Casting and scripting: Visibility,responsibility,and legitimacy in transcultural psychiatry apprenticeships in Paris

Abstract

Transcultural psychiatry was developed in France to promote cultural and linguistic diversity and address the mental health needs of immigrants who were excluded from accessing other public mental health services. Professionals in health and social services refer patients to transcultural psychiatry consultations when miscommunications arise or when professionals determine that patients need culturally sensitive therapy. In transcultural psychiatry consultations, a group of therapists, composed primarily of psychologists and psychiatrists, as well as other health and social service professionals, receives a patient, the patient’s family, and referring professionals. Previous research on transcultural psychiatry has emphasized the importance of culturally diverse therapy teams and the ways that therapists’ diversity could permit patients to open up in consultation sessions. This study draws on ethnographic research in two transcultural psychiatry consultations in Île-de-France, and pays particular attention to the experiences of apprentice therapists, who were often graduate students in clinical psychology. Apprentice therapists reported being introduced to patients in ways that they would not choose themselves. As a result, therapists felt that they had to overemphasize their cultures or countries of origin and French therapists questioned their place in the group. This article describes how transcultural therapy groups are a theater in which belonging, identity, and Frenchness are contested and performed. Apprentice therapists proposed more intersectional and inclusive ways of portraying diversity in the transcultural groups.

Keywords

apprenticeship ethnography France migration transcultural psychiatry consultations

Introduction

In France, public hospitals are considered “culturally neutral” since their primary role is to care for patients and cure diseases (Bertossi & Prud’homme, 2011, pp. 2–3). However, others suggest that hospitals establish and reproduce identities about migrant communities through routine interactions that “signal inclusion or exclusion within the broader society” (Sargent & Erickson, 2013, p. 50). In spite of an apparent adherence to universal principles in the provision of care to all patients, the personnel within hospital settings often invoke what many refer to as cultural explanations or ethnic stereotypes for behavior considered deviant in routine medical procedures among migrant patients (Cognet, 2001; Kotobi, 2000, Nacu, 2011, Sargent & Larchanché, 2009). State institutions, such as hospitals, are not simply “receptacles of ideas or passive sponges of national identity” (Bowen, Bertossi, Duyvendak, & Krook, 2013, p. 13). Rather, the perspectives above suggest that these institutions and their staff are actively involved in the shaping of ideas concerning identity, assimilation, and exclusion.

Mental health care is a particularly crucial site through which to consider how belonging and legitimacy are produced, since these may have an impact on psychosocial vulnerability. Psychiatric epidemiological research in France among immigrant populations, their descendants, and minority groups is relatively scarce, due to a lack of statistics on race and ethnicity in France, though recent studies, such as the Trajectoires et Origines, suggest that there is an increased risk of psychosocial vulnerability associated with migration status and being an ethnic minority (Tortelli, Skurnik, Szöke, & Simon, 2017, p. 580). In fact, a multisite incidence study conducted in six countries, including France, reported higher rates of psychotic disorders in racial and ethnic minority groups (Jongsma et al., 2018, p. 40). Others have described how migrant groups accumulate psychological, social, and administrative vulnerabilities that may have a profound impact on their mental health (Chambon & Le Goff, 2016, p. 130). Moreover, Chambon and Le Goff (2016) assert that this vulnerability is exacerbated among undocumented or unauthorized migrants. Additionally, “intangible obstacles,” such as stigmatization, fear, and distrust of clinicians or social service professionals (Larchanché, 2012, p. 858), as well as a lack of language proficiency or fixed housing (André & Azzedine, 2016; Chambon & Le Goff, 2016), may hinder unauthorized immigrants’ access to the health care to which they are entitled.

Transcultural psychiatry was developed in France to promote cultural and linguistic diversity and address the mental health needs of immigrants who were excluded from accessing other public mental health services. Moreover, it sought to create an open dialogue with the patient about different systems of cultural representations and to build links between the representation systems of the patient and those of the therapists (Sturm, Baubet, & Moro 2010; Sturm, Nadig, & Moro, 2011). Within transcultural psychiatry, culture is defined as a dynamic process based in interactions and that permits a way of coding the ensemble of the lived experiences of a person, and that structures and gives coherence to a person’s experience (Moro, 1998, pp. 12–15). Transcultural psychiatry’s leading practitioner in France, child and adolescent psychiatrist Marie Rose Moro, as well as her colleagues, distanced themselves from Moro’s predecessor and former mentor, psychologist Tobie Nathan, whose practice of ethnopsychiatry during the 1980s and 1990s came under criticism for overemphasizing cultural differences of patients, for not respecting universal principles that guide the provision of health services in France, and for challenging universal biomedical perspectives in psychiatry (Corin, 1997; Fassin, 1999; Fassin & Rechtman, 2005, 2009; Rechtman, 2000, 2003). Yet like Nathan (1986/2013), Moro’s transcultural psychiatry continued to conduct therapy in a large group, wherein a patient or family would be received by a dozen therapists—typically psychologists and psychiatrists—and where the group would discuss medical and migration histories, cultural representations, and the patient’s current experiences in France.

Scholarship on transcultural psychiatry groups has emphasized the importance of culturally diverse therapy groups and the ways that therapists’ diversity could permit patients to open up in therapy sessions (Corin, 1997; Delanoë & Hamlat, 2012; Larchanché, 2010; Moro & Baubet, 2013; Streit, 1997; Sturm, Nadig, & Moro, 2010; Sturm et al., 2011). A few rich accounts exist on the diversity of clinicians in culturally sensitive mental health settings in France, including a collection of autobiographies of senior clinicians in Moro’s transcultural psychiatry consultation at the Avicenne Hospital in the suburbs of Paris (Moro & Moro Gomez, 2004). Psychologist Gesine Sturm and colleagues (Sturm, 2005; Sturm, Nadig, & Moro, 2010) described how therapists within the transcultural psychiatry setting often spoke about their own belonging, whether real or imaginary, in order to build a therapeutic alliance with a patient. Anthropologist Stéphanie Larchanché (2010, pp. 126–127) has described how the presence of culturally diverse clinicians within transcultural therapy settings serves to “celebrate cultural hybridity” and reframe cultural difference as non-threatening, all the while attempting to reduce the anxieties of patients. Since the therapists in the group have diverse origins and migration histories, their comments and propositions “evoke a multiplicity of theoretical universes,” and therefore permit the patient to avoid being tied to one particular discourse (Corin, 1997, p. 350). Moreover, clinicians’ migration experience was considered favorable since it gave them the authority to understand the specificities of immigrants’ experiences (Fassin & Rechtman, 2005; Larchanché, 2010).

Study objectives and guiding questions

Research on citizenship, belonging, and identity in France has illustrated how many consider practices and expressions of identities, particularly those concerning religion, ethnicity, and language, to be disruptive or incompatible with French identity (Bowen, 2007; Kastoryano, 2002, 2004; Tilly, 1995). In this view, claims to dual or plural identities in the public sphere are thought to inevitably weaken the sense of being French (Foner & Simon, 2015; Scott, 2007; Simon, 2012). In this article, I demonstrate how transcultural therapy groups provide a unique window to consider the ways in which notions of identity, diversity, and culture in France are enacted and debated. This article draws on Erving Goffman’s (1959) work on performance and self-presentation, as well as Cristiana Giordano’s (2014) analysis of the theatricality of immigrant mental health settings in an Italian context. Specifically, this article draws on the perspectives of apprentice therapists, who were primarily graduate students in clinical psychology and who undertook training in transcultural therapy groups over the course of an academic year. Building on prior research, this article considers the processes by which apprentice therapists were encouraged and learned to elicit their own migration histories, identities, and linguistic abilities within these spaces. How do apprentices respond to the use of their identities and linguistic capabilities by their supervisors? How do the ways that apprentices present themselves impact their entrance into these therapy groups?

In their seminal book on apprenticeship, Lave and Wenger (1991/2009) described the interwoven processes of constructing identities and learning. They conceptualized identities as “long-term, living relations between persons and their place and participation in communities of practice” (p. 53). Communities of practice are groups of individuals who are engaged in a particular form of collective action, and where newcomers learn by becoming participants in these communities. Moreover, membership in this kind of community involves engagement with other members and therefore, the recognition of others as members of the same community (Wenger, 1998). Yet some have cautioned that while the concept of identity has been used to do a great deal of analytic work, it is “riddled with ambiguity, riven with contradictory meanings, and encumbered by reifying connotations” (Brubaker & Cooper, 2000, p. 34). Brubaker and Cooper called for alternative concepts, such as identification, self-understanding, commonality, and connectedness, which allow for the parsing of the work that the concept of identity potentially does. Taking these perspectives together, I focused on the process by which individuals learned to become part of a community, which included becoming familiar with the norms or rules of that that community, and to consider themselves and others as part of that community.

In this article, I contend that supervisors appropriated apprentices’ diverse identities in consultation sessions in order to encourage patients to speak of their own cultural identities and migration histories. I argue that while diversity in apprentices’ identities and linguistic capabilities granted them access to these communities of practice, these apprentices often found that their supervisors used them in an instrumental manner. Some—notably the supervisors in these settings—may find this to be a harsh critique; however, I draw on the wise words of Becker, Geer, Hughes, and Strauss (1961/2003, p. 15), “this is how things look and feel down under … for the students,” to emphasize that I am attempting to provide a coherent space for apprentice therapists’ concerns.

Research and analytic approach

This project is based on observations in two transcultural therapy groups (Table 1) in Paris and its suburbs, as well as open-ended interviews with graduate students in their first or second year of their master’s degree in clinical psychology, and supervising psychiatrists or psychologists. No data concerning patients was used in this article. The groups varied in the number of supervising and apprentice therapists present, and the number of therapy sessions conducted per week. Significantly, additional therapy sessions meant that apprentice therapists gained more clinical experience, and additional supervising therapists meant that apprentices could observe subtle variations in the practice of their supervisors.

Table 1.

Transcultural therapy groups in Paris, France.

	Group A	Group B
Supervising therapists	5 clinical psychologists, 1 psychiatrist	1 psychologist, 2 psychiatrists
Apprentice therapists	5	8
Therapy sessions/week	4	2
Patient population	Families and adults from West and North Africa, South Asia	Families from West and North Africa, China

The data presented in this article is part of a larger project on apprenticeship and cultural sensitivity training, which is based on ethnographic fieldwork in four mental health settings for immigrants in Île-de-France, and interviews with 65 apprentice therapists and their supervisors. Interviews explored apprentices’ tasks and responsibilities in transcultural therapy groups, as well as their experiences of integration into the groups. Interviews with supervisors explored the instructions given to apprentices, the tasks assigned to apprentices, and the knowledge that supervisors intended to transmit to apprentices. Interviews were audio recorded and lasted between 30 and 90 minutes. This project was reviewed and received approval from the Institutional Review Board of the author’s university (IRB12-1152) and received local site permission from each transcultural therapy group. Informed consent was obtained from all individual participants in the study.

This project followed the approach proposed by Attride-Stirling (2001) for qualitative data analysis. Interview transcripts were coded to identify salient and recurrent subjects, and then passages and quotations were selected and compared. Next, clusters of codes were used to identify themes. These themes were refined to ensure that they were sufficiently specific in order to not be repetitive, but also sufficiently vast to include an ensemble of ideas.

Selection: The deliberate construction of diverse transcultural groups

At the start of every academic year, a new cohort of apprentice therapists, made up of apprentices in clinical psychology and psychiatry, began their apprenticeship in the transcultural therapy group. Principal therapists selected 5 to 10 apprentices from a larger pool of applicants. The variation in the number of apprentices had to do with the capacities of each transcultural therapy group, since some groups already had a larger number of permanent therapists, some of whom had been in the group for several years. My principal therapist informants, such as this psychiatrist, explained selecting apprentices based on their histories of migration:

I select, I try to have a lot of migrant students but I also have a few spots for students who are not migrants. So since we, the principal therapists, are not migrants, we try to have migrants among our students in order to have a transcultural group, and it’s mostly with the students that we are able to do that.

In addition to selecting apprentices with migration experiences, other supervising clinicians, including this psychiatrist, described how visible diversity, manifest in terms of skin color, was important for the group:

I think that different skin colors are important, meaning that if everyone is white, especially here in France, where there is a history, I think there needs to be different skin colors in order to permit multiple ways of identifying. I say that, and I know how that can make people react, but I think it’s an important point … there need to be different phenotypes because if everyone looks like me, it will not work.

Indeed, this psychiatrist’s comments about multiple ways of identifying reflect a point raised by the clinical psychologist Nathalie Zajde (2011, p. 189):

If they are a dozen “white” or “Parisian” psychologists, they will probably give an identical interpretation and approach about the clinical case … what compels a plurality of thinking and diversity of practices is the fact that this particular setting brings together psychologists who are the bearers of theories and practices from distinct cultural universes.

Moreover, the psychiatrist quoted above emphasized that this diversity is particularly crucial given France’s colonial past and that many patients come from former French colonies.

Apprentices picked up on their supervisors’ selection practices:

I was chosen because of my origins but not because of who I am … we were all chosen because we have diverse origins. A person who is white and French, who has “French” origins, or distant origins that he or she doesn’t know, that person would have a harder time being chosen for the consultation … It’s frustrating to be accepted into the consultation because of my origins but not because I might have something interesting to say.

Prior to starting their apprenticeship in transcultural psychiatry groups, apprentices would apply by submitting a letter of interest detailing their experiences. Applications, in which individuals describe their prior experience and objectives, may be an obvious feature of many apprenticeship contexts. But they also represent sites at which potential apprentices perform their goodness of fit for the groups. Indeed, the form and content of apprentices’ applications suggest that the processes of socialization and the enculturation into the therapy groups begin even before apprentices undertake their training (Hafferty & Franks, 1994).

Introducing the therapists: The group ritual

At the beginning of each therapy session, the principal therapist, who was a psychologist or psychiatrist, welcomed the patient, accompanying professional, and at times, family members, into the consultation room. Prior to the start of a session, these individuals remained in the waiting room while the group, made up of 10 to 12 therapists, discussed the notes from the previous consultation session. Once the group was ready to start, the principal therapist exited the room and returned with the patient and accompanying individuals. Once the patient entered the room, the group stood, in a somewhat ceremonious manner, to greet the patient and only sat when the patient sat. The group sat in a circle or semi-circle, with the patient seated in between the principal therapist and the referring professional. This arrangement was pragmatic since it was the principal therapist who conversed directly with the patient, whereas the other therapists only spoke when called upon by the principal therapist. This arrangement was also representative of the fact that the patient was between institutions and their professionals, since patients were referred when there were misunderstandings or when the referring professional did not feel well equipped to support the patient. This group ritual, as some of my informants described it, was how each transcultural session began.

Next, the principal therapist introduced the others in the transcultural group to the patient. These introductions were carried out in every session, even in instances in which the patient had attended therapy sessions for years. The reason for this, I was told, was to maintain the continuity and familiarity of the group since therapy sessions typically only took place every one to two months. Moreover, each academic year, the composition of the group changed with new apprentices joining the group and replacing the apprentices of the previous year. Introductions of each group member typically involved the person’s first name, role or function in the group, and country of origin.

In one session, a woman from the Democratic Republic of Congo came to the group as a patient¹ for the first time. She seemed initially apprehensive to enter into the consultation room because of the size of the group, though eventually she agreed. The principal therapist proceeded to introduce the members of the group, “This is József,² a graduate student from Hungary; Maria, an anthropologist from Colombia; Pauline, a graduate student who is of Algerian origin; Meixiang, a psychologist from China; Claire, a graduate student; Patrick, a psychiatrist.” Then, the principal therapist finished Claire and Patrick’s introduction with, “They’re French. They’re from here.”

At the end of the consultation, everyone stood once again and the principal therapist accompanied the patient out of the room and returned alone. During the discussion following the consultation, Claire and Patrick spoke up about the way that the principal therapist had introduced everyone. Claire, the apprentice, said that she did not appreciate being introduced as being “from here.” Patrick, the psychiatrist, stated that this kind of introduction made him question his place in the group. Pauline, another apprentice, stated that she felt uncomfortable being introduced as of Algerian origin. After all, it was her mother who was from Algeria, and Pauline felt that she was expected to speak in a way that reflected her Algerianness if she was introduced in this way. Patrick added that it did not make sense to say that Meixiang was from China since it is such a large and diverse country and that she, being from Shanghai, likely had little in common with someone from Beijing. Meixiang stated that she probably had more in common with someone from Beijing than with someone from the rural outskirts of Shanghai.

Later, the principal therapist commented that the introductions were important for patients and families in the consultation since they allowed these individuals to see and learn about the diverse origins of the therapists. The principal therapist also stated, somewhat dismissively, that many of the apprentice interns were reflecting on their own identities and origins and that these introductions were perhaps as important for them as they were for the patients. The point about how the casting of the therapists was a formative moment for the apprentices in the group was surprising since it suggested an assumption that apprentices would eventually become more comfortable speaking about their identities and origins and get over their hang-ups about these introductions.

This situation illustrates that therapists were not always introduced in the ways that they would choose to introduce themselves, but rather in the ways that were beneficial to the work of the group. As a result, apprentice therapists, such as Pauline, may find that they must perform a certain identity when they’ve been introduced in a particular way. Additionally, therapists seen as being French or “from here,” such as Claire or Patrick, may question their position in and contribution to the group. And therapists like Meixiang may be labeled as Chinese without any attention to regional or linguistic particularities.

Maria, introduced above, reflected on the discrepancy in the ways she was introduced, both in terms of her country of origin and her profession:

I’m always introduced as either Colombian or an anthropologist. But I’m actually from Peru. And I’m also a psychologist, but I’m never introduced as a psychologist. In terms of nationality, it’s interesting because the group requires flexibility, sometimes I say I’m Peruvian or Argentine or Colombian, it depends, and I play with that. It’s interesting for me and for the group … and I think it’s interesting for the group to introduce an anthropologist because that adds diversity.

The statement, “the group requires flexibility,” suggests that therapists’ origins and identities must be able to serve the needs of the group. However, Maria’s suggestion that she could “play” with the ways in which she mobilized her identities, in terms of her country of origin or her profession, implies that therapists were able to navigate the constraints imposed with certain introductions. While Maria, and the group, found interest in the ways that she could play with her identities, it is also important to consider the ethical implications for patients. Claire, introduced above, stated that patients did not necessarily buy into the introductions:

It’s like we’re taking the patients for idiots … under the pretext of being multicultural, it’s like we’re telling the patient something that’s not necessarily true. Meanwhile, I’m pretty sure the patient, who has been in France for a while now, understands that there are a few French people in the room [laughs].

Claire’s comments demonstrate that these introductions were potentially patronizing to patients since they presume that therapists could manipulate identities without patients taking notice. Moreover, Claire suggests that the group sought to elicit a particular kind of speech act or narrative from patients.

In one of the transcultural groups, the apprentice therapists asked the principal therapist if they could introduce themselves, and the principal therapist agreed. This arrangement permitted therapists to describe themselves as they saw fit and speak with their own terms, voices, and accents. József, also introduced above, described how being able to introduce themselves made the apprentice therapists feel present as equals in the group:

It gives you kind of more of a presence, yeah, presence, when you get to introduce yourself … that’s a normal way when there’s a group of equals. And when there’s one person who goes around and introduces everyone else, that’s less of a group of equals.

József also mentioned the potential impact self-introductions had on the individuals who came to transcultural therapy groups as patients:

What I noticed with the patients when we introduced ourselves is that the patient would, 99% of the time, end up saying, “Okay, et moi, je suis Jonathon et je suis congolais [Okay, and I’m Jonathon and I am Congolese].” So they would end up announcing their own origins out of peer pressure, in a way. But I think that was a helpful thing, actually. That was a very obvious way how the original idea behind a multiethnic or multi-nationality group kind of accommodates this person.

Additionally, József discussed how speaking for themselves represented an experiment that forced apprentice therapists to think about their outward presentation:

It was a very interesting experiment, to say who I am. Because it forced me to think about this question. And I don’t think I was the only one. There was this particular guy who is French, but one of his parents is English, so he ended up saying, “Je suis anglais [I am English]” I think, not even “d’origine anglaise [I have English roots]” or something like that … and I think, saying that week after week, it’s a very interesting reflection on who you are … it can be awkward … it’s a very constrained way to formulate your identity.

József elaborated on the distinction between being of a nationality and having origins in a particular place. Unlike the apprentice he mentions above, many of the apprentice therapists preferred using language of origins and roots rather than nationality, particularly since many of them were born in France and it was their parents or grandparents who were born elsewhere or held other nationalities. Pauline, introduced earlier, whose mother was from Algeria, felt apprehensive about speaking for Algerians and speaking as an Algerian since it was her mother, and not Pauline, who was from Algeria. Others noticed this apprehension as well. Claire, the apprentice introduced above as “from here,” reflected on the ways that apprentices’ presumed forms of belonging are mobilized in the therapy groups:

Pauline is introduced as having Algerian origins, and maybe she knows some [Algerian] recipes, but I’m sorry, she’s French … I don’t know who in her family is Algerian. She doesn’t speak the language, her first name is not Algerian, we’re not going to go all the way back to the Middle Ages to say “oh yeah, my ancestor was Russian” or whatever to introduce ourselves as Russian, because we’re looking everywhere to be multicultural.

Additionally, identifying oneself with respect to a particular nation may prove to be problematic for individuals such as József, who felt apprehensive about stating he was Hungarian due to its sociopolitical connotations:

I thought, should I say, Joseph? Should I use my first name in the French way? The moment I say my first name, József, in my own way, I all of a sudden, bring in Hungary, which for me is very intrusive. For a while, I felt very uncomfortable about [saying I am from Hungary] because especially at the time, you might recall in the news, Hungary was being very nasty to refugees. So I felt very uncomfortable being linked to that.

Atossa Araxia Abrahamian (2014) asks why nations have the last word in determining our identities. Identifying oneself with respect to a nation has the consequence of being associated with the sociopolitical baggage that comes with that nation. Moreover, this kind of identification forecloses more cosmopolitan forms of being. Indeed, as scholars of cosmopolitanism, such as Homi Bhabha (1996), have identified, cosmopolitanism involves the performance of dialogic relations at the interstices between circles of identity. Perhaps a key word is interstices, since cosmopolitanism involves a combination of attitudes, practices, and abilities attained from experience, contacts, and identification (Vertovec, 2009). In short, cosmopolitanism can be thought of as infinite ways of being and openness to engage with others (Jonas, 2013; Pollock, Bhabha, Breckenridege, & Chakrabarty, 2002). Taking these perspectives together, cosmopolitanism reflects multiple and accumulated forms of identification, dispositions, and practices that are manifest through performance. As a result, identifying oneself or being identified with respect to a particular place neglects the multiplicity of forms of being and belonging, and stifles the performance of these forms since singular dimensions of identity are emphasized.

By introducing apprentice therapists in a certain way, principal therapists gave them roles that they may not feel comfortable playing. Another apprentice therapist, who was born in France, but whose father was born in the Central African Republic, expressed frustration with being asked about their father’s linguistic and migration history:

They asked me, “Do you speak the language?” It really frustrated me because I don’t speak the language of my father. I felt a bit like an exotic object … because of potential understandings I have about my father’s culture … If you ask me about my childhood in France, it’s easy, I’ll tell you about going to the boulangerie with my parents and the smell of croissants and pain au chocolat … They said, “Your father immigrated to France,” but I can talk about leaving my parents’ house and moving to [Paris]. It’s not that far in terms of distance, but it’s still another world. It’s also a form of migration. There’s also the migration from adolescence into adulthood. There are a lot of things like that, a lot of different things that we can know. We’re all transcultural at different levels. But that was not as important.

These comments suggest that apprentices’ self-presentation took secondary importance to the way in which the group wished to present them. The statement “I feel a bit like an exotic object” echoes Rosemary Coombe’s (1993) discussion of how cultural appropriation involves the representation or visibility of individuals but in an absence of their voice. Additionally, attending to this apprentice’s father’s migration history potentially foreclosed discussions of other forms of migration or elements of her identity that may be important. These exchanges suggest that supervising clinicians emphasized one strand of apprentices’ identities, rather than considering the intersectional or multilayered nature of identities (Crenshaw, 1991; Prins, 2006).

The work of Goffman (1959) and Giordano (2014) is analytically effective in reflecting upon the casting and introductions of apprentices in immigrant mental health settings. Goffman describes how in a given situation in which actors are to inhabit an established role, the actor may find that a particular “front” has been established for the role. A front refers to the “expressive equipment” that an actor intentionally or unintentionally uses during her or his performance (Goffman, 1959, pp. 22–24). In the present context of transcultural therapy groups, apprentices are cast into roles of culturally diverse therapists and the introductions of apprentices as being from a particular country or origin are the fronts that apprentices use in their performance in transcultural therapy groups.

Importantly, while these introductions are brief and take place at the outset of therapy sessions, they have a longer lasting effect of casting apprentices into particular roles in the groups. When a principal therapist called upon an apprentice during a therapy session, the apprentice would contribute to the group by proposing imagery or an association in response to the narrative of patients. Apprentices did not speak directly with patients, but directed their speech toward the principal therapist, who would reformulate the apprentice’s statements to the patient. In so doing, principal therapists may reinforce the roles of apprentices by anchoring their speech in terms of nationality. It would not be uncommon to hear a principal therapist say to a patient, “What [apprentice’s name] just said, that is what they say in [name of country].” Sturm, Heidenreich, and Moro (2008, p. 37) have suggested that the “enactments” of therapists illustrate their own cultural positions and diversity through the use of stories and traditions, and it is through these enactments that the therapy group and patient can engage in different life worlds. The experiences of apprentice therapists suggest that these enactments may be shaped or even constrained by their supervisors, who may frame different life worlds along axes of nationality and not other dimensions such as gender, generation, or religion. For example, as the apprentice whose father came to France from the Central African Republic suggested, the transcultural experiences of moving to the big city and coming of age seemed to be less valuable than transnational migration experiences, even though the latter was not this apprentice’s own experience.

Giordano (2014) describes the theatricality of health and social service institutions that receive people in different situations of migration, as these settings enable different roles and subjectivities. The stages created within these settings enable patients to work through traumatic experiences, and are where ethnopsychiatric practitioners can enact “different forms of listening” (Giordano, 2014, p. 231). In the present context, transcultural therapy groups may also be considered a stage where patients and clinicians can make sense of past traumatic events and current mental health problems. However, the group nature of these settings suggests that the listening that clinicians perform is diffracted across the therapists and the pedagogical nature of these settings suggests that apprentices were learning to develop listening techniques. Considering the contributions of Goffman and Giordano in the present context, apprentice therapists learn to inhabit roles and perform the tasks associated with these roles within the therapeutic and theatrical spaces of these settings. While apprentices were learning to become culturally sensitive listeners to the stories of patients, they were also learning to perform the tasks that their supervisors and the institutions created for them.

In a rich ethnographic account of an ethnoclinical family consultation (which resembles transcultural therapy groups), Lila Belkacem (2015, p. 54) demonstrates how these consultations represent a space where the diverse “origins” of patients and therapists are dramatized and that the performativity of these consultations depends on several felicitous speech acts. Belkacem (2013, 2015) identifies important power dynamics and asymmetries since apprentice interns were often categorized by ethnoclinicians as French and lacking migration experience or cultural competence. Belkacem’s analysis of this asymmetry is crucial in understanding the position of apprentice interns in these settings.

My research departs from Belkacem’s in a few principal ways. First, I am interested primarily in apprentices’ perceptions of the ways in which their identities and origins are dramatized in these settings. Additionally, I am concerned with the ways in which apprentices’ performances are evaluated is shaped by their supervisors and peers. Second, my field sites presented a different scenario from what Belkacem observed; apprentice therapists were those who added diversity to the therapy groups and were at times selected based on their origins, languages, or their migration experiences. As a result, these apprentices were positioned simultaneously as apprentices who were learning to become culturally sensitive therapists, yet they were also often the ones who were assumed to possess the necessary ways of knowing conferred through their diverse identities and origins. Finally, my informants appeared to challenge, or at least question, their supervisors’ and peers’ use of identities and origins within these therapy groups.

Contesting Frenchness

The emphasis on diversity of group members led to notions of Frenchness being called into question. Indeed, as described above, Claire and Patrick stated how being introduced as “from here” made them question their place in the group. Others, such as Maria, reflected on how participating in a transcultural group was particularly challenging for “French” therapists:

I also think it’s difficult for the French [therapists]. French apprentices who are unable to say, “how can I find difference within myself to show something?”

Psychiatrist Claire Mestre (2006) described how cultural difference represents a source of creativity in therapy. Yet Maria’s statement above suggested that French therapists may find it challenging to identify their own experiences of difference and may therefore find it difficult to develop creative therapeutic strategies. One could argue that the French therapists who felt left out of these therapeutic spaces failed to recognize their privilege of being “from here,” since they may never have encountered the everyday forms of discrimination or humiliation that many minorities or people in different situations of migration face. One could also argue that diversity and otherness were perhaps being conflated in statements like these, resulting in the notion that what is diverse is taken to represent anything that is not French. Moreover, the distinction between diversity and Frenchness suggests that closed, rather than hybrid definitions of culture were being deployed within these spaces. I frequently encountered variations of closed definitions of culture over the course of my fieldwork, often manifested in concerns about whether French therapists could contribute to transcultural groups.

It is important to note that not everyone held this particular view regarding the diversity of therapists. While some therapists raised concerns about how a lack of apparent cultural diversity prevented clinicians from conducting transcultural therapy, other transcultural clinicians frequently insisted how anyone, regardless of their background, could do this kind of work. Moreover, Moro (2002; Moro & Baubet, 2013) has stated that being an immigrant oneself is neither necessary nor sufficient to conduct ethnopsychoanalysis; rather, individuals must have experience of decentering, or stepping away from their assumptions, and becoming familiar with other cultural systems. Additionally, more recent scholarship has emphasized the importance of super diversity and intersectionality in intercultural therapy in France (Sturm, Bonnet, Coussot, Journot, & Raynaud, 2017; Sturm, Guerraoui, Bonnet, Gouzvinski, & Raynaud, 2017). Of course, not everyone employed a closed definition of culture that distinguished diversity from Frenchness. As Patrick, the psychiatrist, stated, “French culture is already made of multiple cultures that mix and enrich each other reciprocally and are evolving.” Additionally, another psychologist emphasized how individuals use culture differently: “I’m Senegalese and Wolof but not all Wolof people use Wolof culture the way I do, there’s a difference.” These statements harken to Marie Rose Moro’s (1998) discussion of culture as a dynamic process that takes place through interaction.

As I have emphasized throughout this article, newer generations of apprentices, who saw themselves as being transnational and as being part of the fabric of multicultural France, appeared to challenge their supervisors by advancing more intersectional perspectives on identity. The experiences of apprentice therapists in these settings are crucial as they reflect newer directions and debates in multiculturalism in France. The French political culture of Republicanism has been characterized by colorblindness and does not recognize a pluralism of allegiances or claims based on race or religion (Bertossi, 2012; Lamont, 2001; Wihtol de Wenden, 2004). However, research on minorities in France has challenged the widely held notion that one cannot hold multiple allegiances. In a survey among ethnic minorities conducted by the National Institute for Demography (INED) and the National Institute for Statistics and Economic Research (INSEE), respondents reported that having multiple identities and allegiances was both complementary and even enhanced their commitment to their French identity (Simon, 2012, p. 6). These findings echo those of other scholars, who have emphasized that “multiculturalism is the only way to maintain a strong and vibrant French identity” (Wihtol de Wenden, 2004, p. 73). Similarly, apprentices in the present context resisted being identified along lines of nationality and instead opted for multicultural and intersectional ways of being.

The apprehension or frustration experienced by apprentices in discussing their origins seemed to reflect the sentiments that many experience when being asked the question, “Where are you from?” Demographer Patrick Simon (2012) writes that this question is not in itself pejorative, nor does it imply a value judgment, but its recurrence reinforces perceptions of cultural difference. Moreover, identifying oneself with respect to a particular nation may be less meaningful, particularly since individuals, whether therapists or patients, may experience simultaneous forms of being and belonging in France and in their countries of origin or ancestry (Levitt & Glick Schiller, 2004). Moreover, this emphasis on otherness seemed to reinforce the idea that even the children and grandchildren of immigrants from prior decades are not immune from being permanently inscribed as being of a “migrant background” (De Genova, 2016, p. 80).

Presence and responsibility

Principal therapists expected apprentice therapists in the group to be present and visible in certain ways and at certain times. For example, Patrick described the importance of having an apprentice therapist from Mozambique present in the group when one of the other supervisors, originally from Senegal, was absent:

During consultations when Omar was not there, I relied on, on Nélio to help me because, voilà, that’s part of how we welcome other cultures, all the physical differences.

Upon initial consideration, it seems that this statement represents an essentialization of people from African countries and a lack of sensitivity to the differences between West and Southern Africa. This statement also represents how supervisors relied upon the visible presence of their apprentices in order to conduct their therapeutic work. Another apprentice elaborated upon what may be expected of them when called upon during consultation sessions:

I had a role that’s at times a translator or even an interpreter whenever there were Arabic- or Kabyle-speaking families and the rest of the time, I was equally an apprentice and a reference about those cultures … I find that it’s complicated but also interesting because we are solicited on two dimensions, meaning on the one hand, to translate what the person says but also to provide perspective that’s both cultural and psychological.

The expectations of principal therapists that apprentice therapists will perform their parts seems to imply that they have somewhat scripted roles within transcultural therapy groups. As this apprentice suggests, being an informant about a cultural or linguistic group may be an exciting but complicated role to inhabit. Indeed, as Ursula Streit (1997) describes, while all therapists participate, those from the same or similar culture as the patient play an important role since this helps the patient to describe what would be said in her or his own cultural group. This experience may be particularly complex since these apprentice therapists were students but were also expected to inhabit authoritative, informant roles.

While supervisors relied on apprentices’ presence and cultural expertise, one psychologist suggested that there were limits to how much individuals were supposed to share, especially concerning faith:

Everyone relies on his or her culture, and of course, a bit too much. It’s important that Vera doesn’t talk too much about Islam, I think that’s her minor flaw. And Nélio should not talk too much about the Bible. I tell him “Nélio, don’t talk about God.”

Others, such as this psychologist, also discouraged speaking about religion:

When Josephine introduces herself as Jewish, we’re in a culture where at the moment, religion is a very sensitive topic. So she should introduce herself, “I am Josephine, I was born in France but I have Tunisian heritage, it’s a country that’s part of the Maghreb.” But if she introduces herself as Jewish, that poses problems.

It might seem unsurprising that in a country where the headscarf and other visible symbols of religious affiliation are considered at best, matters for the private sphere, or at worst, symbols that draw public ire (Bowen, 2007; Fernando, 2014; Scott, 2007), that individuals might be discouraged from making known any religious affiliations within public settings. But in spaces that purportedly welcomed hybridity and, to some extent, more inclusive forms of Frenchness, it was perplexing that forms of belonging concerning religion, sexuality, or gender, seemed of little importance or potentially undermined forms of belonging centered on nationality. Surely, for a group of apprentices, many of whom were second- or third- or nth-generation immigrants, would these other forms of belonging not take precedence?

Conclusion

Some have described how experience and responsibility are “commodities” that students can never seem to get enough of (Becker et al., 2003, p. 270). But being an apprentice involves being legitimate peripheral participants in communities of practice (Lave & Wenger, 1991/2009). Their position as apprentices in clinical psychology and their diversity grants them access to these communities. Moreover, Lave and Wenger (1991/2009) distinguished between observation and peripheral participation, the latter of which involves absorbing and being absorbed by the culture of practice. In situations where apprentices are simply spectators, they miss out on these processes of absorption. This article analyzed the visibility of apprentice therapists within immigrant mental health settings.

In some instances, apprentices were selected as apprentices because they could provide a combination of racial, linguistic, and experiential authenticity. Yet this authenticity also lent legitimacy to these settings. My supervisor informants reflected on the importance of apprentices’ diversity in terms of their migration experiences, linguistic abilities, maturity, and race. Apprentice therapist informants reflected on the ways in which they were rendered outwardly visible to patients within these settings. In other words, they were made especially visible by their difference.

Apprentices recognized the value of multiple and intersectional identities. They also recognized the challenges and limits of being identified or placed with respect to a particular place. However, these apprentices were also learning to become members of organizations and communities of practice, where they must adhere to certain norms and rules. In this case, the rules call for ways of being that differ from those that apprentices wish to exhibit and that feel more natural to them. Indeed, as this paper illustrates, these settings involve the scripting of individuals into roles, yet suggests that there are hierarchical and paternalistic rules concerning who gets to do the scripting.

By taking the perspectives of apprentice therapists, who were learning to address the uncertainties of clinical practice and how to carry themselves within these settings, the account provided in this article may be considered, particularly among supervising clinicians, to be critical of their pedagogical work. While my intention was not to critique or undermine this important work, I was committed to understanding the apprentices’ view and wanted to bring forward some of their concerns. Insufficient supervision and an absence of space for discussion amplified these concerns. By highlighting their concerns, I am thus able to make recommendations for practice that may aid supervising clinicians.

First, supervisors must create more room for discussion with apprentice therapists about their reactions and experiences in these settings. Apprentice therapists greatly appreciated their individual interactions with supervisors and during the group debriefing sessions, but simply wanted more of it. Apprentices found the existing time for discussion to be insufficient and they completed their apprenticeships with unanswered questions. Therefore, additional time should be conferred both on an individual basis, during which apprentice therapists may raise concerns and discuss their objectives as future therapists, and in groups, where they can make sense of the uncertainties they encounter and learn from each other’s perspectives.

Second, creating more room for discussion also requires supervisors to be open to the suggestions and criticism of apprentice therapists. The data presented in this article suggest how apprentice therapists were critical of the ways in which their supervisors conceptualized and mobilized culture during therapy sessions. They found that how they were introduced to patients and expected to present themselves in the group setting was not compatible with their own self-presentation. Supervising clinicians should thus be more open and reflexive with regard to the positions of apprentices. Specifically, supervisors should allow apprentices to introduce themselves in the ways they see fit. Indeed, supervising clinicians emphasize the importance of being able to decenter in their encounters with patients, and I would suggest that they must also decenter in their pedagogical interactions with apprentice therapists.

Footnotes

Acknowledgments

The author thanks the participants and setting supervisors for facilitating and participating in this project. Additionally, the following individuals provided invaluable guidance at earlier stages of the project: Michele Friedner, Stéphanie Larchanché, Marie Rose Moro, Eugene Raikhel, Michael Rossi, Karin Knorr Cetina, Carolyn Sargent, Lila Belkacem, Simeng Wang, Florence Lévy, Mohammed Sharqawi, and the participants of the Atelier Migrations at the Ecole des Hautes Etudes en Sciences Sociales and the Migration and Incorporation Workshop at the University of Chicago.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This publication is based on a research project supported by the Georges Lurcy Educational and Charitable Trust, the France Chicago Center and the Division of the Social Sciences of the University of Chicago.

ORCID iD

David A. Ansari

Notes

David Ansari, PhD, is a teaching fellow in the Division of the Social Sciences at the University of Chicago. Dr. Ansari’s research and teaching interests lie at the intersections of health and human rights, transnational migration, health services research, and ethnographies of organizations. He is currently preparing a book manuscript tentatively entitled, “‘Dare to be a Future Therapist’: Apprenticeship and Uncertainty in Mental Health Services for Immigrants and Refugees.”

References

Abrahamian

A. A.

(2014) The cosmopolites: The coming of the global citizen, New York, NY: Columbia Global Reports.

André

J. M.

Azzedine

(2016) Access to healthcare for undocumented migrants in France: A critical examination of State Medical Assistance. Public Health Reviews 37(5): ). doi: 10.1186/s40985-016-0017-4.

Appiah, A. (1999). Citizens of the world. In: M. J. Gibney (Ed.) Globalizing rights: The Oxford Amnesty Lectures (189–232). Oxford, UK: Oxford University Press.

Attride-Stirling

(2001) Thematic networks: An analytic tool for qualitative research. Qualitative Research 1(3): 385–405.

Becker

H. C.

Geer

Hughes

E. C.

Strauss

A. L.

(2003) Boys in white: Student culture in medical school, Chicago, IL: The University of Chicago Press. (Original work published 1961).

Belkacem

(2013) Jeunes descendants d’immigrants ouest-africains en consultations ethnocliniques: migrations en heritage et mémoires des “origines”. Revue européenne des migrations internationals 29(1): 69–89.

Belkacem

(2015) Quand la clinique fait l’ethnique? Logiques performatives dans la médiation interculturelle. Genèses 1(98): 47–68.

Bertossi

(2012) French republicanism and the problem of normative density. Comparative European Politics 10(3): 248–265.

Bertossi

Prud’homme

(2011) La “diversité” à l’hôpital: identités sociales et discriminations, Paris, France: Institut français des relations internationales.

10.

Bhabha

(1996) Unsatisfied: Notes on vernacular cosmopolitanism. In: Garcia-Morena

Pfeiffer

P. C.

(eds) Text and nation: Cross-disciplinary essays on cultural and national identities, Columbia, SC: Camden House, pp. 191–207.

11.

Bowen

(2007) Why the French don’t like headscarves. Islam, the state, and public space, Princeton, NJ: Princeton University Press.

12.

Bowen

Bertossi

Duyvendak

J. W.

Krook

M. L.

(2013) European states and their Muslim citizens: The impact of institutions on perceptions and boundaries, Cambridge, UK: Cambridge University Press.

13.

Brubaker, R., & Cooper, F. (2000). Beyond ‘identity.’ Theory and Society, 29(1): 1–47.

14.

Chambon

Le Goff

(2016) Enjeux et controverses de la prise en charge des migrants précaires en psychiatrie. Revue française des affaires sociales 6: 123–140.

15.

Cognet

(2001) Quand l’ethnicité colore les relations dans l’hôpital. Hommes et Migrations 1233: 101–107.

16.

Coombe

R. J.

(1993) The properties of culture and the politics of possessing identity: Native claims in the cultural appropriation controversy. Canadian Journal of Law and Jurisprudence 6(2): 249–285.

17.

Corin, E. (1997). Playing with Limits: Tobie Nathan’s Evolving Paradigm in Ethnopsychiatry. Transcultural Psychiatry, 34(3): 345–358.

18.

Crenshaw

K.W.

(1991) Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review 43(6): 1241–1299.

19.

De Genova

(2016) The European question: Migration, race, and postcoloniality in Europe. Social Text 34(3): 75–102.

20.

Delanoë

Hamlat

(2012) Une consultation d’ethnopsychanalyse en CMPP. ERES Enfance et parentalité 202–205. doi: https://doi.org/10.3917/eres.colle.2012.01.0202.

21.

Fassin

(1999) L’ethnopsychiatrie et ses reseaux: L’influence qui grandit. Genèses 35: 146–171.

22.

Fassin

Rechtman

(2005) An anthropological hybrid: The pragmatic arrangement of universalism and culturalism in French mental health. Transcultural Psychiatry 42(3): 347–366. doi: http://doi.org/10.1177/1363461505055620.

23.

Fassin

Rechtman

(2009) The empire of trauma: An inquiry into the condition of victimhood, Princeton, NJ: Princeton University Press.

24.

Fernando

M. I.

(2014) The republic unsettled: Muslim French and the contradictions of secularism, Durham, NC: Duke University Press.

25.

Foner

Simon

(2015) Fear, anxiety, and national identity: Immigration and belonging in North America and Western Europe, New York, NY: Russell Sage Foundation.

26.

Giordano

(2014) Migrants in translation: Caring and the logics of difference in contemporary Italy, Berkeley, CA: University of California Press.

27.

Goffman

(1959) The Presentation of Self in Everyday Life, New York, NY: Anchor Books.

28.

Hafferty

F. W.

Franks

(1994) The hidden curriculum, ethics teaching, and the structure of medical education. Academic Medicine 69(11): 861–871.

29.

Jonas

(2013) Eating the vernacular, being cosmopolitan. Cultural Studies Review 19(1): 117–137.

30.

Jongsma

H. E.

Gayer-Anderson

Lasalvia

Quattrone

Mulè

Szöke

Tarricone

(2018) Treated incidence of psychotic disorders in the multinational EU-GEI study. JAMA Psychiatry 75(1): 36–46.

31.

Kastoryano, R. (2002). Negotiating identities: States and immigrants in France and Germany (B. Harshav, Trans.). Princeton, NJ: Princeton University Press.

32.

Kastoryano

(2004) Religion and incorporation: Islam in France and Germany. International Migration Review 38(3): 1234–1255.

33.

Kotobi

(2000) Le malade dans sa différence: les professionnels et les patients migrants africains à l’hôpital. Hommes et Migrations 1225: 62–72.

34.

Lamont

(2001) Immigration and the salience of racial boundaries among French workers. French Politics, Culture & Society 19(1): 1–21.

35.

Larchanché, S. (2010). Cultural anxieties and institutional regulation: “Specialized” mental healthcare and “immigrant suffering” in Paris, France (Unpublished doctoral dissertation). Washington University in St. Louis: St. Louis, MO.

36.

Larchanché

(2012) Intangible obstacles: Health implications of stigmatization, structural violence, and fear among undocumented immigrants in France. Social Science & Medicine 74(6): 858–863.

37.

Lave

Wenger

(2009) Situated learning, Cambridge, UK: Cambridge University Press (Original work published 1991).

38.

Levitt

Glick Schiller

(2004) Conceptualizing simultaneity: A transnational social field perspective on society. International Migration Review 38(145): 595–629.

39.

Mestre

(2006) La psychiatrie transculturelle: Un champ nécessaire et complexe. In: Moro

M. R.

De La Noë

Mouchenik

(eds) Manuel de psychiatrie transculturelle, Grenoble, France: La Pensée Sauvage, pp. 179–196.

40.

Moro

M. R.

(1998) Psychothérapie transculturelle de l’enfant et de l’adolescent, Paris, France: Dunod.

41.

Moro

M. R.

(2002) Enfants d’ici venus d’ailleurs, Paris, France: Editions La Découverte.

42.

Moro

M. R.

Moro Gomez

(2004) Avicenne l’andalouse: Devenir thérapeute en situation transculturelle, Grenoble, France: La Pensée Sauvage.

43.

Moro

M. R.

Baubet

(2013) Les soins en situation transculturelle. In: Baubet

Moro

M. R.

(eds) Psychopathologie transculturelle, Issy-les-Moulineaux, France: Elsevier Masson, pp. 143–158.

44.

Nacu

(2011) À quoi sert le culturalisme? Pratiques médicales et catégorisations des femmes “migrantes” dans trois maternités franciliennes”. Sociologie du Travail 53(1): 109–130.

45.

Nathan

(2013) La folie des autres: Traité d’ethnopsychiatrie clinique, Paris, France: Dunod (Original work published 1986).

46.

Pollock

Bhabha

H. K.

Breckenridge

C. A.

Chakrabarty

(2002) Introduction: Cosmopolitanisms. In: Breckenridge

C. A.

Pollock

Bhabha

H. K.

Chakrabatry

(eds) Cosmopolitanism, Durham, NC: Duke University Press, pp. 1–14.

47.

Prins

(2006) Narrative accounts of origins. European Journal of Women’s Studies 13(3): 277–290.

48.

Rechtman

(2000) De la psychiatrie des migrations au culturalisme des ethnopsychiatres. Hommes et Migrations 1225: 46–61.

49.

Rechtman

(2003) L’ethnicisation de la psychiatrie: de l’universel à l’international. L’information psychiatrique 79(2): 161–169.

50.

Sargent

Erikson

S. L.

(2013) Hospitals as sites of cultural confrontation and integration in France and Germany. In: Bowen

Bertossi

Duyvendak

J. W.

Krook

M. L.

(eds) European states and their Muslim citizens: The impact of institutions on perceptions and boundaries, Cambridge, UK: Cambridge University Press, pp. 29–53.

51.

Sargent

Larchanché

(2009) The construction of “cultural difference” and its therapeutic significance in immigrant mental health services in France. Culture, Medicine, and Psychiatry 33: 2–20.

52.

Scott

J. W.

(2007) The politics of the veil, Princeton, NJ: Princeton University Press.

53.

Simon

(2012) French national identity and integration: Who belongs to the national community?, Washington, DC: Migration Policy Institute.

54.

Streit

(1997) Nathan’s ethnopsychoanalytic therapy: Characteristics, discoveries and challenges to Western psychotherapy. Transcultural Psychiatry 34(3): 321–343. doi: https://doi.org/10.1177/136346159703400303.

55.

Sturm, G. (2005). Les thérapies transculturelles en groupe “multiculturel.” Une ethnographie de l’espace thérapeutique (Unpublished doctoral dissertation). University of Paris 13 and the University of Bremen, Paris and Bremen.

56.

Sturm

Baubet

Moro

M. R.

(2010) Culture, trauma, and subjectivity: The French ethnopsychanalytic approach. Traumatology 16(4): 27–38.

57.

Sturm

Bonnet

Coussot

Journot

Raynaud

J. P.

(2017) Cultural sensitive care provision in a public child and adolescent mental health care centre: A case study from the Toulouse University Hospital intercultural consultation. Culture, Medicine, & Psychiatry 41: 630–655.

58.

Sturm

Guerraoui

Bonnet

Gouzvinski

Raynaud

J. P.

(2017) Adapting services to the needs of children and families with complex migration experiences: The Toulouse University Hospital’s intercultural consultation. Transcultural Psychiatry 54(4): 445–465. doi: https://doi.org/10.1177/1363461517724277.

59.

Sturm, G., Heidenreich, F., & Moro, M. R. (2008). Transcultural Clinical Work with Immigrants, Asylum Seekers, and Refugees at Avicenne Hospital, France. Migration, Health and Social Care, 4(4): 33–40.

60.

Sturm

Nadig

Moro

M. R.

(2010) Writing therapies: An ethnographic approach to transcultural therapies. Forum: Qualitative Social Research 11(3): doi: http://doi.org/10.17169/fqs-11.3.1558.

61.

Sturm

Nadig

Moro

M. R.

(2011) Current developments in French ethnopsychoanalysis. Transcultural Psychiatry 48(3): 205–227. doi: http://doi.org/10.1177/1363461511402868.

62.

Tilly, C. (1995). The Emergence of Citizenship in France and Elsewhere. International Review of Social History, 40(S3): 223–236.

63.

Tortelli

Skurnik

Szöke

Simon

(2017) L’importance de la recherche épidémiologique psychiatrique sur les populations migrantes en France. Annales Médico-Psychologiques 175: 577–582.

64.

Vertovec

(2009) Cosmopolitan in attitude, practice, and competence (MMG Working Paper 09-08), Göttingen, Germany: Max Planck Institute for the Study of Religions and Ethnic Diversity.

65.

Wenger

(1998) Communities of practice: Learning, meaning, and identity, Cambridge, UK: Cambridge University Press.

66.

Wihtol de Wenden

(2004) Multiculturalism in France. In: Rex

Singh

(eds) The governance of multiculturalism, Basingstoke, UK: Palgrave, pp. 68–73.

67.

Zajde

(2011) Psychotherapy with immigrant patients in France: An ethnopsychiatric perspective. Transcultural Psychiatry 48(3): 187–204.