Nursing

PSYCHOANALYTIC APPLICATIONS IN A DIVERSE SOCIETY

Pratyusha Tummala-Narra, PhD Boston College

There is considerable tension within psychoanalysis regarding the place of social context in the individual’s inner life. In recent years, applications of psychoanalytic theory have extended to contexts outside of the therapeutic setting, and psychoanalytic scholars have increasingly attended to issues of race and culture within the therapeutic setting. The present article focuses on appli- cations of psychoanalytic theory in clinical and community contexts, with an emphasis on racial and cultural diversity. The author proposes an approach to clinical and community interventions that integrates multiple theoretical per- spectives (e.g., psychoanalytic, community, multicultural) to advance practitio- ners’ and consultants’ engagement with issues of diversity, and considers how practice with racially and culturally diverse populations can inform existing psychoanalytic theory. Two case examples, one from psychotherapy and the other from a community intervention, are presented to illustrate the ways in which psychoanalytic theory can benefit therapeutic work and consultation across sociocultural contexts. Implications of the experiences of minority indi- viduals and communities for psychoanalytic theory, research, practice, and education are discussed.

Keywords: psychoanalytic theory, community, race, culture

In his paper “Wild Psycho-Analysis,” Freud (1910) cautioned against the loose interpre- tation of psychoanalytic theory and technique, as he offered a glimpse into a broader usage of psychoanalytic ideas by those not formally trained as psychoanalysts. Inherent in his critique was a cautionary statement about the analyst’s interpretation of psychoanalytic ideas, and an emphasis on self-discovery by the client without the analyst’s imposition. The notion of loose interpretation of psychoanalytic ideas is complicated. On one hand, psychoanalysis itself has been interpreted differently in some important ways within different schools of thought, such as ego psychology, the British school of object relations, and relational psychoanalysis. If psychoanalysis were not subject to interpretation and

This article was published Online First February 4, 2013. Correspondence concerning this article should be addressed to Pratyusha Tummala-Narra,

PhD, Department of Counseling, Developmental and Educational Psychology, Boston College, 319 Campion Hall, 140 Commonwealth Avenue, Chestnut Hill, MA 02467. E-mail: tummalan@bc.edu

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

Psychoanalytic Psychology © 2013 American Psychological Association 2013, Vol. 30, No. 3, 471–487 0736-9735/13/$12.00 DOI: 10.1037/a0031375

471

modification, then these schools of thought would not have as much to offer as they do today. On the other hand, broader interpretations of psychoanalytic principles may still be experienced as precarious, particularly in the way that psychoanalytic ideas may be applied to understandings of diversity within clinical and nonclinical contexts (e.g., community-based interventions). In some cases, the integration of concepts from other perspectives, such as multicultural and community psychologies, in practice and consul- tation may be viewed as diluting psychoanalysis.

In a way, this dilemma concerning the looseness of interpretation raises questions about who decides what psychoanalysis should look like in theory and practice. I believe that this dilemma is especially relevant to contemporary times, as we have experienced unprecedented changes in demography in the United States and elsewhere, and global- ization characterized by rapid exchange of ideas through the media and Internet. This dilemma is also current in that psychoanalysis continues to face challenges to its scientific legitimacy, or at least the public awareness of this legitimacy, despite evidence for the effectiveness of psychoanalytic psychotherapy (Shedler, 2010). Additionally, questions about the elite status of psychoanalysis and its relevance to helping clients remain largely controversial.

This article addresses some important ways in which psychoanalysis can be interpreted through broader and more inclusive lens as a way of moving toward a more complete understanding of racial and cultural diversity across clinical and community applications. This type of reshaping departs from the ways that psychoanalysis and other Euro-American theories have historically been applied to racially and culturally diverse communities, either through neglect of issues of diversity or through over- simplified modifications of existing psychoanalytic ideas. An example of the latter is the application of the concept of Oedipus complex to non-Western cultures that lacks a consideration of indigenous narratives of family dynamics (Tang & Smith, 1996). This has essentially been a colonizing approach (Altman, 2010), rather than an approach that considers multiple subjectivities and indigenous narrative. From the perspective of a 1.5-generation Indian American (born in India and immigrated to the United States as a child) female psychologist, the present article considers a psycho- analytic perspective that interfaces with multicultural psychology and community psychology frameworks, with the aim of addressing the complexity of racial and ethnic diversity within individual- and community-level interventions, and of consid- ering how practice across settings (e.g., psychotherapy, community work) informs how social context can be addressed in psychoanalytic theory.

Contemporary psychoanalytic perspectives hold the potential for privileging individ- uals’ and communities’ subjective experiences over theoretical principles that have been defined under a cultural lens that either diverges from or devalues individuals and communities that vary in significant ways from mainstream cultural context. This ap- proach is not counter, in fact, to the way that Freud and his contemporaries engaged in extending the practice of psychoanalysis to individuals and communities who were marginalized along social class lines. Such efforts culminated in the establishment of free clinics in Vienna and other parts of Europe, where psychoanalysis was made accessible to students, laborers, factory workers, farmers, domestic servants, and several others who were unable to pay for their treatment (Danto, 2005). As Elizabeth Ann Danto (2005) recognized in her notable book, “Freud’s Free Clinics,” many early psychoanalysts, such as Erik Erikson, Melanie Klein, Anna Freud, and Eric Fromm, although known today for their theoretical revisions of Freud’s theories, saw themselves as “brokers of social change” (p. 4) who challenged political conventions of their time.

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

472 TUMMALA-NARRA

Psychoanalysis indeed has revolutionary roots, not to mention a history of persecution and exile. The history of exile that is part of the psychoanalytic movement in England and the United States has marked a retreat from these efforts centered on social justice. It is only recently that psychoanalysts have written about exile and its impact on the psychoanalytic movement outside of Europe (Danto, 2005). Just as this part of psychoanalytic history has been disavowed for decades, contemporary times demand that we reexamine history and social context and revisit the notion of social change when we conduct practice. In the following sections, I review recent developments in psychoanalytic theory concerning diversity, appli- cations of psychoanalytic theory in community intervention, and then describe two vignettes, one from psychoanalytic psychotherapy and one from a community intervention. This will be followed by a discussion of the applicability of psychoanalytic ideas across settings, and of how psychoanalytic theory can be informed by practice and consultation with racially and culturally diverse individuals and communities.

Psychoanalytic Theory and Attending to Diversity

Over the past 15 years, psychoanalysts, particularly those using the lens of object relations theory and relational psychoanalysis, have written about internal representations of gender, race, culture, sexual orientation, and social class. For example, scholars have described the importance of the therapist confronting his or her own feelings of the racial other in order to address cross-racial and similar-racial interactions effectively (Altman, 2010; Bonovitz, 2005; Leary, 2006, 2012; Yi, 1998). Emotional insight in psychotherapy, within their perspectives, lies in the conceptualization of therapeutic interaction as co-constructed by the therapist and client, and the ability to tolerate ambivalence, anxiety, sadness, guilt, and shame as negotiated within the therapeutic dyad. These perspectives emphasize attachment, separation, and related mourning as essential components of the individual’s growth process, where the client and the therapist are changed by virtue of relating to one another (Mitchell, 1988; Stolorow, 1988).

Psychoanalysts have also explored intrapsychic and interpersonal changes in the context of immigration. Akhtar (1999, 2011) described the many challenges of the mourning process for immigrants, including regression into earlier stages of development, culture shock and discontinuity of identity, disorganization, and a third separation- individuation process. Various aspects of immigrant adjustment and identity, such as bilingualism, pre- and postmigration character, challenges with acculturation, and the role of fantasy about country of origin and adoptive country, have been described in the psychoanalytic literature (Ainslie, 2009; Akhtar, 2011; Eng & Han, 2000; Foster, 2003; Tummala-Narra, 2009a). Additionally, in recent years, issues of spirituality (Aron, 2004; Roland, 1996; Tummala-Narra, 2009b), sexual orientation/identity, and gender identity (Drescher, 2007; Suchet, 2011) have been recognized as central to individual develop- ment. Indeed, there have been considerable advances in the psychoanalytic understanding of diversity within the context of the therapeutic relationship.

Psychoanalytic ideas on diversity have been further developed by scholars who would consider themselves as psychodynamic feminist thinkers. Scholars who integrate perspec- tives from psychoanalysis and multicultural psychology have approached psychoanalytic concepts such as culturally and racially based transference in the therapeutic relationship with an emphasis on the role of power, privilege, and social hierarchies in interpersonal and intrapsychic experience (Comas-Diaz, 2006; Greene, 2007; Tummala-Narra, 2007). These developments in psychoanalytic perspectives and diversity are largely influenced by

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

473PSYCHOANALYTIC APPLICATIONS

multicultural and feminist frameworks, which have been instrumental in raising awareness of the unique experiences of gender, racial, and cultural groups and related structural power dynamics inherent to mainstream society. The influence of multicultural psychol- ogy in particular is evident in research, practice, and training guidelines that emphasize psychologists’ awareness, knowledge, and skills in effectively working with individuals from diverse sociocultural backgrounds (Sue, 2001; Vasquez, 2007).

Psychoanalysis has the potential to provide depth and meaning to various aspects of diversity (e.g., race, culture, social class, sexual orientation, dis/ability) within the pro- fession of psychology. Indeed, psychoanalytic literature has increasingly recognized the need to attend to social context in the therapeutic dyad. For example, Flores (2007) noted the importance of “a mode of psychoanalytic listening” (p. 255) that involves the psychic and social aspects of the therapeutic dyad. The decontextualization of individual experi- ence in psychotherapy has been thought to be as a dissociative process that interferes with therapeutic work (Bodnar, 2004). Smith (2006) noted that psychoanalysts work with the specifics of clients’ intrapsychic lives, and, as such, the analyst should consider the specifics of experiences with diversity and how they shape the psyche. He further cautioned that we have to be in a position to recognize the specifics in order to “analyze what is manifest or infer what is unconscious” (p. 9). The alternative to this, of course, is to disavow relevant aspects of our clients’ and our own identities, and render these dimensions of the psyche invisible. Unfortunately, this has been the case for a good part of psychoanalytic history, as evidenced in Freud’s ambivalence toward and rejection of cultural specifics, reducing cultural dimensions to neurotic adaptation (Akhtar & Tum- mala-Narra, 2005; Altman, 2010).

Psychoanalytic Theory and Community Intervention

Psychoanalytic concepts have been increasingly applied in community-based interven- tions over the past decade. Some theorists have integrated concepts such as transference, enactments, defense mechanisms, and working through to understand their experiences of working with clients in community interventions (Borg, 2004; Darwin & Reich, 2006; Miller, 2008; Twemlow & Parens, 2006). Borg (2004) described a project with a low-income community in Los Angeles in the aftermath of the riots following the Rodney King verdict in 1992. In this account, he noted the shared emphasis on collaboration in community empowerment theory and interpersonal psychoanalysis, and emphasized the importance of addressing tensions related to conflicting points of view within this collaborative approach. Borg coined “community character,” which “reflects unconscious internalization” of patterns of behavior and unspoken rules that help the community cope with anxiety (p. 151). In the case of the riots in Los Angeles, he conceptualized the relational patterns of community residents as characterized by racial, ethnic, and gender stereotyping, and hostility toward outsiders, reflecting both actual relationships with significant others and the broader social context (Borg, 2004). Relatedly, King and Shelley (2008) drew connections between community psychology and psychoanalysis, highlight- ing Adler’s (1966) valuing of social context and community feeling as essential to the individual’s adjustment to communal life.

Twemlow and Parens (2006) further described the overlap between psychoanalysis and community psychology, including the use of a developmental perspective, respecting and privileging all sides of conflict in the working through process, the importance of holding and containing, appreciation of subjectivity, and assessing for a sufficient level of

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

474 TUMMALA-NARRA

anxiety to motivate change. They suggested that psychoanalytic knowledge is critical for community-based work and advocated for an actively supportive community psychoan- alytic method with less emphasis on interpretation. This approach (Twemlow & Parens, 2006; Volkan, 2001) involves several features: establishing a point of similarity between participants allowing for tolerance of differences and negative emotions; collaboration, developing personal relationships such that the process becomes humanized; establishing mutual respect for differences that can trigger racial, religious, gender, and ethnic stereotypes; developing a common language for better communication; accepting that the process requires ongoing maintenance; understanding that collaborative nonblaming pro- motes change; and the adoption of a neutral position of the facilitator who encourages mutual problem solving. Such an approach may pose challenges to the psychoanalytic practitioner’s sense of identity, as it requires an integration of multiple theoretical perspectives in a nonclinical context.

Several psychoanalytic practitioners have written about how their experiences of working in community settings, many of which suffered considerable trauma, raised questions about their psychoanalytic identity. For example, Miller (2008) described his experience working with a New York City firehouse in the aftermath of severe loss at the World Trade Center on September 11, 2001. In his account, Miller recognized his role as requiring flexibility to best suit the needs of the community. In one example, he noted potentially conflicting roles, as he questioned whether his identification with the trauma- tized members of the community interfered with his sense of neutrality. In a different account, Granatir (2004) described how his personal experience as a Jew and minority helped him identify with and relate to boys and girls in a school-based program in Washington, D.C. He noted how his training as an analyst prepared him to listen with openness, curiosity, and acceptance of differences across people. In each of these exam- ples, psychoanalytic practitioners point to the ways in which their personal and profes- sional identities expanded through their efforts with integrating psychoanalytic perspec- tives beyond the clinical setting.

Liang, Tummala-Narra, and West (2011) reviewed several psychoanalytic concepts, such as intersubjectivity, transference, enactments, and the role of affect, as highly relevant to community based interventions. They encourage all practitioners and consul- tants involved in community-based work to actively integrate a psychodynamic under- standing of interpersonal aspects of interventions, including racial and cultural conflicts, with a collaborative approach that fosters empowerment and meaningful change. In this perspective, psychoanalytic theory approaches the study of power and social injustice with complexity and multidimensionality, such that community collaborators (e.g., consultants and community members) can more effectively address individual, group, and environ- mental stress.

Interestingly, although recent psychoanalytic applications in community interventions have raised interest in how best to conceptualize group dynamics in the community setting from a psychoanalytic perspective, few scholars have addressed how community-based work may better inform an understanding of social context within psychoanalysis more broadly (Twemlow & Parens, 2006; Twemlow, Fonagy, Sacco, Vernberg, & Malcolm, 2011). In the following sections, I describe two case vignettes that include components of my work in a psychoanalytically oriented psychotherapy and a community based inter- vention, both focusing on racial and cultural dynamics. These vignettes are presented with the purpose of (a) illustrating potential applications of psychoanalytic concepts and an integration of multicultural and community psychologies in addressing racial and cultural dynamics in two distinct settings, and (b) considering the implications of therapeutic

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

475PSYCHOANALYTIC APPLICATIONS

practice and community consultation with racial and ethnic minority clients for psycho- analytic theory and identity.

Case Example: Psychoanalytic Psychotherapy With “Reena”

“Reena” is a 30-year-old Hindu, Indian American woman, born and raised in the northeastern part of the United States. She works full time and sought psychotherapy to cope with her increasing anxiety at work. She was referred to me by her primary care physician. She had never previously worked with a psychotherapist. I worked with Reena in weekly psychotherapy for approximately 3 years.

Reena’s parents immigrated to the United States from a northern region of India in the late 1970s, during a time of mounting violence between Hindus and Muslims in the region. Her parents spoke little English and worked in a family business when they first arrived in the United States. Reena has a younger sister with whom she feels close. She described her childhood as feeling “hectic,” with her parents working most of the time and her relatives (aunts, uncles at varying times) taking care of her and her sister. She stated that this experience was mixed in that she felt safe when her parents were there and most of the time with her relatives. However, she did recall that between ages 5 and 8 years, she periodically witnessed her maternal uncle physically abuse his wife, during times when they were babysitting her and her sister. She did not tell her parents about these incidents, as she did not want to upset them and felt as though there was not another alternative. In one session, she told me that she felt scared during these times, especially for her aunt.

Reena spoke in Hindi primarily at home, and in English outside of the home. She and her sister would often translate for their parents outside the home. She recalled this experience as a generally good one in that she felt that she was contributing to her family and that her parents appreciated her help. The family’s visits to India were infrequent, due to limited financial resources. Reena was encouraged to excel academically and took on this role as a shared dream with her parents. She completed her graduate education and feels that she has fulfilled her wishes as well as that of her parents. Reena reported having a closer relationship with her mother than her father, and that she felt sorry for her mother, who carried the burden of working outside the home and taking care of children at home. She stated, “It’s like she never had a break until we left home.” At the time that I met Reena, she had been living far away from her parents’ home, and maintained frequent contact with them by phone and e-mail.

Reena’s school experiences were characterized by considerable anxiety. She recalled having few friends in her school and mostly interacted with friends in her neighborhood. Most of the children in her school (elementary through high school) were from middle- class White European American backgrounds. Reena recalled being teased because of her Hindu background, her brown skin color, and for wearing her hair in a braid and a bindi (dot) on her forehead when she was in elementary school. As she entered middle school, she told her parents that she no longer wanted to wear the bindi. Difference at school, more generally, was considered to be bad. Reena recalled an experience in high school where a Sikh boy was teased to a point when his parents moved to a different school district. She remembered feeling afraid of being seen as different and, at the same time, angry about what had happened to this boy. Reena began to hide her Indian identity when she was around her non-Indian friends in high school, and found partial success in doing this. She felt that she was more included by others, and yet, felt that her Indian and

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

476 TUMMALA-NARRA

American worlds were disconnected. In college, she began dating men whom she never introduced to her parents. In fact, she worked hard to keep these relationships a secret from them.

In her late twenties, Reena began to feel pressured by her parents to marry an Indian American man. When I met her, Reena had been dating a White American man who was of Italian and French heritage for about 1 year, and she felt increasingly anxious about her intimacy with him. This fear was in part related to her memories of her abusive uncle, and in part to her concerns about racial and cultural differences. She worried about the difference in their cultural background and further separating from speaking in Hindi. However, she felt somewhat more comfortable with his working-class background, as it resembled her own social class background growing up. At the same time, she was upset about what she experienced as racist attitudes of his parents. In one incident, when she went out for dinner with his family, his father made derogatory statements about African Americans. Reena was taken aback and wondered about how he felt about her racial background and her brown skin color. Although she felt as though she loved her boyfriend, she remained cautious about their relationship. She found herself increasingly worried at her workplace as well, having thoughts about others viewing her as inferior in some way. Her concerns at her workplace were especially salient when some coworkers commented on how “exotic” she looked, which she experienced as derogatory.

In psychotherapy, Reena and I worked on better understanding her anxiety both within and outside of the therapeutic relationship. She asked me on two different occasions if I felt that her contact with her parents was too frequent. She spoke with them twice a week by phone and e-mailed them twice a week. I asked her if she enjoyed talking with her parents. She said “Yes, it’s important to me that I talk with them.” When we talked about her questioning herself, she expressed that most of her friends who are not Indian told her that she was too dependent on her parents. I believe that it was important for her to hear that it is fine to talk with her parents as much as she wanted and to be able to speak in Hindi with them. Early in our work, we began to challenge some of these assumptions that were based on Western, European American ideas about parent–child relationships, about which she felt ambivalent.

As our work progressed, Reena expressed concern that I would not approve of her relationship with a non-Indian man, especially one that comes from a “racist family.” In one session, she stated, “You’re probably thinking about why I’m with this guy. I don’t know that I really understand.” When I asked her to say more about what she was imagining about my response, she said, “I don’t know if you would think this is ok, I mean to be with someone not Indian. You are probably married to someone Indian. I’ve wondered about this. Then, I wonder what it will be like to tell my parents, when I don’t even know if I want to be with him.” I responded, “What would it be like for you if I was married to an Indian man?” She stated, “Well, it would be good, I guess. You would be doing all the right things, you know being a professional and marrying the right type of person, bring a good Indian woman.” We went on to explore the “right type of Indian woman” and her feelings of difference from me. Difference was also apparent in the contrast between Reena’s light brown skin tone and my darker brown skin tone. Through our discussions of our skin color differences, Reena understood her fantasy of me being married to an Indian man as reflecting her association between darker skin color and a stronger Indian identification. These discussions about skin color provoked anxiety for both of us, as we had each brought to our interaction complicated histories with race and skin color as Indian American women. For example, Reena felt unsure about what her relationship with her boyfriend and his family would mean for her own racial identity

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

477PSYCHOANALYTIC APPLICATIONS

development, specifically that her racial minority status and her experiences with discrim- ination would be invisible to them. Memories of my own experiences with racial and skin color discrimination outside of the Indian American community and within the Indian American community, respectively, were elicited while working with Reena. As I identify with a bicultural Indian American orientation and as a person of color in the United States, I recognized that I shared some of Reena’s experiences and, at the same time, wanted to help her become more aware of the conscious and unconscious meanings accompanying her experiences with race and ethnicity. Attending to our differences in skin color facilitated an exploration of authenticity as Indian origin women and a sense of belonging within and outside of the Indian American community (Tummala-Narra, 2007).

We further struggled with difference and similarity as Reena later revealed that she felt as though I could understand her Indian American and Hindu backgrounds, but perhaps not her working-class background. Reena imagined that our shared cultural experience was disrupted by the possibility that I am married to an Indian man. I was also aware of the absence of the Hindi language in our work, another point of separation for us. Some of my countertransferential reactions included feeling rejected by her, as I felt that she had not seen my experiences with social class. I immigrated to the United States as a child and experienced shifts across social class throughout my life. Somehow, in our interactions, Reena had not recognized this part of my life and it disappointed me. Perhaps, I, too, felt distant from her and my own past in these moments. Like Reena, I had struggled with separation from my parents and acculturating to the Western cultural context. At the same time, I recognized that we were both experiencing ambivalence about our relatively privileged positions, with cultural identifications, and separation from parents. My expe- rience was invisible to her, as hers was invisible to her parents, her peers in school, and her boyfriend and his family. Our work evoked questions about the position of the therapist or analyst whose multiple identities are both seen and unseen by the client.

In the course of our work together, we increasingly talked about her experience of hiding aspects of her life from important people in her life (e.g., parents, boyfriend) and the experience of talking about these “hidden parts” with me. This discussion of her social context and identity, particularly with respect to culture, race, gender, and social class, helped to create a space in which Reena could more fully explore her racial and cultural identities, an essential component of her conflicts with intimacy with family members, friends, and boyfriend.

Case Example: Community Intervention

As a coordinator for a community-based outreach project in a large city in the northeastern part of the United States, I was asked by an administrator in an urban middle school to help develop psychoeducational group meetings in an afterschool program. The staff and majority of the students at the middle school are African American, and the rest of the students are of Latino or multiracial backgrounds. The staff at the afterschool program had been increasingly concerned about students’ exposure to violence in their neighborhoods. Many of the staff members recognized the stress experienced by the students, particularly a few boys who verbally expressed their anger after witnessing two men mugging a young woman. My colleague, a White American woman, and I arranged a meeting with the staff of the afterschool program.

At this initial meeting with the staff, my colleague and I learned that this type of incident was a relatively common experience for many students and that traumatic

T hi

s do

cu m

en t

is co

py ri

gh te

d by

th e

A m

er ic

an Ps

yc ho

lo gi

ca l

A ss

oc ia

tio n

or on

e of

its al

lie d

pu bl

is he

rs .

T hi

s ar

tic le

is in

te nd

ed so

le ly

fo r

th e

pe rs

on al

us e

of th

e in

di vi

du al

us er

an d

is no

t to

be di

ss em

in at

ed br

oa dl

y.

478 TUMMALA-NARRA

experiences were typically not talked about in the family or at school. The staff hoped to find ways to address students’ exposure to violence at a weekly discussion group focused on health topics (physical and emotional), which the students were required to attend. During our meeting, an African American staff member also expressed concern about the ability of “doctors from a predominantly White institution” to relate to the concerns of the school, students, and community. When I heard this staff member’s response, I was moved by her honesty and, at the same time, felt as though she had not noticed my race or ethnicity. It was as though she was solely responding to my White colleague, who was silent through most of the meeting. I acknowledged to the staff that my institution was predominantly White and asked them to provide more detail about their concerns. A different staff member stated, “We really want to make sure that you all understand the community here, and what our kids go through and what is realistic for them.” Other staff members agreed and joined in voicing their concerns about our approach to the afterschool program. It was clear that the staff were understandably protective of the students’ welfare and cautious about any negative outside influence that would further stress the students. The staff’s concerns reflected previous experiences with health care professionals who had disappointed the school community. One example of this was raised by a staff member who stated, “I’m worried about how many of our boys have the label ADHD, and the parents are just told to give them medicine. Some of these boys just need someone to talk to, not all of these drugs, but this is what the doctors tell them to do.” As the staff discussed their concerns, I was aware that many of staff and students had previously experienced institutional racism, and aware of the cultural mistrust toward me, possibly because of a concern that I may have internalized the oppressive culture of these institutions and toward my colleague, who may have been experienced as representing institutions that have discriminated against African Americans and other ethnic minorities. Toward the end of our first meeting, my colleague and I thanked the staff for sharing their concerns, and we requested several more meetings prior to starting the discussion groups with the students in the afterschool program. We felt that this was necessary to establish a collaboration to develop an adequate intervention.

While driving back to our office, I asked my colleague why she had remained silent through this meeting. She shared with me that she felt overwhelmed by a sense of sadness and guilt, and worried that she would enact the situation that the staff and she feared by “taking over” the meeting by talking. She chose to stay silent to cope with feeling simultaneously like an outsider and oppressor. I told her that, interestingly, I felt like an outsider because my race and ethnicity were treated as irrelevant or invisible, and that racial difference had been conceptualized around Black–White lines, as they typically are in mainstream American society. My colleague stated that she felt surprised by my reaction and that she had seen me as an insider because of my Indian background. Indeed, the consultants had felt “othered,” and, at the same time, we wondered whether we had “othered” the staff in some way. We were also aware of being outside of the comfort zone of our offices and potentially imposing ourselves at the school. It was clear that my colleague’s feelings of White guilt and my feelings of invisibility, which were connected with long-standing racial dynamics concerning Black–White lines and the ambivalent position of race and racial identity among Indian Americans (Tummala-Narra, Inman, & Ettigi, 2011), contributing to racial dynamics among professionals from African Ameri- can, Indian American, White American backgrounds that are typically unexplored.

Order now and get 10% discount on all orders above $50 now!!The professional are ready and willing handle your assignment.

ORDER NOW »»