Abstract
On a recent holiday in India, I (R.S.) took my 10-year-old son to visit the Taj Mahal. We were accompanied by two of my friends – one a middle-aged gay Asian man and the other an older Asian, heterosexual woman. We were followed around by a photographer, who insisted on taking a ‘family photograph’. He was convinced that my gay friend and I were a couple and that my female friend was an aunty or grandma. Although we could easily have been mistaken for a three generational family anywhere in the world, I was curious about the photographer’s readiness to cast us in those roles. He was focusing on interdependence and relatedness and thus constructing only familial relationships. He was assuming that platonic relationships between men and women did not exist and that everybody is heterosexual and has children.
We all carry templates, based on our cultural, societal and idiosyncratic experiences of what it means to be a family. When these assumptions are unchecked, we run the risk of imposing our world views on the clients we work with. Recently, when working with an English, middle-class family, I (R.S.) was surprised by the way in which the daughter-in-law spoke to her mother-in-law, which I experienced as disrespectful. It was only through examining my own culturally based ideas about relationships with extended family that I was able (more helpfully) to reframe the daughter-in-law’s anger as ‘speaking up courageously on behalf of the rest of the family’.
It is a difficult time to belong to a minority ethnic group, and as a South Asian migrant, I (R.S.) am keenly aware of recent attitudes towards migrants, of Islamophobia, racism and prejudice. How does one live and work in London’s multicultural society when multiculturalism has become a bad word? How can we provide robust clinical services that cater to the different levels of difference that our clients present? How can we hold the different levels of difference, and their intersectionality in mind, so that we are not merely paying lip service to the social GRRAAACCEEESSS 1 (Burnham, 2012) but are prepared to embrace the complexity of difference?
Eileen Munro (2010) has critiqued a ‘technocratic’ view of practice that has become prevalent in public services according to which we make use of techniques we have learnt to analyse and solve problems, rather than it being ‘the individuals involved and how they work together’ (p. 16) and the relationships involved in this that are important. An ‘evidence base’ has developed of models of working which seems to suggest that such techniques will work for all clinicians, with all populations and in all contexts, providing that we remain ‘model compliant’, that is, we are doing it right!
While we have found some of these models and the techniques attached to them profoundly helpful in helping us to stay focused and purposeful in our work with families, this picture of what is involved in the work has always seemed to us to be partial and limited, not giving sufficient weight or importance to the relationship between ourselves and our client families, and the context in which we meet together. As an older White, middle-class man working in a largely working class and ethnically diverse area of East London, I (P.M.) am made acutely aware on a daily basis of the differences between myself and my client families, and that my words will be heard differently according to the relationships that I have been able to make across these differences. Indeed, the very same evidence base has consistently demonstrated that the specific technique or approach that is used by therapists is not as important in accounting for effectiveness as non-specific factors linked to the quality of the relationship that is developed between the client family and the therapist: see, for example, the review in the field of Child and Adolescent Mental Health by Chatoor and Krupnick (2001).
So what do these ‘non-specific factors’ involve? Who we are, who our clients are, the circumstances of our meeting together and the way in which we as clinicians conduct ourselves will all make important differences to the quality of the relationships that we are able to develop. Many of my (P.M.’s) clients in Child and Adolescent Mental Health Services (CAMHS) come to our service uncertain or sceptical about the likely relevance of our contact to their lives, many having had failed experiences of ‘help’ in the past. We will need to find ways of creating in our fledgling relationships with such clients the seeds of hope that these relationships can be worthwhile and carry the potential of change.
A White working-class adolescent boy in trouble for what was seen by school staff as racist violence, and coming to our service as the price he had to pay for being allowed to continue at his school, was initially certain that I as a middle-class professional would have no appreciation of the difficulties he faced in living on his estate, and was belligerently insistent on his rights and entitlement to use his physical prowess to defend his position there. A Black African mother referred to our service because of the behavioural difficulties of her son in school was initially reticent about sharing details of family life, seeing White professionals such as me as judgemental and critical of her need to hold down several jobs, and her son as picked on unfairly by a largely White school staff team. A Bangladeshi father whose son had been referred after disclosing physical abuse at his hands and referred to our service for help in finding other ways to manage his son’s behaviour felt initially that I as a White non-Muslim would assert Western ideas about child care which would have little respect for the values that he saw as precious.
In all three cases, what helped to make the contact with my agency helpful was the establishment of relationships with these different clients which started with a respectful attention to their contexts and the beliefs and principles underlying their actions, alongside an acknowledgement of difference. I (P.M.) as a White middle-class professional would need such clients’ help if I was really to understand the context of their lives and motivations for their behaviour, and any suggestions that I had about possible change would need to be framed tentatively as possibly having relevance to them rather than asserted as universal truths.
Anyone working in multicultural contexts (and in a world of ever increasing migration, this applies to increasing numbers of us) will have experience of having to build such relationships across differences in culture as well as class, gender, age, sexuality and religion and will have developed skills in doing so in order to be effective, but such skills have been little honoured or articulated. This special edition is born out of our placing of value in these skills and practices as worthy of a place in this journal, and in the increasingly ‘technocratic’ world of mental health and social care services.
All these articles argue in different ways for the importance of beginning from a position of self-reflexivity: being aware how our own culture, class, profession or religious beliefs will constrain our thinking and impact upon our interventions with families and how these will be experienced. Ruma Bose describes Bangladeshi parental ethnotheories illustrating the rich cultural meanings that orientate parental action and how new meanings emerge following migration and cultural change. She points out how our professional understandings of child rearing and parenting are not culture free and argues that we need to examine the cultural frames of our professional theories to enhance reflexivity in our clinical practice. Karen Zilberstein’s soapbox about how class matters in parenting interventions also points to the need to recognise the ‘cultural and socioeconomic overtones’ of parenting programmes.
Mina Fazel and colleagues’ work on the experience of adolescent refugees in the United Kingdom of school-based mental health services informs us about the effects of the uncertainty of the asylum process on their lives, as well as the important role played by teachers in supporting contact with mental health services. Hannah Sherbersky discusses how family therapists can understand and effectively intervene in families who hold fundamentalist beliefs, identifying herself as ‘broadly secular humanist’ and arguing that therapists need to reflexively ‘examine their position’ with regard to fundamentalism. Mark Rivett in his response to this article points out how this reads to a therapist who is a person of faith, seeing an inherent implication that it is the religious beliefs of such families that are causing psychological problems, and that there is something ‘deluded’ about such beliefs.
Taiwo Afuope acknowledges that ‘who she is’ has shaped the models and approaches that she has been drawn to in her work as a therapist. She calls for a move beyond having an ‘awareness of difference’ towards taking a more active stance in opposing discrimination and oppression alongside our clients, giving a moving and powerful account of a piece of clinical work exemplifying such an approach.
We found that each of the articles challenged our ideas and practice and hope that you will enjoy reading this Special Issue as much as we enjoyed editing it.