2004 Advanced Study Institute

June 3 and 4, 2004

Culture and Psychotherapy in a Creolizing World

"I call creolization the meeting, interference, shock, harmonies and disharmonies between the cultures of the world... [it] has the following characteristics: the lightening speed of interaction among its elements; the awareness of awareness: thus provoked in us; the reevaluation of the various elements brought into contact (for creolization has no presupposed scale of values); unforeseeable results. Creolization is not a simple cross breeding that would produce easily anticipated results." (Edouard Glissant, 1998).

The practice of psychotherapy depends on a fund of tacit knowledge shared by patient and clinician. Intercultural work in psychotherapy challenges this shared assumptive world and poses problems of translation and positioning: of working across and between systems of meaning and structures of power that underpin the therapeutic alliance and processes of change. Once viewed as self-contained communal worlds of meaning, cultural worlds are now shaped by forced migration, globalization, hybridization, and the rapid creation and destruction of local worlds of meaning. This conference will explore the implications of these new dynamics of culture for psychotherapy. An international faculty will address basic issues related to the theory and practice of psychotherapy and related forms of interpersonal and symbolic healing in a wide range of social and cultural contexts. The meeting will address three themes: (1) the universal and the particular in psychotherapy; (2) alterity and identity in the therapeutic encounter; and (3) practical strategies for intercultural work.

Guest faculty include: Gadi BenEzer, Gilles Bibeau, Sushrut Jadhav, Sudhir Kakar, Ravi Kapur, Inga Britt Krause, Myrna Lashley, Roland Littlewood, Yemi Oloyede. Antti Pakaslahti, Richard Rechtman, Carlo Sterlin, Lennox Thomas.

McGill faculty: Ellen Corin, Jaswant Guzder, Laurence Kirmayer, Toby Measham, Lucie Nadeau, Cécile Rousseau.

Dates: June 3 & 4, 2004 (12 hours) Th & F, 08h30-17h00

Reception: June 3, Th; 1700h-19h00

Location: Institute of Community and Family Psychiatry 4333 Cote Ste-Catherine Road, Montreal (Quebec)

More information on the Summer Program in Social & Cultural Psychiatry can be found here.


Culture and Psychotherapy in a Creolizing World

Thursday June 3 AM

The universal and the particular in psychological intervention

8:30-9:00 Introduction: Culture in a creolizing world Laurence Kirmayer

9:00-9:25 Plato's cave: On the techniques of traditional healers and some Western reflections. An ethnopsychotherapeutic study from India Antti Pakaslahti

9:25-10:15 Film: Family treatmentbya traditional healer in India: A case study (Antti Pakashlahti)

10:15-10:45 Break

10:45-11:30 Some Timeless Principles of Psychotherapy: Lessons From Indian Spiritual and Philosophical Traditions Ravi Kapur

11:30-12:30 Panel Discussion: Laurence Kirmayer (Chair) Sushrut Jadhav, Sudhir Kakar, Ravi Kapur, Antti Pakaslahti


Thursday, June 3 PM

Alterity and psychotherapy

2:00-2:30 Introduction: Alterity in psychiatry and psychotherapy Ellen Corin

2:30-3:15 Culture in psychoanalytic psychotherapy Sudhir Kakar

3:15-4:00 The racialisation of transference and countertransference Lennox Thomas

4:00-4:15 Break

4:15-5:00 Counter-transference to overseas doctors in the UK Roland Littlewood

5:00-6:00 Panel Discussion: Ellen Corin (Chair), Sudhir Kakar, Roland Littlewood, Lennox Thomas

6:00 7:30 PM Reception


Friday, June 4

Strategies for Intercultural Work

8:30- 9:00 Introduction Ccile Rousseau

9:00-9:45 Mutual creative space": A principle for intercultural psychotherapeutic work - Gadi BenEzer

9:45-10:30 Accessing Hidden Points of View: The Implications for Ethnography and Cross-Cultural Systemic Psychotherapy - Inga Britt Krause

10:30-10:45 Break

10:45-11:30 Cultural standards, power and subversion in cross-cultural psychotherapy Richard Rechtman

11:30-12:30 Panel Discussion: Ccile Rousseau (Chair), Gadi BenEzer, Inga Britt Krause, Richard Rechtman

12:30 2:00 Lunch

2:00-2:30 Introduction Sushrut Jadhav

2:30-3:00 Discourse and Dialogue in Indigenous contexts: Language of and Language in Therapy Radhika Santhanam

3:00-3:30 Psychotherapy with rape victims from Albania - Yemi Oloyede

3:30-4:30 Panel Discussion: Reflections on culture and psychotherapy Chair: Sushrut Jadhav, Gadi BenEzer, Ellen Corin, Jaswant Guzder, Sudhir Kakar, Ravi Kapur, Inga Britt Krause, Yemi Oloyede, Richard Rechtman, Radhika Santhanam, LennoxThomas


Mutual Creative Space: A Principle for Inter-Cultural Psychotherapeutic Work Gadi BenEzer, PhD

Can a patient and therapist have a meaningful and effective psychotherapeutic encounter in a cross-cultural setting when they do not share the same worldview? Is psychotherapy possible in a cross-cultural context? The present paper explores this question, focusing on inter-cultural psychotherapy with Ethiopian immigrants in Israel. In the first part the Ethiopian cultural code of coping is presented and the way it is expressed in the therapeutic situation is explored. This is compared with the way the Israeli therapist defines adaptive coping and the way s/he perceives the therapeutic situation. In the second part communication patterns of both cultures are discussed and the ensuing problem of cross-cultural communication in psychotherapy is examined. Finally, a principle, which I have termed mutual creative space, is suggested as a means for solving the problem and rising up to the challenge of inter-cultural psychotherapy. Examples of how it could be used in the therapeutic situation, including working with dreams in that setting, will round this paper up.


Some Timeless Principles of Psychotherapy: Lessons from Indian Spiritual and Philosophical Traditions R.L.Kapur

Over the years cultural factors have more and more been emphasized in the practice of psychotherapy. Contributions form the discipline of social anthropology which have demonstrated differences in the way the children grow up in various societies, the way the people interact, the values regarding healthy and unhealthy behavior, the communication patterns and the nature of conflicts have been important in highlighting the role of these factors However, it seems that the influence of cultural differences has been overemphasized lately to such an extent that a therapist from one culture has often been considered unsuitable for working with person from other culture. While it is useful to understand the cultural issues in psychotherapeutic work, we should not forget that there are a lot of commonalities between different societies, if for no other reason than that we share a common biological heritage and that people across cultures show a similar range of emotional reactivity to situations of stress. One has only to read the Epics and Literary Classics from different cultures and from different historical times to realize how similar is the nature of major conflicts and the existential problems they cause. Indian civilization is an old one and has perhaps developed methods of coping with these problems to a greater extent than the civilizations, which are relatively younger. Further, such has been the history of cultural commingling in this subcontinent that creolisation has been seen more times than one can count. Could one then take some lessons from the philosophical and spiritual traditions of the Indian civilization to deal with the conflicts produced by the meeting, interference, shock, harmonies and disharmonies between the cultures of the world. of which Edourd Glissant talks about? Could one a take inspiration from Jung who in one of his writings, could not help saying, "the psychotherapist who is seriously concerned with the question of the aim of the therapy cannot remain unmoved when he sees (that) this question has occupied minds of the East for more than 2000 years and in this respect methods and philosophical doctrines have been developed which simply put all Western attempts along these lines into shade"? Psychotherapy is an art, which one learns, like other arts, through apprenticeship. It is more than likely that what might emerge in the presentation will not be a series of concepts but half formed images and stories that have shaped the authors maturing as a therapist under the tutelage of his teachers and patients as well as his work the folk healers and the Sanyasis of India.


Accessing Hidden Points of View: Implications for Ethnography and Cross-Cultural Systemic Psychotherapy Inga-Britt Krause PhD

This paper will explore connections and shared agendas between ethnography and systemic psychotherapy. It will take its starting point in a examination of the 1936 epilogue to Naven, Batesons most famous anthropological study. It will argue that for the development of methods in ethnography and in systemic psychotherapy, Naven contains the beginnings of a research methodology based on the relational subject. With the direction taken in the 1958 epilogue to Naven the significance of these earlier insights for the relationship between ethnographers and their subjects on the one hand and systemic psychotherapists and their clients on the other, were lost in the two disciplines. This was so for different reasons. The paper will develop this argument and show that in both disciplines research methods and methodology are political and ethical issues central to the development of equitable practice.


Counter-Transference and Two Sexually Abusing Overseas Doctors Roland Littlewood

Personal reactions are inevitable when one's patient convincingly acknowledges they have committed major sexual violence. In the case of two foreign doctors who told me in therapy about their widespread rape of vulnerable women patients, these reactions inevitably become compounded by one's own social perceptions, including implicit racism. The inter-relationship of a therapist's psychological reactions to sexual violence with those to 'alien' status are discussed.


Psychotherapy with Rape Victims from Albania Yemi Oloyede

One of the documented forms of war crime is sexual violence and many such crimes were reported in Kosovo, during the Balkans conflict, notably amongst them rape of women by members of the occupying Serb Army and the police. In Kosovo, when a woman is raped, she is not only a victim of that act but also a victim of beliefs and customs in the community. This can result in her becoming an outcast. For women who had the opportunity to flee the war and move to another country, life does not seem to be so kind in helping them forget about the rape. For many, however, the scars left by the rape seem to be less of a problem than the sanctions they fear if the rape was disclosed due to the cultural and religious meanings their families and communities would give the event. This presentation will look at the effects of being a social outcast and social misnomer after the experience of rape and the role of culture and religion in the survival of refugee women outside their country of origin.


Plato's cave: Techniques of traditional healers and some Western reflections. An ethnopsychotherapeutic study from India Antti Pakaslahti

There is considerable evidence from the Indian subcontinent that rural and urban community-based healers and healing shrines offer help for mental suffering. There are many unanswered questions about such traditional practices that enjoy not only viability but in some places ascendant esteem among help seekers. This study is based on empirical research on healers and their clients at the healing shrines in Balaji, Rajasthan. The research was conducted on 10 visits up to 2002. Data consists of field notes together with extensive audio and video recordings. These were initially transcribed into a Hindi "oral text", and subsequently analysed for both process and content. At Balaji, mental suffering is helped through the cultural idiom of spirit illness with family and group oriented therapeutic interventions. The results reveal that these are associated with intricate cultural logic and systemic causality. The author argues that an empirical clinical study of how healers operate in a particular setting contributes new elements to understanding of the 'universal' in psychological healing. The study also suggests a need for revision of existing 'western' interpretation about spirits, possession, exorcism, and trance, in order to more accurately reflect local cultural reality.


Discourse and Dialogue in Indigenous contexts: Language of and Language in Therapy Radhika Santhanam

Discourse in therapeutic settings reflects both hidden and explicit relationships between language and power. In this talk I will explore aspects of therapeutic discourse and dialogue in Indigenous contexts. The way clinicians position themselves in the dominant discourse will shape not just the way languages are used in therapy, but crucially the language of therapythat is, the pragmatic, social, interpersonal and emotional dimensions of speech that help us construct narratives about ourselves and others. The unpredictable nature of engagement in working across 'difference' and working with 'otherness' determines how and whether issues of inequality and inequity get challenged in therapies.


Gadi BenEzer, Ph.D., is Senior Lecturer in Psychology and Anthropology, Department of Behavioral Sciences, College of Management, Tel Aviv, Israel.

Ellen Corin, Ph.D., Associate Professor, Departments of Anthropology and Psychiatry, McGill University; Researcher, Psychosocial Research Division, Douglas Hospital Research Centre.

Jaswant Guzder, M.D.,Associate Professor, Department of Psychiatry, McGill University; Director, Child Psychiatry; Sir Mortimer B. DavisJewish General Hospital.

Sushrut Jadhav MBBS, MD, MRCPsych., PhD, is Senior Lecturer in Cross-cultural Psychiatry, University College London. Hon. Consultant Psychiatrist, Psychiatric Intensive Care Unit, St. Pancras Hospital, London, Editor, Anthropology & Medicine.

Sudhir Kakar, Ph.D.,, is a psychoanalyst and author who lives and practices in India. He is the author of numerous works including: The Inner World (Oxford); Shamans, Mystics and Doctors: A Psychological Inquiry into India and Its Healing Traditions (Chicago);, and The Analyst and the Mystic: Psychoanalytic Reflections on Religion and Mysticism. Oxford University Press has recently published, The Essential Writings of Sudhir Kakar.

Ravi Kapur, M.D., Ph.D., is Professor Emeritus at the National Institute of Advanced Studies 9in Bangalore, India. He has a Ph.D in Psychiatry from the University of Edinburgh and is a Fellow of the Royal College of Psychiatrists in United Kingdom. He is also a Fellow of the Indian Academy of Sciences and the Indian National Academy of Medical Sciences. After studying in UK, with Professor G.M. Carstairs of Edinburgh University, he spent 4-years in rural Karnataka, India, researching the patterns of mental disorder. This work was later published in The Great Universe of Kota (Hogarth Press). As Professor of Community Psychiatry and the Head of the Department of Psychiatry (1974-1983) at the National Institute of Mental Health and Neurosciences, Bangalore, he pioneered the community mental health movement in India. Currently, he is involved in a study of Sanyasis and Sadhus who live high up in Himalayas, in collaboration with Ellen Corin of McGill and Gilles Bibeau of the University of Montreal.

Laurence J. Kirmayer, M.D., is James McGill Professor and Director, Division of Social and Transcultural Psychiatry, McGill University. He is Editor-in-Chief of Transcultural Psychiatry; and Director of the Culture and Mental Health Research Unit, Sir Mortimer B. DavisJewish General Hospital, where he conducts research on Aboriginal mental health, cultural consultation and the role of metaphor in psychiatric theory and practice.

Ingra Britt Krause, Ph.D., is a Social Anthropologist and a Systemic Psychotherapist. She studied Social Anthropology at the London School of Economics and has carried out fieldwork amongst High Caste Hindus in Nepal and as a Medical Anthropologist with Punjabi Sikhs in Britain. She has trained in Systemic Psychotherapy at the University of London and has practiced in the NHS in London for 13 years. During this time she has set up specialist services for Asian client populations. She is currently Training & Development Consultant with respect to Race & Equity at the Tavistock Clinic. Her publications include Therapy Across Culture (Sage 1998) and Culture & System in Family Therapy (Karnac Books 2002).

Roland Littlewood, M.B., D.Phil., D.Lit, F.R.C.Psych is Professor of Anthropology and Psychiatry, University College London and Director of the UCL Medical Anthropology Centre. He has done fieldwork in Trinidad, Albania, Haiti, Lebanon and Italy. He is the author of seven books and over150 papers. His most recent books are: Religion, Agency and Restitution (Oxford University Press, 2001) and Pathologies of the West: An Anthropology of Mental Illness in Europe and America (Ithaca: Cornell University Press, 2002).

Yemi Oloyede, Ph.D., is a psychotherapist and Service Manager at the Central and North West London Mental Health NHS Trust Refugee Support Service. She is also an Associate of the Medical Anthropology Centre, University College London.

Antti Pakaslahti, M.D., Ph.D., is Docent of Psychiatry, Department of Psychiatry, University of Oulu, Finland. He is a licensed psychotherapist and advisor on mental health issues for Ministry of Justice. He conducts research on schizophrenia, psychosomatic medicine and transcultural psychiatry and is particularly interested in visual documentation in transcultural psychiatry. From 1998-2002, he was a member of the WPA Transcultural Section Committee and he is currently Chairman of the Transcultural Section of the Psychiatric Association of Finland.

Richard Rechtman, M.D., is a psychiatrist and anthropologist, CESAMES (CNRS, Universit Paris V) & Editor-in-Chief, lEvolution Psychiatrique, Paris.

Ccile Rousseau, M.D., M.Sc., Associate Professor, Department of Psychiatry, McGill University & Director, Transcultural Clinic, Montreal Childrens Hospital.

Radhika Santhanam, Ph.D., is a clinical psychologist working with Indigenous families, communities and service providers in Far North Queensland. She is also a Senior Lecturer with the School of Population Health at the University of Queensland. The overarching theme for her clinical and research work team is 'empowerment' and with colleagues she is studying the 'control' factor in social determinants of health. Her participatory action research focuses on the evaluation of child and youth mental health service delivery models.

Lennox K. Thomas, Ph.D., is a psychoanalyst and former director of Nafsiyat, London, an anti-racist mental health service founded by Jafar Kareem, offering psychodynamic psychotherapy.

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