing major developments and contributions, and addressing the topics of psychotherapy integration and evidence-based practice. In the second section, the personal accounts of our authors are presented on their reflections on and critique and integration of the field. Each chapter includes for illustration case examples from the authors' clinical practice and experience.

    In Chapter 3, John McLeod addresses the cultural resources and processes involved in psychotherapy and counseling from a narrative, meaning-oriented perspective. Chapter 4, by Doralee Grindler Katonah, provides a holistic view of human experience, based on Gendlin's experiential focusing-oriented approach to psychotherapy. These two chapters touch on the generic, cultural processes involved in psychotherapy and counseling. In Chapter 5, William Mikulas discusses the integration of world psychologies, including the Buddhist tradition with Western psychology. Chapter 6, by William Rezentes, presents Hawaiian psychology as an integration of Native Hawaiian concepts and practices of healing and Western psychology. Both chapters illustrate how Western psychology can be integrated with, and learn from, other cultural traditions. Chapter 7, by Dana Becker, provides a feminist, ecological view on psychological practice, including issues of diagnostic practice. Chapter 8, by Susan Gere, offers a woman's view of clinical trauma theory and therapy. These two chapters, in particular, emphasize sensitivity to gender, class, and macro systemic issues, requiring professionals to take a value stance. In Chapter 9, John Christopher further explores the moral dimension of psychotherapy from a hermeneutic perspective. This is followed in Chapter 10 by Del Loewenthal's discussion of issues of values and cultural conflict from a relational, existential perspective.

    The final section consists of a summary and discussion of what is learned from the contributed chapters and the perspectives of this group of psychotherapists and counseling educators. Collective themes and recommendations are highlighted. It is my hope that our work will stimulate conversation and reflection in the psychology profession and the related fields, toward a more comprehensive understanding of the cultural nature and implications of psychological theory and practice in the enterprise of psychotherapy and counseling.

    In a book that claims to provide critical perspectives on the field, I must also share two qualifications I have about the work presented here. One is that our collective voices would have been further strengthened by the inclusion of additional authors from diverse ethnic, cultural, and national backgrounds. Short of accomplishing this, I hope that colleagues from varied backgrounds and orientations will offer their opinion and critique of our work, and share them in their teaching and publication. The other concern I have is that we may not have addressed sufficiently the organizational and political context of the systems in which our authors have conducted their work as psychotherapists, counseling educators, and researchers. When clinical and relational values so often collide with institutional and political realities, the readers could benefit from knowing more about how professionals manage such tensions. Perhaps some of us will address this in our future work.


    I wish to express my gratitude to the authors for their willingness to be transparent about their worldviews, therapeutic stances, and personal convictions, and for sharing the insights from their professional work and life experience. It has been a privilege to collaborate with this exceptional group of colleagues. I also want to thank Arthur Pomponio, our editor, and the production and marketing staff at Sage Publications for endorsing and assisting with this project. This work has been partially supported by the sabbatical leave I was granted in the fall semester of 2004 by Lesley University, where my own perspectives on the field have further evolved with teaching and interactions with colleagues. While it is not possible to acknowledge everyone, I would like to mention Susan Gere, Joan Klagsbrun, and Rick Reinkraut, who have provided encouragement or input at different points of this project. I also want to thank my colleague and friend, George Howard, and others who have maintained an interest and enthusiasm for the work that I have chosen to undertake. Finally, I am grateful for my family whose love and hold on my humanity have continued to keep me grounded.

  • Author Index

    About the Editor

    Lisa Tsoi Hoshmand is Professor of Counseling and Psychology at Lesley University, Cambridge, Massachusetts. She is the author/editor of 3 books and over 40 other publications. Her recent work includes an edited book, Creativity and Moral Vision in Psychology: Narratives of Identity and Commitment in a Postmodern Age (Sage, 1998); an article “Narrative Psychology” in the Encyclopedia of Psychology (American Psychological Association and Oxford University Press, 2000); the book chapter “Psychotherapy as an Instrument of Culture” in Critical Issues in Psychotherapy (Sage, 2001); and an article “Narratology, Cultural Psychology, and Counseling Research” (Journal of Counseling Psychology, 2005, volume 52, issue 2). She has published and presented on cultural psychology, qualitative research methodology, clinical teaching, reflective practice, and transformative education. A Fellow of the American Psychological Association and a licensed psychologist, she has served on the editorial boards of a number of journals in counseling psychology, theoretical and philosophical psychology, and community psychology.

    About the Contributors

    Dana Becker, PhD, is Associate Professor of Social Work at the Bryn Mawr College Graduate School of Social Work and Social Research, Bryn Mawr, Pennsylvania. She has degrees in both social work and developmental psychology and has practiced as a feminist psychotherapist for over 20 years, specializing in both individual and family therapy. She has also served as clinical training director on a number of federally funded grants aimed at refining family therapy treatments for drug-abusing, inner-city youth and their families. She is the author of the books Through the Looking Glass: Women and Borderline Personality Disorder (Westview, 1997) and The Myth of Empowerment: Women and the Therapeutic Culture in America (New York University Press, 2005) as well as articles and book chapters focusing on family therapy, gender, and psychiatric diagnosis.

    John Chambers Christopher, PhD, is Professor of Counseling Psychology in the Department of Health and Human Development at Montana State University, Bozeman, Montana, and a senior staff psychologist at the MSU Counseling Center. He is the recipient of the 2003 Sigmund Koch Early Career Award by the Division of Theoretical and Philosophical Psychology of the American Psychological Association. He specializes in cultural psychology and theoretical and philosophical psychology. He has written on the cultural, moral, and ontological underpinnings of theories of psychological well-being, moral development, and psychotherapy. His primary interests are in using interactivism and philosophical hermeneutics to develop alternative conceptions of the self and of well-being and metatheories for psychological inquiry. His recent publications include Counseling's Inescapable Moral Visions, Situating Psychological Well-Being: Exploring the Cultural Roots of its Theory and Research, “Culture and Psychotherapy: Toward a Hermeneutic Approach,” “Moral Visions of Developmental Psychology, Culture and Character Education: Problems of Interpretation in a Multicultural Society,” and “Values and the Self: An Interactivist Foundation for Moral Development.”

    Susan H. Gere, PhD, is Associate Professor of Counseling and Psychology and Director of the Division of Counseling and Psychology at Lesley University, Cambridge, Massachusetts. Over the past 35 years, she has practiced, taught, consulted, and administered programs in the community and in graduate education. While continuously working with teaching and clinical practice, her most recent areas of interest are in psychological trauma and post trauma therapy and community consultation. Her scholarship includes work on understanding the role of clinical trainers with student trauma survivors, the aesthetics of clinical teaching, cultural identity issues of refugees and homeless women, and feminist pedagogy. She is the first author (with Hoshmand and Reinkraut) of the book chapter “Constructing the Sacred: Empathic Engagement, Aesthetic Regard and Discernment in Clinical Teaching” in Passion and Pedagogy (Peter Lang, 2002).

    Doralee Grindler Katonah, PsyD, MDiv, is a clinical psychologist with special interests in spirituality and health psychology. She is currently Associate Core Faculty at the Illinois School of Professional Psychology, and staff psychologist and faculty at Advocate Medical Group Center for Complementary Medicine, Park Ridge, Illinois. Dr. Grindler Katonah is also faculty and a certifying coordinator for The Focusing Institute in New York. She has taught Focusing for over 20 years, presented nationally and internationally, and conducted research on Focusing with people who have cancer. She was the first director of The Focusing Institute and has published in the area of Focusing and medicine. She especially enjoys bringing a Focusingoriented approach to deeper issues of personal and spiritual growth.

    Del Loewenthal, DPhil, is Chair of the Centre for Therapeutic Education in the School of Psychology and Therapeutic Studies at Roehampton University, London. A chartered psychologist in the United Kingdom, he originally trained as a psychotherapist with the Philadelphia Association founded by R. D. Laing. He is the editor of the European Journal of Psychotherapy, Counselling and Health (Routledge). He is the coauthor (with R. Snell) of the books Postmodernism for Psychotherapists (Brunner Routledge, 2003), and (with D. Winter) What Is Psychotherapeutic Research? (UKCP/Karnac, in press). The author of Case Studies in Relational Research (Palgrave Macmillan, in press), he has various publications on emotional learning and psychotherapeutic training.

    John McLeod, PhD, is Professor of Counselling at the University of Abertay Dundee, Scotland. His publications include Narrative and Psychotherapy (Sage, 1997), Qualitative Research in Counselling and Psychotherapy (Sage, 2001), An Introduction to Counselling (3rd ed., Open University Press, 2003), and The Handbook of Narrative and Psychotherapy (coedited with Lynne Angus, Sage, 2004). He is interested in the potential of qualitative inquiry as a means of generating knowledge that can inform the practice of psychotherapy, and in the role of counselling in relation to social inclusion, participation, and generativity.

    William L. Mikulas, PhD, is Professor of Psychology at the University of West Florida, where he has received many awards for research and teaching. He is also a permanent Visiting Professor at Chulalongkorn University in Thailand and an Honorary Professor at the University of Flores in Argentina. A leader in the integration of Eastern and Western psychologies, he belongs to several international organizations that are involved in such integrative efforts. He is the author of the book The Integrative Helper (Brooks/Cole, 2002), and has published numerous books and articles on psychotherapy and the integration of different healing traditions.

    William C. Rezentes III, PhD, is a practicing psychologist on O'ahu, Hawai'i. He specializes in transcultural therapy and research with Hawaiians. His work includes individual and family therapy, organizational consultation, research, writing, student mentoring, and community forums and workshops on Hawaiian psychology. He is also a Hawaiian musician, recording artist, and song and chant composer. He is the author of the book Ka Lama Kukui [Hawaiian Psychology]: An Introduction (‘A'ali'i Books, 1996), and several other publications on Native Hawaiian acculturation.

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